Antenatal small-class education versus auditorium-based lectures to promote positive transitioning to parenthood - A randomised trial.

Prospective parents widely use education to gain information about, e.g., labour and parenting skills. It is unknown if antenatal education in small classes is more beneficial for parenting stress and parenting alliance compared with other types of antenatal education. In the present randomised trial, we examined the effect of antenatal education in small classes versus auditorium-based lectures on perceived stress, parenting stress, and parenting alliance. A total of 1,766 pregnant women were randomised to receive: antenatal education in small classes three times in pregnancy and one time after delivery, each session lasted 2.5 hours, versus standard care consisting of two times two hours auditorium-based lectures. Previous analysis of the primary outcome showed no difference between intervention and control group. Here we conduct an exploratory analysis of three secondary outcomes. Effects of the interventions on parents' global feelings of stress at 37 weeks gestation and nine weeks and six months postpartum and parenting stress nine weeks and six months postpartum were examined using linear regression analyses and mixed models with repeated measurements. The effect on parenting alliance six months postpartum was examined using the non-parametric Wilcoxon rank-sum test. Antenatal education in small classes had a small beneficial main effect on global feelings of stress six months postpartum and a statistically significant interaction between time and group favoring antenatal education in small classes. The P values of intervention effects on parenting stress and parenting alliance were all larger than the threshold value (0.05).

Adolescent Weight Status: Associations With Structural and Functional Dimensions of Social Relations.

PURPOSE: To examine the associations between weight status and structural and functional dimensions of social relations among 11- to 15-year-old girls and boys. METHODS: Analyses were based on cross-sectional data from the Danish contribution to the international Health Behavior in School-aged Children study 2010. The study population (n = 4,922) included students in the fifth, seventh, and ninth grade from a representative sample of Danish schools. Multinomial logistic regression analyses were used to study the associations between weight status and social relations, supported by a conceptual framework for the study of social relations. RESULTS: Among girls, overweight/obese weight status was associated with spending less time with friends after school compared to normal-weight status (0 days/week: odds ratio: 6.25, 95% confidence interval: 2.18-17.95, 1 day/week: 2.81, 1.02-7.77, 2 days/week: 3.27, 1.25-8.56, 3 days/week: 3.32, 1.28-8.61, and 4 days/week: 3.23, 1.17-8.92, respectively vs. 5 days/week). Among girls, overweight/obese weight status was associated with being bullied (2.62, 1.55-4.43). Among boys, overweight/obese weight status was associated with infrequent (1 to 2 days vs. every day) communication with friends through cellphones, SMS messages, or Internet (1.66, 1.03-2.67). In the full population, overweight/obese weight status was associated with not perceiving best friend as a confidant (1.59, 1.11-2.28). No associations were found between weight status and number of close same-sex and opposite-sex friends, mother/father as confidant, and perceived classmate acceptance. CONCLUSIONS: This study shows that overweight/obese adolescents have higher odds of numerous poor social relations than their normal-weight peers both in terms of structural and functional dimensions of social relations.

Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial.

OBJECTIVE: To examine the effect of an antenatal education programme in small classes versus standard auditorium-based lectures. DESIGN: Randomised trial using random-generated web-based 1:1 allocation. SETTING: The largest birth site in the Capital Region of Denmark, from August 2012 to May 2014. PARTICIPANTS: 1766 pregnant women. Inclusion criteria ≥18 years, pregnant with a single child, and able to speak and understand Danish. Women were enrolled in the trial from 10+0 to 20+0 weeks of gestation. INTERVENTIONS: The intervention programme consisted of three times 2.5 hours of antenatal education in small classes (n=6-8 women), and focused on improving information and problem-solving skills for expectant parents in order to ease birth and the transition to parenthood. The control group received standard auditorium-based lectures consisting of two times 2 hours in an auditorium with participation of ∼250 people. MAIN OUTCOME MEASURES: The primary trial outcome was use of epidural analgesia. Other types of pain relief and obstetric interventions were analysed as explorative outcomes. RESULTS: There was no statistically significant difference in use of epidural analgesia between participants in the intervention group (30.9%) versus the control group (29.1%), adjusted OR 1.10 (95% CI 0.87 to 1.34). Also, the two groups did not differ regarding other types of pain relief or obstetric interventions. Concomitant birth preparation was common in both groups and highest in the control group, but did not seem to influence our results noticeably. CONCLUSIONS: Antenatal education in small groups versus standard auditorium-based lectures did not differ regarding use of epidural analgesia, other pain relief, or obstetric interventions. TRIAL REGISTRATION NUMBER: NCT01672437; Results.

Validity of a hospital-based obstetric register using medical records as reference.

BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database as having given birth in 2013 to the National Patient Register with coverage of all births in 2013. Validity of eleven selected indicators from the Obstetric Database was assessed using medical records as a golden standard. Using a random sample of 250 medical records, we calculated proportion of agreement, sensitivity, specificity, and positive and negative predictive values for each indicator. Two assessors independently reviewed medical records and inter-rater reliability was calculated as proportion of agreement and Cohen's κ coefficient. RESULTS: We found 100% completeness of the Obstetric Database when compared to the Danish National Patient Register. Except for one delivery all 6,717 deliveries were present in both registers. Proportion of agreement between the Obstetric Database and medical records ranged from 91.1% to 99.6% for the eleven indicators. The validity measures ranged from 0.70 to 1.00 indicating high validity of the Obstetric Database. κ coefficients from the inter-rater reliability ranged from 0.71 to 1.00. CONCLUSION: Completeness and validity of the Obstetric Database were found acceptable when using the National Patient Register and medical records as golden standards. The Obstetric Database therefore offers a valuable source for examining clinical, administrative, and research questions.

Trends in Social Inequality in Tooth Brushing among Adolescents: 1991-2014.

This study examines whether social inequality in tooth brushing frequency among adolescents changed from 1991 to 2014. The data material was seven comparable cross-sectional studies of nationally representative samples of 11- to 15-year-olds in Denmark with data about frequency of tooth brushing and occupation of parents. The total number of participants was 31,464, of whom 21.7% brushed their teeth less than the recommended 2 times a day. The absolute social inequality measured as prevalence difference between low and high social class increased from 7.7% in 1991 to 14.6% in 2014. The relative social inequality assessed by odds ratios for infrequent tooth brushing also increased from 1991 to 2014.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes - a systematic review.

BACKGROUND: The aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. METHODS: Bibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered in this review. Studies were assessed for bias using the Cochrane risk of bias tool. Results are presented as structured summaries of the included trials and as forest plots. RESULTS: We identified 5,708 records. Of these, 17 studies met inclusion criteria. Studies varied greatly in content of the experimental and control condition. All outcomes were only reported in a single or a few trials, leading to limited or uncertain confidence in effect estimates. Given the heterogeneity in interventions and outcomes and also the high risk of bias of studies, we are unable to draw definitive conclusions as to the impact of small group antenatal education on obstetric and psycho-social outcomes. CONCLUSIONS: Insufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well-conducted randomized controlled trials with a low risk of bias. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42013004319.

Integrating couple relationship education in antenatal education - a study of perceived relevance among expectant Danish parents.

Little is known about which elements antenatal education should encompass to meet the needs of parents today. Psycho-social aspects relating to couple- and parenthood have generally not been covered in Danish antenatal education, although studies suggest that parents need this information. The aim of this study was to examine perceived relevance of couple relationship topics integrated in an antenatal programme among intervention participants in the NEWBORN trial. Our study shows that 84% of the participants found it relevant to learn about communication skills and changes in the relationship during and after pregnancy.

The effect of antenatal education in small classes on obstetric and psycho-social outcomes: a systematic review and meta-analysis protocol.

BACKGROUND: The aims of antenatal education contain both outcomes related to pregnancy, birth and parenthood. Both content and methods of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education. The latest Cochrane review, assessed as up-to-date in 2007, concluded that the effect of antenatal education for childbirth or parenthood or both remains largely unknown. This systematic review and meta-analysis aims to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. METHODS/DESIGN: Eligible studies include individually randomized as well as cluster-randomized trials irrespective of language, publication year, publication type, and publication status. Only interventions carried out in the Western world will be considered in this review. We will search the databases Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO using relevant search terms. Two independent review authors will extract data and assess risk of bias. Results will be presented as structured summaries of the included trials. A meta-analysis will be conducted. We will assess heterogeneity by using both the Chi-squared test and the I-squared statistic, and conduct subgroup analysis separately for various intervention types. DISCUSSION: In healthcare systems with limited resources evidence of the effectiveness of services provided is important for decision making, and there is a need for policy makers to implement changes in healthcare systems based on scientific evidence. The effectiveness of antenatal education in small classes is still questioned. Therefore an up-to-date systematic review is needed.This systematic review protocol was registered within the International Prospective Register of Systematic Reviews (PROSPERO) as number CRD42013004319.

Group-based antenatal birth and parent preparation for improving birth outcomes and parenting resources: study protocol for a randomised trial.

OBJECTIVES: To examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education. PARTICIPANTS: 2350 Danish pregnant women and their partners ≥18 years old, recruited before 20+0 gestational weeks. Population-based individually randomised superiority trial with two parallel arms: Four sessions of birth and parent preparation in small groups (experimental group); two lectures in an auditorium (control group). Data is collected by (1) questionnaires at baseline (≈18 weeks of gestation), 37 weeks of gestation, 9 weeks-, 6 months-, and 1 year post-partum, (2) the hospital obstetric database, (3) national registers. PRIMARY OUTCOME: use of epidural analgesia. SECONDARY OUTCOMES: stress, parenting alliance; explorative outcomes: depressive symptoms, use of health care services, self-efficacy, well-being, family break-ups. Analyses will be intention-to-treat as well as per protocol. Process evaluation will be conducted using questionnaires and qualitative interviews. The incremental societal cost of the intervention will be computed and compared to the measured outcomes in a cost-effectiveness analysis. CONCLUSION: To the best of our knowledge this is the largest well-designed randomised trial of its kind to date. The trial will bring much-needed evidence for decision makers of the content and form of antenatal education.

Fat intake and weight development from 9 to 16 years of age: the European youth heart study - a longitudinal study.

OBJECTIVE: The literature on associations between fat intake and weight development among both children and adults is inconsistent, even if it is generally assumed that a high dietary fat intake is a major determinant of obesity. The present study aimed at investigating the association between fat intake and weight development among a cohort of children aged 9-10 years at baseline and 15-16 years at follow-up, and, further, at investigating whether parents' obesity is modifying the association. METHOD: Among 384 subjects aged 9 years, data on dietary intake, BMI z-score, physical activity, inactivity, parents' social status, parents' body mass index, child birth weight, and status of puberty was obtained in 1997. Weight and height was measured both at baseline and at 6-year follow-up, and BMI z-score was calculated. Linear regression was used to assess the role of fat intake on subsequent weight change between 1997 and 2003 with the above-mentioned variables as confounders, in 3 different models and for each sex separately. RESULTS: The analysis showed no relation between fat intake (both absolute intake and fat energy percent) at 9 years and subsequent 6-year weight change. Only BMI z-score at baseline had a significant relation to weight change for both sexes, and number of obese parents had significant relation to weight change in girls. Number of overweight parents did not modify the association between fat intake and weight change. CONCLUSION: This study was unable to find a relation between fat intake and 6-year weight change among 9-year-old children. No interaction was seen between number of overweight parents on the relation between fat intake and subsequent weight change.