Pregnant women's attitudes for accepting or declining a serum-alpha-fetoprotein test

This study analyzes attitudes which influence women in their decisions to accept or decline a serum-Alpha-FetoProtein (se-AFP) test. The survey covers all women who have visited antenatal clinics offering the se-AFP test in a given area during a specified period. All in all, the pregnant women answered four questionnaires: three before and one after delivery. 19% of the women declined the se-AFP test. During pregnancy, the women who did not take the se-AFP test said that the reason was anxiety about the results of the test. Many of the women who took the test said that they wanted assurance that the child was healthy. This entails obvious ethical problems when the test is positive. The test-routine does not have a major influence in the decision-making process. A change in routines to shorten the waiting time, and a different cut-off line might influence some of the declining women to accept the test.     

Presenting a routine screening test in antenatal care: practice observed.

People's knowledge of screening tests for which they are eligible and which they may have undergone is frequently low. The aim of the current study is to determine the extent to which this is due to how a test is offered and explained. Routine consultations (n = 102) between midwives, obstetricians and pregnant women were tape-recorded to determine how a routine screening test for fetal abnormalities (maternal serum alpha-fetoprotein) is presented. The test was presented in the vast majority of consultations. Overall, little information was provided about the test, the conditions screened for, and the meaning of either a positive or a negative result. Screening was presented in such a way as to encourage women to undergo the test. The way in which routine prenatal screening is presented is unlikely to maximise informed decisions about whether to participate in this screening programme. Factors likely to be influencing test presentation include knowledge, attitudes and skills of staff, as well as the attitudes of pregnant women. The results of this study highlight a need to train the heath professionals implementing screening programmes in how to inform people fully about low probability but serious events without alarming them unduly, or reassuring them falsely.     

Women as moral pioneers? Experiences of first trimester antenatal screening

The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as 'moral pioneers'. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as 'moral pioneers' in increasingly complex settings.     

昆明地区孕产妇、医务人员HIV母婴垂直传播相关知识、态度对比分析

为了解孕妇及医务人员对HIV母婴垂直传播的知识、态度，为开展孕产妇宣传教育，开展阻断母婴垂直传播自愿检测、咨询及药物治疗提供依据。采用问卷对昆明地区238名孕产妇及227名医务人员进行了HIV母婴传播相关知识、态度及行为的调查。结果发现：昆明地区大部分孕产妇及医务人员了解并认识艾滋病相关认识，赞同将HIV检测列入婚检、产前检查，并自愿接受检测。但医务人对阻断母婴垂直传播知识了解甚少，还存在歧视HIV感染者现象，临床服务中存在较高职业危险暴露行为。建议逐步在婚检、产前检查中试行HIV自愿检测，加强医务人员对HIV垂直传播及HIV职业暴露防护的知识技能培训，尽快在重点地区探索开展降低孕产妇HIV垂直传播模式。     

HIV Testing Among U.S. Women During Prenatal Care: Findings from the 2002 National Survey of Family Growth

Objectives: To measure progress toward the US Public Health Service recommended goal that HIV screening be part of the routine battery of prenatal tests for all pregnant women, using data from a nationally-representative reproductive health survey. Methods: Data from the 2002 National Survey of Family Growth (NSFG) measure self-reported prenatal HIV testing for all women who had a completed pregnancy in the 12 months before interview. We estimated the percentage with a prenatal test for categories defined by major socio-economic groups, HIV risk, knowledge of HIV treatment, and access to health care. Results: Sixty-nine percent of 748 recently pregnant women reported receiving a prenatal HIV test. The percentage tested was significantly higher for women with incomes below 300% of the poverty level (76%) and women who reported some degree of HIV risk (82%), suggesting that prenatal care providers offer and encourage testing based on perceived risk, even though universal HIV screening is recommended. Testing was also higher among women with knowledge of interventions to prevent perinatal HIV transmission (74%), suggesting that more public information on these treatments might be helpful. Conclusions: A national estimate indicates that nearly one in 3 recently pregnant women reported they were not tested for HIV during prenatal care. Studies showing that prenatal testing for other infectious diseases can approach 100% suggest that a similar level of testing is attainable for perinatal HIV screening, particularly if it is incorporated into the routine package of prenatal tests and procedures offered to all pregnant women.     

The impact of a screening mammography program on Sydney general practitioners

Abstract: The aim of this study was to determine changes in Sydney general practitioners' (GPs) knowledge about, attitude towards and intention to recommend screening mammography over the two years since a screening mammography program was first implemented in the Central Sydney Health Service (CSHS) area. 123 GPs from the CSHS area were selected from a list maintained by the Breast X-ray Programme, while 127 GPs from the rest of Sydney were selected from the Yellow Pages telephone directory. The overall response rate was 84 per cent. Outcomes were assessed by a self-administered questionnaire covering knowledge, attitudes and beliefs, self-report of recent referral practice, intention to recommend, and sources of information about mammography screening. Demographic data were also collected. Results showed that overall knowledge has increased both inside and outside the CSHS area, but important deficiencies in knowledge remain in both areas. Attitudes to screening mammography have improved in the CSHS area, especially regarding the efficacy of screening mammography and patient compliance. Importantly, positive views of screening mammography have declined outside the CSHS area, especially about whether screening mammography can save women's lives. GPs in both areas remain concerned about costs. The presence and strategies of the Breast X-ray Programme have had some positive effect on the attitudes of GPs towards, but not knowledge of, screening mammography.     

What participants understand about a maternal serum alpha-fetoprotein screening program.

We investigated the knowledge of pregnant women participating in a maternal serum alphafetoprotein (MSAFP) screening program for the detection of neural tube defects (NTDs) in the fetus. Women participating in the screening program scored higher on two knowledge tests than a comparison group of pregnant women who were not offered screening. However, there were substantial gaps in the knowledge base of women in the program, as measured by one of the tests. Women did not misinterpret a negative test result to mean that the test had identified a potential problem with the fetus; instead, there is a suggestion that they tended to interpret a negative result too positively, as an assurance that the baby was healthy in all respects.     

A measure of informed choice

Objective  To develop a measure of informed choice.
Conceptualization and measurement  The measure is based on the following definition of an informed choice: one that is based on relevant knowledge, consistent with the decision-maker's values and behaviourally implemented. The measure comprises an eight-item scale of knowledge, a four-item scale assessing attitudes towards undergoing the screening test and a record of test uptake.
Participants  Sixty-six women awaiting their first antenatal clinic appointments.
Measure development  In women offered a screening test in pregnancy, the internal reliability of both the knowledge and the attitude scales was acceptable (alpha coefficients 0.82 and 0.83, respectively). Of the 42 women completing both scales, 18 were classified as having made an informed choice, and 24 were classified as having made an uninformed choice.
Conclusion  The results of this preliminary study provide some evidence to support the feasibility of conceptualizing and measuring informed choices regarding screening using a brief measure assessing knowledge and attitudes. The validity and utility of this approach awaits further studies, involving larger numbers of participants, offered different screening tests.     

Knowledge,attitudes and practices about influenza vaccination among pregnant women and healthcare providers serving pregnant women in Managua,Nicaragua

BackgroundNicaragua implemented an influenza vaccination program for pregnant women with high-risk obstetric conditions in 2007. In 2014, the recommendation of influenza vaccination expanded to include all pregnant women. Given the expansion in the recommendation of vaccination, we evaluated knowledge, attitudes and practices of pregnant women and their healthcare providers towards influenza vaccination and its recommendation.MethodsWe conducted surveys among pregnant women and their healthcare providers from June to August 2016 at two hospitals and 140 health facilities in Managua. The questions were adapted from the U.S. national CDC influenza survey and related to knowledge, attitudes and practices about influenza vaccination and barriers to vaccination. We analyzed reasons for not receiving vaccination among pregnant women as well as receipt of vaccination recommendation and offer by their healthcare providers.ResultsOf 1,303 pregnant women enrolled, 42% (5 4 5) reported receiving influenza vaccination in the 2016 season. Of those who reported not receiving vaccination, 46% indicated barriers to vaccination. Pregnant women who were vaccinated were more likely to be aware of the recommendation for vaccination and the risks of influenza illness during pregnancy and to perceive the vaccine as safe and effective, compared to unvaccinated pregnant women (p-values < 0.001). Of the 619 health workers enrolled, over 89% recalled recommending influenza vaccination to all pregnant women, regardless of obstetric risk. Of the 1,223 women who had a prenatal visit between the start date of the influenza vaccination and the time of interview, 44% recalled receiving a recommendation for influenza vaccination and 43% were offered vaccination. Vaccination rates were higher for those receiving a recommendation and offer of vaccination compared with those who received neither (95% vs 5%, p-value < 0.001).ConclusionPregnant women in Managua had positive perceptions of influenza vaccine and were receptive to receiving influenza vaccination, especially after the offer and recommendation by their healthcare providers.     

Cost-effectiveness of prenatal screening for postpartum thyroiditis

Five percent of all pregnant women and 25% of pregnant women with insulin-dependent diabetes mellitus (IDDM) develop postpartum thyroiditis (PPT) during the first year after delivery. PPT has significant morbidity and can be predicted prenatally by the presence of thyroid peroxidase (TPO) antibody. Our objective was to estimate the cost-effectiveness of screening pregnant women for the TPO antibody versus the current strategy of no screening test or an alternative strategy of a thyroid-stimulating hormone (TSH) test 6 weeks postpartum. We performed cost-effectiveness analysis using a decision tree model that accounted for cases of PPT detected, medical outcomes of screening, and costs of screening and care. Hypothetical cohorts of 1000 pregnant women with uncomplicated pregnancies and 1000 pregnant women with IDDM were used to determine direct medical costs, quality-adjusted life years, and cases of PPT detected. The cost of testing 1000 pregnant women for TSH at the 6 week postpartum visit was $75,000, with an effectiveness of 995.2 quality-adjusted life years resulting in a cost-effectiveness ratio of $48,000 per quality-adjusted life year. Checking a TPO antibody was more effective (995.5 quality-adjusted life years) but also more expensive ($93,000). The incremental cost-effectiveness ratio of the TPO antibody strategy was $60,000 per quality-adjusted life year. Results were most sensitive to changes in the test characteristics, incidence of disease, and percentage of women with PPT who were symptomatic. A separate analysis for women with IDDM resulted in an incremental cost-effectiveness ratio of $13,000 per quality-adjusted life year for the TSH strategy and $32,000 per quality-adjusted life year for the TPO strategy. Screening for PPT is likely to be reasonably cost-effective and should be considered for inclusion as part of routine pregnancy care.     

Are women and providers satisfied with antenatal care? Views on a standard and a simplified,evidence-based model of care in four developing countries

BACKGROUND: This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC) model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. METHODS: Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. RESULTS: Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. CONCLUSIONS: Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice.     

Syphilis: still with us, so watch out!

The number of syphilis cases has been increasing in the UK, partly because of localised outbreaks. The sharpest rises have been among men having sex with men, but the incidence among heterosexuals has also risen. Blood-test screening for syphilis is an important part of sexual health, and includes routine screening of pregnant women at the first antenatal visit. Prompt treatment with penicillin in the earlier stages can stop the progression of the disease. Unfortunately, public awareness of syphilis and its potentially serious consequences is low. It is important for health professionals to be alert for signs of the disease and to initiate tests if there is a likelihood that a patient has or is at risk for the disease.     

1993～2008年中国育龄妇女孕产期保健服务利用趋势分析

目的:描述中国1993～2008年代表不同社会经济发展程度的地区类型已婚育龄妇女产前、产时和产后保健利用的变化情况,并探讨其中存在的问题。方法:通过卫生部发布的1993、1998、2003、2008年4次国家卫生服务调查报告中的有关数据,筛选部分关键指标分地区类型、分时段反映15～49岁已婚育龄妇女孕产期保健服务利用水平的变化和其中存在的问题。结果:在1993-2008年间,孕早期检查率、产前检查率、住院分娩率和产后访视率分别从37.0%、69.5%、38.7%和46.0%升至65.2%、94.4%、88.6%和55.6%,剖宫产率从2.35%增至27.20%;产前保健、产时保健和产后保健各项指标的城乡差别均有不同程度缩小;2008年4类农村地区住院分娩率仅为64.30%,大城市剖宫产率高达63.00%。结论:中国孕产期保健服务利用水平在过去十余年间有了较大提高,但孕早期检查和产后访视两项指标仍处于较低水平。多数指标之间的城乡差距不断缩小,但4类农村地区住院分娩率还不理想。剖宫产率在全国范围内迅速攀升,已经远远超过正常水平,需予以重视和适当引导。     

Carrier screening for cystic fibrosis: a pilot study of the attitudes of pregnant women.

We surveyed the attitudes of a consecutive sample of 306 pregnant Caucasian women toward carrier screening for cystic fibrosis. Of the 214 respondents, 98% said that screening should be offered before pregnancy, and 69% said they would accept carrier screening during pregnancy. Twenty-nine percent of the respondents indicated a willingness to terminate a pregnancy if the fetus were found to have cystic fibrosis. We conclude that carrier screening is of interest to pregnant women, although interest in terminating a pregnancy because of screening results may be limited.     

Reasons for non-attendance for computer-managed cervical screening: pilot interviews

A pilot interview study looked at reasons why women did not attend a clinic following an invitation for a cervical smear test offered via a computer-managed scheme. Three broad issues were identified. First, the inaccuracy of the computer database (the FPC register) meant some women were inaccessible because they no longer lived at the address recorded. Other women were ineligible or unsuitable within the criteria of the scheme but had been sent invitations inappropriately because their screening records were incomplete or out of date. Second, aspects of service organisation and provision led to misclassification of some attenders as non-attenders and to various failures of communication such as non-receipt of the invitation or health education leaflet or unsuccessful attempts to rearrange appointments. In addition, the appointment or venue offered could be unsatisfactory. The third issue concerned the characteristics of the women which sometimes interacted with practical problems connected with service provision. Other women believed the test to be inappropriate for themselves while some were deterred by the prospect of the test itself. In general, embarrassment was pervasive and reflected in preferences for different types of service provision. Women who had neither attended nor been otherwise tested were particularly likely to express feelings of fear and fatalism. General attitudes to the test were favourable but this was not always applied personally. A typology of reasons for non-attendance for computer-managed cervical screening is presented.     

Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of women’s experiences and expectations of participation

Objective  To describe the acceptability to women of being offered antenatal Sickle cell and Thalassaemia (SC&T) screening in primary and secondary care at the visit to confirm pregnancy; and to explore the implications of their views for participating in decisions about their health care. Methods Qualitative semi‐structured interviews were conducted with twenty‐one ethnically diverse women registered at twenty‐five general practices in two English inner‐city Primary Care Trusts. The material was analysed thematically, using the method of constant comparison. Results Women generally welcomed the opportunity of early diagnosis, although they expected screening to confirm they were carrying a healthy child. Women felt general practitioners did not present antenatal screening as a choice, but they did not necessarily see this as a problem. Doctors were believed to be acting out of concern for the women’s well being. Conclusions Women were generally positive about being offered screening in primary care at the first visit to confirm pregnancy. To this extent it was acceptable to them, although this was largely informed by assumptions associated with being a ‘good mother’ rather than a straightforward enactment of informed choice, assumed by health‐care policy. This represents the context in which women participate in decisions about their health care.     

Screening HIV in pregnancy: a survey of prenatal care patients

BACKGROUND: Women in Canada, as in the rest of the world, represent an increasing proportion of new HIV positive cases. In 2002, women accounted for 25% of all positive HIV tests reported in Canada; with the majority being in their childbearing years (15 to 39 years), perinatal transmission of HIV in Canada is cause for concern. Following the development of interventions that can effectively reduce vertical transmission rate, prenatal screening of HIV has become the first and most pivotal step in the prevention of mother-to-child HIV transmission. The purpose of this study was to assess how women's knowledge and attitudes regarding HIV and HIV screening in pregnancy influence screening rates. METHOD: A prospective anonymous survey of 231 women attending antenatal care clinics at a teaching university hospital or in a community clinic was conducted. RESULTS: In general, pregnant women supported universal HIV screening in the prenatal period. Women who previously had been tested for HIV and who did not perceive that they were at risk for contracting HIV were more likely to decline HIV testing in their current pregnancy. Overall knowledge regarding HIV and its transmission is less than optimal, particularly among those women who declined HIV testing. CONCLUSION: Knowledge gaps exist between women accepting and declining prenatal HIV screening, particularly relating to benefits of screening. These results suggest that efforts have to continue to be put into educating the public but also, importantly, into changing current attitudes.     

Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices?

BACKGROUND: It is not known if lower uptake of prenatal screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women reflects more negative attitudes towards undergoing the test or women not acting in line with their attitudes i.e. not making an informed choice. METHODS: Uptake of prenatal screening, attitudes towards undergoing the test, uptake-attitude consistency, and informed choice were assessed in a prospective study of 1499 pregnant women attending two UK hospitals. RESULTS: Uptake was higher in white and socioeconomically advantaged women than in other women. There were no differences in attitudes towards undergoing the test; all women expressed relatively positive attitudes. Uptake-attitude consistency was higher in white and socioeconomically advantaged women than others, particularly in those with positive attitudes towards undergoing the test (76% white women with positive attitudes had the test compared with 45% South Asian women [difference 31%, 95% confidence interval (95% CI) 18-43] and 78% socioeconomically advantaged women compared with 63% more disadvantaged women (difference 15%, 95% CI 7-24)). Controlling for demographic variables, South Asian and socioeconomically disadvantaged women with positive attitudes were less likely to make an informed choice than other women [odds ratio (OR) 0.22, 95% CI 0.10-0.45 and OR 0.62, 95% CI 0.41-0.93, respectively]. CONCLUSION: Lower uptake of screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women does not reflect more negative attitudes towards screening but rather lower rates of informed choice, as assessed in this study. Healthcare systems appear to facilitate informed choices in the context of prenatal screening for Down syndrome screening less well for women from minority ethnic groups and those who are socioeconomically disadvantaged than for other women.     

198名孕妇口腔保健知信行状况调查分析

目的了解孕妇对口腔保健知识的掌握程度及其相关态度和行为状况。方法纳入2018年6月-2019年5月产检孕妇198例,怀孕第10~12周在深圳妇幼保健院口腔病防治中心产科建册时自愿到口腔科接受问卷调查。结果①口腔保健知识,61.54%的孕妇认为怀孕前需要进行口腔检查,33.33%的孕妇不知道怀孕后容易发生口腔疾病,仅有43.59%的孕妇知道孕期口腔疾病会对胎儿健康有影响,48.72%的孕妇认为怀孕期间不可以做口腔治疗;②口腔保健相关态度,孕妇对口腔健康教育活动持消极态度及表示怀孕期间出现口腔问题不愿意就诊均占28.21%;③口腔保健相关行为,孕妇每天仅刷1次牙占10.26%,每次刷牙时间会超过2分钟仅有3.59%,从来不使用牙线占56.41%,53.85%的孕妇从计划怀孕至今从未做过口腔检查。结论孕妇在口腔保健知信行方面存在很多不足,尤其在口腔保健行为方面急需改进和提高。     

Less refusal to participate in HIV screening among pregnant women in the Amsterdam region since the introduction of standard HIV screening using the opting-out method

In 2003 the Municipal Health Service in Amsterdam started to screen pregnant women for HIV according to the opting-out method. In this method the HIV test is routinely included in the prenatal screening along with hepatitis B virus (HBV) and syphilis. If the woman does not want to be tested for HIV then she must actively opt out of this test. This screening method was chosen because in the universal screening method used in 2002, women had to give their explicit consent to test for HIV and this led to a high refusal rate (13.6%), especially among women from AIDS-endemic countries. After the introduction of the opting-out method, the refusal rate fell from 3% in the first quarter of 2003 to 1.4% in the last quarter of 2003. None of the women refused to be tested for HBV or syphilis. In 2003, the HIV prevalence among pregnant women was 0.3% (35/13.621). The experiences with this screening method in Amsterdam were used to implement the national opting-out method for HIV screening in pregnant women, which was introduced on 1 January 2004.