Factors Associated With Cannabis Use During the Reproductive Cycle: A Retrospective Cross-Sectional Study of Women in States With Recreational and Medical Cannabis Legalization

Introduction Passage of cannabis laws may impact cannabis use and the use of other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. The present study contributes to the minimal literature on factors associated with cannabis use during the preconception, prenatal, and postpartum periods including state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care. Methods We conducted a cross-sectional analysis using combined survey data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS) collected from 36,391 women. Logistic regression was used to estimate the impact of state-legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and post-partum periods. Results In the preconception model, residence in a recreationally legal state (OR: 2.37; 95% CI, 2.04–2.75) or medically legal state (OR:3.32; 95% CI, 2.90–3.80) compared to a non-legal state was associated with higher odds of cannabis use. In the prenatal model, residence in a recreationally legal state was associated with higher odds of cannabis use (OR: 1.51; 95% CI, 1.29–1.79) whereas there was no association with residence in a medically legal state. Tobacco use including e-cigarettes and moderate prenatal alcohol use were also significantly associated with cannabis use. Conclusion Recreational cannabis legalization is associated with the use of cannabis prior to, during, and after pregnancy. Renewed clinical and policy efforts may be warranted to update prenatal substance use prevention programs, educational campaigns, and provider education as cannabis legalization evolves.

Adequacy of prenatal care services and associated factors in Southern Ethiopia

Background Prenatal care is an important component for the continuum of care in maternal and child health services. Despite increased attention on prenatal care service coverage, the adequacy of service provision has not been well addressed in Ethiopia. Therefore, this study aimed to describe the status of the adequacy of prenatal care and its associated factors in Southern Ethiopia. Method A longitudinal study done by the Performance care Monitoring and Accountability (PMA2020) project was used. The study was conducted from August 2016 to January 2017 in Southern Ethiopia. A multistage stratified cluster design in which all enumeration areas were randomly selected using probability proportional to size and all households were screened to identify 324 pregnant women of six or more months. Questions regarding early attendance of prenatal care, enough visits, and sufficient services were asked to measure the adequacy of prenatal care. Finally, an ordered logistic regression analysis was employed to assess factors associated with the adequacy of prenatal care services. Results Of the total pregnant women 44.21 % attended enough visits, 84.10 % had early visits, and 42.03 % received sufficient services. The women residing in urban areas had 2.35 odds of having adequate prenatal care in reference to rural areas (adjusted odds ratio (aOR) 2.35 [95 % CI 1.05–5.31]). Women who attended primary and secondary education had 2.42(aOR 2.42 [95 % C.I. 1.04, 5.65]), and 4.18 (aOR 4.18 [95 % CI 1.32, 13.29]) odds of adequate prenatal care in reference with those who never attended education respectively. The women participating in one to five networks have 2.18 odds of adequate prenatal care in reference to their counterparts (aOR 2.78 [95 % CI 1.01, 7.71]). Conclusions The adequacy of prenatal care services in Southern Ethiopia is very low. The Ethiopian health care system should strengthen one to five networks to discuss on family health issues. Further research, should validate the tools and measure the adequacy of the services in different contexts of Ethiopia using a mixed method study for an in-depth understanding of the problem.

Association between Prenatal Care Adequacy Indexes and Low Birth Weight Outcome

Objective To investigate the association between prenatal care (PNC) adequacy indexes and the low birth weigth (LBW) outcome. Methods A total of 368,093 live term singleton births in the state of Rio de Janeiro (Brazil) from 2015 to 2016 were investigated using data from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos, SINASC, in Portuguese). Seven PNC adequacy indexes were evaluated: four developed by Brazilian authors (Ciari Jr. et al., Coutinho et al., Takeda, and an index developed and used by the Brazilian Ministry of Health – MS) and three by authors from other countries (Kessner et al., the Adequacy of Prenatal Care Utilization index – APNCU, and the Graduated Prenatal Care Utilization Index – GINDEX). Adjusted odds ratios were estimated for the PNC adequacy indexes by means of multivariate logistic regression models using maternal, gestational and newborn characteristics as covariates. Results When the PNC is classified as “inadequate”, the adjusted odds ratios to the LBW outcome increase between 42% and 132%, depending on which adequacy index is evaluated. Younger (15 to 17 years old) and older (35 to 45 years old) mothers, those not married, of black or brown ethnicity, with low schooling (who did not finish Elementary School), primiparous, with preterm births, as well as female newborns had increasing odds for LBW. The models presented areas under the receiver operating characteristic (ROC) curve between 80.4% and 81.0%, and sensitivity and specificity that varied, respectively, between 57.7% and 58.6% and 94.3% and 94.5%. Conclusion Considering all PNC adequacy indexes evaluated, the APNCU had the best discriminatory power and the best ability to predict the LBW outcome.

Adequacy of prenatal care considering nutritional assistance in Southern Brazil: Maternar Cohort Study

We verified the prevalence of adequacy in prenatal care considering nutritional assistance and associated factors. It is a cross-sectional study, part of Maternar Cohort Study, conducted between 2018-2019 in Southern Brazil. Women were interviewed during hospitalization in the immediate postpartum period and data were collected from the prenatal chart. Prenatal adequacy and nutritional care were assessed according to criteria from the Brazilian Ministry of Health. Two outcome models were constructed. Outcome 1 consisted of minimal coverage (early prenatal start and minimum number of visits) and exams, and Outcome 2 comprised minimal coverage, exams, and nutritional assistance. Poisson regression was used to estimate prevalence ratios. A total of 802 women were analyzed, and we identified 57% of adequacy of Outcome 1. Unplanned pregnancy (PR = 0.76; 95%CI: 0.68-0.86), parity (PR = 0.88; 95%CI: 0.83-0.94) and prenatal care outside Porto Alegre, Rio Grande do Sul State (PR = 0.80; 95%CI: 0.69-0.92), were associated with lower prenatal adequacy frequencies. Outcome 2 was considered adequate for 10.2% of women. Follow-up by different professionals during prenatal care was associated with lower adequacy (PR = 0.49; 95%CI: 0.28-0.86). Women with high-risk pregnancies had a higher frequency of adequacy in Outcome 1 (PR = 1.21; 95%CI: 1.07-1.37) and in Outcome 2 (PR = 1.75; 95%CI: 1.16-2.64). General adequacy was considered low in both outcomes. There was a lack of nutritional assistance during prenatal care. Characteristics such as pregnancy planning, lower parity, prenatal care in Porto Alegre, follow-up by the same professional and high-risk pregnancy were predictors for the adequacy of prenatal care.

To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort

Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011–2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.

Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.