scholarly journals Association between late presentation to prenatal care and adverse outcomes among women with chronic hypertension

2022 ◽  
Vol 226 (1) ◽  
pp. S624-S625
Author(s):  
Jacqueline M. Powell ◽  
Alyssa R. Hersh ◽  
Michaela C. Rickert ◽  
Amy M. Valent
2022 ◽  
Vol 226 (1) ◽  
pp. S355-S356
Author(s):  
Michaela C. Rickert ◽  
Amy M. Valent ◽  
Alyssa R. Hersh ◽  
Jacqueline M. Powell

2020 ◽  
Vol 37 (08) ◽  
pp. 800-808 ◽  
Author(s):  
Aleha Aziz ◽  
Noelia Zork ◽  
Janice J. Aubey ◽  
Caitlin D. Baptiste ◽  
Mary E. D'Alton ◽  
...  

As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. Key Points


Author(s):  
Cheng Gao ◽  
Sarah Osmundson ◽  
Bradley Malin ◽  
You Chen

Objectives: Like other areas of care affected by the COVID-19 pandemic, telehealth (both audio and video) was rapidly adopted in the obstetric setting. We performed a retrospective analysis of electronic health record (EHR) data to characterize the sociodemographic and clinical factors associated with telehealth utilization among patients who received prenatal care. Materials and Methods: The study period covered March 23rd, 2020 to July 2nd, 2020, during which time 2,521 patients received prenatal care at a large academic medical center. We applied a generalized logistic regression to measure the relationship between the patients’ sociodemographic factors (in terms of age, race, ethnicity, urbanization level, and insurance type), pregnancy complications (namely, type 2 diabetes, chronic hypertension, and fetal growth restriction), and telehealth usage, as documented in the EHR. Results: During the study period, 2,521 patients had 16,516 prenatal care visits. 938 (37.2%) of the patients participated in at least one of 1,934 virtual prenatal care visits. Prenatal visits were more likely to be conducted through telehealth for patients who were older than 25 years old and lived in rural areas. In addition, patients who were with type 2 diabetes were more likely to use telehealth in their prenatal care (adjusted Odds Ratio (aOR) 7.247 [95% Confidence Interval (95% CI) 4.244 – 12.933]). By contrast, patients from racial and ethnic minority groups were less likely to have a telehealth encounter compared to white or non-Hispanic patients (aOR 0.603 [95% CI 0.465 – 0.778] and aOR 0.663 [95% CI 0.471 – 0.927], respectively). Additionally, patients who were on state-level Medicaid were less likely to use telehealth (aOR 0.495 [95% CI 0.402 – 0.608]). Discussion: Disparities in telehealth use for prenatal care suggest further investigations into access barriers. Hispanic patients who had low English language proficiency may not willing to see doctors via virtual care. Availability of high-speed internet and/or hardware may hold these patients who were insured through state-level Medicaid back due to poverty. Future work is advised to minimize access barriers to telehealth in its implementation. Conclusions: While telehealth expanded prenatal care access for childbearing women during the COVID-19 pandemic, this study suggested that there were non-trivial differences in the demographics of patients who utilized such settings.


2014 ◽  
Vol 210 (1) ◽  
pp. S158
Author(s):  
Allison Allen ◽  
Jonathan Snowden ◽  
Bethany Sabol ◽  
Jennifer Salati ◽  
Shireen de Sam Lazro ◽  
...  

2018 ◽  
Vol 33 (10) ◽  
pp. 1638-1642
Author(s):  
Jose R. Duncan ◽  
Erin J. MacDonald ◽  
Katherine M. Dorsett ◽  
Mannu Nayyar ◽  
Zoran Bursac ◽  
...  

Author(s):  
Allen Suzane França ◽  
Catherine M. Pirkle ◽  
Tetine Sentell ◽  
Maria P. Velez ◽  
Marlos R. Domingues ◽  
...  

Adequate health literacy is important for strong health outcomes during pregnancy, particularly among mothers with high risk of adverse outcomes related to pregnancy and childbirth. Understanding the health literacy of young pregnant women in low-income settings could support strategies to reduce adverse outcomes in this population. This exploratory study assessed the health literacy of young pregnant adolescents and young adults from a rural area in Northeast Brazil and associated factors such as socioeconomic conditions, adequacy of prenatal care, and social support from family and friends. In this cross-sectional study, 41 pregnant adolescents (13–18 years) and 45 pregnant adults (23–28 years) from the Rio Grande do Norte state, Brazil, were assessed regarding health literacy through the Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA, score from 0–18, inadequate if <15). Income sufficiency, self-perceived school performance, compliance with recommendations for adequate prenatal care, and social support were also assessed. A linear regression analysis was conducted to evaluate the variables associated with the SAHLPA score. Ninety-five percent of the adolescents and 53.3% of the adults (p < 0.001) presented inadequate health literacy. Adolescent age (β − 3.5, p < 0.001), poorer self-perceived school performance (β − 2.8, p < 0.001), and insufficient income for basic needs (β − 2.8, p = 0.014) were associated with worse SAHLPA scores. Adolescent mothers have higher rates of inadequate health literacy in this population. Policies are needed to improve access to health information for young populations from rural low-income areas.


2019 ◽  
Vol 36 (13) ◽  
pp. 1394-1400 ◽  
Author(s):  
Courtney J. Mitchell ◽  
Alan Tita ◽  
Sarah B. Anderson ◽  
Daniel N. Pasko ◽  
Lorie M. Harper

Objective We assessed the risk of small for gestational age and other outcomes in pregnancies complicated by chronic hypertension with blood pressure <140/90 mm Hg. Study Design Retrospective cohort of singletons with hypertension at a single institution from 2000 to 2014. Mean systolic blood pressure and mean diastolic blood pressure were analyzed as continuous and dichotomous variables (<120/80 and 120–139/80–89 mm Hg). The primary outcome was small for gestational age. Secondary outcomes included birth weight, preeclampsia, preterm birth <35 weeks, and a composite of adverse neonatal outcomes. Results Small for gestational age was not increased with a mean systolic blood pressure <120 mm Hg compared with a mean systolic blood pressure 120 to 129 mm Hg (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI] 0.92–2.79). Mean diastolic blood pressure <80 mm Hg was associated with a decrease in the risk preeclampsia (AOR 0.57; 95% CI 0.35–0.94), preterm birth <35 weeks (AOR 0.35; 95% CI 0.20–0.62), and the composite neonatal outcome (AOR 0.42; 95% CI 0.22–0.81). Conclusion Mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg were not associated with increased risk of small for gestational age when compared with higher, normal mean systolic and diastolic blood pressures.


2016 ◽  
Vol 128 (2) ◽  
pp. 270-276 ◽  
Author(s):  
Jamie L. Morgan ◽  
David B. Nelson ◽  
Scott W. Roberts ◽  
C. Edward Wells ◽  
Donald D. McIntire ◽  
...  

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Heather Baldwin ◽  
Siranda Torvaldsen ◽  
Kristen Rickard ◽  
Tanya Nippita ◽  
Jillian Patterson

Abstract Background Gestational diabetes, hypertension, thyroid conditions and morbid obesity in pregnancy are associated with increased risks of adverse outcomes. Hospital data are important for research on these conditions, however, up-to-date validation of reporting is needed to understand the extent to which the data reflect the clinical situation. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Obstetric data, from the ObstetriX system, was used as the gold standard to which linked hospital data, from the Electronic Medical Record, were compared. Results There were 35,928 births included. Gestational and pre-existing diabetes had high sensitivity (83.6% and 88.2%) and positive predictive values (PPV, 92.7% and 86.0%). Pre-eclampsia and eclampsia, gestational hypertension and any hypertension had good sensitivity (80.0%, 80.1%, 81.5%), but moderate PPVs (59.7%, 65.6%, 70.4%), while for chronic hypertension sensitivity (53.5%) and PPV (53.2%) were lower. Obesity and thyroid conditions showed low sensitivity (9.8%, 12.9%; PPV 65.6%, 82.3%). Specificity and NPV were high for all conditions. Conclusions We found reliable reporting of gestational diabetes, pre-existing diabetes and all types hypertension, except for chronic hypertension which was moderately well reported. Thyroid conditions and morbid obesity were very poorly reported. Key messages Diabetes appears well reported in the hospital data, and sensitivity for hypertension may be improved by using a grouped category. Hospital data on thyroid conditions and obesity should be used with caution.


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