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INTRODUCTION - Complementary and alternative medicine (CAM) is commonly used among women, but few national data exist regarding CAM use during pregnancy or the postnatal period.
METHODS - Data from the 2007 National Health Interview Survey were analyzed for women ages between the ages of 18 and 49 years who were pregnant or had children less than 1 year old. CAM use was identified based on standard definitions of CAM from the National Institutes of Health's National Center for Complementary and Alternative Medicine. CAM use among women who were pregnant or with a child less than 1 year was compared with the other similarly aged female responders. CAM use was examined among these women stratified by sociodemographics, health conditions, and conventional medicine use through bivariable and multivariable logistic regression models.
RESULTS - Among pregnant and postpartum women from the ages of 19 to 49 years in the United States, 37% of pregnant women and 28% of postpartum women reported using CAM in the last 12 months compared with 40% of nonpregnant/non-postpartum women. Mind-body practices were the most common CAM modality reported, with one out of four women reporting use. Biological therapies, excluding vitamins and minerals, during the postpartum period were used by only 8% of women. Using multivariable regression modeling, we report no significant difference in CAM use among pregnant compared with non-pregnant women (adjusted odds ratio [AOR], 0.88; [95% confidence interval 0.65-1.20]), but lower CAM use among postpartum women compared with non-pregnant women (AOR 0.67; [0.52-0.88]), while adjusting for sociodemographics.
CONCLUSION - CAM use among pregnancy similar to women who are not pregnant, while postpartum CAM use decreases. Further evaluation of CAM therapies among pregnant and postpartum women is necessary to determine the costs and benefits of integrative CAM therapies in conventional care.
Viral bronchiolitis affects 20%-30% of infants; because there is no known effective treatment, it is important to identify risk factors that contribute to its pathogenesis. Although adequate folate intake during the periconceptional period prevents neural tube defects, animal data suggest that higher supplementation may be a risk factor for child respiratory diseases. Using a population-based retrospective cohort of 167,333 women and infants, born in 1995-2007 and enrolled in the Tennessee Medicaid program, we investigated the association between the filling of folic acid-containing prescriptions and infant bronchiolitis. We categorized women into the following 4 groups in relation to the first trimester: "none" (no prescription filled), "first trimester only," "after first trimester," and "both" (prescriptions filled both during and after the first trimester). Overall, 21% of infants had a bronchiolitis diagnosis, and 5% were hospitalized. Most women filled their first prescriptions after the fifth to sixth weeks of pregnancy, and most prescriptions contained 1,000 µg of folic acid. Compared with infants born to women in the "none" group, infants born to women in the "first trimester only" group had higher relative odds of bronchiolitis diagnosis (adjusted odds ratio = 1.17, 95% confidence interval: 1.11, 1.22) and greater severity (adjusted odds ratio = 1.16, 95% confidence interval: 1.11, 1.22). This study's findings contribute to an understanding of the implications of prenatal nutritional supplement recommendations for infant bronchiolitis.
INTRODUCTION - The purpose of this study was to examine the effects of CenteringPregnancy group prenatal care on breastfeeding outcomes, relative to traditional prenatal care delivered in an individual format.
METHODS - A quasi-experimental research design was conducted with 794 women receiving prenatal care delivered in a group or individual format at 4 sites in Tennessee. Propensity scores were used to create groups of women statistically matched on background demographics and medical history. Outcomes included breastfeeding at discharge and breastfeeding at postpartum follow-up.
RESULTS - Compared with the matched comparison group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had significantly higher odds of any breastfeeding at discharge (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32-3.26; P < .001). Across the 4 sites, there were no consistent differences in the odds of any breastfeeding at follow-up or exclusive breastfeeding at discharge or postpartum follow-up.
DISCUSSION - CenteringPregnancy group prenatal care may have beneficial effects on initial rates of breastfeeding relative to individually delivered care. However, there is not sufficient evidence to conclude that CenteringPregnancy group prenatal care has robust effects on exclusive breastfeeding at discharge or postpartum follow-up.
© 2013 by the American College of Nurse-Midwives.
We examined the effects of CenteringPregnancy group prenatal care versus individually delivered prenatal care on gestational age, birth weight, and fetal demise. We conducted a retrospective chart review and used propensity score matching to form a sample of 6,155 women receiving prenatal care delivered in a group or individual format at five sites in Tennessee. Compared to the matched group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had longer weeks of gestation (b = .35, 95 % CI [.29, .41]), higher birth weight in grams (b = 28.6, 95 % CI [4.8, 52.3]), lower odds of very low birth weight (OR = .21, 95 % CI [.06, .70]), and lower odds of fetal demise (OR = .12, 95 % CI [.02, .92]). Results indicated no evidence of differences in the odds of preterm birth or low birth weight for participants in group versus individual prenatal care. CenteringPregnancy group prenatal care had statistically and clinically significant beneficial effects on very low birth weight and fetal demise outcomes relative to traditional individually delivered prenatal care. Group prenatal care had statistically significant beneficial effects on gestational age and birth weight, although the effects were relatively small in clinical magnitude.
BACKGROUND - The relationship between HIV knowledge and HIV-related behaviors in settings like Mozambique has been limited by a lack of rigorously validated measures.
METHODS - A convenience sample of women seeking prenatal care at two clinics were administered an adapted, orally-administered, 27 item HIV-knowledge scale, the HK-27. Validation analyses were stratified by survey language (Portuguese and Echuabo). Kuder-Richardson (KR-20) coefficients estimated internal reliability. Construct validity was assessed with bivariate associations between HK-27 scores (% correct) and selected participant characteristics. The association between knowledge, self-reported HIV testing, and HIV infection were evaluated with multivariable logistic regression.
RESULTS - Participants (N = 348) had a median age of 24; 188 spoke Portuguese, and 160 spoke Echuabo. Mean HK-27 scores were higher for Portuguese-speaking participants than Echuabo-speaking participants (68% correct vs. 42%, p<0.001). Internal reliability was strong (KR-20>0.8) for scales in both languages. Higher HK-27 scores were significantly (p≤0.05) correlated with more education, more media items in the home, a history of HIV testing, and participant work outside of the home for women of both languages. HK-27 scores were independently associated with completion of HIV testing in multivariable analysis (per 1% correct: aOR:1.02, 95%CI:0.01-0.03, p = 0.01), but not with HIV infection.
CONCLUSIONS - HK-27 is a reliable and valid measure of HIV knowledge among Portuguese and Echuabo-speaking Mozambican women. The HK-27 demonstrated significant knowledge deficits among women in the study, and higher scores were associated with higher HIV testing probability. Future studies should evaluate the role of the HK-27 in longitudinal studies and in other populations.
BACKGROUND - Correlates of prenatal physical activity can inform interventions, but are not well-understood.
METHODS - Participants in the Pregnancy, Infection, and Nutrition 3 Study were recruited before 20 weeks gestation. Women self-reported frequency, duration, and mode of moderate and vigorous physical activities. We used logistic regression to identify correlates of any physical activity (≥10 minutes/week of any mode), any recreational activity (≥10 minutes/week), and high volume recreational activity (either ≥150 minutes/week of moderate or ≥75 minutes/week of vigorous). Our analysis included 1752 women at 19-weeks gestation and 1722 at 29 weeks.
RESULTS - Higher education, white race, and enjoyment of physical activity were positively correlated with all 3 outcomes. Any recreational activity was negatively associated with parity, body mass index, and history of miscarriage. The associations of history of miscarriage and body mass index differed at 19 weeks compared with 29 weeks. Single marital status, health professional physical activity advice, and time for activity were associated with high volume recreational activity only.
CONCLUSIONS - Correlates of physical activity differed by mode and volume of activity and by gestational age. This suggests that researchers planning physical activity interventions should consider the mode and amount of activity and the gestational age of the participants.
We assessed attitudes of a multi-ethnic sample of pregnant women in regard to participation in five data collection procedures planned for use in the National Children's Study. A cross-sectional survey was conducted in nine prenatal clinics in Kent County, Michigan between April and October 2006. Women were approached in clinic waiting rooms at the time of their first prenatal visit and 311 (91.0%) participated. Women were asked about their willingness to participate, and the smallest amount of compensation required for participation in a 45-min in-person interview, a 15-min telephone interview, maternal and infant medical record abstraction, and an infant physical examination. Percentages for willingness to participate were highest for telephone interview (83%), followed by in-person interview (60%), infant examination (57%), and maternal (56%) and infant medical records (54%). About 34-48% of women reported that no compensation would be required for participation by data procedure. Some women reported unwillingness to participate in telephone (9%) or personal (17%) interview, record abstraction (34%) or infant examination (26%), even with compensation. Education greater than high school was associated with increased odds of refusal for infant physical examination, adjusted odds ratio 2.44 [95% confidence interval 1.41, 4.23]. In conclusion, 9-34% of pregnant women, depending on procedure, stated they would not participate in non-invasive research procedures such as medical record abstraction and infant examination, even with compensation. Resistance to these research procedures was especially noted among more highly educated women. Planning for the National Children's Study will have to address potential resistance to research among pregnant women.
OBJECTIVES - To create a fetal size nomogram for use in sub-Saharan Africa and compare the derived centiles with reference intervals from developed countries.
METHODS - Fetal biometric measurements were obtained at entry to antenatal care (11-22 weeks' gestation) and thereafter at 4-week intervals from pregnant women enrolled in a longitudinal ultrasound study in Kinshasa, Democratic Republic of Congo. The study population comprised 144 singleton gestations with ultrasound-derived gestational age within 14 days of the menstrual estimate. A total of 755 monthly ultrasound scans were included with a mean +/- SD of 5 +/- 1 (range, 2-8) scans per woman. Estimated fetal weight (EFW) was calculated at each ultrasound examination using the Hadlock algorithm. A general mixed-effects linear regression model that incorporated random effects for both the intercept and slope was fitted to log-transformed EFW to account for both mean growth and within-fetus variability in growth. Reference centiles (5(th), 10(th), 50(th), 90(th) and 95(th) centiles) were derived from this model.
RESULTS - Nomograms derived from developed populations consistently overestimated the 50(th) centile EFW value for Congolese fetuses by roughly 5-12%. Differences observed in the 10(th) and 90(th) centiles were inconsistent between nomograms, but generally followed a pattern of overestimation that decreased with advancing gestational age.
CONCLUSIONS - In low-resource settings, endemic malaria and maternal nutritional factors, including low prepregnancy weight and pregnancy weight gain, probably lead to lower fetal weight and utilization of nomograms derived from developed populations is not appropriate. This customized nomogram could provide more applicable reference intervals for diagnosis of intrauterine growth restriction in sub-Saharan African populations.
OBJECTIVE - To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.
DESIGN - Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.
RESULTS - Of 540 infants, 100 (18.5 %) weighed
208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake CONCLUSIONS - In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
OBJECTIVE - To describe smoking cessation interventions by prenatal care providers and to identify factors associated with best practice.
METHODS - A mailed survey assessed implementation of the "5 A's" of best practice (Ask about smoking; Advise patients to quit; Assess willingness to quit; Assist with a cessation plan; and Arrange follow-up), practice characteristics, intervention training, resources, barriers, and attitudes toward reimbursement. Each factor in association with provider type and best practice implementation was analyzed.
RESULTS - Of 1,138 eligible North Carolina health professionals, 844 responded (74%); 549 were providing prenatal care and returned completed surveys. Most asked about smoking (98%) and advised cessation (100%). Across provider type, one third (31%) consistently implemented all "5 A's" of best practice. Most providers (90%) had at least one material resource (eg, pamphlets), which correlated with nearly 10 times the adjusted odds of best practice (odds ratio [OR] 9.6, 95% confidence interval [CI] 1.3-72.9). Seventy percent had at least one counseling resource. Having a counseling resource (OR 2.5, 95% CI 1.4-4.4) and a written protocol to identify staff responsibilities (OR 2.5, 95% CI 1.5-4.3) were equally associated with best practice. More than one half of providers endorsed reimbursement as influential on best practice.
CONCLUSION - Best practice is well-established to promote prenatal smoking cessation yet implemented by only one third of prenatal care providers in North Carolina. In this study, best practice was associated with resources, practice organization, and reimbursement. Augmented use of available resources (eg, toll-free hotlines) and adequate reimbursement may promote best practice implementation.