Journal of midwifery & women's health最新文献_第2页

Implementing Food Security Screening in all Pregnant Women: Call to Action 对所有孕妇进行食品安全筛查：行动呼吁。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-26 DOI: 10.1111/jmwh.13708

Jennifer Woo CNM, PhD, WHNP, Divya Parmar RN, Valeria Millinga MS, Tracie Kirkland PhD, DNP, ANP, PNP

引用次数: 0

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups 产前护理综合指数的开发与测试：不同种族和族裔群体与早产和胎龄偏小的关系。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-26 DOI: 10.1111/jmwh.13707

Sueny P. Lima dos Santos MS, Eric E. Calloway PhD, RDN, Ilana R. A. Chertok PhD, MSN, RN, IBCLC, Zelalem T. Haile PhD, MPH

Introduction

Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion.

Methods

This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices.

Results

The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from −2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups.

Discussion

The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

导言：早产和胎龄过小 (SGA) 是美国重大的公共卫生问题，不同种族和民族群体之间存在明显差异。传统的产前保健充分性指数在全面反映其多面性方面存在局限性。我们的研究引入了产前护理综合指数（CPCI），通过整合产前咨询和健康促进的关键要素，对产前护理进行更全面的评估：这项横断面研究使用了 2016-2021 年妊娠风险评估监测系统的数据。CPCI 是在综合文献回顾的基础上开发的，包含了产前检查的时间、频率和内容等要素。该指数采用项目反应理论（IRT）进行了验证，并与 Kotelchuck 和 Kessner 指数进行了比较：研究共纳入 139 181 名孕妇。CPCI 显示出很强的内部一致性（Cronbach's α，0.75；ω total，0.81）。IRT分析证实了该指数能够捕捉产前护理质量的变异性，项目难度参数范围在-2.93至+2.10之间。CPCI 分数与不良分娩结局几率的降低有明显关联。在非西班牙裔白人妇女中，充分的 CPCI 护理可将早产几率降低 63%，在西班牙裔妇女（几率比 [OR]，0.59）和亚裔妇女（OR，0.38）中也观察到类似的降低。就 SGA 而言，适当的护理对非西班牙裔白人妇女（OR，0.86）和西班牙裔妇女（OR，0.82）具有保护作用，但对其他群体的影响则不尽相同：讨论：与传统指数相比，CPCI 提供了一个更具包容性的产前护理质量衡量标准。研究结果表明，综合产前护理在减少不良分娩结局和解决种族及民族差异方面发挥着重要作用。未来的研究应侧重于完善 CPCI 并探索其在不同人群中的适用性，从而为有针对性的、文化敏感的产前护理策略提供依据。

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引用次数: 0

Family-Centered Antenatal Care With a Life-Limiting Fetal Condition: A Developmental Theory-Guided Approach 以家庭为中心的产前护理：胎儿生命垂危：以发展理论为指导的方法。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-26 DOI: 10.1111/jmwh.13710

Carrie J. Henry CNM, PhD, RN, Denise Côté-Arsenault PhD, RN, CPLC

Trisomy 18 (T18) is the second-most common autosomal trisomy and includes multiple anomalies, growth restriction, and a severely shortened life span, often lasting only hours or days. Côté-Arsenault and Denney-Koelsch extended Reva Rubin's work, describing the psychosocial stages of pregnancy by describing the stages and developmental tasks for a pregnancy altered by a life-limiting fetal condition such as T18. When a diagnosis of T18 is made prenatally, the pregnancy changes dramatically, although it remains a psychosocial developmental process. The extended stages of pregnancy with T18 or another life-limiting fetal condition are: Pre-Diagnosis, Learning the Diagnosis, Living With the Diagnosis, Birth and Death, and Post Death. As they navigate these stages, parents must also address 7 developmental tasks of pregnancy, which are (1) Navigating Relationships, (2) Comprehending Implications of the Condition, (3) Revising Goals of Pregnancy, (4) Making the Most of Time With Baby, (5) Preparing for Birth and Inevitable Death, (6) Advocating for Baby With Integrity, and (7) Adjusting to Life in Absence of Baby. Knowledgeable health care providers can do much more than support parents through grief and facilitate discussions about birth planning. This case report highlights the importance of a knowledgeable provider who can help parents navigate the stages and tasks of pregnancy, empowering them to make choices consistent with their values so they have no regrets.

18 三体综合征（T18）是第二常见的常染色体三体综合征，包括多种畸形、生长受限和寿命严重缩短，通常只能持续数小时或数天。Côté-Arsenault 和 Denney-Koelsch 扩展了 Reva Rubin 的工作，描述了妊娠的社会心理阶段，从而描述了因 T18 等限制胎儿生命的疾病而改变的妊娠阶段和发育任务。当产前确诊 T18 时，妊娠会发生巨大的变化，尽管它仍然是一个社会心理发展过程。患有 T18 或其他限制胎儿生命的疾病时，妊娠的扩展阶段包括诊断前、了解诊断、与诊断共存、出生和死亡以及死亡后。在经历这些阶段时，父母还必须处理好孕期的 7 项发展任务，即（1）处理好人际关系；（2）理解病情的影响；（3）修正孕期目标；（4）充分利用与宝宝在一起的时间；（5）为出生和不可避免的死亡做准备；（6）为宝宝进行诚信宣传；（7）适应没有宝宝的生活。知识渊博的医疗服务提供者所能做的远不止帮助父母度过悲痛和促进有关分娩计划的讨论。本病例报告强调了知识渊博的医疗服务提供者的重要性，他们可以帮助父母了解怀孕的各个阶段和任务，使他们有能力做出符合自己价值观的选择，从而不留遗憾。

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引用次数: 0

Research and Professional Literature to Inform Practice, November/December 2024 为实践提供信息的研究和专业文献》，2024 年 11 月/12 月。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-24 DOI: 10.1111/jmwh.13712

Rebecca R. S. Clark CNM, PhD, MSN, RN

引用次数: 0

Building Integrity and Trust in Clinical Trials 在临床试验中建立诚信。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-22 DOI: 10.1111/jmwh.13719

Melissa D. Avery CNM, PhD, Linda A. Hunter CNM, EdD, Ira Kantrowitz-Gordon CNM, PhD

The Journal of Midwifery & Women's Health (JMWH) leadership strives to ensure the highest level of scholarly publication, including consistency with national and international guidance related to scientific integrity and excellence. Since July 1, 2005, the International Committee of Medical Journal Editors (ICMJE) has recommended registration of all clinical trials.1 Clinical trial registration is necessary for study results to be published in journals that adhere to the ICMJE guidelines. Thus, investigators are responsible for ensuring their trials have been appropriately registered. JMWH has a long history of commitment to following these recommendations.2 Some authors, however, may be unaware of the requirements. Therefore, the background and current standards are reviewed here.What is clinical trial registration and why is it important? The purposes of registration of clinical trials in a national or international database are transparency and reporting integrity. When clinical trial information is publicly available before participant enrollment, individuals interested in trial participation can search opportunities in available registry databases. Researchers can search ongoing trials in their area of study to avoid unnecessary duplication. Clinical trial registration aims to prevent bias in the reporting of research such as only reporting selected outcomes. Trial registries can also be helpful to institutional review boards that are examining newly proposed studies.3Clinical trials are defined by ICMJE as “any research project that prospectively assigns people or a group of people to an intervention, with or without concurrent comparison or control groups, to study the relationship between a health-related intervention and a health outcome.”3(p 1) The treatment or intervention may be pharmacologic, surgical, behavioral, dietary, educational, or changes in care processes. Feasibility type studies that assign participants to a single treatment without a control or comparison group are also considered clinical trials for the purpose of trial registration.3 Examination of the clinical trial registration date can assure the public that information was provided to the registry before enrollment of participants, which is essential to preventing bias in reporting.Registration of a clinical trial involves investigators providing specific information about the trial to an approved registry.4 For example, Clinicaltrials.gov is a trial registry database maintained by the National Library of Medicine and contains information about trials conducted in the United States and many other countries. The World Health Organization (WHO) requires a specific set of items about trials to be included, such as a unique trial identifier (assigned by the regis

助产学杂志；妇女健康（JMWH）领导层努力确保最高水平的学术出版，包括与科学诚信和卓越相关的国家和国际指导保持一致。自2005年7月1日起，国际医学杂志编辑委员会（ICMJE）建议注册所有临床试验临床试验注册是研究结果发表在符合ICMJE指南的期刊上的必要条件。因此，调查人员有责任确保他们的试验得到适当的登记。JMWH长期以来一直致力于遵循这些建议然而，一些作者可能不知道这些要求。因此，本文对背景和现行标准进行了综述。什么是临床试验注册？为什么它很重要？在国家或国际数据库中注册临床试验的目的是透明度和报告的完整性。当临床试验信息在参与者登记前公开时，对参与试验感兴趣的个人可以在可用的注册数据库中搜索机会。研究人员可以在他们的研究领域搜索正在进行的试验，以避免不必要的重复。临床试验注册的目的是防止研究报告的偏倚，例如只报告选定的结果。试验登记对正在审查新提出的研究的机构审查委员会也有帮助。临床试验被ICMJE定义为“任何研究项目，前瞻性地分配人或一组人进行干预，有或没有同时进行的对照组或对照组，以研究与健康相关的干预与健康结果之间的关系。”治疗或干预可以是药物、手术、行为、饮食、教育或护理过程的改变。可行性类型的研究将参与者分配给单一治疗而没有对照组或对照组，也被认为是临床试验注册的目的对临床试验注册日期的检查可以向公众保证，在参与者入组之前已向注册中心提供了信息，这对于防止报告偏差至关重要。临床试验的注册涉及研究者向批准的注册中心提供有关试验的具体信息例如，Clinicaltrials.gov是一个由国家医学图书馆维护的试验注册数据库，其中包含有关在美国和许多其他国家进行的试验的信息。世界卫生组织（WHO）要求纳入一组关于试验的特定项目，如唯一试验标识符（由注册中心分配）、试验注册日期、首次入组日期、研究发起者信息、纳入和排除标准、研究信息描述、研究方法的完整信息和研究结果ICMJE要求在2019年1月之后招募参与者的试验提供数据共享声明，该声明必须包括共享去识别数据的描述和计划。试验登记是由世界卫生组织在国际上批准的。注册中心必须遵守世卫组织的要求，包括向所有潜在注册人开放，显示世卫组织试验数据集中包含的所有数据，并且一旦注册就不得删除试验。注册中心必须确保显示有效数据，包括试验注册人存在、试验存在以及提供了完整的数据。此外，注册中心必须公开显示数据，包括对研究所做的任何更改的公开审计跟踪，使信息可免费访问和搜索，确保没有重复试验，有足够的技术支持，并确保一定程度的行政支持。临床试验研究在医学文献中更为常见，因此，报告更有可能包含适当的注册信息。一些护理、助产和医学以外领域的研究人员可能不太熟悉注册临床试验的要求，以便在科学期刊上发表他们的研究结果，导致完成这一过程的可能性较低。这种熟悉程度的差距可能导致作者错误地将研究方法标记为符合ICMJE定义的临床试验以外的东西。鉴定为临床试验应包括在稿件标题，其中包括可行性和试点试验。此外，编辑过程和同行评审在确保符合临床试验定义的研究作为评审过程的一部分得到适当注册方面发挥着至关重要的作用。在过去的一年中，JMWH的指导和审查已经得到了加强，不再只是说明需要进行试验注册。作者在上传稿件时必须审查一份声明，承认他们知道需要进行临床试验注册，并通过复选框确认他们的同意。提供了ICMJE和世卫组织指南的链接，其中包括定义和可接受的试验登记清单。除了简单的核对外，JMWH编辑人员还会审查所有提交的手稿，以确定是否进行了临床试验。如果是，检查稿件，看是否在摘要和方法部分提供了试验注册表和唯一标识符。对试验注册中心进行检查，以确保在参与者登记开始之前进行了注册。JMWH还要求使用基于研究类型的报告指南，通常是临床试验报告的综合标准（CONSORT）8。在向JMWH或任何其他科学期刊投稿之前，作者应熟悉上述信息。通过确认作者对指南的了解，JMWH编辑团队表明了我们对维护学术标准的承诺。此外，试验注册日期的确认确保了与ICMJE指南的一致性，为期刊在稿件提交时验证作者提供的信息提供了一种机制。我们分享这些信息的目的是让读者、审稿人和作者了解JMWH的流程，以进一步提高期刊和投稿稿件的质量。

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引用次数: 0

Alcohol Use in Pregnancy 孕期饮酒。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-19 DOI: 10.1111/jmwh.13717

Prenatal alcohol exposure is a leading cause of preventable birth defects and developmental problems. There is no known safe amount of alcohol you can drink during pregnancy or while trying to get pregnant. Too many people continue to drink during pregnancy. About 1 in 10 pregnant people in the United States drank alcohol in the past 30 days. About 1 in 22 pregnant people in the United States had 4 or more drinks at one time (binge drinking) in the past 30 days. These problems are completely preventable if a person does not drink alcohol during pregnancy. Why take the risk?Drinking alcohol during pregnancy can cause miscarriage, stillbirth, preterm birth, and sudden infant death syndrome (SIDS) and a range of physical, behavioral, and intellectual disabilities for the baby that can last a lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). Some of the health and other problems of people with FASDs include learning disabilities, hyperactivity, difficulty with attention, speech and language delays, intellectual disabilities, and poor reasoning (thinking) and judgment skills. People born with FASDs can also have problems with their organs, including the heart and kidneys. Some babies with FASDs can have a smaller head, weigh less than other babies, and have parts of their faces that look different than other babies.There is no known safe amount of alcohol use during pregnancy or when you are trying to get pregnant. Alcohol is passed through the placenta and the fetus is exposed to the same amount as the pregnant person. All exposure to any drinks with alcohol can affect a baby's growth and development and cause FASDs. A 5-ounce glass of wine has the same amount of alcohol as a 12-ounce can of beer or a 1.5-ounce shot of straight liquor. All types of alcohol—even wine, wine coolers, seltzers, hard cider and beer—can harm your developing baby. The Chart on the following page shows when your baby is developing different parts of its body that may be harmed by drinking alcohol.It is best to stop drinking alcohol when you start trying to get pregnant. Many people become pregnant and do not know it right away. It may be up to 4 to 6 weeks before you know for sure that you are pregnant. This means you might be drinking and exposing your developing baby to alcohol without meaning to. If you think you have a problem with alcohol, it's best to get treatment before you try to get pregnant.If you drank before you knew you were pregnant or before you knew it could harm your baby, stop now. The less exposure, the better for your baby. If you are having trouble quitting drinking, ask your health care provider for help. There are many treatment options that can help and are safe in pregnancy. Together, you can develop a plan to quit drinking.Flesch Kincaid 7.3Approved October 2024. This handout replaces “Alcohol in Pregnancy” published in Volume 60, Issue 1, January/February 2015.</

产前酒精暴露是可预防的出生缺陷和发育问题的主要原因。在怀孕期间或准备怀孕期间，没有已知的安全饮酒量。太多的人在怀孕期间继续喝酒。在过去的30天里，美国约有十分之一的孕妇饮酒。在过去的30天里，美国约有1 / 22的孕妇一次喝了4杯或更多的酒（狂饮）。如果一个人在怀孕期间不喝酒，这些问题是完全可以预防的。为什么要冒这个险？怀孕期间饮酒会导致流产、死胎、早产和婴儿猝死综合症（SIDS），以及婴儿的一系列身体、行为和智力残疾，这些残疾可能持续一生。这些残疾被称为胎儿酒精谱系障碍（FASDs）。fasd患者的一些健康和其他问题包括学习障碍、多动、注意力困难、言语和语言迟缓、智力障碍、推理（思考）和判断能力差。患有先天性fasd的人也可能有器官问题，包括心脏和肾脏。一些患有fasd的婴儿可能会有一个较小的头部，体重比其他婴儿轻，并且他们的面部部分看起来与其他婴儿不同。在怀孕期间或准备怀孕时，没有已知的安全饮酒量。酒精通过胎盘，胎儿与孕妇接触的酒精量相同。接触任何含酒精的饮料都会影响婴儿的生长发育，并导致fasd。一杯5盎司的葡萄酒所含的酒精与一罐12盎司的啤酒或一杯1.5盎司的烈性酒所含的酒精相同。所有类型的酒精——甚至是葡萄酒、冰酒、苏打水、烈性苹果酒和啤酒——都会伤害你正在发育的宝宝。下一页的图表显示了宝宝身体的不同部位何时会受到饮酒的伤害。当你开始尝试怀孕时，最好停止饮酒。许多人怀孕了，却没有马上意识到。你可能需要4到6周的时间才能确定自己怀孕了。这意味着你可能会无意中喝酒，让你正在发育的宝宝接触到酒精。如果你认为自己有酒精问题，最好在怀孕前接受治疗。如果你在知道自己怀孕之前就喝酒了，或者在你知道它会伤害你的孩子之前，马上停止。接触越少，对你的宝宝越好。如果你在戒酒方面有困难，向你的健康护理人员寻求帮助。有许多治疗选择可以帮助和安全的怀孕。你们可以一起制定一个戒酒计划。2024年10月批准。本讲义取代2015年1月/ 2月第60卷第1期发表的“孕期饮酒”。卫生保健专业人员可以复制本讲义用于非商业用途，与患者分享，但不允许对讲义进行修改。本讲义中的信息和建议不能替代医疗保健。向您的医疗保健提供者咨询有关您和您的健康的具体信息。

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引用次数: 0

Congenital Cytomegalovirus (CMV) 先天性巨细胞病毒 (CMV)。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-19 DOI: 10.1111/jmwh.13715

Cytomegalovirus (sy-toh-mega-loh-virus), or CMV, is a common virus that causes cold-like symptoms. It does not harm most people and may cause a few days of sore throat and feeling tired. CMV stays silent in the body and can become active from time to time. There are different types of CMV. If a person catches CMV right before becoming pregnant or during pregnancy, or a previous infection becomes active, their fetus may get CMV. Babies that get CMV during pregnancy are referred to as having congenital CMV, or cCMV.About one in every 200 babies born in the United States has cCMV.Most babies with cCMV have no signs you can see at birth. About 10–20% of babies born with cCMV will have more serious problems. At birth they may have a low birth weight and/or small head size (microcephaly). They may also have other signs at birth such as hearing loss, feeding difficulties, jaundice, and a purple spotted rash. Congenital CMV can also lead to long-term health problems, like later hearing loss and developmental delay. Common health problems associated with cCMV are listed in the box, below.CMV is transmitted through body fluids, like saliva, urine, and semen. People who catch CMV can pass the virus to others for months. Young children, especially those in daycare or preschool, often have CMV in their body fluids. If a pregnant person gets those infected body fluids in their body (e.g. by kissing), they may get CMV and their baby may develop cCMV.People who spend time with young children are at a higher risk of catching CMV and having a baby with cCMV. This includes people with young children, and those who work with young children such as daycare workers, teachers, and other health care providers. People who have had CMV can catch it again and pass it to their baby during pregnancy.Only one-third of people who catch CMV while pregnant pass it to their baby. Most people who catch CMV while pregnant do not have babies with cCMV.Some health care providers may offer routine testing for CMV antibodies at the beginning of the pregnancy. This is to find out if you have ever had a CMV infection, or if you have a current infection. Others may offer testing if you think you may have been exposed, or for those who spend time with young children. Your health care provider may also recommend CMV testing if certain results are seen on ultrasound, such as slow growth, smaller head size, or other signs of infection.Your health care provider may recommend some blood tests for antibodies or discuss testing your amniotic fluid. This is to see if your baby has the virus. Ultrasounds can monitor the baby's growth and look for other signs of congenital CMV, like slow growth or small head size.There are no known treatments for cCMV during pregnancy. In the United States, anti-viral medication or treatment with immunoglobulins are not recommended. Research has not found these treatments safe or effective for the ba

巨细胞病毒（sy-toh-mega-loh-virus），或CMV，是一种常见的病毒，会引起类似感冒的症状。它不会对大多数人造成伤害，可能会导致几天的喉咙痛和感觉疲劳。巨细胞病毒在体内保持沉默，有时会变得活跃。巨细胞病毒有不同的类型。如果一个人在怀孕前或怀孕期间感染巨细胞病毒，或者以前的感染变得活跃，他们的胎儿可能会感染巨细胞病毒。在怀孕期间获得巨细胞病毒的婴儿被称为先天性巨细胞病毒或cCMV。在美国，大约每200个婴儿中就有一个患有cCMV。大多数患有cCMV的婴儿在出生时没有任何迹象。大约10-20%患有cCMV的婴儿会有更严重的问题。出生时，他们可能出生体重低和/或头小（小头畸形）。他们在出生时也可能有其他症状，如听力丧失、喂养困难、黄疸和紫色斑疹。先天性巨细胞病毒也会导致长期的健康问题，比如后来的听力损失和发育迟缓。与cCMV相关的常见健康问题列在下面的方框中。巨细胞病毒通过体液传播，如唾液、尿液和精液。感染巨细胞病毒的人可以将病毒传染给他人数月。幼儿，尤其是日托或学龄前儿童，体液中经常有巨细胞病毒。如果孕妇体内有这些受感染的体液（例如通过接吻），她们可能会感染巨细胞病毒，她们的婴儿可能会患上巨细胞病毒。与幼儿在一起的人感染巨细胞病毒和生下患有巨细胞病毒的婴儿的风险更高。这包括有幼儿的人，以及那些与幼儿一起工作的人，如日托工作者、教师和其他卫生保健提供者。患有巨细胞病毒的人可能会再次感染并在怀孕期间将其传给婴儿。只有三分之一在怀孕期间感染巨细胞病毒的人会将其传给婴儿。大多数在怀孕期间感染巨细胞病毒的人不会生下患有巨细胞病毒的婴儿。一些医疗保健提供者可能会在怀孕初期提供巨细胞病毒抗体的常规检测。这是为了了解你是否曾经有过巨细胞病毒感染，或者你是否现在有感染。如果你认为你可能已经接触过，或者那些和小孩子在一起的人可能会提供测试。如果在超声波上看到某些结果，如生长缓慢，头部尺寸较小或其他感染迹象，您的医疗保健提供者也可能建议进行巨细胞病毒检测。你的医疗保健提供者可能会建议你做一些血液抗体测试或讨论测试你的羊水。这是为了检查你的宝宝是否感染了病毒。超声波可以监测婴儿的生长情况，并寻找先天性巨细胞病毒的其他迹象，如生长缓慢或头小。目前尚无已知的治疗妊娠期cCMV的方法。在美国，不建议使用抗病毒药物或免疫球蛋白治疗。研究还没有发现这些治疗方法对婴儿安全或有效。是的，你可以顺产，如果你的宝宝生长得很好，而且没有产后出血的问题。不，目前并不是所有的婴儿都接受了cCMV检测。一些保健中心将对所有未通过新生儿听力测试的婴儿进行cCMV检测。一些州已经开始对所有婴儿进行筛查。宝宝出生后，如果你愿意，你可以抱着宝宝肌肤接触，拥抱，甚至母乳喂养。只要你的宝宝做得很好，没有必要在他们出生后的最初几个小时进行特殊的测试。您宝宝的护理人员可能会检测唾液或尿液中的巨细胞病毒，以确定您的宝宝是否患有巨细胞病毒。如果您的宝宝确实患有cCMV，他们将接受听力和视力检查。您宝宝的护理人员可能会建议您与专家讨论您宝宝可能使用的药物。大多数出生时看起来健康的cCMV婴儿不会出现听力损失或发育问题。随着时间的推移，一些婴儿可能会出现症状，如听力丧失（10-15%）、发育迟缓（1-2%）和轻度视力丧失（2%）。随着时间的推移监测宝宝的听力和发育是很重要的。卫生保健专业人员可以复制本讲义用于非商业用途，与患者分享，但不允许对讲义进行修改。本讲义中的信息和建议不能替代医疗保健。向您的医疗保健提供者咨询有关您和您的健康的具体信息。

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引用次数: 0

Systematic Reviews to Inform Practice, November/December 2024 为实践提供依据的系统综述》，2024 年 11 月/12 月。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-13 DOI: 10.1111/jmwh.13711

Nena R. Harris CNM, PhD, FNP-BC, CNE, Abby Howe-Heyman CNM, PhD

引用次数: 0

Perinatal Loneliness and Isolation Early in the COVID-19 Pandemic in New York City: A Qualitative Study 纽约市 COVID-19 大流行初期围产期的孤独感和隔离感：定性研究。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-11-09 DOI: 10.1111/jmwh.13695

Brooke S. West PhD, Lida Ehteshami BA, Clare McCormack PhD, Beatrice Beebe PhD, Ginger D. Atwood BA, Judy Austin PhD, Vitoria Chaves BA, Violet Hott BA, Yunzhe Hu BA, Maha Hussain MS, Margaret H. Kyle BA, Georgia Kurman BA, Marissa Lanoff MA, Andréane Lavallée RN, PhD, Jeremiah Q. Manning BA, Mary T. McKiernan RN, Nicolò Pini PhD, Grace C. Smotrich BA, William P. Fifer PhD, Dani Dumitriu MD, PhD, Sylvie Goldman PhD

Introduction

During the COVID-19 pandemic, birthing parents were identified as a high-risk group with greater vulnerability to the harms associated with SARS-CoV-2. This led to necessary changes in perinatal health policies but also to experiences of maternal isolation and loneliness, both in hospital settings, due to infection mitigation procedures, and once home, due to social distancing.

Methods

In this study, we qualitatively explored birthing and postpartum experiences in New York City during the early days of the pandemic when lockdowns were in effect and policies and practices were rapidly changing. Using thematic analysis, our focus was on experiences of isolation, navigating these experiences, and the potential impacts of isolation and loneliness on maternal health for 55 birthing people.

Results

Participants described numerous stressors related to isolation during the birthing process, including reconciling their hopes for their birth with the realities of the unknown and separation from partners, family, and friends in the hospital. During the postpartum period, loneliness manifested as having limited or no contact with family and friends, which led to feelings of a need for strengthened social support systems. The impact of these negative experiences shaped mental health. Overall, we found that solitary experiences during birthing and postpartum isolation were major sources of stress for participants in this study.

Discussion

To support impacted families and prepare for future crisis events, clinicians and researchers must prioritize the development of strong clinical and social support structures for perinatal people to ensure both maternal and child health.

导言：在 COVID-19 大流行期间，分娩的父母被确定为高危人群，更容易受到 SARS-CoV-2 的伤害。这导致围产期保健政策发生了必要的变化，但同时也造成了产妇的孤立和孤独，无论是在医院环境中的感染缓解程序，还是回家后的社交疏远：在这项研究中，我们对纽约市在大流行初期的分娩和产后经历进行了定性探索，当时纽约市正在实行封锁，政策和实践也在迅速变化。通过主题分析，我们重点关注了 55 名分娩者的孤独经历、如何应对这些经历以及孤独和寂寞对产妇健康的潜在影响：结果：参与者描述了在分娩过程中与孤独有关的许多压力，包括协调他们对分娩的希望与未知的现实，以及在医院中与伴侣、家人和朋友的分离。在产后期间，孤独感表现为与家人和朋友的联系有限或没有联系，这让她们感到需要加强社会支持系统。这些负面经历对心理健康产生了影响。总体而言，我们发现分娩时的孤独经历和产后的隔离是本研究参与者的主要压力来源：讨论：为了支持受影响的家庭并为未来的危机事件做好准备，临床医生和研究人员必须优先为围产期人群建立强大的临床和社会支持结构，以确保母婴健康。

{"title":"Perinatal Loneliness and Isolation Early in the COVID-19 Pandemic in New York City: A Qualitative Study","authors":"Brooke S. West PhD, Lida Ehteshami BA, Clare McCormack PhD, Beatrice Beebe PhD, Ginger D. Atwood BA, Judy Austin PhD, Vitoria Chaves BA, Violet Hott BA, Yunzhe Hu BA, Maha Hussain MS, Margaret H. Kyle BA, Georgia Kurman BA, Marissa Lanoff MA, Andréane Lavallée RN, PhD, Jeremiah Q. Manning BA, Mary T. McKiernan RN, Nicolò Pini PhD, Grace C. Smotrich BA, William P. Fifer PhD, Dani Dumitriu MD, PhD, Sylvie Goldman PhD","doi":"10.1111/jmwh.13695","DOIUrl":"10.1111/jmwh.13695","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 During the COVID-19 pandemic, birthing parents were identified as a high-risk group with greater vulnerability to the harms associated with SARS-CoV-2. This led to necessary changes in perinatal health policies but also to experiences of maternal isolation and loneliness, both in hospital settings, due to infection mitigation procedures, and once home, due to social distancing.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 In this study, we qualitatively explored birthing and postpartum experiences in New York City during the early days of the pandemic when lockdowns were in effect and policies and practices were rapidly changing. Using thematic analysis, our focus was on experiences of isolation, navigating these experiences, and the potential impacts of isolation and loneliness on maternal health for 55 birthing people.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 Participants described numerous stressors related to isolation during the birthing process, including reconciling their hopes for their birth with the realities of the unknown and separation from partners, family, and friends in the hospital. During the postpartum period, loneliness manifested as having limited or no contact with family and friends, which led to feelings of a need for strengthened social support systems. The impact of these negative experiences shaped mental health. Overall, we found that solitary experiences during birthing and postpartum isolation were major sources of stress for participants in this study.\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 To support impacted families and prepare for future crisis events, clinicians and researchers must prioritize the development of strong clinical and social support structures for perinatal people to ensure both maternal and child health.\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 1","pages":"124-130"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13695","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adapting Group Prenatal Care for Telehealth: A COVID-Era Innovation to Address Barriers to Care for Latinx Clients 为远程医疗调整集体产前护理：COVID 时代的创新，解决拉丁裔客户的护理障碍。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-10-28 DOI: 10.1111/jmwh.13701

Catherine Daily CNM, DNP, Ashley Gresh CNM, PhD, Elizabeth R. Hamilton MPH, CPHQ, Christina X. Marea CNM, PhD, MA, MSN

The use of telehealth prenatal care increased exponentially during the coronavirus disease 2019 (COVID-19) pandemic, but there is no literature describing its use for group prenatal care during this time. The COVID-19 pandemic also exacerbated structural barriers to care that disproportionately affect Black and Latinx people. Telehealth enabled pregnant people to access health care and minimize infectious risks. Telehealth group prenatal care (T-GPNC) incorporated the essential elements of CenteringPregnancy with telehealth is an innovative care delivery method borne out of necessity during the COVID-19 pandemic that has potential to mitigate structural barriers to care.

Mary's Center is a federally qualified health center (FQHC) in Washington, DC, and Maryland that rapidly pivoted to individual telehealth prenatal care early in the pandemic. Mary's Center used our experience with group care and guidance from the Centering Healthcare Institute on virtual Centering to launch T-GPNC. This new model included home self-monitoring equipment and video classrooms, mixed with in-person individual care visits. We used a team-based approach with nurses, midwives, and community health workers to provide holistic care to pregnant people. Our robust care coordination team also connected them to home visiting, mental health services, and nutrition counseling.

The purpose of this article is to describe how Mary's Center modified the CenteringPregnancy model of group prenatal care for telehealth, following the hallmarks of CenteringPregnancy, and met the needs of Spanish-speaking clients, henceforth Latinx clients. A secondary purpose is to demonstrate how telehealth can expand access to health care and remove structural barriers that may prevent pregnant people from attending in-person appointments. We also discuss the structural inequities in digital access and literacy in the context of program implementation.

在 2019 年冠状病毒病（COVID-19）大流行期间，远程保健产前护理的使用成倍增加，但没有文献描述在此期间将其用于集体产前护理。COVID-19 大流行还加剧了医疗保健的结构性障碍，而这些障碍对黑人和拉丁裔人群的影响尤为严重。远程医疗使孕妇能够获得医疗保健服务，并将感染风险降至最低。远程保健产前团体护理（T-GPNC）结合了远程保健的 "以孕为中心"（CenteringPregnancy）的基本要素，是 COVID-19 大流行期间应运而生的一种创新护理方法，具有减轻结构性护理障碍的潜力。玛丽中心（Mary's Center）是华盛顿特区和马里兰州的一家联邦合格医疗中心（FQHC），在大流行初期迅速转向个人远程保健产前护理。玛丽中心利用我们在团体护理方面的经验以及中心医疗保健研究所在虚拟中心化方面的指导，推出了 T-GPNC。这一新模式包括家庭自我监测设备和视频教室，以及个人护理访问。我们与护士、助产士和社区卫生工作者采用团队合作的方式，为孕妇提供整体护理。我们强大的护理协调团队还将她们与家访、心理健康服务和营养咨询联系起来。本文旨在介绍玛丽中心是如何根据 CenteringPregnancy 的特点，将 CenteringPregnancy 的产前团体护理模式修改为远程医疗模式，并满足讲西班牙语的客户（以下简称拉丁裔客户）的需求的。另一个目的是展示远程医疗如何扩大医疗服务的可及性，以及如何消除可能阻碍孕妇亲自赴约的结构性障碍。我们还讨论了在项目实施过程中数字访问和扫盲方面的结构性不平等。

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引用次数: 0