Factors associated with inadequacy of prenatal care utilization

OBJECTIVE: To identify factors associated with inadequacy of prenatal care utilization in urban community. METHODS: A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of S?o Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. RESULTS: There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. CONCLUSIONS: Prenatal care showed low coverage in the municipality of S?o Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.     

Personal costs associated with high-risk prenatal care attendance

Personal costs associated with attending prenatal care may influence women's care-seeking behavior, particularly poor, pregnant women and those with complicated pregnancies who receive more visits. This study described personal costs incurred by poor, high-risk pregnant women while attending care. Personal costs included direct out-of-pocket and time costs. Also, the relationship between personal costs and attendance was examined. Mean direct costs throughout pregnancy were $101.96 per patient. Women waited a mean of 3.22 hours per visit for care and received direct physician care for a mean of 5 minutes. As child care costs increased, attendance decreased significantly (r = 0.60, p < or = 0.05). As transportation costs, meal costs, wages lost, and time spent awaiting care increased, attendance decreased. Prenatal care has associated dollar and time costs for patients. Problem solving these issues with patients is critical. System changes to decrease waiting times and to address child care issues are needed.     

产前检查及产前健康教育与妊娠结局的关系

目的:分析产前检查的次数及健康教育与妊娠结局的关系。方法:对2278例在该院住院分娩的孕产妇进行回顾性分析,并对产前检查手册进行相应的回顾性调查。按产前检查次数<5次、≥5次分为两组,对两组的妊娠结局进行对照分析。结果:①产前检查次数<5次组胎盘早剥、妊娠期高血压疾病、过期妊娠、早产、前置胎盘伴出血、产后出血发生率明显高于产前检查次数≥5次组,差异有显著性(P<0.05)。②产前检查次数<5次组新生儿窒息、早产、围产儿死亡、低体重儿、呼吸窘迫综合征、出生缺陷的发生率高于产前检查次数≥5次组,差异有极显著性(P<0.01)。③接受过产前健康教育的孕产妇产前检查次数明显高于未接受过产前健康教育者(P<0.01)。结论:加强产前保健及产前健康教育,提高产前检查次数和质量,及时发现并治疗高危妊娠,可有效降低孕产妇及围产儿并发症的发生。     

Good outcome of teenage pregnancies in high-quality maternity care

BACKGROUND: Teenage pregnancies have been associated with fetal growth restriction, low birth weight, preterm birth and neonatal mortality. These could be due to biological immaturity, lifestyle factors or inadequate attendance to maternity care. The objective of this study was to assess the relationship between young age of the mother and pregnancy risk factors and adverse pregnancy outcome in conditions of high-quality maternity care used by almost the entire pregnant population. METHODS: We analysed a population-based database of 26,967 singleton pregnancies during 1989-2001. Only 185 of these mothers were under 18 years old. Data were collected using a self-administered questionnaire at 20 weeks of pregnancy and clinical records of pregnancy, delivery and newborn child. The information covered maternal risk factors, pregnancy characteristics and obstetric outcomes. Odds ratios (ORs) for adverse pregnancy outcomes in teenage compared with older mothers were obtained from multiple logistic regression models. RESULTS: Teenage mothers smoked, were unemployed and had anaemia or chorioamnionitis more often than older mothers. On the other hand, they were overweight and had maternal diabetes less often than adults. Teenage mothers had as many instrumented deliveries (OR 0.70; 95% confidence interval 0.39-1.27) but fewer Caesarean sections (0.62; 0.39-0.97) than adults. We found no evidence for increased risk of preterm delivery, fetal growth restriction, low birth weight, or fetal or perinatal death in teenage mothers. CONCLUSIONS: These results suggest that increased risks for adverse pregnancy outcomes in teenage pregnancies can most probably be overcome by means of high-quality maternity care with complete coverage.     

Alcohol Use,Injuries, and Prenatal Visits During Three Successive Pregnancies Among American Indian Women on the Northern Plains Who have Children with Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome

Introduction The purpose of the study was to compare three sequential pregnancies of American Indian women who have children with FAS or children with incomplete FAS with women who did not have children with FAS. Methods Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome (FAS) (Study 1) or incomplete FAS (Study 2) in 1981–1993. Three successive pregnancies ending in live births of 43 case mothers who had children with FAS, and 35 case mothers who had children with incomplete FAS were compared to the pregnancies of 86 and 70 control mothers who did not have children with FAS, respectively, in the two studies. Prenatal records were abstracted for the index child (child with FAS or incomplete FAS) and siblings born just before and just after the index child, and comparable prenatal records for the controls. Results Compared to the controls, significantly more case mothers used alcohol before and after all three pregnancies and during pregnancy with the before sibling and the index child. Mothers who had children with FAS reduced their alcohol use during the pregnancy following the birth of the index child. All Study 1 case mothers (100%) and 60% of Study 2 case mothers used alcohol during the pregnancy with the index child compared to 20 and 9% of respective control mothers. More study 1 case mothers experienced unintentional injuries (OR 9.50) and intentional injuries during the index pregnancy (OR 9.33) than the control mothers. Most case mothers began prenatal care in the second trimester. Conclusions Alcohol use was documented before, during and after each of the three pregnancies. Women of child-bearing age should be screened for alcohol use whenever they present for medical services. Mothers who had a child with FAS decreased their alcohol consumption with the next pregnancy, a finding that supports the importance of prenatal screening throughout pregnancy. Women who receive medical care for injuries should be screened for alcohol use and referred for appropriate treatment. Protective custody, case management and treatment services need to be readily available for women who use alcohol.     

Perinatal health service use by women released from jail

Few studies have examined health care access for the growing population of pregnant women who cycle in and out of urban jails. The present study compared use of Medicaid-funded perinatal services for births to women who were in jail during pregnancy and births to women who had been in jail, but not while pregnant. Jail contact during pregnancy increased the likelihood women would receive prenatal care (odds ratio [OR] = 5.95; 95% confidence interval [CI] 2.18-16.23) and maternity support services (OR = 1.80; 95% CI 1.12-2.88), but was associated with fewer total prenatal and support visits. Jail contact during a previous pregnancy was associated with fewer prenatal care visits, more support service visits, and longer time receiving case management. Jail settings can become a place of coordination between public health and criminal justice professionals to ensure that pregnant women receive essential services following release. Service coordination may increase women's engagement in health services during future pregnancies, with or without subsequent incarceration.     

The effects of prenatal education intervention on unwed prospective adolescent fathers

This study assesses the impact of a prenatal education program dealing with human sexuality, pregnancy, prenatal care, labor, delivery, and infant and child care on the unwed expectant adolescent father. It also assesses the relationship between the father's knowledge in these areas and his supportive behaviors toward the adolescent mother and the expected infant. The 28 black 15–18-year-old adolescent males who volunteered to participate in the study were randomly assigned to an experimental group (n = 15) or a control group(n = 13). Each was pretested (T-1) with Form A of a 75-item prenatal questionnaire, and posttested (T-2) with Form B of the same instrument after an intervention for the experimental group, or 4 weeks after the initial assessment for the comparison group. Findings suggest significant gains in knowledge for the experimental group at T-2 versus T-1 with regard to 1) pregnancy and prenatal care, and 2) infant development and child care. The data also suggest that fathers who were more informed tended to report more supportive behaviors toward the mother and the infant.     

Drawing women into prenatal care

Participation in prenatal care services in the United States is low relative to that in many other developed countries, and rates of use are declining among some high risk groups. In 1986, 18 percent of all U.S. infants were born to women who delayed care until the second trimester of pregnancy; four percent, to women who initiated care in the third trimester; and about two percent, to women who obtained no prenatal care at all. Among the major barriers to prenatal care are inadequate insurance coverage, limitations in the Medicaid program, inadequate capacity in the maternity care system, lack of coordination between health and social services for low-income women and inhospitable conditions at some sites where prenatal care is delivered. The personal beliefs, knowledge, attitudes, fears and lifestyles of some pregnant women also constitute obstacles to care. For example, having an unwanted pregnancy, attaching little value to prenatal care and having a tenuous connection to the health care system in general are important predictors of insufficient care. Encouraging universal participation in prenatal care will require a major overhaul of the maternity care system. However, while consensus for fundamental reform builds, several immediate steps should be taken--such as reducing financial barriers to care; expanding the capacity of the maternity care system; improving the policies and practices that shape prenatal services at the site where they are delivered; and increasing public information.     

Effects of Prenatal Care on Child Health at Age 5

The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child’s development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5—maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children’s health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.     

Preconceptional Health Promotion:

Efforts to prevent perinatal mortality and morbidity are traditionally directed at the pregnant woman. It is during the prenatal period that the mother's health status is closely monitored; her exposure to substances known to be harmful to the fetus is assessed, and intensive patient education on behaviors likely to benefit the unborn child is offered. Unfortunately, the initiation of prenatal care may already be too late to prevent spontaneous abortions, congenital anomalies, and some causes of low birthweight. Until routine prepregnancy care is available to all women of childbearing age, many opportunities for the primary prevention of poor reproductive outcomes will be lost. This paper describes the rationale for prepregnancy or preconceptional counseling and the specific purposes it should serve. A model program providing such services is described, and findings for a low socioeconomic population involved in the model program are given.     

西藏藏族孕产妇产前检查次数与低出生体重儿的关联

  目的  了解西藏藏族孕产妇产前检查次数与低出生体重儿的关联,为提高产前保健质量、减少低出生体重儿的发生提供参考。  方法  选取2012年1月-2018年12月在西藏拉萨市某医院分娩的藏族产妇及新生儿为研究对象,收集所有单胎活产分娩孕产妇的基础资料、分娩资料及新生儿出生资料。采用Logistic回归模型对孕产妇产前检查次数与其分娩的新生儿出生体重进行关联性分析。  结果  5 563例孕产妇,规范产前检查率为10.48%。孕产妇所分娩新生儿中,低出生体重儿占11.32%。随着孕产妇产检次数的增加,新生儿低出生体重率呈现下降趋势（χ2=14.57,P=0.002）。多因素Logistic回归模型显示,在控制了孕产妇年龄、胎儿性别、分娩方式、胎儿窒息等因素后,未接受产前检查和接受1~2次产前检查的孕产妇分娩的低出生体重儿发生率分别是接受规范产前检查孕产妇的1.41倍（95% CI:1.00~1.98）和2.34倍（95% CI:1.09~5.02）。  结论  西藏藏族孕产妇接受规范的产前检查的比例较低,存在较高的低出生体重儿的发生风险。建议加强少数民族地区的妇幼保健工作质量,保障母婴安全。     

Preconceptional health promotion: a health education opportunity for all women

Efforts to prevent perinatal mortality and morbidity are traditionally directed at the pregnant woman. It is during the prenatal period that the mother's health status is closely monitored; her exposure to substances known to be harmful to the fetus is assessed, and intensive patient education on behaviors likely to benefit the unborn child is offered. Unfortunately, the initiation of prenatal care may already be too late to prevent spontaneous abortions, congenital anomalies, and some causes of low birthweight. Until routine prepregnancy care is available to all women of childbearing age, many opportunities for the primary prevention of poor reproductive outcomes will be lost. This paper describes the rationale for prepregnancy or preconceptional counseling and the specific purposes it should serve. A model program providing such services is described, and findings for a low socioeconomic population involved in the model program are given.     

Gender inequality, family planning, and maternal and child care in a rural Chinese county

This study examines the determinants of prenatal and obstetric care utilization within the context of recent social and economic changes in contemporary rural China. The aim of this study is to test the general hypothesis that gender inequality (women's status and son preference) and the state's family planning policy have a significant influence on maternal and childcare utilization. Both qualitative and quantitative data from a field survey in 1994 in rural Yunnan were used in the study. The findings lend support to this hypothesis. For example, the extent to which the husband shares housework and childcare, as an important marker of rural Chinese women's position within the family, is positively associated with the likelihood that a woman receives prenatal examinations, stops heavy physical work before birth, and gives birth under aseptic conditions. Also, a woman's exposure to the larger world beyond the village increases her chances of giving birth with the assistance of a doctor or health worker. Son preference is an impeding factor for maternal and child health care utilization. Already having a son in the family reduces the chances that the mother will stop heavy physical work before birth for a subsequent pregnancy. Female infants with older sisters are the least likely to receive immunizations. Women with "outside the plan" pregnancies are less likely than those with "approved" pregnancies to receive prenatal examinations, to stop strenuous work before birth, and to deliver under aseptic conditions. Thus, the study provides further evidence that the family planning policy has a negative impact on women and their families, whose fertility and son preferences conflict with the birth control policy.     

Characteristics of patients initiating raloxifene compared to those initiating bisphosphonates

Background

The purpose of the study is to examine the effects and feasibility of individual physical activity (PA) counseling in maternity and child health clinics in Finland.

Methods

Three clinics including both maternity and child health care signed up for the experimental (EXP) and three for the control group (CON). The participants were 132 pregnant and 92 postpartum primiparas. The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits. An option for supervised group exercise was offered. In CON former practices, usually including brief PA advice, were continued. Leisure-time PA (LTPA) prior to pregnancy was elicited by questionnaire and followed 16–18 and 36–37 weeks' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics. Feasibility included safety, participant responsiveness, realization of counseling and applicability.

Results

According to analysis of covariance adjusted for baseline LTPA and possible confounders, no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics. At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43% (95% CI: 9, 87) higher and the weekly duration of at least moderate-intensity LTPA 154% (95% CI: 16, 455) higher in EXP compared with CON. Counseling proved feasible in both maternity and child health clinics.

Conclusion

Counseling encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practices. No effects were observed if counseling was initiated postpartum.

Trial registration

Current Controlled Trials ISRCTN21512277     

On this day of mothers and sons

Telling a pregnant woman and her family about a fetal demise is one of the greatest challenges for maternity care clinicians. In this essay, the author reflects on such an encounter in her work as a community health center clinician, maternity care teacher, and mother herself.     

产前检查对孕产妇及围产儿保健作用分析

[目的 ]　了解孕期保健对妊娠结局及围产儿影响的相关因素。　 [方法 ]　对 960例孕产妇进行回顾性分析。将无产前检查的 476例作为观察组 ,有产前检查的 484例作为正常对照组 ,对两组的妊娠结局进行对照分析。　 [结果 ]　无产前检查的孕妇过期妊娠、前置胎盘、妊娠高血压综合征、产后出血发生率较有产前检查者高。无产前检查者新生儿窒息、低体重儿、死胎、早产儿、呼吸窘迫综合征 (RDS)、新生儿宫内感染、颅内出血 (HIE)发生率较有产前检查者高。无产前检查者胎盘早剥、早产、横位等发生率较有产前检查者高。　 [结论 ]　应加强产前检查 ,及早发现高危妊娠 ,积极治疗产科并发症 ,保障孕妇及胎儿健康     

Implementing and Evaluating a Telephone-Based Centralized Maternity Care Coordination Program for Pregnant Veterans in the Department of Veterans Affairs

PurposeThe purpose of this study was to develop and evaluate a comprehensive, telephonic maternity care coordination (MCC) program for all pregnant veterans enrolled for care at New England Department of Veterans Affairs (VA) facilities that comprise the Veterans Integrated Service Network 1.Research DesignTelephone interviews were conducted with postpartum women veterans who had participated in the MCC program during their pregnancies. The program evaluation instrument assessed satisfaction and use of MCC services, prenatal education classes, and infant and maternal outcomes (e.g., newborn birthweight, insurance status, maternal depression) using both closed-ended and open-ended questions.ResultsA substantial majority (95%) of women enrolled in the MCC program expressed satisfaction with the services they received in the program. Women were most satisfied with help understanding VA maternity benefits and acquiring VA services and equipment, such as breast pumps and pregnancy-related medications. More than one-third of women noted their infants had experienced health problems since delivery, including neonatal intensive care unit hospitalizations. A majority of women planned to return to VA care in the future.ConclusionsOur findings suggest that MCC services play an important role for women veterans as they navigate both VA and non-VA care systems. MCC staff members coordinated maternity, medical, and mental health care services for women veterans. Additionally, by maintaining contact with the veteran during the postpartum period, MCC staff were able to assess the health of the mother and the infant, and refer women and their infants to medical and psychosocial services in the community as needed.     

Advocacy for healthy births

Each year, more than 250,000 American babies are born prematurely or with a low birthweight. Every two minutes a baby is born with a birth defect. These conditions cause and contribute to more than 40,000 infant deaths annually. Early and regular prenatal care is proven effective in reducing the risk of low birthweight. Given the importance of prenatal care, the March of Dimes advocates the availability of maternity care for all pregnant women. This article outlines the March of Dimes public affairs program, its involvement in the successful expansion of Medicaid coverage for poor pregnant women and infants, and the opportunity for continued advocacy to improve maternal and child health care.     

Regional disparities in prenatal care services in rural China

The study compared the prenatal care programs in the Central-East, Northwest, and Southwest regions of China. Data were collected on 14 indicators of the quality of the prenatal care process, as well as the percentage of women with high-risk pregnancies who were screened. The average number of prenatal examinations for those women who received prenatal care was 5.01, and 62.6% of pregnant women had their first examination within 12 weeks of their pregnancy. About 35% of these pregnant women had at least 1 high-risk screening, and 20.8% had 3 high-risk screenings. Among the 3 regions, the Central-East region had the best overall quality prenatal services, and the Northwest area had the poorest quality. The quality of prenatal health care in poor, rural China is in need of improvement.