Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 183
Filtrar
1.
BMC Public Health ; 24(1): 1662, 2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38909211

RESUMO

BACKGROUND: Preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland. METHODS: Grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel. RESULTS: The searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours. CONCLUSIONS: This scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.


Assuntos
Política de Saúde , Cuidado Pré-Concepcional , Humanos , Cuidado Pré-Concepcional/normas , Irlanda , Feminino , Reino Unido , Guias de Prática Clínica como Assunto , Gravidez
2.
Genet Med ; 26(7): 101137, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38814327

RESUMO

Carrier screening has historically assessed a relatively small number of autosomal recessive and X-linked conditions selected based on frequency in a specific subpopulation and association with severe morbidity or mortality. Advances in genomic technologies enable simultaneous screening of individuals for several conditions. The American College of Medical Genetics and Genomics recently published a clinical practice resource that presents a framework when offering screening for autosomal recessive and X-linked conditions during pregnancy and preconception and recommends a tier-based approach when considering the number of conditions to screen for and their frequency within the US population in general. This laboratory technical standard aims to complement the practice resource and to put forth considerations for clinical laboratories and clinicians who offer preconception/prenatal carrier screening.


Assuntos
Triagem de Portadores Genéticos , Testes Genéticos , Genética Médica , Genômica , Diagnóstico Pré-Natal , Humanos , Triagem de Portadores Genéticos/métodos , Triagem de Portadores Genéticos/normas , Gravidez , Feminino , Genômica/métodos , Genômica/normas , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/normas , Testes Genéticos/normas , Testes Genéticos/métodos , Genética Médica/normas , Estados Unidos , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/normas , Aconselhamento Genético/normas , Aconselhamento Genético/métodos
3.
Midwifery ; 132: 103984, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38554606

RESUMO

BACKGROUND: Folic acid (FA) supplementation before and in early pregnancy is known to improve outcomes such as reducing neural tube defects; however, little is known about groups in Australia at risk of low FA use. AIM: To determine whether differences exist in FA supplementation rates between Australian-born women and migrant women, with a secondary aim of examining the sociodemographic characteristics of women who are not supplementing with FA in early pregnancy. METHODS: A retrospective cohort study from January 2018-July 2022 in a high-migrant population in Western Sydney, Australia. Multivariate logistic regression analysis was conducted adjusting for confounders including place of birth, age, ethnicity, parity, history of diabetes, and type of conception. FINDINGS: There were 48,045 women who met inclusion criteria; 65% of whom were migrants. We identified that 39.4% of the study population did not report FA supplementation by early pregnancy. Women who were migrants were more likely to report FA usage than those born in Australia (aOR 1.24; 95%CI 1.17-1.31). Women least likely to report use of FA were women < 20 years of age (aOR 0.54; 95%CI 0.44-0.67) and multiparous women (aOR 0.84; 95%CI 0.82-0.86). Women with type 1 or type 2 diabetes were more likely to report FA use (aOR 1.66; 95%CI 1.11-2.48, aOR 1.30; 95%CI 1.05-1.61). CONCLUSION: A significant proportion of the population did not report FA supplementation before or during early pregnancy. To increase uptake of FA supplementation, clinicians and public health messaging should target at-risk groups.


Assuntos
Suplementos Nutricionais , Ácido Fólico , Migrantes , Humanos , Feminino , Ácido Fólico/uso terapêutico , Ácido Fólico/administração & dosagem , Adulto , Gravidez , Austrália , Estudos de Coortes , Estudos Retrospectivos , Suplementos Nutricionais/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Migrantes/psicologia , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/estatística & dados numéricos , Cuidado Pré-Concepcional/normas , Modelos Logísticos , Defeitos do Tubo Neural/prevenção & controle
4.
BMJ Sex Reprod Health ; 50(3): 165-171, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38336467

RESUMO

BACKGROUND: Documenting medical and lifestyle preconception health risk factors in electronic medical records (EMRs) could assist general practitioners (GPs) to identify those reproductive-aged women who could most benefit from preconception care (PCC). However, it is unclear to what extent PCC risk factors are identifiable in general practice records. This study aimed to determine the extent to which medical and lifestyle preconception health risk factors are documented in general practice EMRs. METHODS: We conducted an audit of the documentation of medical and lifestyle preconception risk factors in 10 general practice EMRs in Melbourne, Australia. We retrospectively analysed the EMRs of 100 consecutive women aged 18-44 years who visited each practice between January and September 2022. Using a template informed by PCC guidelines, we extracted data from structured fields in the EMR and conducted a descriptive analysis. RESULTS: Among the data extracted, the more commonly documented medical and lifestyle preconception health risk factors in the EMRs included smoking (79%), blood pressure (74%), alcohol consumption (63%) and body mass index (57%). Among the women audited, 14% were smokers, 24% were obese, 7% had high blood pressure, 5% had diabetes, 28% had a mental health condition, 13% had asthma, 6% had thyroid disease and 17% had been prescribed and could be using a potentially teratogenic medication. CONCLUSIONS: Better documentation of medical and lifestyle preconception health risk factors in structured fields in EMRs may potentially assist primary care providers including GPs in identifying and providing PCC to women who could most benefit from it.


Assuntos
Registros Eletrônicos de Saúde , Medicina Geral , Cuidado Pré-Concepcional , Humanos , Feminino , Registros Eletrônicos de Saúde/estatística & dados numéricos , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/estatística & dados numéricos , Cuidado Pré-Concepcional/normas , Adulto , Fatores de Risco , Estudos Retrospectivos , Adulto Jovem , Adolescente , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Austrália/epidemiologia , Estilo de Vida , Documentação/estatística & dados numéricos , Documentação/métodos , Documentação/normas , Consumo de Bebidas Alcoólicas/epidemiologia , Fumar/epidemiologia
5.
JAMA ; 330(5): 454-459, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37526713

RESUMO

Importance: Neural tube defects are among the most common congenital malformations in the US, with an estimated 3000 pregnancies affected each year. Many of these neural tube defects are caused by low folate levels in the body. Objective: The US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update on the benefits and harms of folic acid supplementation. Population: Persons who are planning to or could become pregnant. Evidence Assessment: The USPSTF concludes that, for persons who are planning to or could become pregnant, there is high certainty that folic acid supplementation has a substantial net benefit to prevent neural tube defects in their offspring. Recommendation: The USPSTF recommends that all persons planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. (A recommendation).


Assuntos
Suplementos Nutricionais , Deficiência de Ácido Fólico , Ácido Fólico , Defeitos do Tubo Neural , Complicações na Gravidez , Feminino , Humanos , Gravidez , Comitês Consultivos , Ácido Fólico/administração & dosagem , Ácido Fólico/uso terapêutico , Programas de Rastreamento , Defeitos do Tubo Neural/etiologia , Defeitos do Tubo Neural/prevenção & controle , Serviços Preventivos de Saúde , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/diagnóstico , Deficiência de Ácido Fólico/tratamento farmacológico , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Concepcional/normas
6.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34642233

RESUMO

BACKGROUND: A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS: Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS: For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS: To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.


Assuntos
Recém-Nascido de Baixo Peso , Bem-Estar Materno , Pediatria , Cuidado Pré-Concepcional/métodos , Sono , Intervalo entre Nascimentos , Feminino , Humanos , Lactente , Cuidado do Lactente , Mortalidade Infantil , Bem-Estar do Lactente , Recém-Nascido , Cuidado Pré-Concepcional/normas , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade
7.
PLoS One ; 16(7): e0254935, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297760

RESUMO

BACKGROUND: As the studies show, in every minute in the world, 380 women become pregnant and 190 face unplanned or unwanted pregnancies; 110 experience pregnancy-related complications, and one woman dies from a pregnancy-related cause. Preconception care is one of the proven strategies for the reduction in mortality and decreases the risk of adverse health effects for the woman, fetus, and neonate by optimizing maternal health services and improves woman's health. Therefore, this study aimed to estimate the pooled prevalence of utilization of preconception of care and associated factors in Africa. METHODS: Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL, and manually on Google Scholar. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed by the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using a random-effects method using the STATA™ Version 14 software. RESULT: From 249,301 obtained studies, 28 studies from 3 African regions involving 13067 women included in this Meta-analysis. The overall pooled prevalence of utilization of preconception care among pregnant women in Africa was found to be 18.72% (95% CI: 14.44, 23.00). Knowledge of preconception care (P = <0.001), preexisting medical condition (P = 0.045), and pregnancy intention (P = 0.016) were significantly associated with the utilization of preconception care. CONCLUSION: The results of this meta-analysis indicated, as one of best approaches to improve birth outcomes, the utilization of preconception care is significantly low among mothers in Africa. Therefore, health care organizations should work on strategies to improve preconception care utilization.


Assuntos
Cuidado Pré-Concepcional/normas , África , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Mães/estatística & dados numéricos , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Gestantes/psicologia , Qualidade da Assistência à Saúde
8.
Prenat Diagn ; 41(9): 1057-1065, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34176153

RESUMO

OBJECTIVE: Expanded carrier screening (ECS) assesses the risk of individuals and couples of having a child affected with a set of genetic conditions. Carriers have options available to optimize pregnancy outcomes based on personal values and preferences. The greatest range of options is available prior to pregnancy, therefore professional societies recommend this screening be performed preconception. This study aimed to assess awareness of, and interest in, ECS in women preconception. Additionally, it aimed to evaluate preferences for timing and location of education and availability of ECS. METHODS: A total of 260 nulliparous women from the general population were surveyed through Qualtrics, a national market research survey platform. Data were delineated using descriptive statistics. RESULTS: Of this cohort, 43.5% reported being aware of ECS prior to the survey and 77.8% indicated interest. Those previously aware were first informed by family, friends, or independent online research. Interest was primarily driven by a desire for reassurance and to make informed decisions about future pregnancies. Interested respondents indicated a willingness to request testing from providers. Participants showed a preference for education and access from a healthcare provider in person. CONCLUSION: These findings provide insight regarding when and where to best educate and reach women prior to pregnancy about ECS to maximize pregnancy outcomes.


Assuntos
Triagem de Portadores Genéticos/normas , Opinião Pública , Triagem de Portadores Genéticos/métodos , Triagem de Portadores Genéticos/tendências , Humanos , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/tendências , Medição de Risco/métodos , Inquéritos e Questionários
9.
Fertil Steril ; 115(6): 1395-1410, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33838871

RESUMO

This document provides the latest recommendations for the evaluation of potential sperm, oocyte, and embryo donors as well as their recipients, incorporating recent information about optimal screening and testing for sexually transmitted infections, genetic diseases, and psychological assessments. This revised document incorporates recent information from the US Centers for Disease Control and Prevention, US Food and Drug Administration, and American Association of Tissue Banks, which all programs offering gamete and embryo donation services must be thoroughly familiar with, and replaces the document titled "Recommendations for gamete and embryo donation: a committee opinion," last published in 2013.


Assuntos
Seleção do Doador/normas , Destinação do Embrião/normas , Doação de Oócitos/normas , Medicina Reprodutiva/normas , Sêmen , Doadores de Tecidos/psicologia , Consenso , Aconselhamento/normas , Destinação do Embrião/efeitos adversos , Feminino , Testes Genéticos/normas , Nível de Saúde , Humanos , Masculino , Saúde Mental , Doação de Oócitos/efeitos adversos , Cuidado Pré-Concepcional/normas , Gravidez , Medição de Risco , Fatores de Risco
10.
J Obstet Gynaecol Can ; 43(6): 769-780.e1, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33631321

RESUMO

OBJECTIVE: To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada. TARGET POPULATION: This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline. OUTCOMES: Safe and compassionate care for people with physical disabilities who are giving birth. BENEFITS, HARMS, AND COSTS: Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth. EVIDENCE: A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities.


Assuntos
Pessoas com Deficiência , Trabalho de Parto , Cuidado Pré-Concepcional/normas , Complicações na Gravidez , Cuidado Pré-Natal/normas , Canadá , Parto Obstétrico , Feminino , Humanos , Cuidado Pós-Natal , Período Pós-Parto , Gravidez , Sociedades Médicas
11.
Prenat Diagn ; 41(7): 896-904, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33450092

RESUMO

OBJECTIVE: To evaluate the efficacy of three different carrier screening workflows designed to identify couples at risk for having offspring with autosomal recessive conditions. METHODS: Partner testing compliance, unnecessary testing, turnaround time, and ability to identify at-risk couples (ARCs) were measured across all three screening strategies (sequential, tandem, or tandem reflex). RESULTS: A total of 314,100 individuals who underwent carrier screening were analyzed. Sequential, tandem, and tandem reflex screening yielded compliance frequencies of 25.8%, 100%, and 95.9%, respectively. Among 14,595 couples tested in tandem, 42.2% of females were screen-negative, resulting in unnecessary testing of the male partner. In contrast, less than 1% of tandem reflex couples included unnecessary male testing. The median turnaround times were 29.2 days (sequential), 8 days (tandem), and 13.3 days (tandem reflex). The proportion of ARCs detected per total number of individual screens were 0.5% for sequential testing and 1.3% for both tandem and tandem reflex testing. CONCLUSION: The tandem reflex strategy simplifies a potentially complex clinical scenario by providing a mechanism by which providers can maximize partner compliance and the detection of at-risk couples while minimizing workflow burden and unnecessary testing and is more efficacious than both sequential and tandem screening strategies.


Assuntos
Triagem de Portadores Genéticos/métodos , Heterozigoto , Pais/psicologia , Feminino , Triagem de Portadores Genéticos/estatística & dados numéricos , Testes Genéticos/métodos , Humanos , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Fluxo de Trabalho
12.
Am J Obstet Gynecol ; 224(1): 3-15, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32502557

RESUMO

Female childhood, adolescent, and young adult cancer survivors have an increased risk of adverse pregnancy outcomes related to their cancer- or treatment-associated sequelae. Optimal care for childhood, adolescent, and young adult cancer survivors can be facilitated by clinical practice guidelines that identify specific adverse pregnancy outcomes and the clinical characteristics of at-risk subgroups. However, national guidelines are scarce and vary in content. Here, the International Late Effects of Childhood Cancer Guideline Harmonization Group offers recommendations for the counseling and surveillance of obstetrical risks of childhood, adolescent, and young adult survivors. A systematic literature search in MEDLINE database (through PubMed) to identify all available evidence published between January 1990 and December 2018. Published articles on pregnancy and perinatal or congenital risks in female cancer survivors were screened for eligibility. Study designs with a sample size larger than 40 pregnancies in childhood, adolescent, and young adult cancer survivors (diagnosed before the age of 25 years, not pregnant at that time) were eligible. This guideline from the International Late Effects of Childhood Cancer Guideline Harmonization Group systematically appraised the quality of available evidence for adverse obstetrical outcomes in childhood, adolescent, and young adult cancer survivors using Grading of Recommendations Assessment, Development, and Evaluation methodology and formulated recommendations to enhance evidence-based obstetrical care and preconception counseling of female childhood, adolescent, and young adult cancer survivors. Healthcare providers should discuss the risk of adverse obstetrical outcomes based on cancer treatment exposures with all female childhood, adolescent, and young adult cancer survivors of reproductive age, before conception. Healthcare providers should be aware that there is no evidence to support an increased risk of giving birth to a child with congenital anomalies (high-quality evidence). Survivors treated with radiotherapy to volumes exposing the uterus and their healthcare providers should be aware of the risk of adverse obstetrical outcomes such as miscarriage (moderate-quality evidence), premature birth (high-quality evidence), and low birthweight (high-quality evidence); therefore, high-risk obstetrical surveillance is recommended. Cardiomyopathy surveillance is reasonable before pregnancy or in the first trimester for all female survivors treated with anthracyclines and chest radiation. Female cancer survivors have increased risks of premature delivery and low birthweight associated with radiotherapy targeting the lower body and thereby exposing the uterus, which warrant high-risk pregnancy surveillance.


Assuntos
Sobreviventes de Câncer , Aconselhamento , Guias de Prática Clínica como Assunto , Cuidado Pré-Concepcional/normas , Complicações na Gravidez/psicologia , Adolescente , Criança , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Adulto Jovem
13.
J Clin Endocrinol Metab ; 106(4): 952-967, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33331893

RESUMO

CONTEXT: This review presents an up-to-date summary on management of type 1 diabetes mellitus (T1DM) among women of reproductive age and covers the following time periods: preconception, gestation, and postpartum. EVIDENCE ACQUISITION: A systematic search and review of the literature for randomized controlled trials and other studies evaluating management of T1DM before pregnancy, during pregnancy, and postpartum was performed. EVIDENCE SYNTHESIS: Preconception planning should begin early in the reproductive years for young women with T1DM. Preconception and during pregnancy, it is recommended to have near-normal glucose values to prevent adverse maternal and neonatal outcomes, including fetal demise, congenital anomaly, pre-eclampsia, macrosomia, neonatal respiratory distress, neonatal hyperbilirubinemia, and neonatal hypoglycemia. CONCLUSION: Women with T1DM can have healthy, safe pregnancies with preconception planning, optimal glycemic control, and multidisciplinary care.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Cuidado Pós-Natal , Cuidado Pré-Concepcional , Gravidez em Diabéticas/terapia , Adulto , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Recém-Nascido , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Período Pós-Parto/fisiologia , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/normas , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Adulto Jovem
14.
J Dev Orig Health Dis ; 12(5): 798-810, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33256879

RESUMO

Emerging evidence suggests that parents' nutritional status before and at the time of conception influences the lifelong physical and mental health of their child. Yet little is known about the relationship between diet in adolescence and the health of the next generation at birth. This study examined data from Norwegian cohorts to assess the relationship between dietary patterns in adolescence and neonatal outcomes. Data from adolescents who participated in the Nord-Trøndelag Health Study (Young-HUNT) were merged with birth data for their offspring through the Medical Birth Registry of Norway. Young-HUNT1 collected data from 8980 adolescents between 1995 and 1997. Linear regression was used to assess associations between adolescents' diet and later neonatal outcomes of their offspring adjusting for sociodemographic factors. Analyses were replicated with data from the Young-HUNT3 cohort (dietary data collected from 2006 to 2008) and combined with Young-HUNT1 for pooled analyses. In Young-HUNT1, there was evidence of associations between dietary choices, meal patterns, and neonatal outcomes, these were similar in the pooled analyses but were attenuated to the point of nonsignificance in the smaller Young-HUNT3 cohort. Overall, energy-dense food products were associated with a small detrimental impact on some neonatal outcomes, whereas healthier food choices appeared protective. Our study suggests that there are causal links between consumption of healthy and unhealthy food and meal patterns in adolescence with neonatal outcomes for offspring some years later. The effects seen are small and will require even larger studies with more state-of-the-art dietary assessment to estimate these robustly.


Assuntos
Comportamento do Adolescente/fisiologia , Qualidade dos Alimentos , Saúde do Lactente/estatística & dados numéricos , Cuidado Pré-Concepcional/normas , Adolescente , Comportamento do Adolescente/psicologia , Feminino , Humanos , Masculino , Noruega , Cuidado Pré-Concepcional/estatística & dados numéricos
15.
Acta Diabetol ; 58(3): 355-362, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33098473

RESUMO

BACKGROUND: Pregnant women with type 1 diabetes (T1D) have high risk of complications despite improved care based on technology advancements. OBJECTIVE: To assess the effects of pregnancy planning on fetal and maternal outcomes in T1D women treated with continuous subcutaneous insulin infusion (CSII). STUDY DESIGN: We retrospectively assessed maternal and neonatal outcomes in T1D women using CSII who had planned or unplanned pregnancies between 2002 and 2018. The study was done in two European countries with similar sustained programs for pregnancy planning over the study period. RESULTS: Data from 107 pregnancies and newborn babies were collected. Seventy-nine pregnancies (73.8%) had been planned. HbA1c was lower in planned versus unplanned pregnancy before and during all three trimesters of pregnancy (p < 0.0001). Pregnancy planning was associated with a reduction in the occurrence of iatrogenic preterm delivery (RR 0.44, 95% CI 0.23-0.95; p = 0.01). Risk reduction persisted after adjustments for mother's age above 40 years and preeclampsia. High HbA1c before or during pregnancy was associated with an increased risk of iatrogenic preterm delivery (RR 3.05, 95% CI 1.78-5.22, p < 0.0001). Premature newborns needed intensive care more often than those at term (RR 3.10, 95% CI 1.53-4.31; p = 0.002). CONCLUSIONS: Pregnancy planning in T1D women using CSII was associated with better glucose control and decreased risk of iatrogenic preterm delivery. Hence preconception care also improves pregnancy outcome in patients using an advanced mode of insulin delivery. Planned pregnancies could further benefit from the use of new metrics of glucose control.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Serviços de Planejamento Familiar , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/terapia , Adulto , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , França/epidemiologia , Controle Glicêmico/estatística & dados numéricos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Itália/epidemiologia , Masculino , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/epidemiologia , Gravidez não Planejada , Prognóstico , Estudos Retrospectivos
16.
Artigo em Inglês | MEDLINE | ID: mdl-33327583

RESUMO

The prevalence of inflammatory bowel disease in Korea is rapidly increasing. Women with inflammatory bowel disease have a higher risk of adverse birth outcomes than healthy women, and the magnitude of this risk is related to the severity of the disease at the time of pregnancy. For a woman with inflammatory bowel disease to have a healthy pregnancy, interventions are needed to manage the disease before pregnancy-implying a need for pregnancy planning. In this study, the intervention mapping protocol was used to develop a program for this purpose. This protocol contains the following stages: needs assessment, setting of program outcomes and performance objectives, selection of methods and strategies based on theory, and development of the program and its materials. Through individual in-depth interviews and a literature review, individual and environmental determinants were assessed and six change objectives of the program were set. The methods and practical strategies were developed based on the information-motivation-behavioral skills model, self-efficacy theory, and social support theory. The final program, consisting of four sessions and the corresponding materials, was completed by making revisions based on a content validity assessment by experts and a pilot test. Follow-up studies on the implementation of this program will be conducted in the future.


Assuntos
Protocolos Clínicos , Doenças Inflamatórias Intestinais , Cuidado Pré-Concepcional , Desenvolvimento de Programas , Protocolos Clínicos/normas , Feminino , Humanos , Doenças Inflamatórias Intestinais/terapia , Motivação , Cuidado Pré-Concepcional/normas , Desenvolvimento de Programas/normas , República da Coreia
18.
Int J Gynaecol Obstet ; 151 Suppl 1: 6-15, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32894587

RESUMO

With the increase in obesity prevalence among women of reproductive age globally, the risks of type 2 diabetes, gestational diabetes, pre-eclampsia, and other conditions are rising, with detrimental effects on maternal and newborn health. The period before pregnancy is increasingly recognized as crucial for addressing weight management and reducing malnutrition (both under- and overnutrition) in both parents to reduce the risk of noncommunicable diseases (NCDs) in the mother as well as the passage of risk to her offspring. Healthcare practitioners, including obstetricians, gynecologists, midwives, and general practitioners, have an important role to play in supporting women in planning a pregnancy and achieving healthy nutrition and weight before pregnancy. In this position paper, the FIGO Pregnancy Obesity and Nutrition Initiative provides an overview of the evidence for preconception clinical guidelines to reduce the risk of NCDs in mothers and their offspring. It encourages healthcare practitioners to initiate a dialogue on women's health, nutrition, and weight management before conception. While acknowledging the fundamental importance of the wider social and environmental determinants of health, this paper focuses on a simple set of recommendations for clinical practice that can be used even in short consultations. The recommendations can be contextualized based on local cultural and dietary practices as part of a system-wide public health approach to influence the wider determinants as well as individual factors influencing preconception health.


Assuntos
Doenças não Transmissíveis/prevenção & controle , Cuidado Pré-Concepcional/métodos , Saúde da Mulher , Peso Corporal , Feminino , Humanos , Saúde do Lactente/normas , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Guias de Prática Clínica como Assunto , Cuidado Pré-Concepcional/normas , Gravidez
19.
PLoS One ; 15(8): e0237571, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810195

RESUMO

BACKGROUND: Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. METHODS: Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. RESULTS: The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations risk by 71%, (Risk ratio (RR) 0.29; 95% CI: 0.21-0.40, 25 studies; 5903 women; high-certainty evidence). The results also show that PCC may lower HbA1c in the first trimester of pregnancy by an average of 1.27% (Mean difference (MD) 1.27; 95% CI: 1.33-1.22; 4927 women; 24 studies, moderate-certainty evidence). Furthermore, the results suggest that PCC may lead to a slight reduction in the risk of preterm delivery of 15%, (RR 0.85; 95% CI: 0.73-0.99; nine studies, 2414 women; moderate-certainty evidence). Moreover, PCC may result in risk reduction of perinatal mortality by 54%, (RR 0.46; 95% CI: 0.30-0.73; ten studies; 3071 women; moderate-certainty evidence). There is uncertainty about the effects of PCC on the early booking for antenatal care (MD 1.31; 95% CI: 1.40-1.23; five studies, 1081 women; very low-certainty evidence) and maternal hypoglycemia in the first trimester, (RR 1.38; 95% CI: 1.07-1.79; three studies; 686 women; very low- certainty evidence). In addition, results of the meta-analysis indicate that PCC may lead to 48% reduction in the risk of small for gestational age (SGA) (RR 0.52; 95% CI: 0.37-0.75; six studies, 2261 women; moderate-certainty evidence). PCC may reduce the risk of neonatal admission to intensive care unit (NICU) by 25% (RR 0.75; 95% CI: 0.67-0.84; four studies; 1322 women; moderate-certainty evidence). However, PCC may have little or no effect in reducing the cesarean section rate (RR 1.02; 95% CI: 0.96-1.07; 14 studies; 3641 women; low-certainty evidence); miscarriage rate (RR 0.86; 95% CI: 0.70-1.06; 11 studies; 2698 women; low-certainty evidence); macrosomia rate (RR 1.06; 95% CI: 0.97-1.15; nine studies; 2787 women, low-certainty evidence); neonatal hypoglycemia (RR 0.93; 95% CI: 0.74-1.18; five studies; 880 women; low-certainty evidence); respiratory distress syndrome (RR 0.78; 95% CI: 0.47-1.29; four studies; 466 women; very low-certainty evidence); or shoulder dystocia (RR 0.28; 95% CI: 0.07-1.12; 2 studies; 530 women; very low-certainty evidence). CONCLUSION: PCC for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations. In addition, it may improve the risk of preterm delivery and admission to NICU. PCC probably reduces maternal HbA1C in the first trimester of pregnancy, perinatal mortality and SGA. There is uncertainty regarding the effects of PCC on early booking for antenatal care or maternal hypoglycemia during the first trimester of pregnancy. PCC has little or no effect on other maternal and perinatal outcomes.


Assuntos
Cuidado Pré-Concepcional , Resultado da Gravidez , Gravidez em Diabéticas/terapia , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/normas , Promoção da Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Cuidado Pré-Concepcional/métodos , Cuidado Pré-Concepcional/organização & administração , Cuidado Pré-Concepcional/normas , Cuidado Pré-Concepcional/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/epidemiologia , Prognóstico , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Resultado do Tratamento
20.
Prim Care ; 47(3): 443-452, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32718442

RESUMO

The continuum of preconception, antenatal period, fourth trimester, and interconception period are a critical time for comprehensive care to advance maternal-child health and deliver family-centered care. Immunizations are a key component of this care delivery; however, there are intricacies around indications of vaccinations during this key period. Both active immunity to the individual receiving the vaccine as well as passive immunity passed to the fetus during pregnancy highlight the benefits of this care. Understanding the indications and benefits of vaccine administration during this continuum is critical for providers caring for individuals of reproductive age.


Assuntos
Cuidado Pré-Concepcional/organização & administração , Cuidado Pré-Natal/psicologia , Atenção Primária à Saúde/organização & administração , Vacinas/administração & dosagem , Vacinas/imunologia , Feminino , Humanos , Saúde Materna , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Concepcional/normas , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Atenção Primária à Saúde/normas , Viagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...