Objectives Early first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change. Methods The study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions—when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care. Results On average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card. Conclusions for Practice This study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted. What is already known on this subject? Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit. What this study adds? Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.
Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers’ understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.
Background There are known gender differences in the impacts infertility has on quality of life and well-being. Less is known about how infertile couples spend time on fertility-related tasks and associations with quality of life. The purpose of this study is to evaluate whether time spent on tasks related to family-building decision-making (including research, reflection, discussions with partner, discussions with others, and logistics) were associated with fertility-specific quality of life or anxiety among new patients. Methods Couples or individuals ( N = 156) with upcoming initial consultations with a reproductive specialist completed the Fertility Quality of Life (FertiQoL) tool, which produces a Core (total) score and four subscales: Emotional, Relational, Social, and Mind-Body. We developed questions to measure time spent in the previous 24 h on tasks related to family-building. We tested for differences by gender in time use (McNemar’s Test) and used ordinary least squares regression to analyze the relationship between time use and FertiQoL scores. Results In the week before a new consultation, a higher percentage of women reported time spent in the past 24 h in research, reflecting, discussion with others, and logistics compared to male partners (all p < 0.05). In adjusted models, more time spent reflecting was associated with worse FertiQoL scores for both men and women, as well as with higher anxiety for men. Time spent in discussion with others was associated with higher anxiety for women but better Social FertiQoL scores for men. Conclusions Couples seeking infertility consultation with a specialist reported spending time on tasks related to family-building before the initial visit. There were gender differences in the amount of time spent on these tasks, and time was associated with fertility-specific quality of life and anxiety.
INTRODUCTION: Secondary traumatic stress (STS) is the resulting effects from exposure to adverse medical events and may include symptoms of depression, fear, or work avoidance. Â1 This study aims to understand STS in Ob-Gyn physicians and assess needs for interventions to promote wellness. METHODS: An explanatory mixed-methods analysis used an anonymous survey distributed to an Ob-Gyn department at a Midwest academic institution followed by focus groups and individual interviews. IBM® SPSS® 24.0 generated descriptive statistics, point-biserial correlations, and reliability analysis. Constant comparative analysis identified themes. Institutional IRB approval was obtained. RESULTS: Twenty-seven individuals (52% residents/40% faculty) completed the reliable (alpha=0.71) survey. Ten faculty participated in interviews/focus groups. Anxiety (81%), guilt (62%), disruptive sleep (58%) were most frequently reported STS symptoms (mean number of symptoms=(3.4±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (rpb=0.5, p<.006); those reporting guilt would go to friends (rpb=0.5, p<.007). Disrupted sleep more commonly led to seeking mental health services (rpb=0.5, p<.007). Provider description of STS included: responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Effects varied from task avoidance to hypervigilance. Protective factors included support from colleagues and ability to compartmentalize work/home. Mental health treatment and faith-based, introspective beliefs facilitated coping. Desires for support varied: those reporting anxiety were more interested in peer-to-peer responders (rpb=0.6, p<.001), those reporting guilt would use debriefing sessions (rpb=0.4, p<.023). CONCLUSION: STS wellness programs including peer support and group processing can promote collegiality, shared learning, and emotional support. A breadth of resources is imperative to address individual provider needs.
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