Women's attitude towards prenatal screening for red blood cell antibodies, other than RhD

Background: Since July 1998 all Dutch women (± 200,000/y) are screened for red cell antibodies, other than anti-RhesusD (RhD) in the first trimester of pregnancy, to facilitate timely treatment of pregnancies at risk for hemolytic disease of the fetus and newborn (HDFN). Evidence for benefits, consequences and costs of screening for non-RhD antibodies is still under discussion. The screening program was evaluated in a nation-wide study. As a part of this evaluation study we investigated, according to the sixth criterium of Wilson and Jüngner, the acceptance by pregnant women of the screening program for non-RhD antibodies. Methods: Controlled longitudinal survey, including a prenatal and a postnatal measurement by structured questionnaires. Main outcome measures: information satisfaction, anxiety during the screening process (a.o. STAI state inventory and specific questionnaire modules), overall attitude on the screening program. Univariate analysis was followed by standard multivariate analysis to identify significant predictors of the outcome measures. Participants: 233 pregnant women, distributed over five groups, according to the screening result. Results: Satisfaction about the provided information was moderate in all groups. All screen- positive groups desired more supportive information. Anxiety increased in screen- positives during the screening process, but decreased to basic levels postnatally. All groups showed a strongly positive balance between perceived utility and burden of the

Does unemployment in family affect pregnancy outcome in conditions of high quality maternity care?

BACKGROUND: The influence of unemployment in the family on pregnancy outcome is controversial. Only a few studies have involved investigation of the effect of unemployment of the father on pregnancy. The objective of this study was to assess the effects of unemployment of one or both parents on obstetric outcome in conditions of free antenatal care attended by the entire pregnant population. METHODS: The data of 24 939 pregnancies included maternal risk factors, pregnancy characteristics and outcome, and was based on a self administered questionnaire at 20 weeks of pregnancy and on clinical records. RESULTS: Unemployment was associated with adolescent maternal age, unmarried status and overweight, anemia, smoking, alcohol consumption and prior pregnancy terminations. Multivariate logistic regression analysis indicated that after controlling for these maternal risk factors small differences only were found in pregnancy outcomes between unemployed and employed families. Unemployed women had significantly more often small-for-gestational-age (SGA) infants, at an OR of 1.26 (95% CI: 1.12 – 1.42) whereas, in families where both parents were unemployed, the risk of SGA was even higher at an OR of 1.43 (95% CI: 1.18 – 1.73). Otherwise, pregnancy outcome was comparable in the groups studied. CONCLUSION: Free antenatal care was unable to fully overcome the adverse pregnancy outcomes associated with unemployment, SGA risk being highest when both parents are unemployed

Preconceptional factors associated with very low birthweight delivery in East and West Berlin: a case control study

BACKGROUND: Very low birthweight, i.e. a birthweight < 1500 g, is among the strongest determinants of infant mortality and childhood morbidity. To develop primary prevention approaches to VLBW birth and its sequelae, information is needed on the causes of preterm birth, their personal and social antecedents, and on conditions associated with very low birthweight. Despite the growing body of evidence linking sociodemographic variables with preterm delivery, little is known as to how this may be extrapolated to the risk of very low birthweight. METHODS: In 1992, two years after the German unification, we started to recruit two cohorts of very low birthweight infants and controls in East and West Berlin for a long-term neurodevelopmental study. The present analysis was undertaken to compare potential preconceptional risk factors for very low birthweight delivery in a case-control design including 166 mothers (82 East vs. 84 West Berlin) with very low birthweight delivery and 341 control mothers (166 East vs. 175 West). RESULTS: Multivariate logistic regression analysis was used to assess the effects of various dichotomous parental covariates and their interaction with living in East or West Berlin. After backward variable selection, short maternal school education, maternal unemployment, single-room apartment, smoking, previous preterm delivery, and fetal loss emerged as significant main effect variables, together with living in West Berlin as positive effect modificator for single-mother status. CONCLUSION: Very low birthweight has been differentially associated with obstetrical history and indicators of maternal socioeconomic status in East and West Berlin. The ranking of these risk factors is under the influence of the political framework

Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods

Dutch' figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more 'possibly avoidable' risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective

Avaliação da reprodutibilidade e validade de questionário de atividade física para gestantes Evaluation of the reproducibility and validity of a physical activity questionnaire for pregnant women

INTRODUÇÃO: A prática de atividade física tem sido incentivada por vários organismos nacionais e internacionais visando a promoção de saúde. Entretanto não existe consenso acerca da influência e da intensidade ótima de atividade física durante a gestação, possivelmente devido a dificuldades de mensuração e classificação do nível de atividade física através de questionários. Não se identificou qualquer estudo de validação de questionário de atividade física em gestantes no Brasil. O objetivo do presente estudo é analisar a reprodutibilidade e validade concorrente de um questionário de atividades físicas para gestantes. MÉTODOS: Em amostra de 68 gestantes, no segundo trimestre de gestação foi realizada entrevista para aplicação do questionário, que foi repetida com aproximadamente uma semana de intervalo e no puerpério. No período entre as duas primeiras entrevistas, as mulheres utilizaram monitor de freqüência cardíaca (n=38). RESULTADOS: As análises de reprodutibilidade foram adequadas com coeficientes de correlação intraclasse variando de 0,54 a 0,85. A análise das variáveis categóricas, com questões subjetivas e de autopercepção da atividade física, resultou em maior intervalo de coeficiente kappa com valores entre 0,29 e 0,76 entre a aplicação do questionário com uma semana de intervalo, e 0,08 a 0,70 comparado ao puerpério. As análises de validade conduziram a resultado satisfatório quanto à média das diferenças encontrada por intermédio do gráfico de Bland e Altman (1986) entre o questionário e o freqüencímetro. Entretanto, o intervalo da dispersão não se apresentou adequado, visto que variou em mais de sete horas para atividades leves e em quase onze horas por dia para atividades moderadas. As análises do presente estudo parecem assegurar a reprodutibilidade do questionário de atividade física para gestantes. No entanto, com relação à validação, a comparação com os resultados obtidos pelo freqüêncímetro não mostrou graus de concordância adequados.<br>INTRODUCTION: Physical activity practice has been encouraged by several national and international entities aiming health promotion. However, there is no consensus concerning the influence and optimal intensity of physical activity during pregnancy, probably due to difficulties to measure and classify the level of physical activity by questionnaires. It has not been identified any validation study of physical activity questionnaire on Brazilian pregnant women. The purpose of the present study is to analyze the reliability and concurrent validity of a physical activity questionnaire for pregnant women. METHODS: A sample of 68 women in the second trimester of pregnancy has been interviewed by the elaborated questionnaire. Reliability was assessed after approximately a week and in the postpartum. The subjects used a heart rate monitor between the two first interviews (n=38). RESULTS: Reproducibility analyses were adapted with interclass correlation coefficients varying from 0.54 to 0.85. The analysis of categorical variables, with subjective questions of self-perception of physical activity, resulted in wider range of kappa coefficients, with values between 0.29 and 0.76 for application of the questionnaire within one week of interval, and between 0.08 and 0.70 when compared with the postpartum. The validity analyses had a satisfactory result considering the average of differences seen through Bland-Altman graphics comparing questionnaire and the heart rate monitors. However, the dispersion interval was not adequate, since it varied in more than seven hours for light activities and almost eleven hours per day for moderate activities. Analyses of current study seem to assure the reliability of the physical activity questionnaire for pregnant women. However, concerning validation, the comparison with results obtained by heart rate monitors did not show adequate degrees of agreement