Struggling for motherhood with an intellectual disability—A qualitative study of women's experiences in Sweden

Objectiveto gain a deeper understanding of the experiences of childbearing in women with intellectual disabililty (ID).Design/settingten women with ID, who had given birth within seven years, were interviewed twice and data were analysed with content analysis.Findingsthe overarching theme was: Struggling for motherhood with an ID. The significance of having an intellectual disability became evident when the women encountered mixed reactions from partners and relatives, who sometimes suggested an induced abortion. The women disclosed their diagnosis if they believed it was beneficial for them. Throughout the process the women also felt anxious and distressed about the custody of the child. Women experienced the pregnancy as a physical and psychological transition. It was mostly a happy and responsible life event, and the women were aware of physical signs in their bodies and contact with the unborn child. Parent education was considered important but not adequately adapted to their needs. The women described the delivery as hard and painful work, sometimes difficult to understand and they had different strategies to handle the pain and strain of labour. The child was welcomed with warmth and curiosity by the women, who cared for and breast fed the child even if the hospital environment could be confusing and continued custody not taken for granted.Conclusionswomen with ID struggle for motherhood and fear losing custody of the child. Professionals need to identify and support these women, who may not always disclose their diagnosis. Since pregnancy, delivery and the transition into motherhood can be difficult to understand, information and support should be better tailored to their needs.     

Prospective study of maternal and neonatal outcome in great-grand multiparous women (≥10 births) and in aged-matched women with lesser parity

Purpose  

Evaluation of outcome of labor/delivery in great-grand multiparous (GGMP) women relative to women with lower parity is complicated because of confounding parity with (older) age. Herein, we compare maternal and neonatal outcome in GGMP from a large obstetrics department to that in older women with lesser parity.     

Disabled women׳s maternal and newborn health care in rural Nepal: A qualitative study

Objective

there is little evidence about disabled women?s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women?s experiences of maternal and newborn care in rural Nepal.

Design

we used a qualitative methodology, using semi-structured interviews.

Setting

rural Makwanpur District of central Nepal.

Participants

we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women.

Findings

married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women.

Key conclusions and implications for practice

integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care.     

The relationship of maternal–fetal attachment and depression with social support in pregnant women referring to health centers of Tabriz–Iran, 2016

Purpose: The objective of this study was to determine the relationship of maternal–fetal attachment and depression during pregnancy with social support.

Methods: This cross-sectional study was done on 287 primipara women. The data collection tools used included a demographic characteristics questionnaire, Maternal–Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Social Support Scale. Pearson’s correlation test and general linear model were used for data analysis.

Results: The mean maternal–fetal attachment score was 90.0 (SD: 10.3). The highest score was obtained in the “role taking” domain and the lowest in the “interaction with the fetus” domain. The mean depression score was 8.5 (SD: 4.0). The score of perceived social support was 135.5 (SD: 15.6). Pearson’s correlation test showed a significant positive correlation between social support and maternal–fetal attachment (r?=?0.36, p?r= ?0.14, p?=?.018).

Conclusion: The present study found a significant relationship between maternal–fetal attachment, depression and social support. It is recommended to devise plans for increasing the support given to women and to improve the society’s and families’ awareness about these issues in the attempt to have healthy mothers and thereby healthy families and communities.     

The relationship between maternal–fetal attachment and maternal self-efficacy in Iranian women: a prospective study

Introduction: This prospective study was conducted to determine the relationship between maternal–fetal attachment and maternal self-efficacy. Maternal self-efficacy contributes significantly to the mental health of the mother and infant. Maternal–fetal attachment facilitates maternal role attainment and might improve maternal self-efficacy.

Methods: This study was conducted on 242 women. The data collection tools used included a socio-demographic and obstetric questionnaire, Cranley’s Maternal–Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Maternal Self-Efficacy Scale. A multivariate linear regression was used to estimate the extent to which maternal–fetal attachment affects maternal self-efficacy.

Results: Pearson’s correlation test showed a moderate but significant positive correlation between maternal–fetal attachment and self-efficacy (r = 0.48, P < 0.001). The highest correlation with self-efficacy was observed in the domain of ‘differentiation of self from fetus’ (r = 0.43) and the lowest in the domain of ‘giving of self’ (r = 0.25). According to the multivariate linear regression, the domain of ‘Interaction with fetus’ had a significant relationship with maternal self-efficacy (P = 0.009).

Conclusion: Maternal–fetal attachment would appear to be a factor related to postpartum maternal self-efficacy which suggests identifying and supporting women with low self-efficacy may increase maternal–fetal attachment and thereby maternal self-efficacy.     

Problems with condoms – a population-based study among Finnish men and women

Objective?This study evaluates men's and women's opinions of condom use and problems with it in real life.

Methods?Random samples of men and women, aged 18–50 years, were drawn from the Finnish Population Register and were mailed a questionnaire on family planning. Response rates were 36% for men (706) and 58% for women (1136). Respondents were asked e.g. about condom use, whether they had had problems with it and why they used condoms. Moreover they were asked if they had received advice on how to use condoms.

Results?Among both men and women 87% had at some time used condoms. Of all men 37% and of women 34% reported that they had at some time had a failure with condom use; among both men and women one in four had experienced condom breakage. The use of condoms with the main purpose of preventing sexually transmitted diseases was somewhat low. The proportion of respondents having received advice on condom use was greater among younger men and women.

Conclusion?A patient with problems in condom use is not uncommon in consultations in primary health care, and thus personnel working there hold a key position in promoting condom use. The role of school health care should be assured to offer basic sexual and reproductive counselling to every generation.     

Motivational interviewing in obese women with polycystic ovary syndrome – a pilot study

Lifestyle intervention is first line treatment in obese women with polycystic ovary syndrome (PCOS). The effect of motivational interviewing (MI) as add on to standard advice (SA) on weight loss and quality of life (QoL) has not been evaluated in obese women with PCOS. We aimed to examine whether MI as add on to SA induced higher weight loss and improved QoL in obese women with PCOS. Thirty-seven obese women with PCOS (BMI ≥30?kg/m2) were randomized to MI?+?SA (n?=?19) vs. SA (n?=?18) for six months. Anthropometric measures (BMI, waist) and questionnaires (World Health Organization-5 (WHO-5), Major Depression Index (MDI), Short Form-36 (SF-36) and PCOS-Questionnaire (PCOS-Q)) were performed at baseline and at follow-up, www.clinicaltrials.gov, NCT02924025. Twenty-eight (14?+?14) women completed the study. At baseline, 24/28 women had WHO-5 scores <67 and 12/28 women had MDI scores indicating depression. Changes in weight and QoL were similar between MI?+?SA vs. SA group. However, WHO-5 (p=.028) and MDI (p=.008) scores improved significantly in the 12/24 women with MDI scores indicating depression. MI as add on to SA did not improve QoL or weight loss. Obese women with PCOS had low QoL.     

Experiences of a lifestyle intervention in obese pregnant women – A qualitative study

Objectiveto describe obese women's experiences of participating in a lifestyle intervention and its experienced impact on health and lifestyle.Designqualitative method with a phenomenological lifeworld approach. The interviews were analyzed in accordance with the phenomenological method.Participants and setting11 women who had participated in a lifestyle intervention project, targeting pregnant women with BMI ≥30 in southwestern Sweden, were interviewed a few weeks before delivery.Findingsthe essence of these women's experiences was expressed as: implementing new habits required support, from midwives, partners, relatives, friends, or obese pregnant women in the same situation, or by participating in the intervention itself. The support had to be non-judgmental and with a balanced outlook on weight. Participation had taught them about weight gain control. The women were motivated to try to control their gestational weight gain, although not all of them were initially convinced that this would be possible. The essential structure of participation can be described with the following constituents: ‘‘pregnancy encourages change’’, ‘‘to be supported by non-judgmental people’’, ‘‘from bad habits to conscious choices’’ and; ‘‘barriers to change’’.Key conclusionsin order to implement new habits, participants expressed a need for support, given with a non-judgmental attitude and a balanced outlook on weight. The women experienced that the lifestyle changes could be less burdensome than previously imagined, and that slight changes could yield unexpectedly successful results. In order to maintain a lifestyle change, obese women must perceive some kind of results, i.e. increased quality of life or weight gain control.Implications for practicenon-judgmental support from midwives is crucial. Affinity with other pregnant obese women in an exercise group or dietary group setting is supportive.     

Is maternal serum relaxin associated with preterm delivery in Chinese pregnant women? A meta-analysis

Objective: A meta-analysis was performed to study the relationship between serum relaxin and preterm delivery in women with singleton pregnancies without estrogen stimulation.

Methods: Cohort and case-control studies were identified through searching databases (PubMed, Embase, Ovid, CBM, Wan fang, VIP, and CNKI). We carried out a continuous variable meta-analysis. The outcome was preterm delivery (gestation age <37 weeks).

Results: Fifteen studies were included, involving 1607 women with a singleton pregnancy. The pooled standard mean deviation (SMD) of 15 studies was 0.559 (95%CI: 0.002–1.196) and the heterogeneity was 96.6%. To reduce the heterogeneity, we chose random effects model and made subgroup analysis according to gestational age at sample testing (<18 weeks and ≥18 weeks) and race of included pregnant women. The pooled SMD of gestational age at sample testing ≥18 weeks and Chinese were 1.19 (95%CI: 0.63–1.75) and 1.61 (95%CI: 0.82–2.41) and the heterogeneity values (measured by I²) were 93.5% and 76.5%, respectively.

Conclusions: Elevated maternal serum relaxin of later than 18 weeks of gestational age is associated with singleton preterm birth in Chinese women. It might be an important information to prevent singleton preterm delivery in Chinese women. What’s already known about this topic? Previous reports reveal that there is a relationship between elevated maternal serum relaxin and preterm birth. However, the included articles contained twin pregnancies and estrogen stimulation, which obviously resulted in higher relaxin concentrations. What does this study add?     

Repeat induced abortion – a matter of individual behaviour or societal factors? A cross-sectional study among Swedish women

ABSTRACT

Background Almost 40% of all induced abortions in Sweden are repeat abortions; little is known about the risk factors.

Objective To investigate differences between women who had a first-time abortion and those with repeat abortion, and to identify factors associated with repeat abortion.

Methods A questionnaire was answered by 798 abortion-seeking women in Sweden during 2009. A regression model was used to assess risk factors for repeat abortions.

Results In the age range 20–49 years, 41% of women had experienced at least one previous abortion. Risk factors for repeat abortion were parity (OR 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Some women (n = 55) considered economic support and work opportunities could have enabled them to continue the pregnancy. Increased Sex and Relationship Education (SRE), easy access to high-quality contraception and counselling, were suggested (n = 86) as interventions for preventing unintended pregnancies.

Conclusions Even in a country with long established SRE and a public health policy to enhance sexual and reproductive health over a third of women requesting abortion have experienced one previously and the rate is maintained. Some specific factors are identified but, overall, a picture of vulnerability among women seeking repeat abortion stands out that needs to be considered in the prevention of unintended pregnancies.     

Thromboembolic risk in pregnant women with SARS-CoV-2 infection – A systematic review

The infection by SARS-CoV-2 is associated with a thromboembolic complications risk theoretically increased. Pregnancy, isolated, is considered a pro-thrombotic state.This systematic review has the main goal to evaluate the thromboembolic risk in pregnant women with COVID-19 disease, namely for pulmonary embolism (PE) and deep vein thrombosis (DVT). The secondary goal is the evaluation of the need for thromboprophylaxis in these cases.Three databases - PubMed, Scopus and Web of Science – were searched on October 2021, using the following Mesh terms and keywords: “(covid-19 OR SARS-CoV-2 OR Covid) AND (pregnancy) AND (coagulopathy OR blood coagulation disorders OR thrombotic complications OR thromboembolic risk OR venous thromboembolism OR venous thrombosis)”. Information about thrombotic complications in pregnancy and thromboprophylaxis was collected, by two independent reviewers.In total, 12 articles were analyzed, corresponding to 18205 pregnant women with SARS- CoV-2 infection. A total of 85 cases of thromboembolic events were diagnosed (0.46%, 95% CI 0.37–0.58%), of which only 17 reported the use of thromboprophylaxis (20.00%, 95% CI 12.10–30.08%). There were 3 deaths due to thromboembolic complications (3.53%, 95% CI 0.73–9.97%).In conclusion, in pregnant women, the SARS-CoV-2 infection increases the risk of thromboembolic complications. However, the risk is not greater than in the general population. It is recommended thromboprophylaxis with low molecular weight heparin for hospitalized pregnant women, and in groups with moderate to high thromboembolic risk at home self-isolation.     

Composite measures of women’s empowerment and their association with maternal mortality in low-income countries

Background

Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women’s empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women’s advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants.

Methods

Using data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures – the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) – with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive.

Results

Two gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = –0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = –0.04, P = 0.04). No gender measure was significant.

Conclusions

In African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women’s motivation to deliver in a hospital setting. Improving gender equality and SBA rates is unlikely to reduce MMR in Africa unless corruption is addressed. In other regions, increasing SBA rates can be expected to lower MMRs.

     

Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh – A cross-sectional study

ObjectiveTo estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation.DesignA cross-sectional study design using a structured self-report survey.SettingTwo Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts.ParticipantsIndigenous women of reproductive age (15–49 years) within 36 months of delivery.Measurements and findingsA modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16–29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28–0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2–13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0–11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3–7.2 and one to three visits AOR 2.7, 95% CI 1.5–5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict.Key conclusions and implications for practiceIndigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services.     

Pregnancy outcomes in women aged 35 years or older with gestational diabetes – a registry-based study in Finland

Objective: To compare pregnancy outcomes of women ≥35 years to women <35 years with and without gestational diabetes.

Methods: The data include 230?003 women <35 years and 53?321 women ≥35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28–31 and 32–36 weeks' gestation), Apgar scores <7 at 5?min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA).

Results: In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30–1.88), admission to the NICU (OR 3.30, CI 2.94–3.69) and shoulder dystocia (OR 2.12, CI 1.05–4.30) were highest in insulin-treated women ≥35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73–3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant.

Conclusions: GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.     

A patient with Mullerian abnormalities, renal dysplasia, cervical spine fusion, cataracts and intellectual disability: MURCS-plus?

We report a 15-year-old girl with features of the MURCS (Mullerian abnormalities, renal agenesis/ectopy and cervicothoracic somite dysplasia) association and birth defects not typically associated with MURCS. In addition to seizures and intellectual disability, she has cortical brain heterotopia, bilateral subclinical cataracts, submucous cleft palate and patent ductus arteriosus. We propose that this patient represents a more severe form of MURCS, or 'MURCS-plus', which may represent a defect of or insult to mesodermal morphogenesis.     

The clinical value of maternal and fetal Doppler parameters in low-risk postdates pregnancies – a prospective study

Objective: The objective of this study is to determine the clinical significance of maternal and fetal ultrasound Doppler flow indices in postdates pregnancies.

Methods: This prospective study comprised 120 low-risk pregnant women beyond 40 weeks of gestation. All participants underwent Doppler assessment including of fetal middle cerebral artery (MCA), umbilical, and uterine arteries. Perinatal outcomes were recorded and evaluated for possible associations with Doppler flow values. Adverse perinatal outcomes were defined as umbilical cord arterial pH <7.1, Apgar score <7 at 5?min, neonatal admission to a neonatal intensive care unit, and emergency cesarean section due to abnormal intrapartum cardiotocogram

Results: Adverse perinatal outcome rate was 17.5% (n?=?21). Doppler indices of umbilical artery, MCA, uterine artery and the cerebroplacental ratio (CPR) did not differ significantly between pregnant women with and without adverse perinatal outcomes. Neonatal birth weight was found to correlate negatively with umbilical artery Doppler indices, including the peak systolic to end diastolic ratio (p?=?.04), the resistance index (p?=?.02), and the pulsatility index (p?=?.01). Doppler values of the uterine artery, MCA and CPR did not correlate with neonatal birth weight.

Conclusions: The contribution of maternal and fetal ultrasound Doppler to the prediction of adverse perinatal outcomes in low-risk postdates pregnancies is low. Hence, performing routine Doppler examination as part of postdates pregnancy assessments is unlikely to yield significant clinical benefit.     

Anti muellerian hormone serum levels in women with endometriosis: A case–control study

Objective.?To compare the anti muellerian hormone (AMH) serum levels in women with and without endometriosis.

Design.?A case–control study

Setting.?Women's General Hospital, Linz, Austria.

Patient(s).?Our study included a total of 909 patients undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment or consulting our specific endometriosis unit. After proofing the exclusion criteria, 153 of these patients with endometriosis (study group) were matched with 306 patients undergoing IVF/ICSI treatment because of a male factor (control group).

Interventions.?None.

Main outcome measures.?AMH serum level.

Results.?Mean AMH serum level was significantly lower in the study than in the control group (2.75?±?2.0?ng/ml vs. 3.46?±?2.30?ng/ml, p?<?0.001). In women with mild endometriosis (rAFS I-II), the mean AMH level was almost equal to the control group (3.28?±?1.93?ng/ml vs. 3.44?±?2.06?ng/ml; p?=?0.61). A significant difference in mean AMH serum level was found between women with severe endometriosis (rAFS III-IV) and the control group (2.38?±?1.83?ng/ml vs. 3.58?±?2.46?ng/ml; p?<?0.0001).

Conclusion.?Lower AMH serum levels and an association with the severity were found in women with endometriosis. Physicians have to be aware of this fact. Because of the expected lower response on a controlled ovarian hyperstimulation (COH), AMH serum level should be measured to optimise the dose of gonadotropin treatment previous to a COH, especially in women with severe endometriosis.