HIV-infected women and infants: Social and health factors impeding utilization of health care

The utilization of health care by HIV-seropositive pregnant women and their infants was studied in an indigent urban population. Ninety HIV-seropositive women delivered 99 HIV-exposed infants at the Johns Hopkins Hospital from August 1, 1988, to April 1, 1991. Repeat pregnancies occurred in 17 (18.9%) women during the study period. Completion of the primary immunization series by age nine months was the criteria for infant adherence to medical care. Of all infants, 72.9% achieved adequate immunization status by nine months. However, only 41 (45.6%) women reported ever seeking HIV-related health care. Factors associated with maternal adherence with HIV-related health care included HIV status of her infant, maternal drug use, and incarceration. Number of living children, maternal age, educational level, marital status, and repeat pregnancy were not associated with mothers seeking HIV-related health care. Despite low adherence to HIV-related health care in this sample of HIV-seropositive women, the majority of their infants did receive adequate immunizations, one proxy measure of adequate infant health care.     

The Association of Inadequate and Intensive Prenatal Care With Maternal,Fetal, and Infant Outcomes: A Population-Based Study in Manitoba,Canada

ObjectiveLittle is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba.MethodsThis retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours.ResultsThe distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.ConclusionInadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.     

A systematic,multidisciplinary approach to address the reproductive needs of HIV-seropositive women

Nearly 130,000 American women are human immunodeficiency virus (HIV) seropositive. The present study sought to establish a comprehensive programme to address their fertility needs in order to minimize infectious, medical and reproductive risks to prospective patients. Forty women, aged 27–42 years, were evaluated. HIV was diagnosed 7.2 ± 0.7 years prior to their seeking care, and most women (n = 38) were on highly active antiretroviral therapy. Their prenatal CD4 counts were 712.2 ± 56 cells/mm³ (range 327–1881) and HIV-1 concentrations were undetectable in all cases prior to initiating treatment. HIV-seropositive women were statistically identical to their age-matched HIV-seronegative counterparts with respect to the IVF clinical outcome parameters measured. Throughout the pregnancies, maternal HIV-1 RNA concentrations remained undetectable and CD4 counts were stable. All infants, tested at birth and at 3 and 6 months of age, remained HIV negative. This is the first report of an institutional paradigm in the USA dedicated to evaluate and treat HIV-seropositive women. Using a multidisciplinary approach to care, HIV-seropositive women may be successfully managed in a programme of assisted reproduction.     

A study of out-of-wedlock pregnancies: outcome and utilization of maternal/child health services

The characteristics of unwed pregnant women, their utilization of maternal and child health services and the infant mortality among these out-of-wedlock births were investigated. During the study period, 5% of all pregnancies (48 of 855) were of this nature. Utilization of antenatal services was poor among unwed pregnant women, compared to those who were married. However, they used the child care services satisfactorily, as observed by the well-baby-clinic visits and acceptance of immunization. The infant mortality was 125 per 1000 live births, more than double the rate among infants born to married women. Either immediately after child birth or within one year after delivery, 50% of the unwed mothers started living with the putative fathers.     

The impact of maternal HIV status on infant feeding patterns in Nakuru, Kenya.

The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P < .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (> mean birth weight, P < .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. J Hum Lact . 24(1):34-41.     

Methamphetamine use in pregnancy,child protection,and removal of infants: Tertiary centre experience from Western Australia

AbstractThe aim of this study is to explore factors that determine infant removal by Child Protective Services and placement in out of home care, for methamphetamine-using women receiving pregnancy care with Western Australia Women and Newborn Drug and Alcohol Service.MethodA prospective cohort study of 112 methamphetamine-using women attending Women and Newborn Drug and Alcohol Service for pregnancy care from 2015 to 2018 was undertaken. Maternal methamphetamine use was assessed during each trimester of pregnancy using a standardised assessment tool. Drug use was by maternal self-report. Involvement of Western Australia's Department for Child Protection and Family Support and removal from maternal care were recorded. Infant development was formally assessed at 12 months with Griffiths Mental Development Scales. The comparison was made between three groups: those women who had no involvement with Child Protection, those for whom Child Protection was involved but the child remained in maternal care and those women who had their infants removed from their care. A comparison between Aboriginal and non-Aboriginal women was also undertaken.ResultsOf the 110 infants born to 112 women, 33 (30.3%) of infants were removed from maternal custody after delivery. Overall 60 (53.5%) of women had Child Protection involvement. Aboriginal women were overrepresented in our population 59 (52.7%) and 24 out of the 33 infants were Aboriginal were removed and placed into out of home care. Infants were removed from women with a high level of risk factors associated with MA use including those who were homeless, in prison, unemployed or continued high use of MA, mental health issues. Aboriginal infants were at increased risk of removal. Children removed from maternal care had a trend towards poorer developmental attainment at around 12 months compared to those who remained with their mother. Infants who were removed by the Child protection had lower general quotients (p = 0.132) than infants who had no involvement or some involvement.ConclusionInfants removed from maternal care were more likely to be from women with high use, adverse social factors and born to mothers who identified as being Aboriginal. Resources are required that work intensively with families to reduce the number of infants being removed from maternal care to overcome the risks and challenges of addiction.Implications for practiceResources that provide long term support and community-based models that offer a comprehensive range of maternal-child services and in-home-support would be more effective in keeping families together.     

Determinants of periodontal health in pregnant women and association with infants' anthropometric status: a prospective cohort study from Eastern Uganda

ABSTRACT: BACKGROUND: Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in sub Saharan Africa and has been linked to poor periodontal health during pregnancy. This study investigated predisposing and enabling factors as determinants of oral health indicators in pregnancy as well as the association between periodontal problems at 7 months gestational age and the infants' anthropometric status METHOD: A community --based prospective cohort study was conducted in Mbale, Eastern Uganda between 2006 and 2008. Upon recruitment, 713 pregnant women completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices. A total of 593 women were followed up with anthropometric assessments of their infants 3 weeks after delivery. Multiple logistic regression analyses were used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) was used to investigate the relationship between periodontal problems and the child's anthropometric status in terms of wasting, underweight and stunting RESULTS: A total of 67.0% of women presented with periodontal problems, 12.1% with poor oral hygiene, 29.8% with recent dental visit and 65.0% with periodontal symptoms. Of the infants, 2.0% were wasted, 6.9% were underweight and 10.0% were stunted. The odds ratio of having CPI > 0 increased with increased maternal age and single marital status, and was lower in primiparous women and those who used mosquito bed nets. Mean wasting scores discriminated between mothers with CPI = 0 and CPI > 0 as well as between mothers with good and poor OHI-S scores CONCLUSIONS: Socio-demographic factors and information about oral health were associated with oral health indicators in pregnant women. Second, the height- for- age status at 3 weeks postpartum was worse in infants of mothers having periodontal problems and poor oral hygiene during pregnancy. Efforts to prevent oral diseases during pregnancy should be part of the local state and national health policy agenda in Uganda.     

Perinatal addiction: outcome and management.

The care of the pregnant drug-dependent woman and her newborn infant has become a major and controversial health problem requiring specific approaches to this high-risk mother and neonate. A comprehensive approach to the care of 278 pregnant drug-dependent women and their infants at the Philadelphia General Hospital has significantly reduced maternal and infant morbidity heretofore associated with pregnancies complicated by opiate addiction. Most significantly, the incidence of low birth weight has been reduced to below 20 per cent, and a decrease in severe withdrawal in infants born to mothers in the comprehensive care program has occurred. We propose that application of this approach to women whose pregnancies are complicated by drug dependency is a significant factor in successful management.     

Congenital syphilis after maternal treatment for syphilis during pregnancy

OBJECTIVE: The purpose of this study was to characterize pregnancies that were complicated by maternal syphilis that had been treated before delivery in which the newborn infant was diagnosed with congenital syphilis. STUDY DESIGN: Prospective surveillance from January 1, 1982, to December 31, 1998, involved women who received antenatal treatment for syphilis. Infants who were born with congenital syphilis were identified by clinical or laboratory criteria. Antepartum factors such as gestational age, time to delivery and VDRL titers were then analyzed and compared with those of women who had been treated and who were delivered of an uninfected infant. The 1:1 match was based on the stage of syphilis and the gestational age at treatment. RESULTS: Forty-three women who received antepartum therapy for syphilis were delivered of an infant with congenital syphilis. Most of the women had been treated for early syphilis; the mean gestational age at treatment was 30.3 weeks. Thirty-five percent of the women were treated >30 days before delivery. Fifty-six percent of the infants were preterm. The 1:1 match revealed that treatment and delivery high VDRL titers, prematurity, and a short interval from treatment to delivery were significantly different in those infants who were diagnosed with congenital syphilis. CONCLUSION: High VDRL titers at treatment and delivery, earlier maternal stage of syphilis, the interval from treatment to delivery, and delivery of an infant at < or =36 weeks' gestation are associated with the delivery of a congenitally infected neonate after adequate treatment for maternal syphilis.     

Influenza and tetanus, diphtheria, and acellular pertussis vaccinations during pregnancy

Vaccinations in pregnancy are an important aspect of prenatal care and of improving not only maternal health but also neonatal outcomes. Only 2 vaccines are specifically recommended during pregnancy: influenza and tetanus, diphtheria, and acellular pertussis (Tdap). Because influenza illness disproportionately affects pregnant women compared with other populations, annual prevention of influenza illness is recommended for all women who will be pregnant during influenza season (October to May). Influenza vaccination has been recently reported to also result in decreased febrile respiratory illnesses in the newborn, likely through passive antibody transfer. Pertussis infection rates are rising in the United States as vaccine-induced immunity wanes, with the mortality burden primarily seen in infants aged <6 months. Pertussis immunization with Tdap is now recommended for all pregnant women during the late second (>20 weeks) or third trimester with the intent to both protect the pregnant woman and provide passive antibody to the infant before vaccination at 2 months of age. Provider support for these recommendations regarding both annual influenza vaccination and postpartum Tdap vaccination during pregnancy is critical to ensuring vaccine delivery and improving both maternal and fetal health. The article reviews the epidemiology and clinical aspects of influenza and pertussis infection with particular attention to pregnancy and recommendations for vaccination in these women. TARGET AUDIENCE: Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physicians LEARNING OBJECTIVES: After completing this CME activity, obstetricians and gynecologists should be better able to analyze how influenza infection disproportionally affects pregnant women. Assess how influenza vaccination improves maternal and likely neonatal outcomes. Evaluate pertussis infection and immunity in adults, and counsel pregnant women as to the benefits of Tdap vaccination, particularly for the infant.     

Effect of a systematic discharge nursing plan on mothers' knowledge and confidence in caring for infants with congenital heart disease at home.

BACKGROUND AND PURPOSE: Mothers who are separated from their infants due to the necessity of surgical treatment for congenital heart disease (CHD) may develop lack of confidence in their ability to care for their infant. This research developed a systematic discharge nursing plan (SDNP) for mothers to care for their infants with CHD and evaluated the effects of this plan on maternal knowledge and confidence in caring for their infant with CHD at home. METHODS: A quasi-experimental design was adopted for the study. Subjects were recruited by purposive sampling from mothers who had a hospitalized infant with CHD aged from 0 to 6 months. There were 20 mothers in the control group and 15 mothers in the intervention group. Control group subjects received current nursing instruction and were followed at the outpatient department after discharge of the infant from the hospital whereas the intervention group completed the SDNP in addition to current nursing instruction. Evaluations of these 2 groups based on the mother's knowledge of infant care and confidence to provide adequate care were conducted twice, at 1 week and 1 month after the infant's discharge from the hospital. RESULTS: The intervention group had better confidence than the control group at 1 week and 1 month after the infants' discharge (p < 0.05). There was no significant difference of improvement in knowledge of infant care score between the 2 groups. No significant relation was found between knowledge of infant care and maternal confidence. CONCLUSIONS: This research showed that an SDNP improved maternal confidence in caring for an infant with CHD. Thus, an SDNP may be a valuable part of standard clinical practice in caring for infants with CHD.     

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence‐based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow‐up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.     

Mother's birth weight as a predictor of macrosomia

The relationship between a mother's own birth weight and the risk of delivering a large for gestational age infant was studied in 1335 women. Compared to women who weighed 8 pounds or more at birth, women who weighed 6 to 7.9 pounds were only 50% as likely (p = 0.007) and women who weighed 4 to 5.9 pounds were only 15% as likely (p = 0.002) to give birth to a large for gestational age infant. When this relationship was adjusted for nine other factors known to influence birth weight, including maternal weight and weight gain during pregnancy, maternal birth weight was second only to weight gain during pregnancy in predicting the birth of large for gestational age infants. Maternal birth weight was also accurate in the prediction of macrosomia (birth weight greater than 4000 gm). Because of its ability to predict the delivery of a large infant, maternal birth weight should become part of the routine obstetric history.     

Identifying Health Disparities and Social Inequities Affecting Childbearing Women and Infants

This article presents health disparities and social inequities that may underlie adverse outcomes for childbearing women and infants in the United States. It also presents Internet-accessible databases that nurses can use to assess maternal and infant health disparities at a national or state level. Such assessments are basic to planning programs to address gaps in health care and advocating for practice and policy changes to improve the health care of childbearing women and infants.     

Factors affecting the duration of exclusive breastfeeding among HIV-infected and -uninfected women in Lusaka, Zambia.

Exclusive breastfeeding (EBF) is optimal for infant health and is associated with decreased risk of mother-to-child HIV transmission compared with mixed feeding of breast milk and other foods. To investigate why many women stop EBF before the recommended 6 months, maternal and infant health and infant-feeding data were collected from 177 HIV-infected and 177-uninfected Zambian women regularly from 34 weeks gestation to 16 weeks postpartum. Despite strong support for good breastfeeding practice, only 37% of women were still EBF at week 16. Factors significantly associated with shorter duration of EBF were primiparity, maternal systemic illness, and infant length at 6 weeks. The results suggest that the association of EBF with lower rates of mother-to-child HIV transmission may not be causal but may be secondary to the reduced duration of EBF associated with poor maternal or infant health. Programs supporting EBF should include support for maternal health.     

Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe,Malawi

Women in sub-Saharan Africa are increasingly learning their HIV status in prevention of mother-to-child transmission of HIV (PMTCT) programmes in the context of antenatal care. This paper examines women's decisions about HIV testing and their experience of PMTCT and HIV-related care in one clinic in Lilongwe, Malawi. It is based on qualitative, ethnographic research conducted in 2004 and 2005, including interviews and focus group discussions with 55 HIV-positive women participating in a PMTCT programme, and 21 interviews with key informants from the programme and the health system. Women's expectations from testing were consistent with the benefits for their own health and their infants' health, as communicated by nurses. However, the PMTCT programme only poorly met their expectations. Reasons for this disjuncture included the construction of women as still healthy even when they needed treatment, a focus only on infant health, health system weaknesses, lack of integrated care and timely referral, and defining HIV exclusively as a medical issue, while ignoring the social determinants of health. Women's own health was particularly marginalised within the PMTCT programme, yet good models exist for comprehensive care for women, infants and their families that should be implemented as testing is scaled up.