Preventing first births among adolescents in Mexico City’s public abortion programme

IntroductionWe examined parity and age among women seeking an abortion in Mexico City’s public first-trimester abortion programme, Interrupcion Legal de Embarazo (ILE). We hypothesised that younger women, especially students, used abortion to prevent first births while older women used abortion to limit births.MethodsWe used clinical data from a sample of 47 462 women who had an abortion between 2007 and 2016 and classified them as nulliparous or parous according to previous births prior to the abortion. We used logistic regression to identify sociodemographic and clinical factors associated with using abortion to prevent a first birth (nulliparous) versus limiting births (parous) and calculated absolute multivariable predicted probabilities.ResultsOverall, 41% of abortions were in nulliparous women seeking to prevent a first birth, and 59% were in women who already had one or more children. The adjusted probability of using abortion to prevent a first birth was 80.4% (95% CI 78.3 to 82.4) for women aged 12–17 years and 54.3% (95% CI 51.6 to 57.0) for women aged 18–24 years. Adolescents (aged 12–17 years) who were employed or students had nearly 90% adjusted probability of using abortion to prevent a first birth (employed 87.8%, 95% CI 82.9 to 92.8; students 88.5%, 95% CI 82.9 to 94.1). At all ages, employed women and students had higher probabilities of using abortion to prevent a first birth compared with unemployed women and women who work in the home.ConclusionLegal first-trimester abortion services in Mexico can help prevent first births in adolescents, especially students.

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Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda

AIDS Research and Treatment ◽

10.1155/2017/3527563 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Rachel Musomba ◽

Frank Mubiru ◽

Shadia Nakalema ◽

Hope Mackline ◽

Ivan Kalule ◽

...

Keyword(s):

Pregnant Women ◽

Older Women ◽

First Trimester ◽

Hiv Positive ◽

Urban Centre ◽

Factors Associated ◽

Point Of Entry ◽

Art Initiation ◽

Hiv Positive Women

Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64–1.0, and P=0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34–0.98, and P=0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.

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Factors associated with HIV and syphilis screenings among pregnant women at first antenatal visit in Lusaka, Zambia

BMC Research Notes ◽

10.1186/s13104-020-05266-0 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Rindcy Davis ◽

Xu Xiong ◽

Fernando Althabe ◽

John Lefante ◽

Maria Luisa Cafferata ◽

...

Keyword(s):

Pregnant Women ◽

Older Women ◽

Prevalence Ratio ◽

Married Women ◽

Antenatal Visit ◽

Hiv Screening ◽

Previous Pregnancy ◽

Younger Women ◽

Factors Associated ◽

Syphilis Screening

Abstract Objectives To identify characteristics associated with obtaining HIV and syphilis screenings of pregnant women attending a first antenatal visit in Lusaka, Zambia. Results Among 18,231 participants from April 2015 to January 2016, 95% obtained HIV screening, 29% obtained syphilis screening, and 4% did not obtain antenatal HIV or syphilis screenings. Divorced/separated women were associated with a moderate decrease in prevalence of obtaining HIV (adjusted prevalence ratio (aPR) 0.88, 95% confidence interval (95% CI) 0.82, 0.95) and syphilis (aPR 0.51, 95% CI 0.27, 0.96) screenings compared to married women. Women with previous pregnancies were associated with a slight decrease in prevalence of obtaining HIV screening (aPR 0.97, 95% CI 0.95, 0.99) compared to women without previous pregnancy. Older women ≥ 35 years were associated with a slight decrease in prevalence of obtaining HIV screening (aPR 0.96, 95% CI 0.92, 0.99) compared to younger women. The statistically significant differences were not of clinical relevance as defined by a proportional difference of 10 percent. Findings of this study show that a vast majority of pregnant women are obtaining HIV screenings but not syphilis screenings during first antenatal visit. Provision of antenatal HIV and syphilis screening at first visit is only weakly related to patient level factors.

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Experience obtaining legal abortion in Uruguay: knowledge, attitudes, and stigma among abortion clients

BMC Women s Health ◽

10.1186/s12905-019-0855-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Shelly Makleff ◽

Ana Labandera ◽

Fernanda Chiribao ◽

Jennifer Friedman ◽

Roosbelinda Cardenas ◽

...

Keyword(s):

Community Outreach ◽

High Volume ◽

First Trimester ◽

Trimester Abortion ◽

Waiting Period ◽

Younger Women ◽

Women’S Experiences ◽

Abortion Law ◽

Women's Experiences ◽

The Law

Abstract Background The abortion law in Uruguay changed in 2012 to allow first trimester abortion on request. Implementation of the law in Uruguay has been lauded, but barriers to care, including abortion stigma, remain. This study aimed to assess women’s experiences seeking abortion services and related attitudes and knowledge following implementation of the law in Uruguay. Methods We interviewed 207 eligible women seeking abortion services at a high-volume public hospital in Montevideo in 2014. We generated univariate frequencies to describe women’s experiences in care. We conducted regression analysis to examine variations in experiences of stigma by women’s age and number of abortions. Results Most of the women felt that abortion was a right, were satisfied with the services they received, and agreed with the abortion law. However, 70% found the five-day waiting period unnecessary. Women experienced greater self-judgement than worries about being judged by others. Younger women in the sample (ages 18–21) reported being more worried about judgment than women 22 years or older (1.02 vs. 0.71 on the ILAS sub-scale). One quarter of participants reported feeling judged while obtaining services. Women with more than one abortion had nearly three times the odds of reporting feeling judged. Conclusions These findings highlight the need to address abortion stigma even after the law is changed. Some considerations from Uruguay that may be relevant to other jurisdictions reforming abortion laws include: the need for strategies to reduce judgmental behavior from staff and clinicians towards women seeking abortions, including training in counseling skills and empathic communication; addressing stigmatizing attitudes about abortion through community outreach or communications campaigns; mitigating the potential stigma that may be perpetuated through policies to prevent “repeat” abortions; ensuring that younger women and those with more than one abortion feel welcome and are not mistreated during care; and assessing the necessity of a waiting period. The rapid implementation of legal, voluntary abortion services in Uruguay can serve in many ways as an exemplar, and these findings may inform the process of abortion law reform in other countries.

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Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age

Scandinavian Journal of Public Health ◽

10.1177/1403494817693456 ◽

2017 ◽

Vol 45 (3) ◽

pp. 222-229 ◽

Cited By ~ 5

Author(s):

Lovisa Brehmer ◽

Kristina Alexanderson ◽

Erica Schytt

Keyword(s):

Sick Leave ◽

Older Women ◽

Inpatient Care ◽

Maternal Age ◽

Mean Values ◽

Younger Women ◽

Pregnancy And Childbirth ◽

Nulliparous Women ◽

Starting Point ◽

Delivery Date

Aims: To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery. Methods: This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006–2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding. Results: Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3–37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4–4.3 days. Conclusions: This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.

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Age at first birth and lifetime fertility

Journal of Biosocial Science ◽

10.1017/s0021932000017405 ◽

1988 ◽

Vol 20 (2) ◽

pp. 167-174 ◽

Cited By ~ 9

Author(s):

T. R. Balakrishnan ◽

K. Vaninadha Rao ◽

Karol J. Krotki ◽

Evelyne Lapierre-Adamcyk

Keyword(s):

Older Women ◽

National Sample ◽

Fertility Survey ◽

Age At First Birth ◽

First Birth ◽

Younger Women ◽

Cumulative Fertility ◽

Catch Up ◽

Late Starters

SummaryAmong a national sample of Canadian women in the Canadian National Fertility Survey of 1984, the excess cumulative fertility of those who started their families early over others has steadily decreased. A difference of approximately two births between early and late starters among older women is reduced to approximately half a child among the younger women. Except for those who start childbearing after age 25, there is little evidence of attempts to catch up after age 30, irrespective of starting age.

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Agreement between maternal recall of distant first birth events with hospital birth records: A cohort study

10.21203/rs.3.rs-951334/v1 ◽

2021 ◽

Author(s):

Mindy Ebrahimoff

Keyword(s):

Logistic Regression ◽

Pain Relief ◽

Birth Outcome ◽

First Birth ◽

Limits Of Agreement ◽

Hospital Records ◽

Nulliparous Women ◽

Maternal Recall ◽

Birth Records ◽

Labour Onset

Abstract BACKGROUND Inter and intra-generational birth cohorts could be particularly useful for predicting the likelihood of labour and birth events for nulliparous women. However, maternal recall of their first childbirth may be imprecise, and hospital records can be inaccurate. Establishing the extent of agreement between mothers’ recall and hospital reports of historical first birth events could be the basis of a prediction tool that could contribute to better health care practices during daughter’s perinatal period. METHODS In 2015, women who had their first baby between 1967 and 1997 were asked to recall gravidity, method of labour onset, type of pain relief, length of labour, birth outcome, and infant’s gender, birthweight and gestational age ≥17 years postpartum. Responses were compared to hospital birth records. Agreement was evaluated using Bland-Altman’s plots and Kappa statistics (k). Logistic regression modeling was used to determine factors influencing discrepant recall. RESULTS Of 150 questionnaires distributed, 101 records were complete. Up to 49 years after birth there was strong agreement for birthweight measured at interval (mean discrepancy -28.69g, SD =170.91g, Bland-Altman 95% limits of agreement (-363.66g, 306.28g)) and category level birthweight k=0.83, good agreement for gestational age (GA) in weeks, at interval level (mean difference=0, SD =0.90, Bland-Altman 95% limits of agreement (-1.766, 1.766)) and at category level GA k=0.56. There was moderate agreement for labour length (≤10hrs/>10hrs) k=0.54; 43% of records did not record this information. For gravidity k=0.43, labour onset k=0.79; any pain relief k=0.61; and birth outcome k=0.91. Univariate logistic regression showed better agreement on infant birthweight in women with higher levels of education, lower agreement for onset of labour method with increasing maternal age at birth, and higher agreement for use of pethidine, but lower agreement for use of epidural in women who had their first babies more recently. CONCLUSIONS Mothers accounts of first birth events generally agree with hospital records. Familial birth data may contribute to more individualised care for nulliparous women, and may limit rising interventions based on population level guidelines. Future research in other settings is warranted before diagnostic criteria may be used in clinical settings.

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Prediction of preterm birth in nulliparous women using logistic regression and machine learning

PLoS ONE ◽

10.1371/journal.pone.0252025 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252025

Author(s):

Reza Arabi Belaghi ◽

Joseph Beyene ◽

Sarah D. McDonald

Keyword(s):

Machine Learning ◽

Neural Networks ◽

Logistic Regression ◽

Artificial Neural Networks ◽

Preterm Birth ◽

First Trimester ◽

Validation Sample ◽

Second Trimester ◽

Nulliparous Women ◽

Artificial Neural

Objective To predict preterm birth in nulliparous women using logistic regression and machine learning. Design Population-based retrospective cohort. Participants Nulliparous women (N = 112,963) with a singleton gestation who gave birth between 20–42 weeks gestation in Ontario hospitals from April 1, 2012 to March 31, 2014. Methods We used data during the first and second trimesters to build logistic regression and machine learning models in a “training” sample to predict overall and spontaneous preterm birth. We assessed model performance using various measures of accuracy including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) in an independent “validation” sample. Results During the first trimester, logistic regression identified 13 variables associated with preterm birth, of which the strongest predictors were diabetes (Type I: adjusted odds ratio (AOR): 4.21; 95% confidence interval (CI): 3.23–5.42; Type II: AOR: 2.68; 95% CI: 2.05–3.46) and abnormal pregnancy-associated plasma protein A concentration (AOR: 2.04; 95% CI: 1.80–2.30). During the first trimester, the maximum AUC was 60% (95% CI: 58–62%) with artificial neural networks in the validation sample. During the second trimester, 17 variables were significantly associated with preterm birth, among which complications during pregnancy had the highest AOR (13.03; 95% CI: 12.21–13.90). During the second trimester, the AUC increased to 65% (95% CI: 63–66%) with artificial neural networks in the validation sample. Including complications during the pregnancy yielded an AUC of 80% (95% CI: 79–81%) with artificial neural networks. All models yielded 94–97% negative predictive values for spontaneous PTB during the first and second trimesters. Conclusion Although artificial neural networks provided slightly higher AUC than logistic regression, prediction of preterm birth in the first trimester remained elusive. However, including data from the second trimester improved prediction to a moderate level by both logistic regression and machine learning approaches.

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Hyponatremia associated with preeclampsia

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0062 ◽

2017 ◽

Vol 45 (4) ◽

Cited By ~ 7

Author(s):

Armin S. Razavi ◽

Stephen T. Chasen ◽

Ritu Gyawali ◽

Robin B. Kalish

Keyword(s):

Older Women ◽

Electronic Medical Records ◽

Serum Sodium ◽

Medical Records ◽

Sodium Level ◽

Descriptive Study ◽

Clinical Factors ◽

Factors Associated ◽

Hypertension In Pregnancy ◽

In Pregnancy

AbstractObjective:The objective of our study was to evaluate the prevalence and clinical factors associated with hyponatremia in patients with preeclampsia.Study design:This is a descriptive study of all patients who delivered at our institution from 2013 to 2014. Patients with preeclampsia were identified from electronic medical records. Preeclampsia with and without severe features was defined using the criteria outlined in the American Congress of Obstetricians and Gynecologists Hypertension in Pregnancy guidelines. As sodium levels have been shown to be approximately 5 mEq/L lower in pregnancy, hyponatremia was defined as a sodium level <130 mEq/L.Results:We identified 332 pregnancies complicated by preeclampsia, including 277 singletons and 55 twins. Hyponatremia was noted in 32 (9.7%) patients. Preeclampsia with severe features was present in the majority of patients with hyponatremia, and hyponatremia was more common in those with preeclampsia with severe features compared to those without (P<0.001). Hyponatremia also occurred more frequently in twins (P=0.001) and in older women (P=0.017). Only one patient without hyponatremia had an eclamptic seizure.Conclusion:Hyponatremia is not uncommon in preeclampsia, and is even more common in those with preeclampsia with severe features and twin gestations. As women with preeclampsia are at risk for hyponatremia, serum sodium should be monitored, especially in women with preeclampsia with severe features or twin gestations.

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When online becomes offline: attitudes to safer sex practices in older and younger women using an Australian internet dating service

Sexual Health ◽

10.1071/sh10164 ◽

2012 ◽

Vol 9 (2) ◽

pp. 152 ◽

Cited By ~ 17

Author(s):

Deborah J. Bateson ◽

Edith Weisberg ◽

Kirsten J. McCaffery ◽

Georgina M. Luscombe

Keyword(s):

Older Women ◽

Safer Sex ◽

Sexual Partners ◽

The Internet ◽

Internet Dating ◽

Younger Women ◽

Factors Associated ◽

Sexually Transmissible Infections ◽

Safer Sex Practices ◽

Sex Practices

Background The prevalence of sexually transmissible infections (STIs) is increasing among older Australian women, partly due to re-partnering after divorce or death of a spouse. Older women may be less likely to use condoms with new sexual partners, exposing themselves to STIs. An online survey compared characteristics of internet dating women aged 40 and above with 18 to 39 year olds, and determined the factors associated with protective safer sex attitudes. Methods: An email directed women who had logged onto the internet dating service ‘RSVP’ in the previous 6 months to a survey hosted by Family Planning New South Wales. The survey explored demographic factors, STI-related knowledge and attitudes towards safer sex practices. Factors associated with discussing STIs before sex and refusing sex without a condom with a new partner were analysed using logistic regression. Results: The questionnaire was completed by 1788 women. Almost two-thirds (62.2%) were aged 40 or over. The majority (64.8%) were seeking a long-term partner. In the previous year, 41.5% of all women met a new sexual partner via the internet. Women aged >40 years were significantly more likely to discuss STIs with a new partner but less likely to refuse sex without a condom compared with younger women. Conclusions: The internet is a useful venue for women of all ages to meet new sexual partners. Older women are vulnerable to STI acquisition through failure to use condoms with a new partner. Research is needed to determine effective interventions to increase condom use in this age group.

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