Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar <7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. Results A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26–1.61; multiparas: 1.39, 95% CI 1.21–1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02–1.27, multiparas: 1.41, 95% CI 1.16–1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79–0.98; multiparas: 0.74, 95% CI 0.66–0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (≥0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage. Conclusions Women’s citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.
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Background: Our aim was to identify dietary patterns by the level of maternal education that contribute to BMI, fat mass index (FMI), and fat-free mass index (FFMI) in children at age 5 and to assess if these dietary patterns are related to BMI at age 10. Methods: Per group (low/middle/high level), Reduced Rank Regression (RRR) was used to derive dietary patterns for the response variables BMI z-score, FMI, and FFMI in 1728 children at age 5 in the Amsterdam Born Children and their Development (ABCD) cohort. Regression analyses were then used to determine the association with BMI at age 10. Results: In each group, pattern 1 was characterized by its own cluster of food groups. Low: water/tea, savory snacks, sugar, low-fat meat, and fruits; middle: water/tea, low-fat cheese, fish, low-fat dairy, fruit drink, low-fat meat, and eggs; and high: low-fat cheese, fruits, whole-grain breakfast products, and low-fat and processed meat. Additionally, in each group, pattern 1 was positively associated with BMI z-scores at age 10 (low: β ≤ 0.43 [95% CI ≤ 0.21; 0.66], p < 0.001, middle: β ≤ 0.23 [0.09; 0.36], p ≤ 0.001, and high: β ≤ 0.24 [0.18; 0.30], p < 0.001). Conclusions: The dietary patterns stratified by the level of maternal education are characterized by different food groups. But in all the groups, pattern 1 is positively associated with BMI at age 10.
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Objective We examined whether the role of maternal education in children's unhealthy snacking diet is moderated by other socio-economic indicators. Methods Participants were selected from the Amsterdam Born Children and their Development cohort, a large ongoing community-based birth cohort. Validated Food Frequency Questionnaires (FFQ) (n = 2782) were filled in by mothers of children aged 5.7±0.5yrs. Based on these FFQs, a snacking dietary pattern was derived using Principal Component Analysis. Socio-economic indicators were: maternal and paternal education (low, middle, high; based on the highest education completed) household finance (low, high; based on ability to save money) and neighbourhood SES (composite score including educational level, household income and employment status of residents per postal code). Cross-sectional multivariable linear regression analysis was used to assess the association and possible moderation of maternal education and other socio-economic indicators on the snacking pattern score. Analyses were adjusted for children's age, sex and ethnicity. Results Low maternal education (B 0.95, 95% CI 0.83;1.06), low paternal education (B 0.36, 95% CI 0.20;0.52), lower household finance (B 0.18, 95% CI 0.11;0.26) and neighbourhood SES (B -0.09, 95% CI -0.11;-0.06) were independently associated with higher snacking pattern scores (p<0.001). The association between maternal education and the snacking pattern score was somewhat moderated by household finance (p = 0.089) but remained strong. Children from middle-high educated mothers (B 0.44, 95% CI 0.35;0.52) had higher snacking pattern scores when household finance was low (B 0.49, 95% CI 0.33;0.65). Conclusions All socio-economic indicators were associated with increased risk of unhealthy dietary patterns in young children, with low maternal education conferring the highest risk. Yet, within the group of middle-high educated mothers, lower household finance was an extra risk factor for unhealthy dietary patterns. Intervention strategies should therefore focus on lower educated mothers and middle-high educated mothers with insufficient levels of household finance.
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Background: Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. Methods/design: In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. Discussion: his study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks.
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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all.This care includes preventive and supportive care that works to strengthen women’s capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population’s curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.
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Through artistic interventions into the computational backbone of maternity services, the artists behind the Body Recovery Unit explore data production and its usages in healthcare governance. Taking their artwork The National Catalogue Of Savings Opportunities. Maternity, Volume 1: London (2017) as a case study, they explore how artists working with ‘live’ computational culture might draw from critical theory, Science and Technology Studies as well as feminist strategies within arts-led enquiry. This paper examines the mechanisms through which maternal bodies are rendered visible or invisible to managerial scrutiny, by exploring the interlocking elements of commissioning structures, nationwide information standards and databases in tandem with everyday maternity healthcare practices on the wards in the UK. The work provides a new context to understand how re-prioritisation of ‘natural’ and ‘normal’ births, breastfeeding, skin-to-skin contact, age of conception and other factors are gaining momentum in sync with cost-reduction initiatives, funding cuts and privatisation of healthcare services.
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Zorgcapaciteit kan een belangrijke schakel zijn tussen multi-probleem omstandigheden en ongunstige ontwikkeling van kinderen. Deze studie heeft als doel om de zorgcapaciteit en de correlaties daartussen te onderzoeken in zeer kwetsbare multiprobleemgezinnen in Rotterdam, Nederland. Zorgcapaciteit (algemeen, emotioneel en instrumenteel) werd prospectief beoordeeld bij 83 zeer kwetsbare vrouwen met behulp van video-observaties van dagelijkse zorgtaken, zes weken postpartum. Ondersteunende gegevens werden verzameld op drie tijdstippen: bij inclusie, zes weken na inclusie en zes weken postpartum, en deze omvatten psychologische symptomen, zelfredzaamheid, problematische levensdomeinen, thuisomgeving, inkomen, depressie, angst en stress. Zwangerschaps- en bevallingsgerelateerde informatie werd verzameld bij verloskundigen. De scores voor zorgverlening door de moeder waren gemiddeld van onvoldoende kwaliteit. Moeders die in een onveilige thuisomgeving leefden (B = 0,62) en moeders met meer problematische levensdomeinen (≤3 domeinen, B = 0,32) vertoonden significant hogere instrumentele zorgcapaciteiten. Andere variabelen waren niet gerelateerd aan zorgcapaciteit. De zorgcapaciteit in deze zeer kwetsbare populatie was van onvoldoende kwaliteit. In de meeste gevallen was er echter geen significant verband tussen zorgzaamheid en de variabelen die gerelateerd zijn aan kwetsbaarheid. Dit betekent dat een mogelijk verband tussen kwetsbaarheid en zorgcapaciteit kan worden veroorzaakt door de interactie tussen verschillende problemen, in plaats van door het type of de omvang van de zorg.
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Objectives: Promoting unstructured outside play is a promising vehicle to increase children’s physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play. Study design: 1875 parents from the KOALA Birth Cohort Study reported on their child’s outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses. Results: Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation. Conclusion: Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility.
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Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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