Association between the number of visits during prenatal care and the occurrence of low birth weight in the United States

BackgroundLow birth weight (LBW) is one of the major child and infant health issues in the United States, standing as one of the main causes of child and infant mortality. While the importance of prenatal visits regarding pregnancy outcomes is recognized, its relationship with birth weight is still a matter of debate.ObjectivesThis study examines the relationship between the number of prenatal visits and low birth weight among children born in the United States in 2017.Study designData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals.ResultsData from the CDCs Online Birth Databases are used for this study. 3,864,754 registered children born in the U.S. in 2017 are included in the analyses. The databases also include information on maternal characteristics, pregnancy history and prenatal care characteristics, pregnancy risk factors, delivery characteristics, and infant characteristics. The outcome variable is low birth weight, defined as weight at birth lower than 2500 grams. The independent variable is the number of prenatal visits grouped in three categories (no visit, 10 visits or less, and more than 10 visits. Confounding and covariates include prematurity and plurality among others. Multiple logistic regression modeling was used, reporting unadjusted and adjusted odds ratios with corresponding 95% confidence intervals. ConclusionThis study reveals that the number of prenatal visits has an inverse relationship with low birth weight, even when confounding and other factors are accounted for. These findings are compatible with the notion that the more a woman goes for prenatal visits, the more likely it is to detect risks of negative pregnancy outcomes.

Psychological Distress of Testing Positive for Human Papillomavirus at Routine Prenatal Visits: A Prospective Observational Study among Chinese Pregnant Women with Normal Cytology

Background To explore the psychological impact of the positive HPV result on pregnant women with normal cytology. Methods The psychological distress level of HPV-positive women was compared with those of HPV-negative women before the results were notified. After the notification, the distress level of women in the HPV-positive group was assessed for the 2nd time and 3rd time before colposcopy and 2 weeks post-colposcopy. The lifestyle characteristics, knowledge of cervical cancer and screening behavior were compared between groups. Logistic regression was used to assess associations between socio-demographic, lifestyle, knowledge and risk of elevated distress level. Results No statistical difference of the distress level (as measured by PHQ-9 and GAD-7) was found between HPV-positive and -negative women. Within HPV-positive group, low distress level remained through all three time-points, regardless of HPV subtypes or colposcopy diagnoses. Half of the participants were suboptimally screened before this study conducted; 7.6% were aware of the causal relationship between HPV and cervical cancer. Post-graduate degree was associated with elevated PHQ-9 score. Conclusions HPV screening was unlikely to cause additional psychological distress among pregnant population in China.

Factors associated with cesarean delivery in adult nulliparous women

The aim of this study was to analyze the sociodemographic factors associated with cesarean section in adult women with conditions favorable for normal delivery and to identify the groups most likely to undergo this surgery in the state of Santa Catarina (SC). A case control study with microdata from the Sistema de Informação de Nascidos Vivos on 7,065 women for 2016 in SC. A relationship between cesarean section and sociodemographic variables was analyzed by logistic regression where we calculated the Adjusted Odds Ratio (AOR), confidence interval and p-value. The probability of cesarean section for each group of women (called "interaction") was also calculated. Among women with more favorable conditions for normal childbirth, the prevalence of cesarean section was 41.1%. Lower chance of cesarean section was found for women without partners (AOR: 0.79 [0.71-0.87]), up to 8 years of schooling (AOR: 0.56 [0.47-0.66]), with up to 2 prenatal visits (AOR: 0.46 [0.23-0.90]). The most likely group of women (51.4% [49.3-53.4]) to undergo cesarean section are women who perform 7 to 15 prenatal visits and have 12 or more years of schooling. A cesarean section occurs with women who have greater access to education and prenatal care and those who have partners, even though the aspects favor normal childbirth, suggesting that this does not seem to be a decision only by women.

Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health

Since the first reports of novel coronavirus in the 2020, public health organizations have advocated preventative policies to limit virus, including stay-at-home orders that closed businesses, daycares, schools, playgrounds, and limited child learning and typical activities. Fear of infection and possible employment loss has placed stress on parents; while parents who could work from home faced chal-lenges in both working and providing full-time attentive childcare. For pregnant individuals, fear of at-tending prenatal visits also increased maternal stress, anxiety, and depression. Not surprising, there has been concern over how these factors, as well as missed educational opportunities and reduced interaction, stimulation, and creative play with other children might impact child neurodevelopment. Lev-eraging a large on-going longitudinal study of child neurodevelopment, we examined general childhood cognitive scores in 2020 and 2021 vs. the preceding decade, 2011-2019. We find that children born during the pandemic have significantly reduced verbal, motor, and overall cognitive performance com-pared to children born pre-pandemic. Moreover, we find that males and children in lower socioeconom-ic families have been most affected. Results highlight that even in the absence of direct SARS-CoV-2 infection and COVID-19 illness, the environmental changes associated COVID-19 pandemic is signifi-cantly and negatively affecting infant and child development.

Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia

Objective To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict. Methods Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively). Results Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits. Conclusion The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.

Vasectomy interest and awareness among patients and their partners in prenatal clinics in the United States

ObjectiveAlthough vasectomy is safer, more effective and less expensive than tubal ligation, rates of permanent contraception are consistently higher in women than in men. We sought to explore vasectomy interest and awareness in patients and their partners during prenatal visits, a time when contraceptive counselling is typically performed.MethodsAnonymous surveys were distributed between January and July 2019 to a cross-sectional, convenience sample of pregnant women and their partners, if available, presenting for outpatient prenatal care at two hospitals (one public, one private) serving different patient populations in Chicago, Illinois, USA. Survey questions gauged participant awareness and interest in vasectomies.ResultsSurveys were completed by 436 individuals (78% female, 24% male). Seventy percent of respondents indicated interest in vasectomy after achieving optimal family size, but most respondents had never discussed it with their healthcare provider. Factors associated with vasectomy interest included being partnered, having a lower household income, and knowing someone who has had a vasectomy. Almost 50% of respondents would be interested in obtaining information about vasectomies from their obstetrician or prenatal care provider.ConclusionsMany patients and their male partners in the prenatal clinic setting were interested in vasectomy as a method for permanent contraception, but most respondents had never received counselling. Since comprehensive prenatal care includes contraceptive planning, obstetric providers are uniquely positioned to educate individuals on vasectomy.