Pregnant immigrant women: occupational activity, antenatal care and outcome

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

北京市朝阳区825例流动孕产妇产前检查现状及影响因素分析

目的了解北京市朝阳区流动孕产妇产前检查的基本现状及相关影响因素,为制定流动孕产妇孕期保健服务的相关卫生政策提供参考依据。方法采用分层整群抽样,选取朝阳区流动人口相对密集的7个街道/乡镇随机抽取825例流动产妇(对象为1岁以下儿童母亲)进行回顾性问卷调查。结果流动产妇中认为妊娠期间需要进行产前检查的为93.0%,而实际孕期建立《母子健康档案》的只占35.5%;21.2%的流动产妇在私人诊所做过产前检查。在对医院服务的综合评价中最不满意的是就诊等候时间。结论私人诊所为流动孕产妇提供廉价和不健全的产前检查服务这一因素不容忽视。通过取缔非法行医诊所,改善医疗管理体制,制定合理的收费标准,以满足不同层次流动孕产妇的孕期保健需求;加大宣传力度是增强孕产妇主动寻求孕期保健服务的有效手段。     

The costs of alternative types of routine antenatal care for low-risk women: shared care vs care by general practitioners and community midwives

OBJECTIVES: To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care. METHOD: A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs. RESULTS: GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = 87.25 Pounds, shared care = 91.15 Pounds, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = 127.76 Pounds, shared care = 131.09 Pounds, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = 118.53 Pounds, shared care = 133.49 Pounds, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = 83.74 Pounds, shared care = 94.43 Pounds, P = 0.46). The total societal cost of antenatal care was 417.28 Pounds per women in the GP/midwife arm of the trial and 450.19 Pounds in the shared care arm of the trial. This difference was statistically significant (P < 0.001). The application of sensitivity analysis did not change these results. CONCLUSIONS: GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care.     

Factors determining health practices: prenatal care in rural and urban environment

A 1978 study of prenatal care patterns in one area of France showed that frequent visits to specialists was the dominant pattern in urban areas, whatever the socioeconomic characteristics, or conditions of health, of the women. In rural areas, however, the patterns adopted varied markedly according to health problems encountered during pregnancy. In the absence of illness, 64% of rural women went to their general practitioner for a reduced number of prenatal visits; when health problems were perceived, however, their practices became more similar to those of city women. These variations remained after allowing for socioeconomic and cultural differences. Overall, patterns adopted varied significantly according to area of residence.     

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was ‘It is normal to experience nausea/vomiting in the first trimester of pregnancy’, the least accurately evaluated statement was ‘Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy’. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.     

Role of antenatal care in toxemia of pregnancy in alexandria

Pre-eclampsia and eclampsia remain one of the major obstetrical problems in less developed countries. Proper antenatal care (ANC) with regular measurement of blood pressure remains the mainstay of screening for hypertension in pregnancy. The aim of the current study was to identify frequency and characteristics of women with toxemia of pregnancy, assess both the quantitative and qualitative adequacy of antenatal care among cases with toxemia of pregnancy and to evaluate the effect of antenatal care on maternal and perinatal outcome. A cross-sectional case series study design was utilized .The study population was all cases, with confirmed diagnosis of toxemia of pregnancy who were admitted to El-Shatby University hospital during the period from January to May 2005. A structured interviewing schedule was used to collect data on characteristics of cases, maternal and fetal outcome. Site, adequacy and quality of received antenatal care were assessed. Out of total cases (336), 14.29% were diagnosed as mild pre-eclampsia, 83.31% were found to have severe pre-eclampsia while 2.40% were suffering from eclampsia. The severity of the condition was significantly associated with older maternal age, multiple pregnancy, primigravity, nulliparity, low socioeconomic conditions, husband's smoking and excessive caffeine consumption. Three-quarters of eclampsia cases (75.0%) didn't receive antenatal care and 60.0% of severe pre-eclamptics received inadequate antenatal care. The mean percent score of quality care domains of antenatal care content for mild pre-eclamptics was 75.62 +/- 13.80%. This was significantly higher than that for those of severe (59.96 +/- 27.95%) or for eclampsia cases (48.75 +/- 20.04%) where X(2) of Kruskal-Wallis=8.316 (P<0.001). Adverse maternal and fetal outcome occurred in 79.4% of women and 72.3% of babies for those who received poor quality ANC. In conclusion, the complications of pre-eclampsia and eclampsia could be prevented by wide spread use of adequate antenatal care, education and training of primary medical care personnel, prompt diagnosis of high risk patients and timely referral to higher level health care.     

Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico

ObjectiveTo propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care.MethodsIn a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage.FindingsBased on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance.ConclusionWhile basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.     

Pregnant women's fear of childbirth in midwife- and obstetrician-led care in Belgium and the Netherlands: test of the medicalization hypothesis

Fear of childbirth has gained importance in the context of increasing medicalization of childbirth. Belgian and Dutch societies are very similar but differ with regard to the organization of maternity care. The Dutch have a high percentage of home births and low medical intervention rates. In contrast, home births in Belgium are rarer, and the medical model is more widely used. By comparing the Belgian and Dutch maternity care models, the association between fear of childbirth and medicalization can be explored. For this study an antenatal questionnaire was completed by 833 women at 30 weeks of pregnancy. Fear of childbirth was measured by a shortened Dutch version of the Childbirth Attitudes Questionnaire. A four-dimensional model with baby-related, pain and injuries-related, general and personal control-related, and medical interventions and hospital care-related fear, fitted well in both countries. Multiple regression analysis showed no country differences, except that Belgian women in midwife-led care were more fearful of medical interventions and hospital care than the Dutch. For the other dimensions, both Belgian and Dutch women receiving midwifery care reported less fear compared to those in obstetric antenatal care. Hence, irrespective of the maternity care model, antenatal care providers are crucial in preventing fear of childbirth.     

Prenatal care in Kinshasa: Knowledge, beliefs, and barriers to timely care

According to the international medical community, adequate antenatal care, beginning by the end of the fourth month of pregnancy, is beneficial to maternal and perinatal outcomes. However, there is little research on timing of antenatal care and factors that influence it, including external barriers and women's beliefs. This research was conducted at antenatal clinics in the Democratic Republic of Congo where rates of infant and maternal mortality are among the highest in sub-Saharan Africa and where antenatal care begins later than in other countries in the region; the goal was to assess knowledge, beliefs and barriers to timely antenatal care. In this paper we present data collected in structured interviews at the women's first antenatal visit (N = 206). Although 75% of women believed antenatal care should start before the end of the fourth month, as recommended by WHO, only 22% presented by this time. Important barriers were financial (37%) and lack of knowledge about appropriate timing (35%). Gravidity was associated with gestational age at first visit (p < 0.001). Average gestational age at first visit was 4.7 months in primigravidae and 5.9 months in women with > or = 2 previous pregnancies. Most women in Kinshasa begin antenatal care later than recommended by WHO. Educating women on the importance of timely antenatal care and improving its financial accessibility should be priorities for maternal and child health programs in the DRC.     

National Health Insurance and the antenatal care use: a case in Taiwan

Many studies have found evidence for the importance of antenatal care on pregnancy outcomes. This paper focuses on the determinants of antenatal care use in Taiwan and provides a comparison of access to care before and after National Health Insurance (NHI) was implemented in 1995. A negative binomial model is applied to data from the 1989 and 1996 Taiwan Maternal and Infant Health Surveys to analyze antenatal care use. The results show that women in some situations had more antenatal care visits than average regardless of NHI implementation. These situations include: having a highly educated husband; gaining more weight than average during pregnancy; experiencing a first pregnancy; carrying twins or triplets; having care provided by a doctor rather than other caregivers; and switching to another health care facility during pregnancy. Regarding societal change, the trend toward delaying pregnancy is causing a change in care use. Additionally, three changes in care patterns after NHI are noteworthy. First, antenatal care visits at maternity clinics increased more than visits at hospitals. Second, before NHI's implementation, women who did blue-collar work or farm work sought care more frequently than housewives, but after NHI began government employees and businesswomen sought care more frequently. Third, antenatal care visits of mothers living in Taiwan's central area increased more than visits of those in the northern area. The expansion of medical care in aboriginal areas and outlying islands may prove to be one of NHI's best achievements.     

Antenatal care in high-risk pregnancies

A retrospective analysis of the antenatal records of women who gave birth to live babies was conducted in the three Districts of the East Sussex Health Area in 1977. A high-risk group was identified and the antenatal care for them was compared with that given to mothers in general. Comparison was also made between Districts. Women in the high-risk group were similar to those in the general group with respect to the number of antenatal visits. Overall this was also found with respect to when the last visit was made, but there were differences among those with short or long gestations. Pregnant women at high risk were more likely to be supervised by the hospital team exclusively during the antenatal period than those in the general group. Maternal characteristics which might have been used to identify high-risk pregnancies were often not recorded. High-risk mothers more frequently had infants with Apgar scores of less than 5 at one minute and birth weights of 2500 g or less than did women in the general group. However, it would appear that District policy on health care varied significantly since various aspects of care were found to be more dependent on the District concerned than on the risk group involved.     

Antenatal care in Maputo, Mozambique.

Mozambique, within its plan for overall social and economic change, has given priority to primary health care with a principal focus on maternal and child health. In 1980 an antenatal control form was introduced into all Maputo's antenatal clinics to monitor pregnancies and to help direct specialist care to mothers at greatest risk--a strategy known by WHO as the "risk approach." In this study three health centres were selected from contrasting areas of the city. Almost 1000 completed antenatal forms were analysed to determine incidence of risk and to evaluate the implementation of this strategy. It was found that: (1) a considerable number of women at risk were identified, referred, and successfully monitored through their pregnancy. (2) Of those women at risk who were identified by the health centres, fewer than half were actually referred for specialist care. (3) Those women at greatest risk were not the highest users of the services, and many of them underused the services compared with those at lower risk. (4) The level of risk and child mortality varied with a measure of urban quality of the areas in which the centres were located.     

Determinants of folic acid knowledge and use among antenatal women.

BACKGROUND: Although recommendations on folic acid use were issued by health authorities in a number of countries in the early 1990s, uptake of peri-conceptional folic acid is still disappointingly low. Regardless of food fortification policies, folic acid promotion will probably be required in most countries to optimize folate levels among women of child-bearing age. The aim of this study was to examine folic acid knowledge and use, and their determinants among antenatal women in the east of Ireland in 1997. METHODS: Three hundred antenatal women attending their initial booking appointment in three Dublin maternity hospitals were surveyed. An interviewer-administered questionnaire was used with questions on folic acid knowledge and use, and demographic and obstetric questions. A univariate analysis of data was undertaken followed by a multivariate analysis using logistic regression to determine factors predicting knowledge and use of folic acid. RESULTS: Seventy-six per cent of respondents had heard of folic acid, 16 per cent had taken it before pregnancy and 51 per cent during pregnancy. Women who had planned their pregnancy, were married and were relatively affluent were significantly more likely to have heard of folic acid, to know that it could prevent neural tube defects and to have taken it peri-conceptionally. Less affluent women tended to use their general practitioner (GP) more as a source of information and advice than those who were better off. In multivariate analysis, marriage and planned pregnancy were important predictors of folic acid knowledge whereas planned pregnancy advice given before pregnancy and relative affluence were predictive of peri-conceptional use. CONCLUSIONS: Many women know of folic acid but do not take it peri-conceptionally. Women may associate folic acid with pregnancy and less with pre-pregnancy. Greater emphasis on peri-conceptional use should improve folic acid uptake. Focusing on less affluent women for folic acid promotion by GPs and other primary care professionals is also important.     

Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands

BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. METHODS: A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. RESULTS: This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. CONCLUSION: Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.     

Out-of-hours palliative care in the UK: perspectives from general practice and specialist services

Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. 'Out-of-hours' periods are a potentially problematic time for delivery of high quality care. We report on two national surveys-one of medical directors of out-of-hours general practitioner cooperatives, the other of medical directors of specialist palliative care units. The aim was to describe general practitioners' and specialists' perspectives on the availability and scope of community nursing and specialist palliative care services. The results point to wide variation in service provision within the community. The two groups differed strikingly in their perceptions, the general practitioners being much less positive than the specialists about the availability of specialist advice and admission to specialist units out of hours. Equitable out-of-hours palliative care services of high quality are unlikely to be achieved without dialogue between primary and secondary care based providers, local needs assessment and adequate resourcing.     

Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities

Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.     

Teenage pregnancy in Scotland: trends and risks.

Teenage pregnancy, considered to be associated with social and medical risks, is seen as a growing problem. Population based information from the Registrar General (Scotland) and Notification of Abortion permitted an analysis of the trends in the numbers, rates and outcomes of pregnancies among women aged less than 20 years. In addition, clinical information is available on all deliveries in Scottish hospitals from the standard hospital discharge document permitting analysis of the association of defined complications with age. Contrary to current perceptions, pregnancies and births among teenagers are not more frequent in 1988 when compared to 1975. There has been, however, a large increase in births to single women, a group with particular problems. The obstetric risks when compared to older women, are small and probably socially, not age related. These include a slightly higher rate of pre-term delivery and low birthweight and a later presentation for specialist antenatal care. The proportion of pregnancies affected by neural tube defects which are terminated is lower among women under 20. These medical risks are small, however, compared to the well-documented social and economic problems which will have long term and indirect effects on health.     

Teenage pregnancy: a comparative study of teenagers choosing termination of pregnancy or antenatal care.

A comparative study of 167 pregnant teenagers in Devon attending either antenatal booking clinics or for National Health Service (NHS) termination of pregnancy was carried out to determine differences in their characteristics, use and experience of local family planning services. Teenagers presenting for termination of pregnancy were younger and more likely to say that they had wished to avoid getting pregnant. Whether the teenager was in a stable relationship was strongly associated with the outcome of the pregnancy, with single girls being more likely to choose a termination of pregnancy. The termination of pregnancy group were also more likely to be condom users, and to have learned about their method of contraception from school rather than from health care professionals. Teenagers' frequency of contact with family planning services suggested that teenagers choosing a termination were less likely than antenatal attenders to have attended regularly. This was mainly due to differences in behaviour among teenagers attending their general practitioner (GP) for contraceptive advice: teenagers having a termination were more likely to describe their visit to their GP as embarrassing. These findings have implications for local family planning services attempting to reduce the number of unwanted teenage pregnancies.     

江苏省26803例妇女孕期保健和妊娠结局情况调查

目的:了解江苏省妇女妊娠期间婚育状况,接触有毒有害物质、患病、孕期保健以及妊娠结局情况。方法:采用结构式问卷对江苏省苏南,苏中、苏北13个市的19个区(县)110个乡镇/街道26 803例中期妊娠孕妇进行一般情况、婚育、疾病史、孕期保健情况调查。数据用SAS 9.0统计软件包统计分析。结果:城区和乡镇在接触有毒有害物质、孕期服用叶酸等方面有统计学差异(P<0.01),与出现的异常妊娠结果相一致。结论:妇女妊娠期间注意补充蔬菜、水果、服用叶酸和福施福等多种微量元素可以减少异常妊娠的发生。