Helse i svangerskapet blant innvandrerkvinner i Norge – en utforskende litteraturoversikt

BAKGRUNN Innvandrerkvinner er en sårbar gruppe innen norsk fødselsomsorg med økt risiko for uheldige svangerskapsutfall. Hensikten med denne utforskende litteraturoversikten var å få en oversikt over tilgjengelig kunnskap om helse i svangerskapet blant innvandrerkvinner i Norge. KUNNSKAPSGRUNNLAG Litteraturoversikten inkluderer 44 fagfellevurderte artikler om helse i svangerskapet blant innvandrerkvinner i Norge, med ulike studiedesign og publisert i perioden 2000–19. Søket ble utført i MEDLINE, Embase, Cochrane Library, CINAHL, Psycinfo, Maternity & Infant Care Database og SveMed+. RESULTATER Svangerskapsdiabetes, fedme, svangerskapskvalme, svangerskapsforgiftning og folatbruk var hyppig studerte temaer. Vi fant en betydelig variasjon i sykdomsrisiko for ulike undergrupper av innvandrere. FORTOLKNING Lite forskning er gjort på spesielt sårbare innvandrergrupper, som nyankomne, papirløse og flyktninger. Vi anbefaler at man i fremtidig forskning vurderer kvalitativt studiedesign der innvandrerfamiliers erfaringer blir belyst, samt intervensjonsstudier hvor effekt av tiltak prøves ut.publishedVersio

Women’s experiences and views on early breastfeeding during the COVID-19 pandemic in Norway: quantitative and qualitative findings from the IMAgiNE EURO study

Background Little is known about women’s experience of care and views on early breastfeeding during the COVID19 pandemic in Norway. Methods Women (n =2922) who gave birth in a facility in Norway between March 2020 and June 2021 were invited to answer an online questionnaire based on World Health Organization (WHO) Standard-based quality measures, exploring their experiences of care and views on early breastfeeding during the COVID-19 pandemic. To examine associations between year of birth (2020, 2021) and early breastfeeding-related factors, we estimated odds ratios (ORs) with 95% confdence intervals (CIs) using multiple logistic regression. Qualitative data were analysed using Systematic Text Condensation. Results Compared to the frst year of the pandemic (2020), women who gave birth in 2021 reported higher odds of experiencing adequate breastfeeding support (adjOR 1.79; 95% CI 1.35, 2.38), immediate attention from healthcare providers when needed (adjOR 1.89; 95% CI 1.49, 2.39), clear communication from healthcare providers (adjOR 1.76; 95% CI 1.39, 2.22), being allowed companion of choice (adjOR 1.47; 95% CI 1.21, 1.79), adequate visiting hours for partner (adjOR 1.35; 95% CI 1.09, 1.68), adequate number of healthcare providers (adjOR 1.24; 95% CI 1.02, 1.52), and adequate professionalism of the healthcare providers (adjOR 1.65; 95% CI 1.32, 2.08). Compared to 2020, in 2021 we found no diference in skin-to-skin contact, early breastfeeding, exclusive breastfeeding at discharge, adequate number of women per room, or women’s satisfaction. In their comments, women described understafed postnatal wards, early discharge and highlighted the importance of breastfeeding support, and concerns about long-term consequences such as postpartum depression. Conclusions In the second year of the pandemic, WHO Standard-based quality measures related to breastfeeding improved for women giving birth in Norway compared to the frst year of the pandemic. Women’s general satisfaction with care during COVID-19 did however not improve signifcantly from 2020 to 2021. Compared to pre-pandemic data, our findings suggest an initial decrease in exclusive breastfeeding at discharge during the COVID-19 pandemic in Norway with little diference comparing 2020 versus 2021. Our findings should alert researchers, policy makers and clinicians in postnatal care services to improve future practices

Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: results from the IMAgiNE EURO study

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.info:eu-repo/semantics/publishedVersio

Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored

Adverse neonatal outcomes in migrant women in Norway

Background: With increasing international migration, more knowledge is needed regarding migrant women’s pregnancies and births. Migrant families represent great diversity and investigating the risk of adverse neonatal outcomes in sub-groups of migrant women is therefore vital. Overall aim: To investigate associations between migration related factors (maternal country of birth, paternal origin, reason for immigration, length of residence and country of a woman’s first birth) and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in migrant and non-migrant women giving birth in Norway. Material and methods: All three papers are based on population-based register studies. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. We investigated associations between: (1) migration related factors (maternal country of birth, paternal origin, reason for immigration, length of residence, and birthplace of firstborn child) and stillbirth in births to migrant and non-migrant women (1990-2013); (2) country of a woman’s first birth and adverse neonatal outcomes (very preterm birth (22+0-31+6 gestational weeks), moderately preterm birth (32+0-36+6 gestational weeks), post-term birth (≥42 gestational weeks), small for gestational age, large for gestational age, low Apgar score (<7 at 5 minutes), stillbirth and neonatal death) in multiparous migrant and non-migrant women (1990-2016); and (3) paternal origin and adverse neonatal outcomes (very preterm birth, moderately preterm birth, low Apgar score and stillbirth) in migrant women (1990-2016). Associations were investigated using multiple logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals (CI). Analyses were performed separately for primiparous and multiparous women. Results: Paper 1: Primiparous women from Sri-Lanka and Pakistan, and multiparous women from Pakistan, Somalia, the Philippines and the Former Yugoslavia had higher odds of stillbirth when compared to non-migrant women (adjusted ORs ranged from 1.58 to 1.79 in primiparous and 1.50 to 1.71 in multiparous women). Primiparous migrant women whose babies were registered with a Norwegian-born father had decreased odds of stillbirth compared to migrant women whose babies were registered with a foreign-born father (aOR = 0.73; CI 0.58–0.93). Primiparous women migrating for work or education had decreased odds of stillbirth compared to Nordic women who migrate freely between the Nordic countries (aOR = 0.58; CI 0.39–0.88). Multiparous migrant women who gave birth to their first baby before arriving in Norway had higher odds of stillbirth in later births in Norway compared to multiparous migrant women who had had their first baby after arrival (aOR = 1.28; CI 1.06–1.55). Length of residence in Norway was not associated with stillbirth. Paper 2: Multiparous migrant women with a first birth before immigration to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (aOR=1.27; CI 1.09-1.48), moderately preterm birth (aOR=1.10; CI 1.02-1.18), post-term birth (aOR=1.19; CI 1.11-1.27), low Apgar score (aOR=1.27; CI 1.16-1.39) and stillbirth (aOR=1.29; CI 1.05-1.58). Similar results were found in births to Norwegian-born women who had their first baby abroad. Paper 3: Compared with births to migrant women with a foreign-born partner, births to migrant women with a Norwegian-born partner were associated with lower ORs for very preterm birth (primiparous: aOR 0.83; 95% CI 0.73-0.96, multiparous: aOR 0.85: 95% CI 0.73-0.98), stillbirth (primiparous: aOR 0.68; 95% CI 0.55-0.86, multiparous: aOR 0.80; 95% CI 0.64-0.99), and low Apgar score (multiparous: aOR 0.87; 95% CI 0.80-0.96). Unregistered paternal origin and unknown paternal identity were both associated with increased odds of adverse neonatal outcomes. Conclusion and clinical implications: The risk of adverse neonatal outcomes varied across sub-groups of migrant women and was higher in women from a number of countries, multiparous women who had their first baby before immigration to Norway, women whose babies had foreign-born fathers and births where paternal origin was unregistered or paternal identity was unknown. Specifically, the risk of stillbirth was lower in primiparous women who had migrated for work or education compared to Nordic migrants who are permitted to migrate freely between the Nordic countries. Stillbirth was not associated with length of residence in Norway. This thesis highlights the need to improve care for sub-groups of migrant women at increased risk of stillbirth and other adverse neonatal outcomes. The results should serve as a reminder of the diverse needs of migrant women, and the importance of midwives and other health care providers collecting a thorough obstetric history in migrant women attending maternity care services

Adverse neonatal outcomes in migrant women in Norway

Background: With increasing international migration, more knowledge is needed regarding migrant women’s pregnancies and births. Migrant families represent great diversity and investigating the risk of adverse neonatal outcomes in sub-groups of migrant women is therefore vital. Overall aim: To investigate associations between migration related factors (maternal country of birth, paternal origin, reason for immigration, length of residence and country of a woman’s first birth) and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in migrant and non-migrant women giving birth in Norway. Material and methods: All three papers are based on population-based register studies. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. We investigated associations between: (1) migration related factors (maternal country of birth, paternal origin, reason for immigration, length of residence, and birthplace of firstborn child) and stillbirth in births to migrant and non-migrant women (1990-2013); (2) country of a woman’s first birth and adverse neonatal outcomes (very preterm birth (22+0-31+6 gestational weeks), moderately preterm birth (32+0-36+6 gestational weeks), post-term birth (≥42 gestational weeks), small for gestational age, large for gestational age, low Apgar score (<7 at 5 minutes), stillbirth and neonatal death) in multiparous migrant and non-migrant women (1990-2016); and (3) paternal origin and adverse neonatal outcomes (very preterm birth, moderately preterm birth, low Apgar score and stillbirth) in migrant women (1990-2016). Associations were investigated using multiple logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals (CI). Analyses were performed separately for primiparous and multiparous women. Results: Paper 1: Primiparous women from Sri-Lanka and Pakistan, and multiparous women from Pakistan, Somalia, the Philippines and the Former Yugoslavia had higher odds of stillbirth when compared to non-migrant women (adjusted ORs ranged from 1.58 to 1.79 in primiparous and 1.50 to 1.71 in multiparous women). Primiparous migrant women whose babies were registered with a Norwegian-born father had decreased odds of stillbirth compared to migrant women whose babies were registered with a foreign-born father (aOR = 0.73; CI 0.58–0.93). Primiparous women migrating for work or education had decreased odds of stillbirth compared to Nordic women who migrate freely between the Nordic countries (aOR = 0.58; CI 0.39–0.88). Multiparous migrant women who gave birth to their first baby before arriving in Norway had higher odds of stillbirth in later births in Norway compared to multiparous migrant women who had had their first baby after arrival (aOR = 1.28; CI 1.06–1.55). Length of residence in Norway was not associated with stillbirth. Paper 2: Multiparous migrant women with a first birth before immigration to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (aOR=1.27; CI 1.09-1.48), moderately preterm birth (aOR=1.10; CI 1.02-1.18), post-term birth (aOR=1.19; CI 1.11-1.27), low Apgar score (aOR=1.27; CI 1.16-1.39) and stillbirth (aOR=1.29; CI 1.05-1.58). Similar results were found in births to Norwegian-born women who had their first baby abroad. Paper 3: Compared with births to migrant women with a foreign-born partner, births to migrant women with a Norwegian-born partner were associated with lower ORs for very preterm birth (primiparous: aOR 0.83; 95% CI 0.73-0.96, multiparous: aOR 0.85: 95% CI 0.73-0.98), stillbirth (primiparous: aOR 0.68; 95% CI 0.55-0.86, multiparous: aOR 0.80; 95% CI 0.64-0.99), and low Apgar score (multiparous: aOR 0.87; 95% CI 0.80-0.96). Unregistered paternal origin and unknown paternal identity were both associated with increased odds of adverse neonatal outcomes. Conclusion and clinical implications: The risk of adverse neonatal outcomes varied across sub-groups of migrant women and was higher in women from a number of countries, multiparous women who had their first baby before immigration to Norway, women whose babies had foreign-born fathers and births where paternal origin was unregistered or paternal identity was unknown. Specifically, the risk of stillbirth was lower in primiparous women who had migrated for work or education compared to Nordic migrants who are permitted to migrate freely between the Nordic countries. Stillbirth was not associated with length of residence in Norway. This thesis highlights the need to improve care for sub-groups of migrant women at increased risk of stillbirth and other adverse neonatal outcomes. The results should serve as a reminder of the diverse needs of migrant women, and the importance of midwives and other health care providers collecting a thorough obstetric history in migrant women attending maternity care services

El omnibus: Tomo I Número 43 - 13 marzo 1852

Copia digital. España : Ministerio de Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

Helse i svangerskapet blant innvandrerkvinner i Norge – en utforskende litteraturoversikt

BAKGRUNN Innvandrerkvinner er en sårbar gruppe innen norsk fødselsomsorg med økt risiko for uheldige svangerskapsutfall. Hensikten med denne utforskende litteraturoversikten var å få en oversikt over tilgjengelig kunnskap om helse i svangerskapet blant innvandrerkvinner i Norge. KUNNSKAPSGRUNNLAG Litteraturoversikten inkluderer 44 fagfellevurderte artikler om helse i svangerskapet blant innvandrerkvinner i Norge, med ulike studiedesign og publisert i perioden 2000–19. Søket ble utført i MEDLINE, Embase, Cochrane Library, CINAHL, Psycinfo, Maternity & Infant Care Database og SveMed+. RESULTATER Svangerskapsdiabetes, fedme, svangerskapskvalme, svangerskapsforgiftning og folatbruk var hyppig studerte temaer. Vi fant en betydelig variasjon i sykdomsrisiko for ulike undergrupper av innvandrere. FORTOLKNING Lite forskning er gjort på spesielt sårbare innvandrergrupper, som nyankomne, papirløse og flyktninger. Vi anbefaler at man i fremtidig forskning vurderer kvalitativt studiedesign der innvandrerfamiliers erfaringer blir belyst, samt intervensjonsstudier hvor effekt av tiltak prøves ut

Bruk av innkomst-CTG hos lavrisikofødende: en klinisk audit

Bakgrunn: Elektronisk overvåkning av fosteret, såkalt innkomst-CTG (kardiotokografi), blir mye brukt ved normale fødsler, til tross for at slik bruk ikke er forbundet med bedre fødselsutfall. Fødselsomsorgen i dag er preget av unødvendig bruk av teknologi, selv om et ledende prinsipp er at tiltak kun skal iverksettes i nødvendige situasjoner, og der intervensjonene kan gjøre mer nytte enn skade. Hensikt: Hensikten med denne kvalitetsforbedringsstudien var å kartlegge bruken av innkomst-CTG hos lavrisikofødende etter iverksatt implementeringstiltak for å redusere forekomsten av innkomst-CTG. Metode: Med klinisk audit som metode kartla vi lavrisikofødende kvinner retrospektivt i fire uker (n = 164). Etter kartleggingen av praksis satte vi inn flere endringstiltak sammen med nøkkelpersoner i miljøet. I etterkant av endringstiltakene besluttet vi å gjennomføre en statistisk prosesskontroll over 18 uker for å observere bruken av innkomst-CTG etter at tiltak var iverksatt (n = 168). Resultat: Auditen viste at det ble tatt innkomst-CTG hos 77 prosent av lavrisikofødende. I samarbeid med nøkkelpersoner i miljøet og ledelsen ga vi tilbakemelding til praksisfeltet samt at vi iverksatte implementeringstiltak skreddersydd for den aktuelle klinikken. Disse tiltakene førte til en forbedring av praksis der bruken av innkomst-CTG var redusert til 30 prosent. Statistisk prosesskontroll viste at endringen av praksis over tid var stabil. Konklusjon: Auditen avdekket at var det en diskrepans mellom praksis og kunnskapsbaserte retningslinjer. Ønsket standard for praksis ble ikke møtt, men etter at vi iverksatte implementeringstiltak, var bruken av innkomst-CTG signifikant redusert