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PubMed1999

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.

Adult↗
PubMed2000

Periconception care.

If we are to provide periconception care to all American men and women of reproductive age, we must consider it all "routine visits." For prevention of birth defects, all reproductive-age women should be counseled about folic acid supplementation and rubella immunity. Many clinicians consider risk reduction and anticipatory activities important in periconception care. This includes counseling families about avoiding tobacco and substance abuse, using passenger restraints, avoiding teratogens, seeking appropriate genetic counseling and early prenatal care, and a variety of other periconceptional health issues. Reproductive-age women with underlying medical problems should be identified and counseled about pregnancy risks.

Evidence-Based Medicine↗
PubMed1995

Primary prevention of birth defects by periconceptional care, including multivitamin supplementation.

Periconceptional care can significantly reduce untoward pregnancy outcomes and birth defects. The avoidance of alcohol, rubella vaccination and special care for certain maternal disorders can prevent some CAs. Periconceptional multivitamin supplementation, including a physiological dose of folic acid, has been shown to reduce the occurrence of NTDs and some other major CAs. The preventable proportion of the latter group is three times higher than the incidence of NTDs. Thus, periconceptional care that includes such supplementation increases the proportion of preventable defects and improves the efficacy of primary prevention.

Adult↗
PubMed1995

Clam enterocystoplasty and pregnancy.

OBJECTIVE: To assess the course and outcome of pregnancy in patients who have undergone clam enterocystoplasty. PATIENTS AND METHODS: A retrospective study was carried out of 19 pregnancies in 18 women aged from 21 to 36 years who had undergone clam enterocystoplasty. RESULTS: Urinary tract infection was common but renal function remained normal with prompt treatment with antibiotics. No other adverse antenatal factors were identified and all pregnancies had a normal fetal outcome. Vaginal delivery was a safer option for these patients, even in those who had undergone an anti-incontinence procedure in addition to enterocystoplasty. CONCLUSION: Careful antenatal monitoring by both an obstetrician and a urologist resulted in a successful pregnancy and vaginal delivery in these patients.

Adult↗
PubMed1995

Fertility in beta thalassaemia major: a report of 16 pregnancies, preconceptual evaluation and a review of the literature.

OBJECTIVES: To examine the pregnancies, mode of delivery and outcomes, review the literature on fertility and discuss preconceptual guidance for women with beta thalassaemia major. DESIGN: An observational study. SUBJECTS: Sixteen women with beta thalassaemia major. SETTING: Two collaborating London teaching hospitals. MAIN OUTCOME MEASURES: Pre-pregnancy assessment, pregnancy course, mode of delivery, gestational age at delivery and birthweight. RESULTS: There were 16 pregnancies in 11 women. Three of these pregnancies were terminated. Of the 13 deliveries, there were two normal deliveries, one forceps delivery and 10 caesarean sections. The main findings in a further five women seeking fertility treatment were of hypogonadotrophic hypogonadism, diabetes and cardiomyopathy. CONCLUSIONS: Pregnancy in women with beta thalassaemia major does not appear to have a deleterious effect on the course of the disease. No increased obstetric complications were encountered except for the high caesarean section rate, essentially due to cephalopelvic disproportion. A high incidence of cardiomyopathy and diabetes dictates a careful assessment before embarking on ovulation induction to treat the hypogonadotrophic hypogonadism which is common in these women.

Adult↗
PubMed1994

Attitudes, knowledge, and skills of internal medicine residents regarding pre-conception care.

BACKGROUND: A questionnaire was designed based on current recommendations for pre-conception care and care of women at the time of diagnosis of pregnancy to evaluate internal medicine residents' attitudes, knowledge, and clinical management skills in the pre-conception care of healthy women and women who have chronic diseases during their reproductive years. METHOD: In early 1991, a self-administered questionnaire was distributed to 104 internal medicine residents at Cook County Hospital, a large, inner-city public hospital. Statistical analysis included the use of chi-square comparison, Pearson correlation, and Student's t-test. RESULTS: Seventy-nine of the residents completed questionnaires. Their levels of knowledge and management skills regarding pre-conception care were relatively low compared with standard recommendations. The residents' attitudes, however, were favorable toward the importance of the topic. Residency training did not appear to improve the residents' management skills, as there was no significant difference in skills among the first-, second-, and third-year residents. CONCLUSION: That the residents' levels of knowledge and management skills were low (despite their favorable attitudes) suggests that the current curriculum for primary care training in internal medicine needs to be revised to improve the readiness of residents to take care of women of reproductive age.

Attitude of Health Personnel↗
PubMed1994

Pregnancy following renal transplant.

Pregnant patients who have experienced a renal transplant require specialized obstetric management and nursing interventions. Patient care must be developed in a multidisciplinary approach that addresses the needs of the pregnancy as well as the allograft status. Medications to protect the allograft from rejection present unique concerns in the clinical care management of pregnant women. This article describes the collaborative patient care that brings these areas together and reviews nursing interventions and therapies appropriate for the patient who experiences a pregnancy following renal transplant.

Adult↗
PubMedDate not supplied

Smoking among female college students: a time for change.

The transition from high school to college begins a time of personal growth accompanied by normal developmental stressors. Some young women use smoking as a coping mechanism. The immediate danger for these students is nicotine dependence, with subsequent maternal and child morbidities. College provides an optimal time to break this devastating trajectory. With an understanding of psychosocial development, nurses who care for college-age women can effect changes in smoking behavior.

Adaptation, Psychological↗
PubMed2004

Multivitamin use and the risk of preterm birth.

Previous research suggests that multivitamin use before and during pregnancy can diminish diet-related deficiencies of certain micronutrients and potentially prevent preterm birth. To assess this association, the authors performed an analysis by using data from the Pregnancy, Infection, and Nutrition Study (n = 2,010). Women were recruited at 24-29 weeks of pregnancy from four prenatal care clinics in North Carolina from August 1995 to June 2000. For women who took multivitamins prior to pregnancy, compared with nonusers, the adjusted risk ratio was 0.50 (95% confidence interval: 0.20, 1.25) for delivering preterm (<37 weeks). In contrast, prenatal and periconceptional use, compared with nonuse, were not related to preterm birth, with adjusted risk ratios of 1.1. Preconceptional multivitamin use was inversely associated with both early (<35 weeks; adjusted odds ratio = 0.59, 95% confidence interval: 0.12, 2.76) and late (35-36 weeks; adjusted odds ratio = 0.40, 95% confidence interval: 0.12, 1.40) preterm birth; findings were based on only two and three exposed cases, respectively. These results suggest that, compared with nonusers, women who take multivitamin supplements prior to conception may have a reduced risk of preterm birth, but further studies are needed with a larger sample of preconceptional users.

Adult↗
PubMed1992

Prepregnancy counselling: experience from 1,075 cases.

OBJECTIVE: To assess the activity of a prepregnancy counselling clinic in terms of investigations, counselling, treatment and subsequent pregnancy outcome. DESIGN: Review of 1,075 couples attending over a nine year period. SETTING: University Hospital offering a tertiary referral service for fetal medicine. SUBJECTS: Couples referred to the clinic from a variety of sources. MAIN OUTCOME MEASURES: Categories of referral, value of diagnostic tests, and subsequent pregnancy outcome. RESULTS: The main categories of referral were: previous miscarriage (44.4%); previous fetal abnormality (19.6%); chronic maternal disease (22.3%); and others (13.7%). Routine investigations produced a low yield of abnormality (1%), in contrast to investigations selected for specific reasons (12%). Subsequent pregnancy outcome, which was unaltered in either the previous miscarriage or fetal abnormality groups, did improve in the chronic maternal disease group. CONCLUSIONS: This study does not prove the value of prepregnancy counselling. However, it does illustrate the importance of making an accurate assessment of previous problems and current health as a means of determining both maternal and fetal risks in a subsequent pregnancy, a process which seems to lead to an improved outcome within selected groups. The importance of continuity of care in all couples, especially when there has been a previous adverse pregnancy outcome is emphasized.

Abortion, Spontaneous↗
PubMed2006

The pre-pregnancy insurance status of public aid recipients in the aftermath of welfare reform: women in the Medicaid Gap.

The passage of welfare reform in 1996 led to sweeping changes in both welfare and Medicaid policy. This study examines the pre-pregnancy Medicaid coverage of women on public aid who had Medicaid payment for delivery in the time periods before and after welfare reform. Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to examine changes in the prevalence of being in the Medicaid Gap (i.e., having no pre-pregnancy Medicaid coverage despite having Medicaid payment for delivery) in eight states between 1996 (n=302) and 1998-2000 (n=364). Of this population, 16.1% of women were in the Medicaid Gap in 1996, compared with 36.5% in 1998-2000. The overall adjusted relationship between time period and being in the Medicaid Gap was 4.5 (95% CI 2.1-9.6). This analysis suggests that in the period after welfare reform, there was an increase in the prevalence of very low-income women who, despite having their delivery paid for by Medicaid, did not have pre-pregnancy Medicaid coverage. Lack of Medicaid coverage regardless of pregnancy, particularly among women who historically have had such coverage and who are at higher risk of adverse pregnancy outcomes, has important implications for progress toward Healthy People 2010 objectives in prenatal care initiation and utilization, low birth weight, and other pregnancy outcomes.

Adult↗
PubMedDate not supplied

Teaching family-centered perinatal care in family medicine, Part I.

Pregnancy, childbirth, postpartum, and infant care are a continuum in the family life cycle for which the family physician is especially qualified to provide primary, comprehensive care. The purpose of this paper is to document and share the controversies, wisdom, and knowledge about caring for women and their families before, during, and after pregnancy. Family physicians can be leaders in developing an appropriate perinatal care system for the community. The level of care the family physician chooses to provide is discretionary. However, the family physician should be invested in ensuring that all families receive the greatest benefit from pregnancy, birth, and the newborn experience. Interest in perinatal care in family medicine is increasing, as reflected by the growing numbers participating in the Society of Teachers of Family Medicine Working Group on Family-Centered Perinatal Care. The authors of this article, who are active in this working group, hope that this information is useful in designing a balanced curriculum and delivery system for perinatal care in family medicine training programs.

Curriculum↗
PubMed1998

Comfort care interventions in a preimplantation genetic testing program.

The fields of human genetics and assisted reproductive technology (ART) have experienced many scientific advances over the past 50 years. The integration of these two clinical specialties has resulted in the ability to perform preimplantation genetic testing (PGT) on an embryo created through ART. This is a technology that can be used by individuals at risk for the transmission of a genetic disorder to prevent occurrence of the disorder in their child. Both the process of PGT and the life experiences that lead to the decision to use PGT stimulate many levels and types of discomfort. Holistic comfort care interventions performed by the nurse are uniquely designed to eliminate or reduce discomfort and to enable those at risk to utilize the available technologies to create healthy families.

Adult↗
PubMed2006

Glycaemic control throughout pregnancy and risk of pre-eclampsia in women with type I diabetes.

The aim of this study was to examine the influence of pre-pregnancy care and its effect on early glycaemic control and also the effect of glycaemic control in later pregnancy on risk of pre-eclampsia in women with type I diabetes. A prospective cohort study of 290 consecutive nonselected pregnancies in women with type I diabetes was performed from 1991 to 2002. We examined the relationship of monthly glycosylated haemoglobin (HbA1c) level, pre-pregnancy care, parity, diabetes duration, microvascular complications, maternal age, weight and smoking with risk of pre-eclampsia. Pre-eclampsia developed in 31/243 singleton births (12.8%). HbA1c level at 24 weeks was significantly increased in women with pre-eclampsia compared with women without pre-eclampsia (6.0 versus 5.6%, P= 0.017) and was, after nulliparity, the strongest independent predictor of increased risk (OR 1.65 for each 1% increase in HbA1c; P= 0.01). In contrast, there was no relationship between pre-pregnancy care or HbA1c level at booking and risk of pre-eclampsia.

Adult↗
PubMed1991

Pregnancy in phenylketonuria: dietary treatment aimed at normalising maternal plasma phenylalanine concentration.

The transport characteristics of the placenta, which favour higher phenylalanine concentrations in the fetus than in the mother, and regression data of head circumference at birth against phenylalanine concentration at conception in maternal phenylketonuria (PKU), suggest that treatment of maternal PKU should ideally aim to maintain plasma phenylalanine concentration within the normal range throughout pregnancy. A patient with classical PKU was treated from before conception by aiming to maintain plasma phenylalanine concentration within the range 50-150 mumol/l and tyrosine within the range 60-90 mumol/l. The diet was supplemented with phenylalanine-free amino acids (100-180 g/day) and tyrosine (0-5 g/day). Plasma amino acid concentrations were monitored weekly by amino acid analyser. Dietary phenylalanine intake ranged from 6 mg/kg/day at conception to 30 mg/kg/day at delivery. Normal weight gain and fetal growth were maintained throughout the pregnancy. A normal baby was born at term with a head circumference of 35.5 cm; at 1 year of age no abnormality is detectable. These results show that with careful monitoring and compliance it is possible, and may be advisable, to maintain plasma phenylalanine concentration within the normal range in the management of PKU pregnancy.

Adult↗
PubMed1994

Seizures in pregnancy.

Seizures in pregnancy may risk the health of both mother and fetus. Epileptic women should ideally plan pregnancies after counseling by their primary care givers. New-onset seizures and any increase in seizure frequency or severity should be promptly evaluated. Eclampsia and status epilepticus represent life-threatening conditions that demand urgent multidisciplinary management.

Anticonvulsants↗
PubMed1997

[Functional insulin therapy and pregnancy].

Pregnant type-I diabetic women have to be treated in an experienced diabetes center where optimal cooperation and exchange of knowledge between obstetrician, diabetologist and neonatologist is guaranteed. Given optimal preconceptional metabolic control and thorough guidance throughout pregnancy maternal and fetal risk of type-I diabetic patients without severe diabetic late complications is similar to that of healthy pregnant women. "Near-normoglycemic" metabolic control and meticulous prevention of severe and long-standing hypoglycemic episodes can be achieved throughout pregnancy by functional insulin therapy employing a basis-bolus regime of insulin administration with frequent blood glucose self control (more than 6 times a day). Non-compliant diabetic patients and those with severe diabetic late complications represent a high-risk group for complications in pregnancy. To avoid such risks special care and preconceptional information is mandatory.

Adult↗