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Purpose To evaluate differences in health characteristics and birth outcomes for participants of a prenatal education and support program for pregnant teens, 'Starting Out Right' (SOR) compared to nonparticipant pregnant teens in Pima, Maricopa, and Gila counties in Arizona to gauge benefits of program participation. Description The SOR program is a community education and support program for pregnant teens based on a structured curriculum. All pregnant teens living in the service area are eligible to participate. Assessment Vital statistics birth data from 2014 to 2019 were obtained from three counties in Arizona that identified SOR and non-SOR program participants. Logistic regression was used to calculate multivariable -adjusted odds ratios (aOR) for specific health characteristics (smoking, hypertensive disorders, overweight and obesity, gestational diabetes, sexually transmitted infections) and birth outcomes (C-section, preterm birth, NICU admission, birthweight, and breastfeeding) for SOR participants compared with nonparticipants. Variables in the adjusted models included age, BMI, smoking, gestational diabetes, race, ethnicity, county, WIC participation, insurance type, plurality, and month and year prenatal care began. Conclusion These results suggest that participation in SOR was associated (p [less than or equal to] 0.06) with a reduced odds for low birthweight [aOR 0.7(95% CI 0.5,1.0)] and increased odds (p [less than or equal to] 0.05) of breastfeeding [aOR 1.3(95% CI 1.0,1.7)] compared to nonparticipants. These results provide evidence that the education components in the SOR program support improved pregnancy and breastfeeding outcomes for pregnant teens., Author(s): Allison D. Root [sup.1] , Laura A. Pedersen [sup.2] , Christina A. Cutshaw [sup.1] , Leslie V. Farland [sup.1] , Douglas L. Taren [sup.1] [sup.3] Author Affiliations: (1) grid.134563.6, [...]

Objectives To compare the prevalence of highly effective contraceptive use by 12 weeks postpartum among participants of Centering Pregnancy®, a model of group prenatal care (GPC), and traditional prenatal care (TPC), and to investigate differences in contraceptive method choice by type of prenatal care. Methods We performed a retrospective review of all eligible patients who participated in GPC (n = 143) and a random sample of patients participating in TPC (n = 290) who followed up at our institution within 12 weeks of delivery. Our primary outcome was the proportion of participants using a highly effective contraceptive method within 12 weeks postpartum. Contraceptives were classified in tiers (Tier 1, long-acting reversible and permanent contraception; Tier 2, oral contraceptive pills, transdermal patch, vaginal ring, or injection; Tier 3, barrier and fertility awareness methods, withdrawal, spermicide; and no method). Tier 1 and Tier 2 methods were considered highly effective. Results The prevalence of highly effective contraceptive use by 12 weeks postpartum was 63.6% (91 of 143) and 63.1% (183 of 290) among participants in GPC and TPC, respectively (p = 0.99). We found no difference in Tier 1 versus other method use (adjusted odds ratio (aOR) 1.05, 95% CI 0.95-1.15, p = 0.34) or Tier 2 versus other method use between groups (aOR 0.98, 95% CI 0.89-1.08, p = 0.69), in a multivariable model controlling for demographic and clinical factors. Conclusions for Practice The prevalence of highly effective contraceptive use at 12 weeks postpartum was not different between GPC and TPC participants in this study. GPC was not associated with increased use of Tier 1 or Tier 2 contraceptive methods., Author(s): Aishat Olatunde [sup.1] , Safiyah Hosein [sup.1] [sup.2] , Andrew Paoletti [sup.1] , Alexis Pitcairn-Ramirez [sup.1] [sup.3] , Elizabeth P. Gurney [sup.1] [sup.4] Author Affiliations: (1) grid.239276.b, 0000 0001 [...]

Introduction Maternal mortality rates have been increasing in the United States for decades. For several years, opioid overdoses have been a leading cause of maternal mortality in several states. New Hampshire (NH) is a particularly severe case, with 50% of all maternal deaths being caused by drug-related overdoses from 2016 to 2017. We report on the implementation of a point-of-care naloxone distribution program for an Ob/Gyn clinic in NH. Methods Naloxone distribution was tracked to measure program implementation. Proportion of patients screened for naloxone need was calculated monthly. Proportion of patients with which discussions about naloxone took place was calculated quarterly. Patient and provider perspectives on the program were captured periodically. Statistical process control charts monitored change over time and evaluated for special-cause variation. Results The clinic has distributed 12 doses of naloxone since program implementation in April 2020. Despite the challenges posed by the COVID-19 pandemic, screening for naloxone need has remained at pre-pandemic rates (moving average: 73%), except for a decrease in April-May 2020. Patient-provider discussions about naloxone have also remained at pre-pandemic rates (moving average: 51%). Qualitative feedback from patients and providers has indicated that the program has been well-received by both groups. Discussion The purpose of this description is to provide a framework for other Ob/Gyn clinics to use in implementing similar naloxone distribution programs. Although too early to determine whether this intervention will result in a significant decrease in maternal mortality due to opioid overdose in our patients, this measure will continue to be tracked annually. Implementation of a naloxone program in the obstetrical context provides an important way to improve outcomes for a vulnerable perinatal population., Author(s): M. Duska [sup.1] , D. Goodman [sup.1] [sup.2] Author Affiliations: (1) grid.414049.c, 0000 0004 7648 6828, The Dartmouth Institute for Health Policy and Clinical Practice, , 74 College St, [...]

Objective Many of the medical risk factors for adverse birth outcomes (e.g., preeclampsia) are regularly monitored in prenatal care. However, many of the psychosocial risk factors associated with adverse birth outcomes (e.g., maternal stress, anxiety, depression, intimate partner violence) are not regularly addressed during routine prenatal care. Comprehensive prenatal screening for psychosocial risk factors for adverse birth outcomes can improve maternal and neonatal outcomes. In this study, we examine an existing tool for opportunities to streamline and improve screening. Methods We reviewed medical records for 528 mother-infant dyads, recording maternal responses to a 21-item prenatal risk screening tool, and gestational age/birth weight of infants. Multiple approaches to scoring were used to predict likelihood of adverse birth outcome. Results Women who answered yes to any of the top four interrelated items were 3.32 times more likely to have an adverse birth outcome. Sensitivity and specificity were 68% and 65%, respectively. Conclusion for Practice We identified a short surveillance tool to identify women who are at highest risk and require more in-depth screening, and to rule out women who are at very low risk of an adverse birth outcome., Author(s): Melissa A. Bright [sup.1] [sup.2] [sup.4] , Melanie Parrott [sup.3] , Serena Martin [sup.3] , Lindsay Thompson [sup.4] , Dikea Roussos-Ross [sup.1] , Diana Montoya-Williams [sup.5] Author Affiliations: (1) [...]

Introduction Most screening tools identifying women with substance use are not validated, used once in pregnancy, and are not reflective of continued substance use. We hypothesized that serial early prenatal substance screening leads to decreased substance use by the end of pregnancy and improved outcomes. Methods This is a retrospective cohort study of mothers and their infants between 1/2015 and 12/2017. A self-reported substance screening tool was administered on the first prenatal visit and subsequent visits until delivery. For analysis, mothers were divided into three groups based on the trimester of their first screen and adjusted for demographics and risk factors. Results Early first trimester screening resulted in 52% of mothers having [greater than or equal to] 3 screens throughout pregnancy vs. 6% of mothers with late third trimester screens (p < 0.001). Compared to third trimester screening, there was a five-fold decrease of any substance use at second trimester, a seven-fold decrease at first trimester, and a nine-fold decrease for marijuana at first trimester. Compared to third trimester screening, there was a significant five-fold increase of negative maternal urine drug screen, 3 ½ -fold increase in well newborn diagnosis, and a five-fold increase of no infant morphine treatment at first trimester. Discussion We identified improved maternal and infant outcomes with serial early prenatal substance use screening. Early maternal substance use identification is crucial for immediate referral for prevention and treatment, and for social and community services. Further research is needed on universal serial early prenatal screenings., Author(s): Stacy L. BODEN [sup.1] , Cresta W. JONES [sup.2] , Erwin T. CABACUNGAN [sup.3] Author Affiliations: (1) grid.30760.32, 0000 0001 2111 8460, Department of Pediatrics, West Bend Health Center, [...]

Objectives In Ohio, African American babies die at 2.5-3 times the rate of White babies. Preterm birth and low birth weight are the leading causes of infant mortality. Home visiting is an evidence-based strategy for serving low-income pregnant women; however, there are relatively few rigorous studies examining its effect on birth outcomes. Methods This study uses a propensity score technique to estimate the causal effect of participation in home visiting on prematurity and low birth weight among a low-income, predominantly African American sample (N = 26,814). Results We found that participation in home visiting significantly reduced the odds of experiencing both adverse birth events, with a larger program effect for the low birth weight outcome. Conclusions for Practice Results suggest that selective prevention strategies must be accompanied by universal attempts to improve the health and life circumstances of low income and minority women., Author(s): Elizabeth R. Anthony [sup.1] , Youngmin Cho [sup.2] , Robert L. Fischer [sup.1] , Lisa Matthews [sup.3] Author Affiliations: (1) grid.67105.35, 0000 0001 2164 3847, Jack, Joseph and Morton [...]

Objectives A life-course perspective emphasizes healthy behaviors before, during, and after pregnancy to support a multi-generational risk reduction in obesity for mothers and infants. Optimal timing, content, and dose of such interventions is not well defined. Methods We conducted a nested cohort within a randomized trial to evaluate whether a healthy lifestyle intervention around pregnancy led to a 'spill-over effect,' including a healthier rate (kg/week) of maternal gestational weight gain, and infant growth during the first year. Study enrollment began in 2012, follow-up data collection completed in 2018, and the data were analyzed in 2019. The intervention focused on healthy maternal diet and physical activity but not pregnancy weight or infant feeding. Outcome data were abstracted from electronic medical records. Results Of the 165 women who became pregnant, 114 enrolled in the nested cohort. The average pre-pregnancy BMI was 29.6 (SD 5.1) kg/m.sup.2. Mixed effects models suggested clinically insignificant differences in both the rate of gestational weight gain (-0.02 kg/week; 95% CI -0.09, 0.06) and the rate of infant growth (difference at 1 year: -0.002 kg/cm; 95% CI -0.009, 0.005). Conclusions for Practice A behavioral intervention that focused on overall maternal health delivered in the time around pregnancy did not result in a 'spill-over effect' on healthy gestational weight gain or healthy infant growth during the first year of life. Trial Registration This study is registered at http://www.clinicaltrials.gov http://www.clinicaltrials.gov NCT01316653., Author(s): William J. Heerman [sup.1] , Lauren R. Samuels [sup.2] , Lauren Barr [sup.3] , Laura E. Burgess [sup.1] , Katherine E. Hartmann [sup.4] , Shari L. Barkin [sup.1] Author [...]

Objective The purpose of this study was to determine the effects of supervised prenatal aerobic exercise on fetal morphometrics at 36 weeks of gestation. Methods This study used data from a, 24-week, two-arm randomized controlled trial: aerobic exercise (EX) and stretching/breathing comparison group (CON). Singleton pregnancies (< 16 weeks pregnant) and women aged 18 to 40 years, BMI between 18.5 and 34.99 kg/m.sup.2, and no preexisting chronic health conditions were eligible. The EX group participated in 150 min of moderate-intensity weekly exercise while CON group participated in low-intensity stretching/breathing. Fetal morphometric outcomes included estimated fetal weight (EFW), ponderal index (PI), abdominal circumference (AC), anterior abdominal wall thickness (AAWT), fat mass, percent body fat, fat-free mass, assessed at 36 weeks gestation. Partial spearman rank correlations were performed, adjusting for 3.sup.rd trimester weight gain. Results Of the 128 pregnant women randomized, 83 (EX [n = 46] and CON [n = 37]) were eligible for analyses. Intention-to-treat analysis showed no differences in EFW (rho.sub.s = - 0.13; p = 0.28), PI (rho.sub.s = 0.03; p = 0.81), AC (rho.sub.s = - 0.22; p = 0.09), AAWT (rho.sub.s = - 0.11; p = 0.40), fat mass (rho.sub.s = - 0.16; p = 0.23), percent body fat (rho.sub.s = - 0.10; p = 0.43), and fat-free mass (rho.sub.s = - 0.22; p = 0.08), after adjusting for 3rd trimester weight gain. Similar results were observed in the per protocol analyses. Conclusions For Practice Moderate-intensity aerobic exercise during pregnancy was not associated with select fetal morphometrics at 36 weeks gestation. Potential differences in offspring morphometrics may only appear in the postnatal period, as previously documented. Further research into offspring tissue composition after birth is encouraged, specifically studies investigating differences in cellular signaling pathways related to adipose and skeletal muscle tissue development., Author(s): Samantha M. McDonald [sup.1] [sup.7] , Ed Newton [sup.2] , Diana Strickland [sup.2] , Christy Isler [sup.2] , Kelley Haven [sup.2] , George Kelley [sup.3] , Lisa Chasan-Taber [sup.4] [...]

Pregnancy-specific stress (PSS) arises from the numerous changes that women experience during pregnancy and from their concerns about childbirth and the health of their offspring. Prolonged or elevated maternal stress heightens risk for poor fetal, infant, and child outcomes. The Prenatal Distress Questionnaire (PDQ) and its expanded successor, the revised Prenatal Distress Questionnaire (NuPDQ), were developed to assess PSS, but their psychometric properties and findings are not well-documented. We reviewed research using the PDQ (n = 45) or NuPDQ (n = 37). Results establish that PSS as measured by these instruments is common in pregnancy; PSS is associated with sociodemographic and obstetric characteristics, perceptions of pregnancy, health behaviors, maternal health, and birth outcomes. The NuPDQ is an especially appropriate tool to assess PSS, with demonstrated reliability and convergent, concurrent, and predictive validity. The ability to assess PSS in a reliable and valid manner is critical to advance research and improve maternal and child health., Author(s): Sirena M. Ibrahim [sup.1] , Marci Lobel [sup.1] Author Affiliations: (1) grid.36425.36, 0000 0001 2216 9681, Department of Psychology, Stony Brook University, , 11794-2500, Stony Brook, NY, USA Introduction [...]

Background Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. Methods and findings This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., Conclusions In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies., Author(s): Damien Foo 1,2,*, Mohinder Sarna 1,2, Gavin Pereira 1,3,4, Hannah C. Moore 1,2, Annette K. Regan 1,2,5,6 Introduction Influenza is a major respiratory infection that is linked with serious [...]

Background Nutritional status may play a role in infant immune development. To identify potential boosters of immunogenicity in low-income countries where oral vaccine efficacy is low, we tested the effect of prenatal nutritional supplementation on immune response to 3 doses of a live oral rotavirus vaccine. Methods and findings We nested a cluster randomized trial within a double-blind, placebo-controlled randomized efficacy trial to assess the effect of 3 prenatal nutritional supplements (lipid-based nutrient supplement [LNS], multiple micronutrient supplement [MMS], or iron-folic acid [IFA]) on infant immune response (n = 53 villages and 1,525 infants with valid serology results: 794 in the vaccine group and 731 in the placebo group). From September 2015 to February 2017, participating women received prenatal nutrient supplement during pregnancy. Eligible infants were then randomized to receive 3 doses of an oral rotavirus vaccine or placebo at 6-8 weeks of age (mean age: 6.3 weeks, 50% female). Infant sera (pre-Dose 1 and 28 days post-Dose 3) were analyzed for anti-rotavirus immunoglobulin A (IgA) using enzyme-linked immunosorbent assay (ELISA). The primary immunogenicity end point, seroconversion defined as [greater than or equal to]3-fold increase in IgA, was compared in vaccinated infants among the 3 supplement groups and between vaccine/placebo groups using mixed model analysis of variance procedures. Seroconversion did not differ by supplementation group (41.1% (94/229) with LNS vs. 39.1% (102/261) with multiple micronutrients (MMN) vs. 38.8% (118/304) with IFA, p = 0.91). Overall, 39.6% (n = 314/794) of infants who received vaccine seroconverted, compared to 29.0% (n = 212/731) of infants who received placebo (relative risk [RR]: 1.36; 95% confidence interval [CI]: 1.18, 1.57, p < 0.001). This study was conducted in a high rotavirus transmission setting. Study limitations include the absence of an immune correlate of protection for rotavirus vaccines, with the implications of using serum anti-rotavirus IgA for the assessment of immunogenicity and efficacy in low-income countries unclear. Conclusions This study showed no effect of the type of prenatal nutrient supplementation on immune response in this setting. Immune response varied depending on previous exposure to rotavirus, suggesting that alternative delivery modalities and schedules may be considered to improve vaccine performance in high transmission settings. Trial registration ClinicalTrials.gov NCT02145000., Author(s): Sheila Isanaka 1,2,*, Souna Garba 3, Brian Plikaytis 4, Monica Malone McNeal 5, Ousmane Guindo 3, Céline Langendorf 1, Eric Adehossi 6, Iza Ciglenecki 7, Rebecca F. Grais 1 [...]

Objective The purpose of this study was to examine the content of the first prenatal visit within an academic medical center clinic and to compare the topics discussed to 2014 American College of Obstetrics and Gynecologists guidelines for the initial prenatal visit. Methods Clinical interactions were audio recorded and transcribed (n = 30). A content analysis was used to identify topics discussed during the initial prenatal visit. Topics discussed were then compared to the 2014 ACOG guidelines for adherence. Coded data was queried though the qualitative software and reviewed for accuracy and content. Results First prenatal visits included a physician, nurse practitioner, nurse midwife, medical assistant, medical students, or a combination of these providers. In general, topics that were covered in most visits and closely adhered to ACOG guidelines included vitamin supplementation, laboratory testing, flu vaccinations, and cervical cancer screening. Topics discussed less often included many components of the physical examination, education about pregnancy, and screening for an identification of psychosocial risk. Least number of topics covered included prenatal screening. Conclusions for Practice While the ACOG guidelines may include many components that are traditional in addition to those based on evidence, the guidelines were not closely followed in this study. Identifying new ways to disseminate information during the time constrained initial prenatal visit are needed to ensure improved patient outcomes., Author(s): J. Dyer [sup.1] , G. Latendresse [sup.1] , E. Cole [sup.1] , J. Coleman [sup.1] , E. Rothwell [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0001 2193 0096, grid.223827.e, College [...]

Objectives Antenatal corticosteroids are standard of care for women at risk of a preterm birth and demonstrated to be protective against poor outcomes in neonates including respiratory disorders, mortality and intraventricular hemorrhage (IVH). Its benefits may vary by gestational age, and accurate estimation is needed in a single-center population to account for practice variation. Methods A retrospective cohort of infants admitted to the hospital's neonatal intensive care unit, 1997-2015. Using Poisson regression, we separately modeled the incidence rate ratio of death, grade III or IV intraventricular hemorrhage (IVH), and moderate to severe bronchopulmonary dysplasia (BPD) testing the moderating effects of gestation on antenatal steroids, controlling for potential confounding. Results Among 5314 infants admitted, death occurred in 298 (6%), severe IVH in 244 (5%), and BPD in 527 (10%). Antenatal steroids were protective of death and BPD in the adjusted analysis, and there was multiplicative interaction where each week increase in gestational age combined with steroid therapy resulted in 13% reduced incidence for each outcome. Conclusions for Practice Antenatal steroids are protective against severe IVH and moderate to severe BPD, and when combined with gestational age, steroids are associated with greater protective benefits in older neonates. There is likely an ideal window to maximize the benefits of antenatal steroids, and future etiologic research should consider the joint effects with gestational age., Author(s): Neal D. Goldstein [sup.1] [sup.2] , Kaitlin M. Kenaley [sup.1] , Robert Locke [sup.1] [sup.2] , David A. Paul [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0004 0444 1241, grid.414316.5, [...]

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes., Author(s): Meghan K. Wally [sup.1] , Larissa R. Brunner Huber [sup.1] , L. Michele Issel [sup.1] , Michael E. Thompson [sup.1] Author Affiliations: (1) Department of Public Health Sciences, UNC [...]

Background Given the large increases in opioid use among pregnant women and associations with hepatitis C virus (HCV) infection, screening pregnant women who are on (opioid agonist) pharmacotherapy for HCV infection has potential to inform medical care for these mothers as well as their newborns. We investigated the HCV testing cascade among pregnant women on pharmacotherapy in order to describe exposure and infection rates and to identify opportunities that would improve care. Methods Secondary analyses of laboratory results were performed for HCV testing, including anti-HCV, viremia (RNA) and genotype. Information was abstracted from the medical records of women who were followed at a comprehensive prenatal care clinic for women with substance use disorders at the University of New Mexico. Results The sample included 190 pregnant women, of whom 188 were on pharmacotherapy (43.7% on buprenorphine and 55.3% on methadone); the remaining two had tested positive for heroin or prescription opioids. A total of 178 (93.7%) were tested for anti-HCV, 94 (98.9%) of whom were tested for RNA, and 41 (57.7%) were genotyped. Prevalence of exposure to HCV by anti-HCV results was 53.3%, and 37.3% were positive for HCV RNA indicating chronic infection. Conclusions The high prevalence of exposure and infection with HCV in pregnant women involved in pharmacotherapy for a substance use disorder indicate a need for ongoing surveillance and testing for HCV. Identifying HCV during pregnancy is crucial because this identification would serve to enhance medical care and potentially prevent vertical transmission. Identifying HCV would also facilitate referrals to newly available curative HCV treatments following delivery., Author(s): Kimberly Page [sup.1] , Lawrence Leeman [sup.2] , Steven Bishop [sup.3] , Sandra Cano [sup.3] , Ludmila N. Bakhireva [sup.1] [sup.2] [sup.3] Author Affiliations: (1) Department of Internal Medicine, [...]

Byline: Pravash. Mishra, Mayadhar. Barik, A. Mahapatra Background: Folic acid and multivitamin supplements ((FAMVS) and genetics involvement is one of the major roles in the development of neural tube defects [...]

Although recent research has examined discrimination in health care, no studies have investigated women's experiences during prenatal or obstetrical care. Analyses of data from the Oregon Pregnancy Risk Assessment Monitoring System showed that 18.53% of mothers reported discrimination by providers during prenatal care, labor, or delivery, most commonly be cause of age or insurance status. Perceived discrimination was associated with maternal characteristics such as age, marital status, and type of insurance, but not with number of subsequent well-baby visits.

Objective: To assess the potential impact of a national iron supplementation programme in rural Vietnam. Methods: The study included questionnaires, focus group discussions of pregnant women and key informant interviews, together with measurements of haemoglobin (Hb) and a stool examination for soil-transmitted helminths. Results: Iron supplementation significantly increased Hb concentration among participants in the second and third trimesters by 0.4 and 0.7 g/dl, respectively (P=0.017 and P Conclusions: The results of this study show that an iron supplementation programme is beneficial as a part of a comprehensive anaemia programme for pregnant women in these communities. These results will be useful for developing improved iron-deficiency anaemia control programs for pregnant women. doi:10.1038/sj.ejcn.1602812; published online 23 May 2007 Keywords: iron-deficiency anaemia; community health; pregnancy; compliance; Vietnam; parasite infestation, Introduction Iron-deficiency anaemia (IDA) is the most frequently observed nutritional deficiency in pregnant women in developing countries (Preziosi et al., 1997). According to the World Health Organization (WHO), many pregnant [...]

: Introduction: Safer conception care encompasses HIV care, treatment and prevention for persons living with HIV and their partners who desire children. In 2012, South Africa endorsed a progressive safer conception policy supporting HIV‐affected persons to safely meet reproductive goals. However, aside from select research‐supported clinics, widespread implementation has not occurred. Using South Africa as a case study, we identify key obstacles to policy implementation and offer recommendations to catalyse expansion of these services throughout South Africa and further afield. Discussion: Four key implementation barriers were identified by combining authors’ safer conception service delivery experiences with available literature. First, strategic implementation frameworks stipulating where, and by whom, safer conception services should be provided are needed. Integrating safer conception services into universal test‐and‐treat (UTT) and elimination‐of‐mother‐to‐child‐transmission (eMTCT) priority programmes would support HIV testing, ART initiation and management, viral suppression and early antenatal/eMTCT care engagement goals, reducing horizontal and vertical transmissions. Embedding measurable safer conception targets into these priority programmes would ensure accountability for implementation progress. Second, facing an organizational clinic culture that often undermines clients’ reproductive rights, healthcare providers’ (HCP) positive experiences with eMTCT and enthusiasm for UTT provide opportunities to shift facility‐level and individual attitudes in favour of safer conception provision. Third, safer conception guidelines have not been incorporated into HCP training. Combining safer conception with “test‐and‐treat” training would efficiently ensure that providers are better equipped to discuss clients’ reproductive goals and support safer conception practices. Lastly, HIV‐affected couples remain largely unaware of safer conception strategies. HIV‐affected populations need to be mobilized to engage with safer conception options alongside other HIV‐related healthcare services. Conclusion: Key barriers to widespread safer conception service provision in South Africa include poor translation of policy into practical and measurable implementation plans, inadequate training and limited community engagement. South Africa should leverage the momentum and accountability associated with high priority UTT and eMTCT programmes to reinvigorate implementation efforts by incorporating safer conception into implementation and monitoring frameworks and associated HCP training and community engagement activities. South Africa's experiences should be used to inform policy development and implementation processes in other HIV high‐burden countries., Introduction Safer conception care encompasses HIV care, treatment and prevention for individuals and couples desiring a child, in which one or both partners are living with HIV [1]. Safer conception [...]

The impact of the introduction of routine opt-out HIV testing in antenatal care in Botswana is examined. The results have shown that routine HIV testing is more accepted than voluntary testing and it has led to substantial increases in the uptake of testing and prevention of mother-to-child transmission (PMTCT) interventions without adverse consequences.

Latina immigrants with limited English proficiency face significant obstacles to using maternal health services. Using a measure of reading skill and problem solving in the health context (the Spanish version of the Test of Functional Health Literacy in Adults), the authors assessed the association between literacy in Spanish and depressive symptomatology among 99 Latinas receiving prenatal care who had limited English proficiency. After adjusting for potential confounds, women with inadequate literacy were found to be more than twice as likely to have Center for Epidemiological Studies-Depression Scale scores greater than 16 (the standard clinical threshold) than women with adequate literacy. The association between low literacy and depressive symptomatology among pregnant Latinas deserves further investigation and should be considered when designing health services for this vulnerable and growing population. Keywords: literacy, educational status, depression, pregnancy, Hispanic Americans

The Cameroon Bapist Convention Health Board implemented to prevent mother-to-child transmission of HIV-1 into routine antenatal care, achieved high uptake of rapid HIV testing and posttest counseling on the same day, implemented routine uses on peripartum single-dose NVP for HIV-positive mothers and their infants in collaboration with the National AIDS Program is described. Consistent training and programmatic support contributed to rapid upscaling and high uptake counseling rates.

The main goal of antenatal care in developing countries is to identify women whose pregnancy or delivery is likely to raise problems and to refer them at the appropriate time to a hospital facility where the necessary medical equipment and expertise (vacuum extractors, cesarian sections, human skill, etc.) is available. This approach, which is known as the Risk Approach (RA) strategy, is expected to significantly reduce maternal morbidity and mortality. However, the RA will function properly only if the women identified at risk agree to give birth in a hospital on the one hand, and if they can indeed reach this hospital on the other hand. In this article the authors assess to what extent women with a risk of difficult labor (nulliparous or primiparous women under 150 cm, history of previous difficult delivery or stillbirth, women with transverse lie) agreed to give birth in a hospital. This descriptive survey, which covered 5060 pregnancies monitored in the Kasongo District, Maniema, in eastern Zaire, showed that the referral success rate in this socioeconomically very disadvantaged region was only 33%, despite some favorable conditions, such as a strong emphasis on community participation, a complementarity of health centers and hospital, and the absence of financial barriers within the health services system. Of the various hypotheses tested, the geographic accessibility of the hospital and the parturient's perception of the risk status were the two most important factors determining the compliance rate. A stratified analysis shows that the intensity of the parturient's perception has a different impact on compliance whether rural or urban situations are considered. In their conclusions, the authors stress the importance of the problem and the need for additional qualitative studies (open interviews, focus group discussions) to better understand the reasons of this low compliance. The phenomenon observed in Kasongo is definitely not a unique one, and unawareness of this problem is likely to be one of the reasons for the low success of pregnancy monitoring programs when they are assessed in terms of reduction of maternal morbidity and mortality. Key words - antenatal care, risk approach strategy, referral compliance