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1.
Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women 总被引:1,自引:0,他引:1
De Santis M De Luca C Mappa I Quattrocchi T Angelo L Cesari E 《European journal of obstetrics, gynecology, and reproductive biology》2011,159(1):106-110
Objective
High-risk behaviours are associated with an increased risk of adverse pregnancy outcomes. Exposure to drugs, infection or radiation is a cause of concern for pregnant women, who contact Teratology Information Services (TIS) to have a counseling but with an accurate medical history is possible to detect additional behavioural risk factors that can significantly interfere with pregnancy outcome.The aim of this study is to describe risk behaviours in a population of Italian women calling our TIS and to identify related maternal factors.Study design
Between December 2008 and January 2010 we collected data from 503 pregnant women calling our TIS (Telefono Rosso, Rome). We investigated about smoke, alcohol and abuse substances addiction and we also collected demographic data.Results
Of the 503 women consenting to participate 34% were found to have an additional risk marker during the current pregnancy. Within this group were 22.7% (n = 119) who reported smoking, the 17.7% (n = 89) admitted to drink and 2 women (0.4%) used illicit drugs. In 13.7% of cases (n = 69) reason for calling represented an exposure to teratogenic agents. Unmarried status and previous induced abortion represent a risk factor for all high-risk behaviours. Lower education (p < 0.001) and use of neurological drugs (p < 0.001) are related with cigarette consumption. A lower parity was a risk factor for alcohol assumption (p = 0.04). Women with high-risk behaviours tend to be exposed to more than a risk factor.Conclusions
Teratogen Information Services are an important system to identify women with pregnancy risk markers. These services should have the ability to provide risk reduction information to women who smoke cigarettes or with alcohol or drug use. In addition to the phone based information these women may benefit from referral back to their physician for assessment and management of substance use/abuse during pregnancy. Substance abuse risks are often underestimated by pregnant women. Single mothers or women with an history of terminations of pregnancy represents an high-risk population. Physicians should inform their patients about possible risks related to high-risk behaviours during preconception counseling or during the first obstetric visit. 相似文献2.
Objective
to describe women's experiences of dietary information and the change of dietary habits during pregnancy.Design
a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions.Settings
five rural and city antenatal clinics in northern Sweden were includedParticipants
twenty-three women in mid-pregnancy participated in groups of three to sevenFindings
three domains were found ‘Dietary information gain’, ‘Reactions to dietary information’ and ‘Dietary management’. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were ‘being confused’, ‘feeling fear and guilt’ and ‘being monitored’, summed up in ‘being uncertain’. The diet was managed by ‘checking food content’, ‘following bodily signals’, ‘using common sense’, and ‘making exceptions’, summed up as ‘being responsible but with a pinch of salt’.Key conclusions
the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves.Implications for practice
sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy. 相似文献3.
Objective
to explore women's experience of singing lullabies in pregnancy and their understanding of possible benefits for themselves and their infants.Design and participants
over four group sessions with musicians, six pregnant women, all expecting their first baby, learnt to sing three lullabies. Qualitative semi-structured interviews were conducted approximately three months after the birth to capture the women's experiences. Participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland.Findings
The women enjoyed participation in the lullaby project and all felt it benefited them and their babies. Themes uncovered included: (1) beyond words: music and the articulation of deep emotion; (2) a balm for the soul: the power and pleasure of beautiful music; and (3) music and the facilitation of infant development.Key conclusions and implications for practise
Singing lullabies in pregnancy had a soothing and calming effect and was a pleasant experience for participants. It was also an emotional experience and appeared to facilitate the expression of difficult emotion such as fear and anxiety. This effect is likely to have a significant and positive impact on well-being for pregnant women and as such warrants further exploration. 相似文献4.
Charrlotte A. Seib Mark Daglish Renée Heath Catriona Booker Carol Reid Jennifer Fraser 《Midwifery》2012
Objective
this study examined the clinical utility and precision of routine screening for alcohol and other drug use among women attending a public antenatal service.Study design
a survey of clients and audit of clinical charts.Participants and setting
clients attending an antenatal clinic of a large tertiary hospital in Queensland, Australia, from October to December 2009.Measurements and findings
data were collected from two sources. First, 32 women who reported use of alcohol or other drugs during pregnancy at initial screening were then asked to complete a full substance use survey. Second, data were collected from charts of 349 new clients who attended the antenatal clinic during the study period. Both sensitivity (86%, 67%) and positive predictive value (100%, 92%) for alcohol and other drug use respectively, were high. Only 15% of surveyed women were uncomfortable about being screened for substance use in pregnancy, yet the chart audit revealed poor staff compliance. During the study period, 25% of clients were either not screened adequately or not at all.Key conclusions and implications for practise
despite recommended universal screening in pregnancy and the apparent acceptance by our participants, alcohol and other drug (A&OD) screening in the antenatal setting remains problematic. Investigation into the reasons behind, and ways to overcome, the low screening rate could improve health outcomes for mothers and children in this at-risk group. Targeted education and training for midwives may form part of the solution as these clinicians have a key role in implementing prevention and early intervention strategies. 相似文献5.
Monique Kaminski Nathalie Lelong Kathy Bean Judith Chwalow Damien Subtil 《European journal of obstetrics, gynecology, and reproductive biology》1995,60(2):121-128
Objective: Analyse the evolution of alcohol, tobacco and coffee consumption during pregnancy in a population characterized by a high level of consumption and a low socioeconomic situation. Study Design: Data were obtained from two studies done with the same protocol and questionnaire in the Roubaix Public Maternity Hospital in 1988 (176 women) and 1992 (235 women); the two periods were compared using univariate tests and multiple logistic regression to control for social factors. Results: Between 1988 and 1992, there was a clear decrease in alcohol consumption, a slight decrease in coffee consumption and an increase in tobacco use. These changes affected usual consumption as well as consumption during pregnancy. The increase in tobacco use was no longer significant after controlling for social factors. However, the decrease in alcohol consumption affected all women regardless of sociodemographic characteristics, and remained significant after controlling for these characteristics. Conclusions: Several factors support the hypothesis that the decrease in the reported alcohol consumption is real, for consumptions in the low to moderate range. However, it is difficult to identify the role of the several factors involved in this evolution: behaviour of the general population, attitude among pregnant women, information and sensitization of prenatal care providers. Besides, one negative aspect needs to be considered: the stability of the incidence of fetal alcohol syndrome, probably reflecting the stability of the proportion of very heavy consumers. 相似文献
6.
目的:探讨农村妇女孕期体重与妊娠结局的关系,为农村孕妇的体重管理提供理论依据。方法:收集2014年2月至2015年2月禹城市人民医院产一科住院分娩的单胎妊娠农村初产妇896例,按孕前体重指数(BMI)分为孕前消瘦组(≤18.5kg/m~2)、孕前体重正常组(18.5kg/m~2BMI24kg/m~2)、超重组(24kg/m2≤BMI28kg/m~2)、肥胖组(≥28kg/m~2);按孕期体重增长分为体重增长适宜组及体重增长过度组。分析各组孕妇妊娠结局及并发症的发生情况。结果:孕前超重组与孕前体重正常组比较,孕期体重增长过度组与孕期体重增长适宜组比较,均显著增加妊娠期高血压疾病、妊娠期糖尿病、剖宫产、产后出血、巨大儿的风险,差异有统计学意义(P0.05)。结论:孕前超重与孕期体重增长过度是导致农村孕妇不良妊娠结局的危险因素,应加强孕妇的体重管理,降低妊娠不良结局发生。 相似文献
7.
Daily average intake of alcohol during pregnancy has consistently been associated with short term adverse outcomes such as miscarriage, preterm birth and intrauterine growth restriction, a large variety of malformations, as well as long term adverse outcomes such as foetal alcohol syndrome, mental retardation and general impairment of cognitive functions including intelligence, attention, learning abilities as well as social and behavioural functions. Weekly average consumption and alcohol binge drinking (usually defined as ≥ 5 drinks on a single occasion) independently of high daily average intake has not been consistently associated with short and long term adverse outcomes. Health authorities in most countries recommend that pregnant women completely abstain from alcohol. Even so, many health professionals including doctors, midwives and nurses do not provide information to pregnant women in accordance with the official recommendations, although a large proportion of women of child bearing age and pregnant women drink alcohol, especially before recognition of pregnancy. The discrepancy between guidelines and the information practice of health personnel is likely to continue to exist because guidelines of abstinence are not clearly evidence-based and not in line with current focus on autonomy and informed choice for patients, and because guidelines do not consider the everyday clinical communication situation. 相似文献
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9.
Diekman ST Floyd RL Découflé P Schulkin J Ebrahim SH Sokol RJ 《Obstetrics and gynecology》2000,95(5):756-763
OBJECTIVE: To examine knowledge, attitudes, current clinical practices, and educational needs of obstetrician-gynecologists regarding patients' alcohol use during pregnancy. METHODS: A 20-item, self-administered questionnaire on patients' prenatal alcohol use was sent to 1000 active ACOG fellows. Responses were analyzed using univariate and multivariate statistical techniques. RESULTS: Of the 60% of the obstetrician-gynecologists who responded to the survey, 97% reported asking their pregnant patients about alcohol use. When a patient reports alcohol use, most respondents reported that they always discuss adverse effects and always advise abstinence. One fifth of the respondents (20%) reported abstinence to be the safest way to avoid all four of the adverse pregnancy outcomes cited (ie, spontaneous abortion, central nervous system impairment, birth defects, and fetal alcohol syndrome); 13% were unsure about levels associated with all of the adverse outcomes; and 4% reported that consumption of eight or more drinks per week did not pose a risk for any of the four adverse outcomes. The two resources that respondents said they needed most to improve alcohol-use assessment were information on thresholds for adverse reproductive outcomes (83%) and referral resources for patients with alcohol problems (63%). CONCLUSION: Efforts should be made to provide practicing obstetrician-gynecologists with updates on the adverse effects of alcohol use by pregnant women and with effective methods for screening and counseling women who report alcohol use during pregnancy. 相似文献
10.
AbstractObjective To investigate the extent to which Danish women attending antenatal care plan their pregnancies and to determine the association between pregnancy planning and the intake of folic acid, alcohol consumption and smoking habits prior to conception and before the 16th week of gestation.Methods A cross-sectional survey of 258 women. Main outcome measures: intake of folic acid, alcohol consumption and smoking. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy (LMUP) and the five graded Swedish Pregnancy Planning Scale.Results Most (77%) of the participants reported that their pregnancies were very or fairly well planned. Higher median LMUP scores were observed in women taking folic acid (p < 0.001), in those consuming less alcohol, and in women who stopped smoking prior to pregnancy (p = 0.043). However, 43% of the respondents with a high degree of pregnancy planning and 98% of those with a low degree of planning had not taken folic acid prior to pregnancy. Binge drinking during early pregnancy was reported by 20% of women with a high degree of planned pregnancy and 31% of those with a low degree (p = 0.1).Conclusion Pregnancy planning was associated with a healthier lifestyle but still many women could improve their lifestyle in connection to pregnancy. Their level of alcohol consumption is higher than that recommended for best pregnancy outcome.Chinese abstract 目的。探讨在何种程度上参加产前保健计划的丹麦妇女怀孕,并确定妊娠规划和叶酸的摄入量,饮酒和吸烟习惯受孕前和怀孕第16周前之间的关联。 方法。采用横断面调查的258名妇女。主要观察指标:摄取叶酸,饮酒和吸烟。怀孕计划是由伦敦的的意外怀孕( LMUP )和五个梯度瑞典妊娠规划规模测量评估。 的结果。大多数(77% )的参与者报道,怀孕非常或相当精心策划。较高的平均LMUP分数,观察妇女服用叶酸( P < 0.001 ) ,在那些消耗少饮酒,在妇女怀孕前戒烟( P = 0.043) 。然而,具有高度的怀孕计划, 98%的那些低度的规划有43%的受访者并没有采取叶酸,怀孕前。具有高度的计划怀孕的程度低( P = 0.1 )和31% , 20%的女性在怀孕早期报道暴饮。 结论。健康的生活方式是与怀孕计划,但仍有许多连接到怀孕妇女可以改善他们的生活方式。他们的酒精消费水平高于建议最佳妊娠结局。. 相似文献
11.
Objective
a wide range of psychosocial variables may influence pregnant women's psychological status. However the association between marital and social support, anxiety and worries during pregnancy is a relatively neglected area of research. Therefore, the aim of this study was to examine the relationship between marital support, social support, antenatal anxiety and pregnancy worries after controlling for the effects of background variables.Setting
public hospital in Athens, Greece.Design
a cross-sectional study.Participants
165 pregnant women attending an antenatal clinic for antenatal screening between January 2011 and March 2011.Methods
anxiety was measured using the State scale of the State-Trait Anxiety Inventory, pregnancy worries were measured with the Cambridge Worry Scale, social support with the Social Support Questionnaire-6 and marital satisfaction with the Quality of Marriage Index. Pearson's correlation coefficients were calculated among all study variables, followed by hierarchical multiple linear regression.Findings
a STAI score of ≥43 was taken as indicative of anxiety and 44.4% of participants responded with a score of 43 or above. Linear regression analysis showed that conception after IVF treatment and low marital satisfaction were both significantly related to anxiety and pregnancy worries. In addition, low income level was significantly related to pregnancy worry whereas low educational level was related to anxiety.Conclusion
the risk factors found in this study could help clinicians target anxiety screening to high-risk populations of pregnant women. Health care professionals and midwives in particular should be trained in the detection and management of anxiety and worries during pregnancy. 相似文献12.
Objective
to explore the experiences related to obesity in women with a body mass index (BMI)>35 kg/m2 during the childbearing process.Design
a qualitative design was used. Data were collected using semi-structured interviews and field notes. Women were interviewed in the third trimester of pregnancy and between three and nine weeks after the birth. Transcribed data were analysed using framework analysis methods.Setting
one maternity service in the North of England.Participants
19 women with BMI>35 kg/m2.Findings
these women highlighted their feelings of humiliation, and the stigma associated with being pregnant, when obese. Interactions with health professionals and the general public reinforced their discomfort about their size. The high-risk status of their pregnancy increased the medicalisation of their pregnancy. The ultrasound scan was a significant source of distress if difficulties imaging the fetus were not clearly explained during the procedure.Key conclusions
pregnant women who are obese are sensitive of their size. The interactions with health professionals and others that they encounter may increase distress.Implications for practice
health professionals should be more aware of the psychological implications of being obese. Communication strategies about care should be clear and honest, and conveyed in a sensitive manner. Written comments related to size on ‘hand-held’ notes should be explained at the time of writing. 相似文献13.
《Midwifery》2016
ObjectiveBeing underweight at pregnancy commencement is associated with a range of adverse maternal and infant outcomes, as is being overweight or obese, yet it is an aspect of maternal health which has been relatively neglected by healthcare professionals and researchers. We aimed to investigate differences in pre-pregnancy and pregnancy healthy lifestyle advice routinely offered by relevant healthcare professionals, including midwives and GPs, to women across three different BMI categories – underweight, normal, and overweight or obese.DesignA cross-sectional study nested in an antenatal survey of pregnant women.SettingAntenatal clinics of three National Health Service (NHS) hospitals in London, UK.ParticipantsPregnant women at any gestation of pregnancy were invited to participate in the study whilst attending a routine antenatal scan appointment.MeasurementsMain outcomes of interest were whether women had sought and/or had been offered healthy lifestyle advice by relevant healthcare professionals before or during the index pregnancy and whether the advice offered had included weight management, tobacco smoking cessation and alcohol intake. Other outcomes included alcohol consumption and tobacco smoking before and during the index pregnancy.FindingsA total of 1173 women completed the survey, with pre-pregnancy BMI data available for 918 (78.3%) women, 632 (69%) of whom were of normal weight, 232 (25%) were overweight or obese, and 54 (6%) were underweight. Overall, 253 (28%) of these women reported they had sought pre-conception advice. Women with a low BMI were offered pre-pregnancy and pregnancy healthy lifestyle advice of a similar content to women with a normal BMI, whereas women with a high BMI were more likely to be offered specific pre-conception and pregnancy advice on healthy BMI (respectively OR 2.55; 95% CI 1.64–3.96: OR 1.79; 95% CI 1.26–2.54), pre-conception healthy diet (OR 1.58; 95% CI 1.06–2.37), reducing alcohol consumption (OR 1.63; 95% CI 1.06–2.51) and smoking cessation (OR 1.62; 95% CI 1.05–2.50). For all women, reported alcohol consumption during pregnancy was lower than pre-conception, but within each BMI group around half of the women reported consuming alcohol at some time during their pregnancy.Key conclusionsWomen with a low BMI are no more likely than women with a normal BMI to be advised by health professionals about a healthy lifestyle or a healthy weight for their height before or during pregnancy. In contrast women with a high BMI are more likely to receive such advice. Provision of pre-conception care could provide opportunity to advise women across the weight spectrum of the importance of adopting a healthy lifestyle for optimal pregnancy outcomes, as well as consider management of any pre-existing medical conditions.Implications for practiceHealthy lifestyle advice, including alcohol consumption and smoking cessation, should be offered to women who are underweight before and during pregnancy as well as to women who are overweight or obese, to improve adherence to recommendations to optimise maternal and infant outcomes. Advice should also be tailored to reflect women’s ethnic background, which could be an important influence on lifestyle behaviour and weight management. The potential clinical benefit of routine provision of pre-conception care, particularly for women who have a high risk of a poorer pregnancy outcome due to weight status or other medical complications, needs to be explored. 相似文献
14.
Objective
to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.Design
the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.Setting
public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.Informants
in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.Findings
the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.Key conclusions and implications for practice
culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting. 相似文献15.
Objective
women experience a range of psychosocial issues during pregnancy, childbirth and the postnatal period. A review of hospital postnatal care in Australia found that many midwives who provide postnatal care find dealing with psychosocial issues a challenge, further complicated by heavy workloads that reduce the opportunity for quality interactions between midwives and women. This study aimed to evaluate an advanced communication skills education package for midwives caring for women during the postnatal period.Design
a before-and-after survey design was used. Midwives attended seven sessions over a six-month period in 2006 and completed a survey before and after the sessions to evaluate the programme. Surveys included items about communication skills, willingness to change, learning style, and knowledge of and attitudes towards psychosocial issues.Setting
the programme was implemented at two sites in Victoria, Australia: a tertiary metropolitan referral hospital and a regional hospital.Participants
25 midwives participated in the study.Findings
21 of the 25 participating midwives (84%) completed both the pre and post survey. Following the educational intervention, participants were more likely to feel competent at identifying women in an abusive relationship (p=0.002); encouraging women to talk about any psychosocial issues (p=0.02); actively encouraging women to talk about things on their mind (p=0.01); and encouraging women to talk about how they are really feeling (p=0.02). Participants also felt more confident in their knowledge of psychosocial issues (p=0.01) and in supporting women experiencing psychosocial issues in the early postnatal period (p=0.02). Participants were very positive about the programme.Key conclusions and implications for practice
the advanced communication programme, implemented for the first time in the postnatal setting, increased the self-reported comfort and competency of midwives to identify and care for women with psychosocial issues during the postnatal period. The effect of this approach should now be evaluated in terms of women’s outcomes. 相似文献16.
17.
《The journal of maternal-fetal & neonatal medicine》2013,26(11):2186-2189
Objective: This study aimed to assess the pregnancy outcomes of women who reported social intake of low or very low alcohol levels during pregnancy. Methods: Obstetric and foetal outcomes were assessed in a prospective cohort of 1667 pregnant women who reported low or very low alcohol consumption during pregnancy (cases) and 1840 alcohol-abstainer women (controls). Results: Among cases, alcohol consumption occurred during the first 4.4 (median) weeks of pregnancy, with a median ingestion of 1.0 (0.01–6.0) drinks/week, equivalent to 7.6 (0.09–47.5) g/week. Cigarette smoking was reported approximately four times more often in the exposed group than in the controls (p < 0.001). Pregnancy outcomes were similar between groups. There were 37 (2.4%) babies born with malformations in the exposed group and 41 (2.4%) in the control group (p = 0.9). Conclusions: Low-to-very low levels of alcohol ingestion during pregnancy do not appear to be associated with adverse maternal or foetal outcomes. 相似文献
18.
Thompson MW Nassar N Robertson M Shand AW 《The Australian & New Zealand journal of obstetrics & gynaecology》2011,51(5):460-463
We conducted a survey among a convenience sample of 149 women and their partners (n = 136) attending antenatal services in the Canberra Hospital in 2010. Over one-third (39%) of women and 63.6% of their partners were overweight/obese, and 69.2% of women had not received advice from their caregiver on their weight. Pregnant women and their partners' health behaviours including smoking, and fruit and vegetable intake were strongly correlated (P ≤ 0.01). Pregnant women require targeted advice on their weight, ideal weight gain and impact of these on pregnancy. 相似文献
19.
《Midwifery》2017
Objectiveto explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives.Designqualitative semi-structured interview study, using thematic analysis and constant comparison.Setting and participantstwenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013.Findingswomen considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them.Key conclusions and implications for practicehealth education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits. 相似文献
20.