Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study

Maternal and Child Health Journal - Early life exposures can have an impact on a child’s developmental trajectory and children born late preterm (34–36 weeks gestational age)...     

The Association of Inadequate and Intensive Prenatal Care With Maternal,Fetal, and Infant Outcomes: A Population-Based Study in Manitoba,Canada

ObjectiveLittle is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba.MethodsThis retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours.ResultsThe distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization.ConclusionInadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.     

The influence of adolescent mothers' breastfeeding confidence and attitudes on breastfeeding initiation and duration

A prospective correlational study was conducted to examine the influence of adolescent mothers' breastfeeding attitudes and confidence on breastfeeding initiation and duration. A convenience sample of 100 pregnant adolescents who were contemplating breastfeeding completed the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and the Breastfeeding Attitude Questionnaire (BAQ). The BSES-SF was readministered during the first week postpartum to those adolescents who initiated breastfeeding (n=84). Adolescents who were breastfeeding at the initial contact received a follow-up contact at 4 weeks postpartum. Comparisons were made between those adolescent mothers who initiated breastfeeding (n=84) and those who did not (n=16). Significantly more mothers with higher prenatal attitude scores initiated breastfeeding. Mothers with higher prenatal breastfeeding attitude scores and higher prenatal and postnatal confidence scores were more likely to continue breastfeeding to 4 weeks postpartum. Health professionals are encouraged to develop strategies to enhance breastfeeding attitudes and confidence among adolescent mothers.     

Examining Early Childhood Health Outcomes of Children Born Late Preterm in Urban Manitoba

Objective The late preterm population [34–36 weeks gestational age (GA)] is known to incur increased morbidity in the infancy stage compared to the population born at term (39–41 weeks GA). This study aimed to examine the health of these children during their early childhood years, with specific attention to the role of socioeconomic status. Methods A retrospective cohort study was conducted using data from the Manitoba Centre for Health Policy, including all live-born children born at 34–36 and 39–41 weeks GA in urban Manitoba between 2000 and 2005 (n?=?28,100). Multivariable logistic regression was used to examine the association of GA with early childhood morbidity after controlling for maternal, child and family level variables. Results The late preterm population was found to have significantly greater adjusted odds of lower respiratory tract infections in the preschool years (aOR?=?1.59 [1.24, 2.04]) and asthma at school age (aOR?=?1.33 [1.18, 1.47]) compared to the population born at term. The groups also differed in health care utilization at ages 4 (aOR?=?1.19 [1.06,1.34]) and 7 years (aOR?=?1.24 [1.09, 1.42]). Additional variables associated with poor outcomes suggest that social deprivation and GA simultaneously have a negative impact on early childhood development. Conclusions for Practice Adjustment for predictors of poor early childhood development, including socioeconomic status, were found to attenuate but not eliminate health differences between children born late preterm and children born at term. Poorer health outcomes that extend into childhood have implications for practice at the population level and suggest a need for further follow-up post discharge.     

Conducting a national survey of women's perinatal experiences in Canada: sampling challenges

In 1999, the Canadian Perinatal Surveillance System of Health Canada decided to undertake a national survey of Canadian women's experiences of their pregnancy, birth and postpartum care. The challenges encountered in selecting a representative sampling frame and developing a sound methodology for conducting a survey of Canadian women at six months after birth are addressed. We considered the advantages and disadvantages of six different sampling options. A sample based on the Census emerged as the optimal approach for providing the most reliable and representative sample.