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Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies., (© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

Background: Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision‐making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital‐based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. Methods: Qualitative semi‐structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision‐makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. Results: Women expect to be included in decisions about their care. Health service administrators and decision‐makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision‐making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. Conclusion: This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient–clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational‐ and system‐wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations. [ABSTRACT FROM AUTHOR]

Background: Implementation of shared decision‐making in antenatal care has had limited exploration. Objective: To assess what is known about shared decision‐making in antenatal care. Search Strategy: Five databases were searched (1997–2022) limited to English language studies from OECD countries. Data Collection and Analysis: A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. Main Results: Four areas of decision‐making were identified with six themes revealing enablers and barriers to shared decision‐making in antenatal care. Conclusion: Implementation of shared decision‐making requires continuity, time and personalisation of care. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. Design: Retrospective observational study. Setting: A total of 54 referral‐level hospitals across the six geopolitical regions of Nigeria. Population: Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. Methods: Secondary analysis of routine maternity care data sets. Random‐effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. Main outcome measures: Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. Results: Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. Conclusions: Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions. [ABSTRACT FROM AUTHOR]

Background: The high maternal and neonatal mortality rate in sub‐Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. Methods: A quasi‐experimental design was used to test a midwife‐delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Results: Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p‐value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p‐value = 0.03). Conclusions: The results of this study indicate that it is feasible to deliver phone‐based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy. [ABSTRACT FROM AUTHOR]

Aim: To clarify the factor structure of "expectant mothers of concern" for whom midwives anticipate difficulties in future childrearing. Methods: The participants were 2633 midwives working at hospitals and clinics in Japan. Data were collected using a 108‐item, five‐point Likert scale questionnaire about the behaviors, appearance, and family relationships of the expectant mothers of concern to the nurses. Items with a mean equal to or greater than 4.0 were selected as items considered relevant to expectant mothers of concern by midwives. Exploratory factor analysis, confirmatory factor analysis, and further secondary factor analysis were conducted. Results: The factor structure of the expectant mothers of concern as perceived by midwives comprised seven factors, including 23 items: "Suspected of being a victim of intimate partner violence," "Uneasy feeling about the expectant mother's marital relationship," "Perception that the expectant mother is conflicted about her pregnancy," "Uneasy feeling about the expectant mother's actions/behaviors concerning her medical checkups," "Engages in physically risky actions and behaviors," "Does not appear to be able to build relationships with children," and "Makes remarks that indicate possible bonding disorder" (goodness‐of‐fit index = 0.910, adjusted goodness‐of‐fit index = 0.879, comparative fit index = 0.939, and root mean square error of approximation = 0.070). Further, a secondary factor, "Expectant mothers who must urgently be connected to support," was extracted. Conclusions: The elucidation of the factor structure of the expectant mothers of concern could help midwives identify expectant mothers who may face difficulties in future childrearing. [ABSTRACT FROM AUTHOR]

Background: On 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy. Aim: This multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy. Materials and methods: An online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021. Results: There were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01). Conclusions: Along with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has dramatically affected pregnant people's prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID‐19‐related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient‐reported information sharing from the providers; and (b) Whether patient‐reported provider information sharing or disruptions to care are associated with patient satisfaction with provider. Methods: Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020. Results: Thirty‐eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled. Discussion: At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing—both generally and during public health crises—and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non‐initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor. Aims: The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population. Methods: The review was performed according to meta‐analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS‐I tool was used to assess risk of bias. Results: Twelve studies were included in the final review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association. Conclusion: Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving‐country‐born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies. [ABSTRACT FROM AUTHOR]

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between continued antidepressant use in pregnancy and postpartum psychiatric visits for eating (ED) or mood/anxiety disorders in women with preexisting ED. Method: Using Danish health registry data (1998–2015), we identified 3529 pregnancies in women with ED prepregnancy: (i) 564 with continued antidepressant use before and during pregnancy; (ii) 778 with discontinued antidepressants before pregnancy; (iii) 2137 unexposed. Outpatient and inpatient postpartum visits for an ED or a mood/anxiety disorder constituted the outcome measures. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox regression with inverse probability of treatment weighting, and performed stratified analyses by antidepressant prescription filling in the first 3 months postpartum. Results: The weighted cumulative incidence for an ED visit at end of follow‐up was 4.5% (continued) and 4.8% (discontinued). We found no association between continued antidepressant and postpartum ED visit, relative to discontinued (HR: 0.89, 95% CI: 0.52–1.52). The HR for postpartum mood/anxiety disorder visit was 1.27 (95% CI: 0.68–2.36) with continued antidepressants versus discontinued but decreased if more than two antidepressant prescriptions were refilled. Continued antidepressant use was associated with a 57% reduced likelihood of a postpartum ED visit versus discontinued use in pregnancies with antidepressant prescription refills in the early postpartum. Conclusion: Among women with preexisting ED, there was no association between continued antidepressant use during pregnancy and the likelihood of postpartum psychiatric visits, relative to discontinued antidepressants before pregnancy. Continuation of treatment into the early postpartum is associated with reduced likelihood of postpartum ED visit. Public Significance: Based on data from the Danish registries, we identified 3529 pregnancies among women with preexisting eating disorders before pregnancy. Women with continued antidepressant treatment both before and during pregnancy did not have a lower probability of having postpartum psychiatric visits for an eating disorder or for mood/anxiety disorders (often coexisting with eating disorders), relative to those who discontinued antidepressants before pregnancy. Further continuation of antidepressant treatment into the early postpartum is associated with improved maternal postpartum outcomes. However, residual confounding by disease severity limits confidence in this conclusion. [ABSTRACT FROM AUTHOR]

Pregnancy is a risk factor for the development and progression of diabetic retinopathy (DR) in women with pre‐gestational diabetes. However, a minority of pregnant women with diabetes adhere to retinal screening recommendations. The introduction of an onsite retinal camera at our tertiary maternity hospital significantly increased the proportion of women who received at least one retinal screen during pregnancy (93.0% vs 54.3%, P < 0.001) and the identification of both DR and DR progression. We conclude that the use of a retinal camera in similar clinics is a feasible option to improve DR screening and diagnosis rates in pregnancy. [ABSTRACT FROM AUTHOR]

This article describes 2 innovative models of advanced practice provider–led medication for opioid use disorder treatment programs offering comprehensive, interprofessional care for pregnant patients and provides implications for broader adaptation of practice. Increasing the number of midwives and nurse practitioners waivered to prescribe buprenorphine and able to connect pregnant patients with opioid use disorder to appropriate community‐based resources, treatment, and self‐help programs could address alarming substance use trends including overdose deaths and other sequelae associated with the opioid epidemic. [ABSTRACT FROM AUTHOR]

The delivery of nutrition‐related interventions and counselling during antenatal care is critical for a healthy pregnancy for both mother and child. However, the accuracy of maternal reports of many of these services during household surveys has not yet been examined. Our objectives were to assess the validity of the maternal reports of 10 antenatal nutrition interventions, including counselling, and examine associates between maternal characteristics and accuracy. Maternal report of services received collected during a post‐partum survey was compared to the gold standard, the direct observation of all women's antenatal care visits. Individual‐level validity was assessed by calculating indicator sensitivity, specificity and area under the operating curve (AUC). The inflation factor (IF) measured population‐level bias. For five indicators, the high true coverage limited our ability to assess the validity of the maternal reports. There were no indicators that had both high individual‐level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25). Indicators with greater true coverage estimates had higher sensitivity and lower specificity estimates compared to those indicators with lower true coverage. There were no maternal characteristics associated with the accuracy of the report. Maternal report of antenatal nutrition‐related interventions and counselling during household surveys was found to have variable validity across indicators. Additional research in settings with varying coverage levels should be considered to best inform antenatal care coverage measurement in household surveys. Key Messages: The coverage of nutrition‐related interventions and counselling was high (>89%) for the majority of indicators.Maternal reports resulted in higher coverage estimates than what was observed for all but one indicator.No indicator assessed had high individual level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25).The greater the indicator's true coverage estimate, the greater the sensitivity and lower the specificity values. [ABSTRACT FROM AUTHOR]

Background: Centers for Medicare & Medicaid Services (CMS) funded 182 US health care sites to reduce preterm birth rates by enhancing prenatal care for at‐risk women. As a funded site, the enhanced prenatal care maternity care home (MCH) model was implemented from 2013 to 2018 for 1042 Medicaid‐eligible pregnant women. Methods: This retrospective study evaluated the impact of enhanced services on preterm birth risk reduction. Certified community health workers provided enhanced services from enrollment through six weeks postpartum. Participants attending enhanced intake and third‐trimester prenatal visits comprised the Active Group (N = 632). Participants missing third‐trimester visits, but participating in enhanced intake and postpartum visits, comprised the Inactive Group (N = 128). Lost Group participants attended only intake visits (N = 282). Data were collected through CMS‐developed intake, third‐trimester, postpartum, and exit forms. Descriptive analysis, analysis of variance, and the chi‐square tests analyzed the impact of risk factors, participant characteristics, and program participation on birth outcomes. Results: Active Group compared with Inactive and Lost Group participants experienced significantly lower preterm birth rates (7.64% vs 22.48% and 15.82%, P < 0.001) and therefore a significantly lower NICU admission rate compared with Inactive and Lost Groups (2.82% vs 11.85% and 5.47%, P < 0.001). Conclusions: The MCH model of enhanced prenatal care reduced preterm birth and NICU admission rates for Active Group participants. The Black Active Group participant preterm birth rate was not significantly different than other Active Group rates, but was lower than Black Inactive and Lost Group rates. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to summarize cases of successful pregnancy and delivery in patients with transposition of the great arteries (TGA) after atrial switch operation (ASO), to provide management, clinical experience, and maternal and fetal outcomes. Methods: During a 16‐year period (2004–2019), we experienced 30 pregnancies in 15 patients after ASO at our institution. We retrospectively reviewed the medical records of the patients. Results: In 30 pregnancies, there were 21 (70%) live births, five (17%) miscarriages, and four (13%) artificial abortions. There were no maternal or neonatal deaths. Cardiac complications occurred in nine (43%) patients: deterioration of right ventricular (RV) function in one, symptomatic heart failure (HF) in three, supraventricular tachyarrhythmia requiring electrical cardioversion in two, sick sinus syndrome that required pacemaker implantation in two, and hemoptysis in one. Obstetric complications occurred in five (24%). Neonatal complications were premature births (delivery at <37 weeks of gestation) in 15 (71%), and birthweight <2500 g in 18 (86%). The mode of delivery consisted of vaginal delivery (VD) in five (24%), and cesarean section (CS) in 16 (76%). Conclusion: A high incidence of preterm CS and cardiac complications including deterioration of RV function was observed in patients who had undergone ASO for TGA. [ABSTRACT FROM AUTHOR]

Aims: To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals. Methods: The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK‐wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad‐level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop. Results: There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well‐being needs of women with diabetes pre‐ to post‐pregnancy, safe full‐term birth, post‐natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy. Conclusions: These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact. [ABSTRACT FROM AUTHOR]

Infectious diseases can directly affect women and men differently. During the COVID-19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of inperson clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex-based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID-19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk-benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID-19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially formaternal health. [ABSTRACT FROM AUTHOR]

Objective: To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff.Methods: Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation.Results: The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby.Conclusions: Facilitators for MWH utilisation according to users and staff were perceived high-quality EmONC, integrated health services, awareness of pregnancy-related complications and the husband's support in overcoming barriers. If providing high-quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC. [ABSTRACT FROM AUTHOR]

Background: This prospective study aims to investigate whether severe fear of childbirth increases pain perceptions during birth and whether co‐occurring maternal health and birth factors as well as length and weight of the child explain the association. Methods: The study sample comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort. Data from the hospital birth's record and questionnaires at weeks 17‐19 and 32 of pregnancy and 8 weeks postpartum were used (n = 1649). Analysis of variance and analysis of covariance were conducted to examine whether ratings of labor pain differed significantly between women with and without severe fear of childbirth and which factors explained the difference. Results: Women with severe fear of childbirth experienced significantly more labor pain than women without severe fear of childbirth (P < .01). However, when controlling for symptoms of maternal depression and anxiety, use of epidural/spinal anesthetic or nitrous oxide gas, and menstrual pain, this difference was no longer significant (P = .09). Discussion: Although the results show that labor pain is related to multiple physiological and psychological factors in a complex manner, symptoms of maternal depression and anxiety seem to play a central role for the experience of labor pain, and should therefore be focused on by health practitioners. [ABSTRACT FROM AUTHOR]

Objective: To evaluate impacts of state Medicaid expansions for low-income parents on the health insurance coverage, pregnancy intention, and use of prenatal care among mothers who became pregnant.Data Sources/study Setting: Person-level data for women with a live birth from the 1997-2012 Pregnancy Risk Assessment Monitoring System.Data Collection/extraction Methods: The sample was restricted to women who were already parents using information on previous live births and combined with information on state Medicaid policies for low-income parents.Study Design: I used a measure of expanded generosity of state Medicaid eligibility for low-income parents to estimate changes in health insurance, pregnancy intention, and prenatal care for pregnant mothers associated with Medicaid expansion.Principal Findings: I found an increase in prepregnancy health insurance coverage and coverage during pregnancy among pregnant mothers, as well as earlier initiation of prenatal care, associated with the expansions. Among pregnant mothers with less education, I found an increase in the adequacy of prenatal care utilization.Conclusions: Expanded Medicaid coverage for low-income adults has the potential to increase a woman's health insurance coverage prior to pregnancy, as well as her insurance coverage and medical care receipt during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To assess birth preparedness and complication readiness (BPCR) as well as knowledge of danger signs during pregnancy, labor/delivery, and the postpartum period.Methods: A cross-sectional study was undertaken of pregnant women attending the prenatal clinic at a tertiary hospital in Nigeria between October and December 2016. A pretested and structured questionnaire was used to collect data on BPCR, and logistic regression was performed to determine factors affecting BPCR.Results: Of 325 participants, 274 (84.3%) had knowledge of BPCR components, and 265 (81.5%) were well prepared for birth and its complications. However, only 89 (27.4%) knew key danger signs during labor/delivery and 81 (24.9%) knew those in the first 2 days after delivery. Older age, higher parity, tertiary education of women, paid employment of women and their spouses, higher social class, frequent prenatal visits, and knowledge of danger signs were significantly associated with BPCR (P<0.05). Higher parity, maternal government employment, and knowledge of danger signs during pregnancy remained determinants of BPCR on logistic regression (P<0.05).Conclusion: Although there was a high level of knowledge and practice of BPCR, knowledge of key danger signs was low. Therefore, prenatal education needs to be improved with an emphasis on teaching pregnant women to recognize key danger signs. [ABSTRACT FROM AUTHOR]

Introduction: In 1999, Danish health authorities modified their recommendation to pregnant women, condoning some alcohol intake. In 2007, the recommendation was changed to one of alcohol abstention. We aimed to assess changes in average alcohol intake (drinks/week) and alcohol binge drinking in early pregnancy from 1998 to 2013 in relation to the changes in official recommendations in 1999 (condoning some intake) and 2007 (abstention).Material and Methods: All Danish-speaking pregnant women attending routine antenatal care at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark, between September 1998 and June 2013 were invited to participate. During the study period, 68 395 pregnant women filled in a self-administered questionnaire at gestational week 11 (median). From 1998, questions on binge drinking included data on the number of binge episodes (≥5 drinks on a single occasion), and the timing (gestational week) of these episodes. Additional questions on binge drinking defined as ≥3 drinks on a single occasion were asked separately from 2000. A question assessed the average number of alcohol-containing drinks per week the woman consumed currently at the time of filling in the questionnaire.Results: From 1998 to 2013 the proportion of women reporting no alcohol intake increased from 31.2 to 83.3% (p < 0.001), the main decline occurring between 1998 and 2007. The proportion of binge drinkers decreased (p < 0.001) but remained more stable across the period.Conclusions: The decline in the proportion of pregnant women consuming alcohol occurred independently of official recommendations. Increasing national and international awareness may partly explain the changes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) is in the process of updating antenatal care (ANC) guidelines.Objectives: To map the existing clinical practice guidelines related to routine ANC for healthy women and to summarise all practices considered during routine ANC.Search Strategy: A systematic search in four databases for all clinical practice guidelines published after January 2000.Selection Criteria: Two researchers independently assessed the list of potentially eligible publications.Data Collection and Analysis: Information on scope of the guideline, type of practice, associated gestational age, recommendation type and the source of evidence were mapped.Main Results: Of 1866 references, we identified 85 guidelines focusing on the ANC period: 15 pertaining to routine ANC and 70 pertaining to specific situations. A total of 135 interventions from routine ANC guidelines were extracted, and categorised as clinical interventions (n = 80), screening/diagnostic procedures (n = 47) and health systems related (n = 8). Screening interventions, (syphilis, anaemia) were the most common practices. Within the 70 specific situation guidelines, 102 recommendations were identified. Overall, for 33 (out of 171) interventions there were conflicting recommendations provided by the different guidelines.Conclusion: Mapping the current guidelines including practices related to routine ANC informed the scoping phase for the WHO guideline for ANC. Our analysis indicates that guideline development processes may lead to different recommendations, due to context, evidence base or assessment of evidence. It would be useful for guideline developers to map and refer to other similar guidelines and, where relevant, explore the discrepancies in recommendations and others.Tweetable Abstract: We identified existing ANC guidelines and mapped scope, practices, recommendations and source of evidence. [ABSTRACT FROM AUTHOR]

Objective: The objective of this analysis was to explore the healthcare-seeking behaviours and experiences of maternity care among women from different socio-economic groups in order to improve understanding of why socially disadvantaged women have poorer maternal health outcomes in the UK.Design: Secondary analysis of a national survey of women conducted 3 months after they had given birth.Setting: England.Sample: A total of 5332 women.Methods: Logistic regression analysis to investigate differences in outcomes among different socio-economic groups, classified by the Index of Multiple Deprivation (IMD).Main Outcome Measures: Healthcare-seeking behaviours, outcomes and experiences of maternity care.Results: With each increase in IMD quintile (decrease in socio-economic position), women were shown to be 25% (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.63-0.90) less likely to have had any antenatal care and 15% (aOR 0.85; 95% CI 0.80-0.90) less likely to have had a routine postnatal check-up. They were 4% (aOR 1.04; 95% CI 0.99-1.10) more likely to have had an antenatal hospital admission, 7% (aOR 1.07; 95% CI 0.99-1.16) more likely to have been transferred during labour and 4% (aOR 1.04; 95% CI 0.99-1.09) more likely to have had a caesarean birth, although these results were not statistically significant. With decreasing socio-economic position women were more likely to report that they were not treated respectfully or spoken to in a way they could understand by doctors and midwives.Conclusions: This analysis suggests the need for a focusing of professionals and services towards pregnant women from lower socio-economic groups and more targeted maternal public health education towards socially disadvantaged women. [ABSTRACT FROM AUTHOR]

Objective To establish the prevalence of symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) among women attending prenatal care in Tanzania, and identify associated factors. Methods A cross-sectional study was conducted of one in five physically well women attending a prenatal-care clinic in Muhimbili National Hospital, Dar es Salaam, between December 2011 and April 2012. Trained research assistants carried out face-to-face interviews using a structured questionnaire. The Hopkins Symptoms Checklist and the PTSD Diagnostic Scale were used to establish levels of depression and anxiety symptoms. Results Among the 1180 women interviewed, 905 (76.7%) had symptoms of anxiety, 923 (78.2%) had symptoms of depression, and 58 (4.9%) had moderate/severe PTSD symptoms. After adjustment for women’s sociodemographic characteristics, age of the woman and their partner, educational level of the woman and their partner, relationship duration, employment, and marital status were associated with symptoms of at least one of the three mental disorders ( P < 0.05 for all). Conclusion Many pregnant women had symptoms of mental health disorders. Screening of mental health disorders during prenatal care and training of healthcare providers are needed. [ABSTRACT FROM AUTHOR]

Zeitlin J, Combier E, Levaillant M, Lasbeur L, Pilkington H, Charreire H, Rivera L. Neighbourhood socio-economic characteristics and the risk of preterm birth for migrant and non-migrant women: a study in a French district. Paediatric and Perinatal Epidemiology 2011; 347-356. Neighbourhood-level deprivation is associated with preterm birth; preterm birth rates are also higher for some, but not all migrant groups. We studied the impact of neighbourhood characteristics (a deprivation score and the proportion of foreign-born residents) on singleton preterm birth in the French district of Seine-Saint-Denis for women born in France, North Africa, sub-Saharan Africa and other countries. Multilevel logistic regression models were adjusted for maternal demographic and health care characteristics. For women born in France, the preterm birth rate rose with neighbourhood deprivation quintile (3.8% in the first to 5.7% in the fifth, adjusted odds ratio: 1.40 [95% confidence interval 1.14, 1.72]) and with increasing proportions of foreign-born residents. Preterm birth rates were not higher in more deprived neighbourhoods for women born outside of France and were lower in neighbourhoods with more foreign-born residents; in multilevel models, the inverse association with deprivation remained significant for women from sub-Saharan Africa. Area-based deprivation measures should be used with caution in populations with large numbers of migrants. These results raise questions about the health benefits of clustering for migrant communities as well as the negative consequences of acculturation. [ABSTRACT FROM AUTHOR]

Objective: We assessed the effect of prenatal and peripartum antibiotics on maternal morbidity and mortality among HIV-infected and uninfected women.Methods: A multicenter trial was conducted at clinical sites in 4 Sub-Saharan African cities: Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. A total of 1558 HIV-infected and 271 uninfected pregnant women who were eligible to receive both the prenatal and peripartum antibiotic/placebo regimens were enrolled. Pregnant women were interviewed at 20-24 weeks of gestation and a physical examination was performed. Women were randomized to receive either antibiotics or placebo. At the 26-30 week visit, participants were given antibiotics or placebo to be taken every 4 hours beginning at the onset of labor and continuing after delivery 3 times a day until a 1-week course was completed. Logistic regression and Cox proportional hazards models were used.Results: There were no significant differences between the antibiotic and placebo groups for medical conditions, obstetric complications, physical examination findings, puerperal sepsis, and death in either the HIV-infected or the uninfected cohort.Conclusion: Administration of study antibiotics during pregnancy had no effect on maternal morbidity and mortality among HIV-infected and uninfected pregnant women. [ABSTRACT FROM AUTHOR]

Objective To explore whether women view decision-making surrounding vaginal or caesarean birth as their choice. Design Longitudinal cohort study utilising quantitative (questionnaire, routinely collected data) and qualitative (in-depth interviews) methods simultaneously. Setting A large hospital providing National Health Service maternity care in the UK. Sample Four-hundred and fifty-four primigravid women. Methods Women completed up to three questionnaires between their antenatal booking appointment and delivery. Amongst these women, 153 were interviewed at least once during pregnancy (between 24 and 36 weeks) and/or after 12 moths after birth. Data were also obtained from women’s hospital delivery records. Descriptive statistical analysis was performed (survey and delivery data). Interview data were analysed using a seven-stage sequential form of qualitative analysis. Results Whilst many women supported the principle of choice, they identified how, in practice their autonomy was limited by individual circumstance and available care provision. All women felt that concerns about their baby’s or their own health should take precedence over personal preference. Moreover, expressing a preference for either vaginal or caesarean birth was inherently problematic as choice until the time of delivery was neither static nor final. Women did not have autonomous choice over their actual birth method, but neither did they necessarily want it. Conclusions The results of this large exploratory study suggest that choice may not be the best concept through which to approach the current arrangements for birth in the UK. Moreover, they challenge the notion of choice that currently prevails in international debates about caesarean delivery for maternal request. [ABSTRACT FROM AUTHOR]

Aim: To study uptake of care at the antenatal and child health clinic (CHC), and maternal and child health up to 5 years after the birth, as reported by mothers with a non-Swedish speaking background (NSB). Methods: A sample of 300 women with a NSB, 175 originated from a poor country and 125 originated from a rich country, were compared with a reference group of 2761 women with a Swedish speaking background. Four postal questionnaires were completed: during pregnancy, and 2 months, 1 year and 5 years after the birth. Results: Mothers with a NSB from a poor country of origin did not differ from the reference group of mothers with a Swedish speaking background regarding number of clinic visits, but they had a lower attendance rate at antenatal and postnatal education classes. Depressive symptoms, parental stress and poor self-rated health were more common in these women, and they reported more psychological and behavioral problems in their 5-year olds. Women with a rich country origin did not differ from the reference group regarding maternal and child health, but had a lower uptake of all out-patient care, except parental classes after the birth. Conclusion: Women originating from a poor country seem to be under great stress during pregnancy and the child's first years. [ABSTRACT FROM AUTHOR]

Objective: To obtain descriptive measures of maternal and perinatal health in the Ba Men Region of Inner Mongolia, China.Methods: Data collected from the Examination Chart for Pregnant Women for approximately 22,000 pregnancies in a three-county area of Inner Mongolia, China from December 1, 1996 through December 31, 1999 were analyzed for maternal, perinatal, and neonatal outcomes.Results: Compared to selected developing countries, a higher percentage of women (99%) in this region received at least one prenatal care visit. This region was also characterized by a low percentage of low birthweight (<2.5 kg) infants (1%) and neonatal mortality rate (5 deaths per 1000 live births).Conclusions: Maternal and neonatal health outcomes in this region of Inner Mongolia were better than those in selected developing countries. [ABSTRACT FROM AUTHOR]

A woman's child-bearing encounter is an experience that reflects the cultural beliefs and practices of the society. The purpose of this study was to describe the perceptions and practices of urban, low socioeconomic, Jordanian women (aged 18–30 years) in relation to their pregnancy career. An opportunistic sample consisting of 67 Muslim first-time pregnant women who followed up antenatal care at two maternity-care centres in East Amman was selected. A qualitative approach, including ethnographic semistructured interview, participant observation data from the households and clinics and oblique interviewing in random conversations initiated by the primigravidae, was conducted over 18 months. Women gave elaborative accounts of their pregnancy and childbirth expectations in narrative, phenomenological forms. Qualitative data analysis was performed concurrently with data collection, revealing the essential themes of immediacy of pregnancy; familial support and changing networks, especially for the after-birth period; fear of pain and medical interventions, all emphasizing the traditional and religious perceptions and practices in a familial context. [ABSTRACT FROM AUTHOR]

Studies of pregnancy outcome are generally based either on geographically defined populations, often from birth records, or on clinic or hospital populations. We compared women recruited into a clinic-based study, the Pregnancy, Infection, and Nutrition (PIN) Study, with women who resided in the geographical area of the study (Alamance, Orange, and Wake Counties in North Carolina) and gave birth over the corresponding time period (1996–2000). Clinic participants were more likely to be Black, younger, have lower education, be unmarried, have a more frequent history of adverse pregnancy outcome, obtain prenatal care later, and smoke more cigarettes. Despite that profile, the proportion of clinic participants delivering preterm was somewhat lower than among area women overall (10.8% vs. 11.3%). Black/White risk ratios for preterm birth were markedly different for area (1.6) vs. clinic women (1.1), whereas other predictors were similar. Patterns may differ across groups for many reasons, including self-selection of clinics and varying clinical practices. [ABSTRACT FROM AUTHOR]

Children First (C1), a nurse home visitation programme for first-time mothers, was implemented statewide in Oklahoma in mid-1997. The objective of this study was to compare the risks of low (<2500 g) and very low birthweight (<1500 g), preterm (<37 weeks) and very preterm (<30 weeks) deliveries and infant mortality between mothers participating and not participating in C1. All 239 466 Oklahoma birth certificates were reviewed. The C1 and birth certificate databases were matched to identify C1 participants. Mother's age at delivery, education level, race, marital status, prior pregnancy loss or pregnancy risk factors, birthweight and gestational age at delivery were measured from the birth certificates. Death certificates were matched to the birth certificates to identify infant deaths.A Bayesian multivariable logistic regression was used to analyse the data. Among single mothers without pregnancy risk factors, the risks of all study outcomes were lower for participants in C1: adjusted odds ratio (aOR) 0.89,[95% Bayesian Credible Interval (BCI) 0.79, 1.00] for preterm delivery; aOR 0.71,[95% BCI 0.50, 0.98] for very preterm delivery; aOR 0.86,[95% BCI 0.75, 0.98] for low birthweight; aOR 0.77,[95% BCI 0.56, 1.02] for very low birthweight and aOR 0.36,[95% BCI 0.17, 0.63] for infant mortality. These risk reductions were not observed among married mothers. In both single and married mothers, the presence of pregnancy risk factors reduced the impact of C1 on lowering the risk of low birthweight and preterm deliveries. The C1 programme targets young, pregnant women of low socio-economic level. We found that among single mothers, the risks of perinatal adverse outcomes are reduced or similar to those found in non-participating mothers.A reduced effect of C1 in the presence of pregnancy risk factors may be because mothers with pregnancy risk factors who did not participate in C1 received better prenatal care, or that C1 interventions do not impact these particular factors. C1 shows promise in reducing infant mortality in single mothers. Lower incidence of preterm and very preterm deliveries is especially interesting and future analyses should focus on isolating programme components specifically associated with influencing these outcomes. [ABSTRACT FROM AUTHOR]

Objectives Ultrasound scan in the mid-trimester of pregnancy is now a routine part of prenatal care in most European countries. The objective of this study was to evaluate the prenatal diagnosis of dysmorphic syndromes by fetal ultrasound examination. Methods Data from 20 registries of congenital malformations in 12 European countries were included in the study. Results There were 2454 cases with congenital heart diseases, 479 of which were recognized syndromes, including 375 chromosomal anomalies and 104 syndromes without chromosomal anomalies. Fifty-one of the 104 were detected prenatally (49.0%). One hundred and ninety-two of 1130 cases with renal anomalies were recognized syndromes, including 128 chromosomal anomalies and 64 syndromes without chromosomal anomalies; 162 of them (84.4%) were diagnosed prenatally, including 109 chromosomal anomalies and 53 non-chromosomal syndromes. Fifty-four of the 250 cases with limb defects were recognized syndromes, including 16 chromosomal syndromes and 38 syndromes without chromosomal anomalies; 21 of these 54 syndromes were diagnosed prenatally (38.9%), including 9 chromosomal syndromes. There were 243 cases of abdominal wall defects including 57 recognizable syndromes, 48 with omphalocele and 9 with gastroschisis; 48 were diagnosed prenatally (84.2%). Twenty-six of the 187 cases with diaphragmatic hernia had recognized syndromes, including 20 chromosomal aberrations and 6 syndromes without chromosomal anomalies. Twenty-two of them (84.6%) were detected prenatally. Sixty-four of 349 cases with intestinal anomalies were recognized syndromes; 24 were diagnosed prenatally (37.5%). There were 553 cases of cleft lip and palate (CL(P)) and 198 of cleft palate (CP) including 74 chromosomal anomalies and 73 recognized non-chromosomal syndromes. Prenatal diagnosis was made in 51 cases of CL(P) (53.7%) and 7 of CP (13.7%). Twenty-two of 188 anencephalic cases were syndromic and all were diagnosed prenatally. 0f290 cases with spina bifida, 18 were recognized syndromes, and of them 17 were diagnosed prenatally. All 11 syndromic encephaloceles were diagnosed prenatally. Conclusions Around 50% of the recognized syndromes which are associated with major congenital anomalies (cardiac, renal, intestinal, limb defects, abdominal wall defects and oral clefts) can be detected prenatally by the anomaly scan. However the detection rate varies with the type of syndrome and with the different countries' policies of prenatal screening. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore differences in the content of prenatal mental representations between a risk group (n = 84) and a low-risk group (n = 296) of pregnant women, enrolled from maternity care centers in southwestern Finland. The method used was semantic differentials of IRMAG (Interview of Maternal Representations During Pregnancy). The risk group was defined by means of questionnaire screens that concerned chemical dependency, depression, difficulties in social environment, and low social support. The ratings on all target subjects, i.e., child, self, partner, self-as-mother and own mother-as-mother, were significantly more negative in the risk group. The representation profiles of the groups differed: especially the ratings of partner and own mother-as-mother were more consistently and strongly negative among the risk mothers. © 2001 Michigan Association for Infant Mental Health. [ABSTRACT FROM AUTHOR]

This article focuses on research papers on family therapy selection. The first paper is titled "Interventions in Perinatal Family Care: A Participatory Study," by J. Gougreau and F. Duhamel. Drawing on the views of eight physicians and four couples, this research explored which interventions were likely to be helpful in preparing pregnant couples for parenting. Overall, interventions aimed to increase levels of exchange between spouses. The second paper is titled "A Parental Perspective on Living With a Chronically Ill Child: A Qualitative Study," by C. Saliford & L.R.M. Hallberg.

Discusses a study which investigated the collaborative care in pregnancy for low-risk pregnant women. Comparison of maternal and neonatal complication rates among those who received collaborative care to traditional care in pregnancy; Information on the fetal heart rates of both groups; Health condition of infants born to women in the two groups.

Discusses research on the factors that reduce low birthweight among women in Colorado. Reference to a study by S. A. Ricketts et al, published in a 2005 issue of the "American Journal of Public Health"; Information on the study procedures and participants; Analysis of the research findings.