Journal of midwifery & women's health最新文献_第7页

Open-Label Randomized Controlled Trial and Feasibility Study of an Oral Probiotic Intervention to Reduce Group B Streptococcus Colonization in Pregnant People by the Time of Birth 口服益生菌干预在出生时减少孕妇B群链球菌定植的开放标签随机对照试验和可行性研究

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-29 DOI: 10.1111/jmwh.13765

Katrina Nardini CNM, WHNP-BC, MPH, Lisa Hanson CNM, PhD, Noelle Borders CNM, DNP, Maharaj Singh PhD, Anna Shields CNM, DNP, FNP, Victoria Y. Trujillo BA, Robyn Lawton CNM, Emily Malloy CNM, PhD

Introduction

The purpose of this midwife-led study was to determine the feasibility of a randomized controlled trial (RCT) of probiotics to reduce group B Streptococcus (GBS) colonization by the time of birth in healthy, GBS-positive, pregnant adults.

Methods

An open-label randomized clinical trial comparing Florajen Digestion, a commercially available combination oral probiotic, with usual care (ClinicalTrials.gov NCT04721912) was conducted in a midwifery practice serving a racially and ethnically diverse population. Eligible patients who tested positive for GBS at routine third-trimester screening were offered informed consent and participation. The primary outcome was feasibility for a larger RCT, including feasibility of probiotic use among participants. Secondary outcomes were intrapartum GBS colonization and Antepartum Gastrointestinal Symptoms of Pregnancy (AP-GI-SA) scores.

Results

A total of 68 participants were enrolled and randomized; 65 participants completed the study, but only 46 had intrapartum cultures collected and processed. Among the 23 pregnant individuals who were eligible but chose not to participate, 3 indicated that they did not want to take a probiotic. After an average of 14 days of the intervention, 7 of 25 (28%) participants in the probiotic group had a negative intrapartum GBS result compared with 3 of 21 (14.3%) in the control group (odds ratio, 2.33; 95% CI, 0.52-10.48). There was no difference in perinatal outcomes or AP-GI-SA scores between groups. No adverse events occurred.

Discussion

The feasibility of a larger RCT was demonstrated. Challenges identified included intrapartum GBS collection and laboratory processing during the COVID-19 pandemic. The study was not powered to detect a significant difference in intrapartum GBS colonization, although a larger decrease in GBS colonization was noted among probiotic-using participants. Florajen Digestion may show efficacy in a RCT with a longer intervention period. It is possible that the probiotic intervention duration was too brief to show a reduction in gastrointestinal pregnancy symptoms.

前言：这项由助产士主导的研究的目的是确定益生菌的随机对照试验（RCT）的可行性，以减少出生时健康的、GBS阳性的孕妇的B族链球菌（GBS）定植。方法：一项开放标签随机临床试验比较Florajen消化，一种市售的联合口服益生菌，与常规护理（ClinicalTrials.gov NCT04721912），在助产实践中服务于不同种族和民族的人群。在常规妊娠晚期筛查中检测为GBS阳性的符合条件的患者给予知情同意和参与。主要结果是更大规模随机对照试验的可行性，包括参与者使用益生菌的可行性。次要结局是产时GBS定植和产前妊娠胃肠道症状（AP-GI-SA）评分。结果：共纳入68名受试者，随机分组；65名参与者完成了这项研究，但只有46名参与者收集并处理了分娩时的培养物。在23名符合条件但选择不参加的孕妇中，有3人表示她们不想服用益生菌。干预平均14天后，益生菌组25名参与者中有7名（28%）分娩时GBS结果为阴性，而对照组21名参与者中有3名（14.3%）(优势比，2.33；95% ci, 0.52-10.48)。围产儿结局或AP-GI-SA评分组间无差异。无不良事件发生。讨论：论证了更大规模随机对照试验的可行性。确定的挑战包括COVID-19大流行期间产时GBS收集和实验室处理。该研究没有发现产时GBS定植的显著差异，尽管在使用益生菌的参与者中发现了GBS定植的较大下降。在一项干预期较长的随机对照试验中，Florajen Digestion可能显示出疗效。可能益生菌干预持续时间太短，无法显示胃肠道妊娠症状的减少。

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引用次数: 0

Diabetes Gestacional (Gestational Diabetes) 妊娠糖尿病（妊娠糖尿病）

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-29 DOI: 10.1111/jmwh.13770

<p>La diabetes es una enfermedad donde hay demasiada azúcar (glucosa) en la sangre pero insuficiente glucosa en las células. Nuestras células usan glucosa como fuente de energía para todas las funciones del cuerpo. Para transportar el azúcar (glucosa) de la sangre a las células, es necesario la insulina. La diabetes resulta cuando el cuerpo pierde la capacidad de producir insulina (diabetes tipo 1), o cuando la insulina que produce el cuerpo no funciona bien (diabetes tipo 2).</p><p>La diabetes gestacional (DG o GDM por sus siglas en inglés) es la diabetes que ocurre por primera vez durante el embarazo. Durante el embarazo, la placenta produce hormonas que impiden que la insulina mueva la glucosa de la sangre a las células. Esto es para garantizar que el bebé reciba suficiente azúcar. Estos cambios llevan a que algunas mujeres tengan más glucosa (azúcar) en la sangre de lo que se considere sano – esto es la diabetes gestacional.</p><p>Cuando una persona tiene DG, su bebé también tiene niveles más altos de (glucosa) azúcar. El bebé guarda este exceso de azúcar en forma de grasa. Esta grasa aumenta la probabilidad de que el bebé tenga obesidad y que de adulto sufra de alta presión, enfermedad cardiaca y diabetes tipo 2. El bebé también puede tener dificultades al nacer si él o ella es demasiado grande (pesado). A raíz de la DG, el recién nacido puede tener cambios repentinos en sus niveles de azúcar en su sangre que puedan requerir de atención médica especial inmediatamente después del parto.</p><p>La mayoría de las mujeres tienen factores de riesgo para la DG. Es por esto que los proveedores de atención médica generalmente ofrecen una prueba de sangre para la DG a todas las mujeres embarazadas. Su proveedor le ofrecerá una prueba de detección para la DG ya sea al principio de su embarazo o cuando tenga entre 24 y 28 semanas de embarazo, dependiendo de su probabilidad de tener DG.</p><p>En la mayoría de los casos de DG, el comer comidas saludables a horas regulares y evitar los alimentos azucarados mantendrá los niveles de glucosa en la sangre a un nivel normal. El ejercicio también bajará sus niveles de azúcar. Algunas mujeres que tienen DG necesitan tomar una pastilla o inyección de insulina para controlar sus niveles de glucosa.</p><p>Si tiene DG, se le pedirá que usted revise sus niveles de glucosa en la sangre varias veces al día. Se reunirá con un educador de diabetes o una enfermera quien le enseñará cómo usar una máquina para revisar sus niveles de glucosa en su sangre. También aprenderá en que horario debe medir sus niveles de glucosa, ya sea antes o después de las comidas. Usted y su proveedor usarán los resultados de sus pruebas de niveles de azúcar para elegir el mejor tratamiento para su DG.</p><p>Las mujeres que desarrollan DG tienen una alta probabilidad de desarrollar diabetes tipo 2 más adelante en la vida. Debe hacerse una prueba de sangre entre 4 a 12 semanas después de dar a luz para asegurarse de que no sigue con diabetes. El c

糖尿病是一种血液中糖（葡萄糖）过多但细胞中葡萄糖不足的疾病。我们的细胞使用葡萄糖作为身体所有功能的能量来源。胰岛素是将糖（葡萄糖）从血液运输到细胞所必需的。当身体失去产生胰岛素的能力（1型糖尿病）或当身体产生的胰岛素不能正常工作（2型糖尿病）时，就会发生糖尿病。妊娠期糖尿病（DG或GDM）是第一次发生在怀孕期间的糖尿病。在怀孕期间，胎盘会产生激素，阻止胰岛素将葡萄糖从血液输送到细胞。这是为了确保婴儿得到足够的糖。这些变化导致一些女性的血液中葡萄糖（糖）含量超过健康水平——这就是妊娠期糖尿病。当一个人患有DG时，他的婴儿也会有更高的糖（葡萄糖）水平。婴儿以脂肪的形式储存多余的糖。这些脂肪会增加婴儿肥胖的可能性，以及成人患高血压、心脏病和2型糖尿病的可能性。如果婴儿太大（太重），出生时也会有困难。在DG之后，新生儿的血糖水平可能会突然发生变化，这可能需要在分娩后立即进行特别的医疗护理。大多数妇女都有患DG的危险因素。这就是为什么卫生保健提供者通常为所有孕妇提供DG血液检测。你的医疗服务提供者会在你怀孕初期或怀孕24 - 28周时为你提供DG检测，这取决于你患DG的可能性。在大多数DG病例中，有规律地吃健康的食物，避免吃含糖的食物，可以使血糖水平保持在正常水平。运动也会降低你的血糖水平。一些患有DG的女性需要服用药片或注射胰岛素来控制血糖水平。如果你有DG，你会被要求每天多次检查你的血糖水平。你将会见糖尿病教育工作者或护士，他们将教你如何使用机器检查你的血糖水平。你还将学习什么时候测量你的血糖水平，饭前或饭后。你和你的医生会根据你的血糖水平测试结果为你的DG选择最好的治疗方法。患有DG的女性在以后的生活中患2型糖尿病的可能性很高。你应该在分娩后4到12周进行血液检查，以确保你没有糖尿病。健康的饮食和定期锻炼对防止你将来患糖尿病很重要。母乳喂养可以帮助你减肥，也可以帮助你的宝宝保持健康的体重。2025年5月批准。本手册取代了发表于2016年9月/ 10月第61卷第5期的“妊娠期糖尿病”。本手册可由医疗保健专业人员复制作非商业用途，与患者分享，但不允许对手册进行修改。本手册中的信息和建议不能取代医疗保健。在你的医疗保健提供者那里了解你和你的健康的具体信息。本文件中的信息和建议不能替代医疗保健。向你的医疗服务提供者咨询针对你和你的健康的信息。

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引用次数: 0

Birth Options After Having a Cesarean 剖宫产后的生育选择

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-29 DOI: 10.1111/jmwh.13774

Overall, your risk of having complications is less if you give birth vaginally. You will likely spend less time in the hospital and recover faster with less pain. Your baby has less chance of breathing problems shortly after a vaginal birth when compared to babies born by cesarean.

You have a higher chance of uterine rupture (uterus opening at the old scar), which is dangerous for you and your baby. Uterine rupture is very rare. Uterine rupture happens to about 7 or 8 of every 1000 people who labor after having a previous cesarean. This is a less than a 1% chance of uterine rupture if you have labor after a cesarean. If your uterus does rupture, there is a higher chance your baby will die. This means that of 10,000 people who had a cesarean and try to have a VBAC, 2 babies will die.

You can schedule when your birth will likely happen and know what to expect from surgery. You can talk to the surgeon about being awake for the surgery and safely involving family in the cesarean birth.

Overall, about 3 out of 4 people who try to have a VBAC will have a successful vaginal birth. Some things in your medical history affect your chance of success.

Choosing your method of birth is an important and very personal decision. Before you make your decision, talk to your health care provider who can help you learn about your chance of having a successful VBAC and your risk of uterine rupture. Your health history, what happened during your last labor, and how your current pregnancy is going will help guide your health care provider to counsel you if a VBAC or repeat cesarean is the best plan of care for you. If your baby is breech, you are carrying more than one baby, or you have had more than one cesarean, your provider may be less likely to recommend that you have a VBAC. You and your family can also discuss how you feel about the following reasons to have a VBAC or repeat cesarean.

It is safest to have a VBAC in a hospital so you and your baby can be monitored during labor. Signs of distress in the baby are usually the first sign of uterine rupture. Because of this, you will have continuous fetal heart rate monitoring during labor. An IV will be placed so that it is available in case there is an emergency. You should be able to have any type of pain medicine you would like.

Flesch-Kincaid Grade Level: 7.4

Approved May 2025. This handout replaces “Birth Options after Having a Cesarean” published in Volume 61, Number 6, November/December 2016.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.

总的来说，如果你顺产，你患并发症的风险会更小。你可能会花更少的时间在医院，恢复得更快，疼痛也更少。与剖宫产相比，阴道分娩后不久宝宝出现呼吸问题的可能性更小。你有更高的机会子宫破裂（子宫在旧疤痕处打开），这对你和你的宝宝都是危险的。子宫破裂非常罕见。剖宫产后，每1000人中就有7 - 8人发生子宫破裂。如果你在剖宫产后分娩，子宫破裂的几率不到1%。如果你的子宫破裂，你的宝宝死亡的几率会更高。这意味着，在1万名剖腹产患者中，有2名婴儿会死亡。你可以安排你的分娩时间，知道手术会带来什么。你可以和外科医生谈谈在手术中保持清醒，以及让家人安全地参与剖宫产。总的来说，大约四分之三尝试VBAC的人会成功地顺产。你的病史会影响你成功的几率。选择你的分娩方式是一个重要的和非常个人的决定。在你做决定之前，和你的医疗保健提供者谈谈，他们可以帮助你了解VBAC成功的机会和子宫破裂的风险。你的健康史，你上次分娩时发生的事情，以及你目前的怀孕情况，将有助于指导你的医疗保健提供者向你提供建议，如果VBAC或重复剖宫产是对你最好的护理计划。如果你的宝宝是臀位，你怀了不止一个孩子，或者你有过不止一次剖腹产，你的医生可能不太可能建议你做VBAC。您和您的家人也可以讨论您对以下原因的感受，以进行VBAC或重复剖宫产。在医院里进行VBAC是最安全的，这样你和你的宝宝在分娩过程中就可以被监控。胎儿出现窘迫的迹象通常是子宫破裂的第一个征兆。因此，在分娩过程中，你将有持续的胎儿心率监测。将放置静脉注射，以便在出现紧急情况时可用。你应该能够得到任何你想要的止痛药。Flesch-Kincaid等级：7.4 2025年5月批准。本讲义取代了2016年11月/ 12月出版的第61卷第6期《剖宫产后的生育选择》。本讲义可以复制用于非商业用途，供卫生保健专业人员与患者分享，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

Research and Professional Literature to Inform Practice, May/June 2025 研究和专业文献为实践提供信息，2025年5 / 6月

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-27 DOI: 10.1111/jmwh.13769

Nancy A. Niemczyk CNM, PhD, Emily G. Roy SN

引用次数: 0

Pregnancy Burden: An Integrative Review and Dimensional Analysis of Pregnancy's Hidden Challenges 妊娠负担：妊娠隐性挑战的综合回顾与维度分析。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-22 DOI: 10.1111/jmwh.13759

Hannah E. Kumarasamy CNM, WHNP-BC, MSN, MPH, Felesia Bowen PhD, DNP, PPCNP-BC, Becca Billings MLIS, AHIP-S, Patricia A. Patrician PhD, RN

Introduction

Outcomes surrounding childbirth have focused on survival, leaving gaps in understanding the comprehensive experience of pregnancy for the pregnant individual. Anecdotally, pregnancy and the opportunity to reproduce is often received with a celebratory response. Yet whether planned or unplanned, a wide array of burdens may exist throughout pregnancy ranging from minor inconveniences to dangerous contributions to morbidity and mortality. The experience of pregnancy is superimposed onto the physical, mental, and social reality that already exists as an individual's life and consistently accentuates aspects of stress that can lead to increased physical, mental, emotional, financial, or other burden that many health and social systems globally lack resources to support. To address this gap, this analysis sought to explore the concept of pregnancy burden.

Methods

A formal search of 5 databases was conducted using integrative review methodology, with a total of 37 articles meeting inclusion criteria. To better conceptualize pregnancy burden, a dimensional analysis was then undertaken posing the research question, “What is pregnancy burden?”

Results

The current social construction of pregnancy burden revealed multidimensional contributors to burden that were identified as both intrinsic and extrinsic, with no current definition available. Five dimensions of pregnancy burden were discovered: health, education, financial or cost, inequity, and social support. Three distinct perspectives were identified that included the pregnant person; their partners, family, or friends; and health systems or care providers. To best answer the research question and focus on the personal experience, the scope of this analysis was limited to the perspective of the pregnant individual.

Discussion

The term burden is discussed and well-developed in chronic disease literature but has not been inclusive of pregnancy. This review revealed that pregnancy burden exists but remains unclassified and understudied, supporting the need for further exploration. Better understanding and valuing of the total experience of pregnancy, inclusive of burden, has the potential to improve the pregnancy experience.

导读：围绕分娩的结果主要集中在生存上，在理解怀孕个体的全面怀孕经历方面留下了空白。有趣的是，怀孕和生育的机会通常会受到庆祝的回应。然而，无论是有计划的还是计划外的，怀孕期间可能存在各种各样的负担，从轻微的不便到对发病率和死亡率的危险贡献。怀孕的经历叠加在个人生活中已经存在的身体、精神和社会现实上，并不断加重压力，可能导致身体、精神、情感、经济或其他方面的负担增加，而全球许多卫生和社会系统缺乏资源来支持这些负担。为了解决这一差距，本分析试图探讨怀孕负担的概念。方法：采用综合评价方法对5个数据库进行正式检索，共有37篇文章符合纳入标准。为了更好地概念化怀孕负担，然后进行了维度分析，提出了研究问题，“什么是怀孕负担？”结果：当前怀孕负担的社会建构揭示了负担的多维因素，这些因素被确定为内在和外在的，目前没有明确的定义。发现了怀孕负担的五个方面：健康、教育、财务或成本、不平等和社会支持。确定了三个不同的视角，包括孕妇；他们的伴侣、家人或朋友；以及卫生系统或医疗服务提供者。为了最好地回答研究问题并专注于个人经验，本分析的范围仅限于怀孕个体的角度。讨论：“负担”一词在慢性病文献中得到了讨论和充分发展，但尚未包括妊娠。本综述揭示了妊娠负担的存在，但仍未分类和研究不足，支持进一步探索的必要性。更好地了解和重视整个怀孕经历，包括负担，有可能改善怀孕经历。

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引用次数: 0

A Community-Centered and Antiracist Model of Whole-Person Perinatal Care: Beloved Birth Black Centering 以社区为中心的反种族主义全人围产期护理模式：以心爱的黑人为中心。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-21 DOI: 10.1111/jmwh.13761

MariaDelSol De Ornelas MSPH, Kim G. Harley MPH, PhD, Danielle Davis MPA, Anna Gruver MSW, LCSW, Dana Cruz Santana MSW, MPH, Krista Hayes, Martha Tesfalul MD, Jyesha Wren CNM, MS

Beloved Birth Black Centering (Beloved) is a community-centered and antiracist model of whole-person perinatal care, created by and for Black people in Alameda County, California. In 2019, a diverse group of birth equity advocates within Oakland's public safety net health care system and public health department came together to design Beloved, following the leadership of Black midwives, public health practitioners, physicians, and doulas. Beloved centers the expertise and vision of Black women and birthing people while working to redefine Black perinatal care and transform Black birthing experiences and outcomes. Growing evidence documents Black women and birthing peoples’ experiences, needs, and preferences for perinatal care. They seek to be respected, heard, believed, the autonomy to make informed decisions, and have access high quality care and supportive resources. Beloved aims to center these needs and preferences and provide whole-person perinatal care so Black women and birthing people not only survive—they thrive. Beloved bundles 5 evidence-informed strategies (referred to as the Gold-Package of Black Love) into its model of whole-person perinatal care: midwifery-led group perinatal care; racially-concordant care; wrap-around support; childbirth education; and doula services. Each evidence-informed strategy has been referenced as a need and preference by Black women and birthing people and has been found to protect against at least one pregnancy-related complication. The model aims to provide patients with holistic social support, high quality person-centered care, and antiracist approaches to care. The founders of Beloved took an asset-based approach and partnered with local community organizations and Black entrepreneurs to implement Beloved during the COVID-19 pandemic despite the inherent challenges of innovating new models in under-resourced, safety net health care systems. The model's development, implementation, theoretical underpinnings, and theory of change are described. Additionally, we discuss key lessons from implementation and future directions for research, quality improvement, sustainability, and community engagement.

心爱的出生黑人中心（Beloved）是一个以社区为中心，反种族主义的全人围产期护理模式，由加利福尼亚州阿拉米达县的黑人创建并为他们服务。2019年，在黑人助产士、公共卫生从业人员、医生和助产师的领导下，奥克兰公共安全网医疗保健系统和公共卫生部门内的一群不同的出生公平倡导者共同设计了宠儿。宠儿中心的专业知识和黑人妇女和生育人员的愿景，同时努力重新定义黑人围产期护理和改变黑人分娩经验和结果。越来越多的证据记录了黑人妇女和生育人群对围产期护理的经历、需求和偏好。他们寻求被尊重、被倾听、被相信、自主做出明智的决定，并获得高质量的护理和支持性资源。宠儿的目标是集中这些需求和偏好，并提供全人围产期护理，使黑人妇女和生育人员不仅生存下来，而且茁壮成长。Beloved将5种循证策略（被称为黑爱金包）捆绑到其全人围产期护理模式中：助产士领导的群体围产期护理；racially-concordant护理;全方位的支持;分娩教育;还有助产师服务。每一种循证策略都被黑人妇女和产妇视为一种需要和偏好，并被发现可以预防至少一种与妊娠相关的并发症。该模式旨在为患者提供全面的社会支持，高质量的以人为本的护理，以及反种族主义的护理方法。Beloved的创始人采取了基于资产的方法，与当地社区组织和黑人企业家合作，在2019冠状病毒病大流行期间实施了Beloved，尽管在资源不足的安全网医疗保健系统中创新新模式存在固有挑战。描述了模型的发展、实施、理论基础和变化理论。此外，我们还讨论了实施过程中的关键经验教训，以及未来研究、质量改进、可持续性和社区参与的方向。

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引用次数: 0

Person-Centered Perinatal Health Care and Empowerment During Pregnancy, Birth, and Postpartum: A Cross-Sectional Mixed-Methods Analysis 以人为中心的围产期保健和授权在怀孕，分娩和产后：横断面混合方法分析。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-19 DOI: 10.1111/jmwh.13760

Rebecca Woofter MPH, Renee Clarke MPH, RN, Prisca C. Diala MD, Molly R. Altman CNM, PhD, MPH, Patience A. Afulani PhD, MBChB, MPH

Introduction

In the United States, Black birthing people report poor-quality health care and face adverse maternal and infant outcomes. Empowerment to advocate with health care providers could help improve outcomes for birthing people of color. The literature is, however, sparse on factors associated with empowerment in the perinatal period. We examined the association between person-centered care and feeling empowered to advocate with health care providers across the perinatal period.

Methods

Data are from 265 postpartum birthing persons who completed an online survey in 2020. The survey included validated scales for Person-Centered Prenatal Care (PCPC) and Person-Centered Maternity (labor and birth) Care (PCMC), feelings of empowerment to advocate with health care providers, and an open-response question regarding empowerment. Multivariable logistic regression models and qualitative thematic analysis were conducted.

Results

A majority of the sample was Black, married, had one child, had college degrees, had private insurance, and gave birth in a hospital with midwives. Overall, about 75% of the sample felt empowered to advocate with health care providers during prenatal care, birth, and postpartum. On average, participants scored 84 of 100 on the standardized PCPC scale and 90 of 100 on the standardized PCMC scale. Each one-point increase in PCPC score was associated with 11% higher odds of feeling empowered during prenatal care. Each one-point increase in PCMC score was associated with 8% higher odds of feeling empowered during both birth and postpartum. Respect and dignity drove the association between PCPC and empowerment during prenatal care, whereas communication and autonomy drove the association between PCMC and empowerment. Qualitative responses emphasized the importance of communication and respect from health care providers, autonomy, and social support from partners and doulas on empowerment.

Discussion

Person-centered perinatal health care is associated with feeling empowered to advocate with health care providers during prenatal care, birth, and postpartum. Effective communication and autonomy are vital for fostering patient empowerment.

在美国，黑人分娩的人报告低质量的医疗保健和面临不利的母婴结局。向医疗保健提供者倡导授权可以帮助改善有色人种的分娩结果。文献是，然而，稀疏的因素与授权在围产期。我们检查了以人为中心的护理和感觉有权倡导整个围产期卫生保健提供者之间的关系。方法：数据来自于2020年完成在线调查的265名产后产妇。该调查包括以人为中心的产前护理（PCPC）和以人为中心的产妇（分娩和分娩）护理（PCMC）的有效量表，向卫生保健提供者倡导授权的感觉，以及关于授权的开放式回答问题。进行了多变量logistic回归模型和定性专题分析。结果：大多数样本是黑人，已婚，有一个孩子，有大学学历，有私人保险，在有助产士的医院分娩。总体而言，约75%的样本认为有权在产前护理、分娩和产后向卫生保健提供者提出建议。参与者在标准化PCPC量表上的平均得分为84分（满分100分），在标准化PCMC量表上的平均得分为90分（满分100分）。PCPC得分每增加1分，在产前护理中感觉自己被赋予权力的几率就会增加11%。PCMC得分每增加1分，在分娩和产后感觉被授权的几率就会增加8%。产前护理过程中，尊重和尊严驱动PCMC与赋权之间的关联，沟通和自主驱动PCMC与赋权之间的关联。定性答复强调卫生保健提供者的沟通和尊重、自主以及伙伴和助产师在增强权能方面的社会支持的重要性。讨论：以人为中心的围产期卫生保健与感觉有能力在产前护理、分娩和产后向卫生保健提供者倡导有关。有效的沟通和自主对于培养病人的自主权至关重要。

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引用次数: 0

Pregnancy, Birth, and Mental Health Outcomes Associated With Recent Reproductive Coercion and Intimate Partner Violence in a Crowd-Sourced National Sample 近期生殖强迫和亲密伴侣暴力与妊娠、分娩和心理健康结果相关的人群来源国家样本

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-05-19 DOI: 10.1111/jmwh.13758

Karen Trister Grace CNM, PhD, MSN, Jhumka Gupta ScD, Kathryn Fay MD, MSc, Tara Altay MSN, FNP-C, Samantha Kanselaar MS, Elizabeth Miller PhD, MD

Introduction

Reproductive coercion (RC) is a type of intimate partner violence (IPV) in which partners control reproductive health decision-making. More evidence is needed on peripartum health outcomes related to RC, with and without IPV, to inform interventions and health care response. The purpose of this study was to determine the impact of RC, with and without other forms of IPV, on pregnancy, birth, and mental health outcomes in a sample of people who were currently or recently pregnant.

Methods

We conducted a cross-sectional survey with people who had been pregnant in the past 2 years (N = 1941). Logistic regression models examined predicted outcomes with RC as a primary exposure and explored combinations of RC and IPV.

Results

A total of 23.8% of the sample reported any past-2-years RC. RC was significantly associated with most pregnancy, birth, neonatal, and mental health outcomes. People who experienced RC alone had 2.44 higher odds of having a low birth weight newborn (95% CI, 1.04-5.71) and 1.78 higher odds of postpartum depression (95% CI, 1.03-3.08) compared with people who did not experience RC or IPV. RC with other forms of IPV had a significant impact on suicidality even controlling for depression and anxiety (odds ratio, 2.85; 95% CI, 1.94-4.18), compared with those who did not experience either.

Discussion

Our findings underscore the importance of studying RC as its own construct due to its clear, independent impact on maternal health outcomes. RC, with and without physical violence, is common and detrimental to the health of pregnant and postpartum people. Greater attention to mechanisms for these associations (and the disproportionate burden on populations experiencing marginalization) is needed to interrupt and prevent harmful downstream effects.

生殖强迫（RC）是一种亲密伴侣暴力（IPV），其中伴侣控制生殖健康决策。需要更多的证据来证明有或没有IPV与RC相关的围产期健康结果，以便为干预措施和卫生保健反应提供信息。本研究的目的是确定RC（有或没有其他形式的IPV）对正在或最近怀孕的人的妊娠、分娩和心理健康结果的影响。方法：我们对过去2年内怀孕的妇女（N = 1941）进行了横断面调查。Logistic回归模型检验了以RC为主要暴露点的预测结果，并探索了RC和IPV的组合。结果：共有23.8%的样本报告了任何过去2年的RC。RC与大多数妊娠、分娩、新生儿和心理健康结果显著相关。与没有经历过RC或IPV的人相比，单独经历过RC的人患低出生体重新生儿的几率高2.44 (95% CI, 1.04-5.71)，产后抑郁症的几率高1.78 （95% CI, 1.03-3.08）。即使在控制抑郁和焦虑的情况下，RC和其他形式的IPV对自杀也有显著影响(优势比，2.85；95% CI, 1.94-4.18)，与没有经历过这两种情况的人相比。讨论：我们的研究结果强调了研究RC作为其自身结构的重要性，因为它对孕产妇健康结果有明确、独立的影响。RC，无论有无身体暴力，都是常见的，对孕妇和产后妇女的健康有害。需要更多地关注这些关联的机制（以及经历边缘化的人群所承受的不成比例的负担），以中断和防止有害的下游影响。

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引用次数: 0

Influence of the Practice of the Pilates Method on Pain Perception During Pregnancy: A Quasiexperimental Study 普拉提方法对妊娠期疼痛感知的影响：一项准实验研究。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-04-11 DOI: 10.1111/jmwh.13748

Carmen Feria-Ramirez CNM, PhD, Juan D. Gonzalez-Sanz CNM, PhD, Rafael Molina-Luque PhD, Guillermo Molina-Recio PhD

Introduction

The physiologic changes associated with pregnancy often result in pain, impacting the quality of life. Therefore, it is crucial to prevent and manage this pain through appropriate health care, including guidance on physical exercise. One of the currently recommended interventions is the Pilates method. However, health care professionals caring for pregnant women must have the necessary knowledge, tools, and resources to advise their patients. This study aimed to examine the impact of Pilates method practice on pregnancy-related pain.

Methods

A quasiexperimental study was conducted in multiple primary care centers between November 2018 and December 2019. Participants (n = 107) self-selected to receive a Pilates program (experimental group; n = 38) or their usual care (control group; n = 69). The presence or absence of pelvic, dorsal, and abdominal pain was evaluated as an outcome measure. The results were compared after the intervention, using descriptive, bivariate, and multivariate statistics. The study was registered at ClinicalTrials.gov (NTC04431102).

Results

Pilates method practice was associated with decreased presence of pelvic pain (odds ratio [OR], 2.73; 95% CI, 1.18-4.51; P = .02) and abdominal pain (OR, 5.24; 95% CI, 2.23-12.35; P < .001). No statistically significant difference was found for the presence of dorsal pain.

Discussion

Pilates appears to be a promising tool for enhancing well-being during pregnancy by reducing pelvic and abdominal pain. It would be beneficial to involve other professionals trained in the Pilates method or, in the future, to train midwives to implement this intervention in birth and parenting programs within primary care.

与妊娠相关的生理变化常导致疼痛，影响生活质量。因此，通过适当的保健，包括体育锻炼指导，预防和控制这种疼痛是至关重要的。目前推荐的干预措施之一是普拉提方法。然而，照顾孕妇的卫生保健专业人员必须有必要的知识、工具和资源来建议他们的病人。本研究旨在探讨普拉提方法练习对妊娠相关疼痛的影响。方法：2018年11月至2019年12月在多家初级保健中心进行准实验研究。参与者（n = 107）自行选择接受普拉提课程(实验组；N = 38)或常规护理(对照组；N = 69)。盆腔、背部和腹部疼痛的存在或不存在作为一种结果测量进行评估。采用描述性、双变量和多变量统计对干预后的结果进行比较。该研究已在ClinicalTrials.gov注册（NTC04431102）。结果：普拉提方法练习与盆腔疼痛发生率降低相关(优势比[OR]， 2.73；95% ci, 1.18-4.51；P = .02)和腹痛(OR, 5.24；95% ci, 2.23-12.35；讨论：普拉提似乎是一种很有前途的工具，可以通过减少骨盆和腹部疼痛来提高怀孕期间的幸福感。让其他接受过普拉提方法培训的专业人士参与进来是有益的，或者在未来，培训助产士在初级保健的分娩和育儿项目中实施这种干预措施。

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引用次数: 0

A Pilot Randomized Controlled Trial of a Multimodal Wellness Intervention for Perinatal Mental Health 围产期心理健康多模式健康干预的随机对照试验

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-04-10 DOI: 10.1111/jmwh.13754

Ellen Goldstein PhD, MFT, Mariam Keita MSN, RN, Christabel Koomson BS, Nathan Tintle PhD, Kirby Adlam CNM, PhD, APRN-FPA, Erin Farah CNM, PhD, FPA-APRN, Mary Dawn Koenig CNM, PhD, RN

Introduction

Evidence has shown that pregnant women who report high rates of psychologic stress are at increased risk for perinatal complications. We conducted a pilot randomized controlled trial (RCT) of a multimodal wellness intervention (MWI) composed of motivational interviewing and mental wellness skills to examine feasibility and acceptability of MWI and to compare changes in subjective measures of psychological and socioemotional outcomes among pregnant women through early postpartum.

Methods

Between March 2023 and February 2024, eligible pregnant individuals aged 18 and older, at 10 to 24 weeks’ gestation, and English-speaking were recruited from a university-affiliated federally qualified health center (FQHC) in a large metropolitan area. Forty participants were randomized 1:1 to 4 weekly individual (45-60 minutes) virtual sessions of MWI or prenatal education control. Patient-reported perinatal distress and wellness indicators were interview-administered at baseline, postintervention, 2 months postintervention, and 6 weeks postpartum. This study was registered at ClinicalTrials.gov (NCT05718479).

Results

The mean (SD) age of participants was 27.9 (5.7) years. Most participants identified as Black or African American (70%) pregnant women, with three-quarters being seen for prenatal services at an FQHC. The mean (SD) number of completed intervention sessions was 3.3 (1.3), with 75% of participants completing all 4 sessions. All participants reported being satisfied with the intervention, with 73% who were very satisfied and 86.7% who found the program very useful. MWI versus prenatal education demonstrated medium- to large-sized effects on reducing anxiety from mild to minimal symptoms and resulted in significantly increased health-promoting behaviors (eg, exercise, sleep, nutrition) at follow-up timepoints.

Discussion

Findings suggest that MWI was feasible and acceptable, in addition to demonstrating larger reductions in anxiety and greater increases in health-promoting behaviors compared to prenatal education among pregnant women. Further exploration of efficacy outcomes would require a larger sample size to detect more precise effects of MWI on psychological and socioemotional functioning during the perinatal period.

有证据表明，报告心理应激率高的孕妇发生围产期并发症的风险增加。我们进行了一项由动机性访谈和心理健康技能组成的多模式健康干预（MWI）的试点随机对照试验（RCT），以检验MWI的可行性和可接受性，并比较孕妇在产后早期心理和社会情绪结果的主观测量的变化。方法：在2023年3月至2024年2月期间，在大城市地区的大学附属联邦合格健康中心（FQHC）招募了年龄在18岁及以上、妊娠10至24周、说英语的符合条件的孕妇。40名参与者被随机分为1:1至4周（45-60分钟）的MWI或产前教育控制虚拟会议。在基线、干预后、干预后2个月和产后6周对患者报告的围产期窘迫和健康指标进行访谈。本研究已在ClinicalTrials.gov注册（NCT05718479）。结果：参与者的平均（SD）年龄为27.9（5.7）岁。大多数参与者被确定为黑人或非裔美国人（70%）孕妇，其中四分之三在FQHC接受产前服务。完成干预疗程的平均（SD）数为3.3(1.3)，75%的参与者完成了所有4个疗程。所有参与者都对干预表示满意，73%的人非常满意，86.7%的人认为该计划非常有用。MWI与产前教育相比，在将焦虑从轻微症状减少到轻微症状方面显示出中等到较大的效果，并在随访时间点显著增加了促进健康的行为（如运动、睡眠、营养）。结论：研究结果表明，与产前教育相比，MWI不仅能显著减少孕妇的焦虑，还能显著增加孕妇的健康促进行为，而且是可行和可接受的。进一步探索疗效结果将需要更大的样本量，以检测围产期MWI对心理和社会情绪功能的更精确影响。

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