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PubMed1996

Absence of negative attitudes toward childbearing among pregnant teenagers. A risk factor for a rapid repeat pregnancy?

OBJECTIVE: To test the hypothesis that adolescent mothers who conceive again during the first postpartum year express more positive attitudes toward childbearing while pregnant than do adolescent mothers who postpone further childbearing. METHOD: Prospective, cross-sectional, population-based survey. DESIGN: A racially diverse group of 200 consecutively enrolled, poor, pregnant 13- to 18-year-old patients in an adolescent-oriented maternity program were interviewed to determine why they had not used contraceptives prior to the index conception. The study participants were followed up prospectively for the first postpartum year. The data analysis included t tests, chi 2 tests, analysis of variance, and logistic regressions. RESULTS: The repeat pregnancy rate was 11.5% during the first postpartum year. As hypothesized, those who became pregnant again were more likely to have expressed positive attitudes toward childbearing during the index pregnancy (60.9% vs 39.6%; P = .05; odds ratio = 2.38; 95% confidence interval, 0.96-5.90). In addition, those who conceived again were more likely to have had a prior miscarriage, dropped out of school, abused illicit substances, moved away from home, and reported inadequate family support during the index pregnancy, and were less likely to plan to use levonorgestrel (Norplant) following delivery. The best model for predicting repeat pregnancy included education status, postpartum plans for Norplant use, and miscarriage history. Having a positive attitude toward childbearing during pregnancy was not included in the final model because it did not contribute to the model or affect any of the other parameters in the model. CONCLUSIONS: The sexually active teenaged mother who does not use contraception poses a perplexing diagnostic dilemma. The differential diagnosis is a long, complex one that includes ambivalent feelings about postponing future childbearing. This study demonstrates an indirect association between positive attitudes toward childbearing during pregnancy and repeat adolescent pregnancy. Our finding that this association operates through common linkages between maternal educational and contraceptive plans and both positive attitudes toward childbearing and repeat adolescent pregnancy suggests that interventions specifically targeting these underlying causes could reduce the unsafe sexual practices that persist among the participants in comprehensive adolescent-oriented maternity programs.

Adolescent↗
PubMed2004

Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth.

BACKGROUND: Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10-30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery. METHODS: A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses. RESULTS: There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%. CONCLUSION: Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.

Anti-Infective Agents↗
PubMed2004

The prevalence of smoking among pregnant and postpartum women in Israel: a national survey and review.

BACKGROUND: Cigarette smoking during pregnancy is a significant health risk to the developing fetus. In order to develop and implement an appropriate preconceptional and prenatal smoking cessation program a national pregnancy risk survey was done. METHODS: The survey was conducted through the Public Health Service's, Mother and Child Health Clinics (MCHC). The nursing staff initiated structured interviews with pregnant women and mothers of newborn infants. Questions included in the survey addressed folic acid utilization, smoking habits, onset of prenatal care and demographic characteristics. RESULTS: Overall, of the 1613 questionnaires received with smoking data, 12.8% of the women had smoked either in the 3 months preceding their current pregnancy and/or during their pregnancy. The smoking prevalence in Jewish women, was significantly greater then that found among Arab women (17.2 and 3.0%, P<.001, OR=7.5, CI=4.2-13.4). The prevalence of smoking for the duration of the pregnancy was 8.0% among Jewish women and 1.8% among Arab women. Among Jewish women, smoking prevalence was significantly associated with education, women who had completed 12 years of education were more likely to be nonsmokers (P=.034, OR=1.8, CI=1.0-3). CONCLUSION: Smoking in the preconceptional and prenatal period is a significant problem among Jewish women. Since less years of education is a significant risk factor, smoking cessation programs should focus on this subgroup of Jewish women.

Adult↗
PubMed1982

The Northwestern University Drug Dependence Program: the impact of intensive prenatal care on labor and delivery outcomes.

In 1976, the Department of Obstetrics and Gynecology at the Prentice Women's Hospital was invited to provide obstetric services to patients of the Drug Dependence Program administered by the Department of Psychiatry at Northwestern University Medical School. Patients were referred in the early stages of pregnancy if they agreed to participate in the Drug Dependence Program at the same time. Between April, 1976, and October, 1980, 58 women received prenatal, intrapartum and postpartum care. Forty-two of these patients had been abusers of opiates; 16 were polydrug abusers. The obstetric performance of these women was characterized by an absence of major problems. The mean weight of all infants delivered was 2,935 gm. There were no perinatal deaths. The individual weights, lengths, and head circumferences of the newborn infants were distributed in a relatively normal manner. Ninety percent of the infants were delivered at 37 weeks or more of gestation.

Adult↗
PubMed2003

Contraceptive use before and after marriage in Shanghai.

Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples' needs in Shanghai and that the family planning program's attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services.

Adult↗
PubMed1984

Maternal and fetal well-being.

Pregnancy outcomes can be improved by following modern recommendations for personal health maintenance. Adequate caloric intake, reflected by a weight gain of about 10 to 12.3 kg (22 to 27 lb) for women of average build, is associated with the lowest rate of perinatal mortality. Maternal dietary protein supplementation should generally be avoided because it may be associated with low-birth-weight pregnancies. Abstinence from social drugs offers the greatest positive opportunity to modify the health of a fetus. Serious perinatal infection can be prevented by preconception immunization (rubella), food hygiene (toxoplasmosis) and attention to the expression of virus in the mother (herpes simplex). Available data do not correlate exercise programs begun before pregnancy and continued during pregnancy with adverse fetal effects. Athletic capacity need not diminish postpartum. Most employment may safely continue until delivery. Routine recommendations for prolonged maternal disability leaves are not medically warranted.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

[Quality of health services in Africa : example of dystocia prenatal screening in Nioki (Zaire)].

Childbirth, though a common yet highly valued social event in Africa, is a major risk for the mother and child. During these last few decades, extension of health services has gained attention and their accessibility has improved. However, these health services remain inefficient because of their poor quality, especially for prenatal screening. This study with 59 cases and 177 controls was carried out in a rural district of Zaire. The objectives were to first assess the quality of the diagnosis of high risk pregnancy (HRP) and secondly to identify the main risk factors associated with complicated deliveries. The diagnosis of HRP has a low sensitivity (53%) yet a high specificity (95%). The diagnosis is based on postpartum hemorrhage and maternal height but does not consider primiparity or previous complicated deliveries. By improving the use of currently available information, a higher sensitivity (72%, could be obtained, identifying close to 3 out of 4 HRPs, but with a lower specificity (67%). The current diagnosis is conservative, partly because health personnel are reluctant to refer pregnant women, who could deliver normally, to the district hospital. Predictive criteria of complicated pregnancy are: primiparity, maternal height, previous difficult childbirth (dystocia), previous postpartum hemorrhage and lack of prenatal care. Prenatal screening should be a major component of safe motherhood programs. Our results show that in developing countries where emphasis is mainly put on the accessibility of health services, the quality of these services should become a priority. Quality is linked to efficiency, yet good quality gives a better image of services and improves compliance of the women.

Adolescent↗
PubMedDate not supplied

A hospital survey of postpartum depression education at the time of delivery.

OBJECTIVE: To assess and characterize health education regarding postpartum depression (PPD) received by recently delivered women during their postpartum hospital stay. DESIGN: Mailed, self-administered survey. SETTING: All 121 hospitals in Ohio that provide obstetric and postpartum care. PARTICIPANTS: Nurse managers for obstetric services, 90 (74%) of whom returned surveys. MAIN OUTCOME MEASURES: Types of postpartum education provided, format of postpartum depression education delivery, attitudes regarding postpartum depression education. RESULTS: Most hospitals (89.7%) educate newly delivered women about PPD, most often by passive methods. Specific educational programs were offered by only 14% of hospitals. Most PPD education was provided during hospitalization after delivery; however, 50% of respondents felt that it should be provided at every possible opportunity. CONCLUSION: PPD education is one of several topics covered during hospitalization for newly delivered mothers. Health providers of all disciplines should be involved in educating a new mother about PPD.

Attitude of Health Personnel↗
PubMed2004

Maternal morbidity during labour and the puerperium in rural homes and the need for medical attention: A prospective observational study in Gadchiroli, India.

OBJECTIVES: To estimate the incidence of maternal morbidity during labour and the puerperium in rural homes, the association with perinatal outcome and the proportion of women needing medical attention. DESIGN: Prospective observational study nested in a neonatal care trial. SETTING: Thirty-nine villages in the Gadchiroli district, Maharashtra, India. SAMPLE: Seven hundred and seventy-two women recruited over a one year period (1995-1996) and followed up from the seventh month in pregnancy to 28 days postpartum (up to 10 visits in total). METHODS: Observations at home by trained village health workers, validated by a physician. Diagnosis of morbidities by computer program. MAIN OUTCOMES: Direct obstetric complications during labour and the puerperium, breast problems, psychiatric problems and need for medical attention. RESULTS: The incidence of maternal morbidity was 52.6%, 17.7% during labour and 42.9% during puerperium. The most common intrapartum morbidities were prolonged labour (10.1%), prolonged rupture of membranes (5.7%), abnormal presentation (4.0%) and primary postpartum haemorrhage (3.2%). The postpartum morbidities included breast problems (18.4%), secondary postpartum haemorrhage (15.2%), puerperal genital infections (10.2%) and insomnia (7.4%). Abnormal presentation and some puerperal complications (infection, fits, psychosis and breast problems) were significantly associated with adverse perinatal outcomes, but prolonged labour was not. A third of the mothers were in need of medical attention: 15.3% required emergency obstetric care and 24.0% required non-emergency medical attention. CONCLUSIONS: Nearly 15% of women who deliver in rural homes potentially need emergency obstetric care. Frequent (43%) postpartum morbidity, and its association with adverse perinatal outcome, suggests the need for home-based postpartum care in developing countries for both mother and baby.

Adolescent↗
PubMed1995

A review of safety, efficacy, pros and cons, and issues of puerperal tubal sterilization--an update.

This review focuses on the safety, efficacy, pros and cons of tubal sterilization procedures performed during the puerperium period while the woman is still in hospital. Findings from four previous reviews are synthesized, and the results published in more recent literature are evaluated. The review finds that tubal sterilization performed while the woman is still on the delivery table, or during a woman's early puerperium while she remains hospitalized, is operationally easy and medically safe, and does not adversely affect lactation. However, reported pregnancy rates are generally higher in puerperal tubal sterilization than in interval sterilization, especially when the mechanical tubal occlusion technique is used. The Pomeroy method, and its modifications via minilaparotomy, is highly recommendable. On the other hand, electrocoagulation via laparoscopy is associated with high efficacy, but a potentially increased risk of complications and difficulties in tubal reversal. Tubal sterilizations can be easily and safely performed at cesarean delivery in selected cases. Tubal sterilization performed during puerperium has a number of advantages over short-acting contraceptive methods, which require strict compliance, for postpartum use. However, candidates for puerperal tubal sterilization need to be carefully screened and counseled, since post-sterilization regret is more likely to occur. Unsettled issues for puerperal tubal sterilization and a number of practical problems that need to be addressed before initiation of a puerperal tubal sterilization program in a maternity clinic/hospital are discussed.

Female↗
PubMed2004

Long-term weight development in women: a 15-year follow-up of the effects of pregnancy.

OBJECTIVE: The aim of this study was to evaluate how well prepregnancy BMI, gestational weight gain, and postpartum weight retention predict retention of weight 15 years later among parous women. RESEARCH METHODS AND PROCEDURES: The Stockholm Pregnancy and Women's Nutrition (SPAWN) study is a long-term follow-up study of women who delivered children in 1984 to 1985 (n = 2342). The participants initially filled out questionnaires about their eating and exercise habits, social circumstances, etc. before, during, and at 1 year after pregnancy. Anthropometric data were also sampled. Fifteen years later, these women were invited to take part in the follow-up study. Anthropometric measurements were collected, and similar questions were asked. Five hundred sixty-three women participated in the SPAWN 15-year follow-up study. The sample was divided into groups to examine three presumably critical time periods: 1) overweight and normal weight before pregnancy; 2) low, intermediate, and high weight gainers during pregnancy; and 3) low, intermediate, and high weight retainers at 1 year after pregnancy. RESULTS: The overweight women did not gain more weight during pregnancy or retain more weight at 1 year follow-up. High weight gainers during pregnancy retained more weight at the 1-year and the 15-year follow-ups. High weight retainers had gained more during pregnancy and retained it at the 15-year follow-up. Fifty-six percent of the high weight gainers during pregnancy ended up in the high weight retainers group. DISCUSSION: Women who are overweight before pregnancy do not have a higher risk of postpartum weight retention than normal weight women. Thus, it is not necessarily the initially overweight woman who should be the target or focus of weight control programs during or after pregnancy. Both high weight gainers and high weight retainers had higher BMI at the 15-year follow-up, although only 56% of the high weight gainers during pregnancy were also classified as high weight retainers at the 1-year follow-up. Weight retention at the end of the postpartum year predicts future overweight 15 years later.

Body Mass Index↗
PubMed1989

Contraceptive practice of Irish married and single first-time mothers.

This study surveys 100 married and 100 unmarried primiparous mothers, attending the National Maternity Hospital, Dublin, with regard to their contraceptive practice, their planning of their pregnancy and the timing of their first antenatal visit. Nineteen per cent of the married women, but 64% of the unmarried women, had never used any contraceptive method. The contraceptive pill was the most popular method for both groups, but while three in five of the married women had at some time used the pill, only a little more than one in five of the unmarried women had ever used it. One quarter of the women who had used contraception reported that their pregnancy was the result of a failure in their contraceptive method. Eighty-nine per cent of the single group and 20% of the married had not planned their pregnancy. None of the married women, but almost a quarter of the single, delayed their first antenatal visit until after they were 20 weeks pregnant.

Contraception Behavior↗
PubMed1985

Obstetrics in the physical therapy curriculum.

We report the status of obstetric education in physical therapy curricula. A questionnaire was sent to 83 accredited physical therapy education programs. Of the respondents from 69 programs, 47 (68%) included a specific unit or information on obstetrics in their program. The reporting programs averaged 7.5 hours for obstetric education. The unit was required in 45 of the 47 programs. Topics covered included anatomy and physiology, psychology, labor and delivery sequence, relaxation techniques, breathing techniques, prenatal and postpartum exercises, body mechanics, nutrition, fetal development, and birthing alternatives. Fifty-three percent of the units were taught by a physical therapist and combination of other professionals including a nurse, physician, nutritionist, psychiatric social worker, physiologist, or anatomist. We present behavioral objectives, required readings, and audiovisual aids used in the units.

Curriculum↗
PubMedDate not supplied

Descriptive study of the clinical and nutritional profile and follow-up of premature babies in a Kangaroo Mother Care Program.

OBJECTIVE: To describe the profile of premature newborns participating in the Kangaroo Mother Care Program and the data from follow-up, and to verify possible correlations between these descriptive data. METHODS: A descriptive study of 70 children, 5-34 months old, born between April 1999 and 2002, with gestational age of 32.5 weeks, birth weight 1,560 g, participating in the Kangaroo Mother Care Program (modified for Brazil) for at least 3 days. They were discharged from Kangaroo Mother Care weighing around 3,000 g and followed-up to 1 year. RESULTS: Birth weight, gestational age and Apgar scores were determinants of better clinical, nutritional and motor outcomes as well as for enrollment on the Kangaroo Mother Care Program. During the second phase of the program 8.6% of the children were readmitted due to apnea. Exclusive breastfeeding started at a mean postconceptual age of 35.3 weeks and mean age postpartum of 18.6 days. By hospital discharge, children were at a mean age of 29 days, mean weight of 1,734 g and 85.7% were on exclusive breastfeeding. Predominant breastfeeding up to 6 months of age was observed in 60.3%. We initially identified motor disorders in 42.8% decreasing to 14.3% in the final review of records, including cerebral palsy (6.9%) and retarded motor development (6.9%). CONCLUSIONS: Enrollment on the Kangaroo Mother Care Program, in common with data on breastfeeding and clinical outcomes were determined by gestational age and birth weight and were influenced by clinical conditions of each preterm infant. Kangaroo Mother Care proved itself a good breastfeeding instrument, but its role as an intervention for motor development must be better investigated.

Adult↗
PubMed1998

Associations between wife-beating and fetal and infant death: impressions from a survey in rural India.

This report examines the linkages between wife-beating and one health-related consequence for women, their experience of fetal and infant mortality. Community-based data are used drawn from women surveyed in two culturally distinct sites of rural India: Uttar Pradesh in the north, in which gender relations are highly stratified, and Tamil Nadu in the south, in which they are more egalitarian. Results suggest that wife-beating is deeply entrenched, that attitudes uniformly justify wife-beating, and that few women can escape an abusive marriage. They also suggest that the health consequences of domestic violence--in terms of pregnancy loss and infant mortality--are considerable and that Indian women's experience of infant and fetal mortality is powerfully conditioned by the strength of the patriarchal social system. Results are tentative because of data limitations, but they are consistent and strong enough to warrant concern. They argue for the integration of services to identify, refer, and prevent domestic violence in the primary or reproductive health programs of the country and for the safe motherhood programs to be particularly vigilant, sensitive, and responsive to the conditions of battered women during pregnancy and the postpartum period.

Developing Countries↗