A systematic review and meta-analysis of brief interventions delivered during antenatal care aimed at promoting energy balance behaviours

BackgroundOptimal energy balance behaviours in pregnancy reduce maternal and foetal risk of obesity. A brief intervention (defined as one that is purposefully limited in frequency and time of contact) delivered by during routine antenatal care may promote health behaviour change. We aimed to assess the effectiveness of brief interventions targeting diet, physical activity (PA) and weight monitoring behaviours in improving gestational weight gain (GWG) and/or energy balance behaviours (diet, PA) during pregnancy.Methods We searched twelve databases for RCT or quasi-RCTs until September 2019. Eligible studies were brief interventions delivered during routine antenatal care, targeting GWG, diet and/or PA behaviours. Controls were either standard antenatal care or more intense lifestyle interventions. Pooled effect sizes were calculated using random-effects meta-analysis. Results were stratified by women’s baseline weight status. The ROB2 tool for risk of reporting bias was applied.ResultsWe identified twelve studies of which nine were eligible for meta-analysis. Meta-analysis showed that brief interventions significantly reduced total GWG by -1.26 kg (95% CI -1.80, -0.73) compared with controls. When reported as a proportion of women exceeding Institute of Medicine GWG guidelines, effects were non-significant (OR 0.99 (95% CI 0.82, 1.19)). Subgroup analysis found greater GWG reductions in women entering pregnancy with overweight or obesity. Study quality was variable; five were ‘high risk’, four ‘some concern’, and three ‘low risk’ for study bias.ConclusionOverall, brief interventions during routine antenatal care can lead to small but significant reductions in GWG. GWG reductions in women with overweight/obesity were more pronounced. Observed effect sizes were of equal magnitude to more resource-intensive antenatal lifestyle interventions. Although there is limited evidence for brief interventions changing diet-related or PA behaviours directly, if delivered during routine antenatal care they may offer a pragmatic strategy to prevent excess GWG.

Ethical Issues Relating to Prenatal Genetic Testing

"Introduction: Non-invasive prenatal testing (NIPT) is a rapidly developing genomic technology that is constantly widening its scope and opening up new possibilities in reproductive medicine. Ten years after NIPT has been made commercially available, it is increasingly entering routine antenatal care as either a first- or second-tier test. In England, France and Germany, for example, NIPT has been made available free-of-charge as a second-tier test to women with a higher chance of common chromosomal anomalies. The clinical implementation of NIPT carries benefits but also raises important ethical questions. Our project analyses these questions within their specific contexts in England, France and Germany. Methods: As part of a wider research project, which will involve qualitative methods, we conducted a document analysis to compare arguments about, and regulations governing NIPT in the three countries in: law and policy document; public reports; medical press; academic literature; and media. Results: Despite the similarities between the three countries to offer NIPT as a second-tier screening tool, they exhibit differences with regard to their public discourses about prenatal genomics, screening policies, the risk-thresholds they use, professional regulations and laws. These differences have an impact on the way ethical issues emerge, and questions about the meaning of health, illness and disability, the scope of public health interventions, social inclusion and exclusion as well as reproductive choice are approached in each country. "

An evaluation of an influenza vaccination campaign targeting pregnant women in 27 clinics in two provinces of South Africa, 2015 – 2018

Introduction Despite prioritization, routine antenatal influenza vaccine coverage is < 16% in South Africa. We aimed to describe maternal influenza vaccine coverage in 27 antenatal clinics (ANCs) in Gauteng and Western Cape (WC) Provinces, where in collaboration with the Department of Health (DoH), we augmented the annual influenza vaccination programme among pregnant women. Methods From 2015 through 2018, 40,230 additional doses of influenza vaccine were added to the available stock and administered as part of routine antenatal care. Educational talks were given daily and data were collected on women attending ANCs. We compared characteristics of vaccinated and unvaccinated women using multivariable logistic regression. Results We screened 62,979 pregnant women during the period when Southern Hemisphere influenza vaccines were available (27,068 in Gauteng and 35,911 in WC). Vaccine coverage at the targeted clinics was 78.7% (49,355/62682), although pregnant women in WC were more likely to be vaccinated compared to those in the Gauteng (Odds ratio (OR) =3.7 p < 0.001). Women aged 25—29 and > 35 years were less likely to be vaccinated than women aged 18—24 years (OR = 0.9 p = 0.053; OR = 0.9 p < 0.001). HIV positive status was not associated with vaccination (OR = 1.0 p = 0.266). Reasons for not vaccinating included: vaccine stock-outs where ANCs depleted available stock of vaccines and/or were awaiting delivery of vaccines (54.6%, 6949/12723), refusal/indecision (25.8%, 3285), and current illness that contraindicated vaccination (19.6%, 2489). Conclusion Antenatal vaccination uptake was likely improved by the increased vaccine supply and vaccine education offered during our campaign.

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

Background Antenatal depression is highly prevalent but a neglected public health problem in low income countries. It has serious effects on the general health of women, birth outcomes and child health. However, there has been limited substantial evidence on the prevalence and predictors of antenatal depression in Ethiopia. This lack of evidence potentiates the consequences of the problem and can limit the attention to intervention. Thus, this study aimed to assess the prevalence and potential predictors of antenatal depression at Debre Tabor and Woreta towns, Northeast Ethiopia. Methods A community-based cross-sectional study was employed on 548 pregnant women recruited by a cluster sampling method. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences Questionnaire (LTE-Q), the Oslo-3 Social Support Scale (OSSS-3), Intimate Partner Violence (IPV) Scale and Fast Alcohol Screening Test (FAST) were also used to measure stressful events, social support, intimate partner violence (IPV) and hazardous alcohol use respectively. Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with antenatal depression. Results The prevalence of antenatal depression was found to be 24.45% (95% CI: 21.20, 28.30%). Being single (AOR =3.32, 95% CI = 1.36, 8.09); fear of pregnancy complication (AOR = 3.84, 95% CI = 1.53,9.62); history of chronic illness (AOR = 8.14, 95% CI = 2.14, 30.91); unplanned pregnancy (AOR = 2.99, 95% CI = 1.36,6.55); history of stillbirth (AOR = 3.56, 95% CI = 1.23, 10.29),one or more negative life events (AOR = 4.06, 95% CI = 1.71, 9.66) and intimate partner violence (AOR = 3.91, 95% CI = 1.65, 9.26) were factors significantly associated with antenatal depression. Conclusion Nearly a quarter of pregnant women suffer from depressive symptoms during pregnancy. Being single; fear of pregnancy complication; history of chronic illness; unplanned pregnancy; history of stillbirth; one or more negative life events and intimate partner violence were important predictors of antenatal depression in this study. Health care workers should consider addressing these risk factors during a routine antenatal care. Also, integrating early screening, detection, and treatment of antenatal depression into routine antenatal care is warranted to improve the quality of life of pregnant women and pregnancy outcomes as well.

Gitelman Syndrome in Pregnancy: A Clinical Challenge

Purpose Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks’ gestation under spinal anesthesia and delivered a healthy 3090-gram female infant. Conclusion Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.

Study of incidence of urinary tract infection during pregnancy and its effect on maternal and perinatal outcome

Background: Urinary tract infection is the commonest bacterial infection in pregnancy, especially in developing countries like India. It has several adverse outcomes not only in the mother but also in the fetus. This study aims to determine the incidence of UTI during pregnancy, the commonest micro-organism causing UTI, and to find out the impact of such infection on maternal and fetal outcomes.Methods: This observational study was carried out in the department of obstetrics and gynaecology Deen Dayal Upadhyay Hospital, New Delhi over a period of 10 months. A total of 196 pregnant women attending the outdoor hospital for ANC check-up without any medical disorder or previous adverse pregnancy outcomes were included in this study. Urine routine microscopy was done as a screening test for UTI. They were followed through their pregnancy and puerperium due to any pregnancy complication and perinatal outcome.Results: Incidence of urinary tract infection was 12.2%, of which 8.2% were asymptomatic and 4.08% were symptomatic. It was found that the incidence of UTI was highest in the age group of 18 to 25 years and also found that UTI was more common in the second (16.7%) and third (16.7%) trimester and lowest in the first trimester (5.7%). Women who had anaemia, pregnancy-induced hypertension, preterm labour, chorioamnionitis, perinatal mortality, and puerperal pyrexia had a high incidence of UTI than those who had not.Conclusions: From this study, we concluded that screening for UTI should be a part of routine antenatal care, and also there is a need to initiate an awareness program to educate women about UTI and their adverse fetomaternal outcome so that prompt and effective treatment can be done.

Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study

Background Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID) DERR1-10.2196/27196

Pregnant Women Utilization of Dental Services: Still a Challenge in Low Resource Setting

Background: Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low.Results: Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pains and swelling of the gum (33.3%). The commonest reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (<0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, <0.001 respectively) were statistically significant.Conclusion: The prevalence of dental consultations during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultations with oral health counseling and check-up incorporated as part of routine antenatal care.