Late presentation to prenatal care and adverse outcomes among pregnant persons with preexisting diabetes

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.

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Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic

American Journal of Perinatology ◽

10.1055/s-0040-1712121 ◽

2020 ◽

Vol 37 (08) ◽

pp. 800-808 ◽

Cited By ~ 18

Author(s):

Aleha Aziz ◽

Noelia Zork ◽

Janice J. Aubey ◽

Caitlin D. Baptiste ◽

Mary E. D'Alton ◽

...

Keyword(s):

High Risk ◽

Prenatal Care ◽

Gestational Hypertension ◽

Medical Center ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Hospital System ◽

Clinical Scenarios ◽

Increased Risk ◽

Virtual Visits

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

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Adolescent Prenatal Care and Adverse Outcomes

Obstetrics and Gynecology ◽

10.1097/00006250-200604001-00223 ◽

2006 ◽

Vol 107 (Supplement) ◽

pp. 94S

Author(s):

Melissa D. Mendez ◽

R Curtis Bay ◽

Dean V. Coonrod ◽

Linda Chambliss

Keyword(s):

Prenatal Care ◽

Adverse Outcomes

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Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.2.43 ◽

2008 ◽

Vol 17 (2) ◽

pp. 43-49

Author(s):

James L. Coyle

Keyword(s):

Treatment Effectiveness ◽

Code Of Ethics ◽

Oropharyngeal Dysphagia ◽

Clinical Importance ◽

Professional Services ◽

Adverse Outcomes ◽

Professional Judgment ◽

Evidence Based ◽

Intervention Selection ◽

Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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