Expatriate pregnancy

Pregnancy outcomes, expatriate vs. staying home

1.      Centers for Disease Control and Prevention/National Center for Health Statistics,  Series 21, #56—Trends in Pregnancies and Pregnancy Rates by Outcome: Estimates for the United States, 1976-96

2.      Curtin SC, Park MM.  Trends in the Attendant, Place and Timing of Births, and in the Use of Obstetric Interventions: United States, 1989-97.  Centers for Disease Control and Prevention/National Center for Health Statistics, Volume 47, #27

3.      Kuvacic I, Skrablin S, Hodzic D, Milkovic G. Possible influence of expatriation on perinatal outcome. Acta Obstet Gynecol Scand 1996 Apr;75(4):367-71. BACKGROUND: In order to test the hypothesis of possible influence of environmental stress on the length of gestation the data on deliveries in the Maternity Unit, Zagreb University School of Medicine in three six months periods; May-October 1991 (active war in Croatia), May-October 1990 (pre-war period), and the same period in 1992 are analysed. METHODS: Deliveries of 7845 women from free areas of Croatia (non-displaced population) and deliveries from 712 women from occupied areas of Croatia, as well of 593 Croatian refugees from Bosnia and Herzegovina and Serbia (expatriated population) were compared. The duration of pregnancy, fetal weight, immediate neonatal condition, mode of delivery and perinatal outcome in non-displaced and expatriated population were compared using chi-square test in statistical analysis. RESULTS: During 1992 and 1991, there was a slight increase in total number of deliveries in comparison to 1990. The number of deliveries by displaced women more than doubled. The incidence of major pregnancy complications was almost the same for both groups in all three time periods. The two populations were comparable regarding their age, parity and previous obstetric history. Slight increase in preterm delivery rate (7.7% in l990, 8.7% in 1991 and 9.4% in 1992), and a subsequent slight decrease in birth weight was found in all women. There was no significant change in the proportion of growth-retarded newborns. Expatriated women both in 1990 and in 1991 delivered twice as often prematurely in comparison to non-displaced women (17.5% and l4.3% deliveries), respectively. Birth weight of their infants was significantly more often under 2500 grams. Slight increase in overall perinatal mortality was observed. Perinatal mortality in the experiated population was significantly higher than in the non-displaced population. Increase in perinatal mortality could be attributed exclusively to increase in prematurity rate. CONCLUSION: Our results support the concept of possible influence of stress, fear, exile and inadequate antenatal surveillance on the length of gestation.

Prenatal care

1.      ACOG Technical Bulletin #187—Ultrasonography in Pregnancy

2.      ACOG Practice Patterns #5—Routine Ultrasound in Low-Risk Pregnancy

3.      ACOG Educational Bulletin #229—Nutrition and Women

4.      Allen LH.  Iron-deficiency anemia increases risk of preterm delivery.  Nutr Rev 1993;51:49-52. In an inner-city sample of pregnant women, iron-deficiency anemia was associated with a higher risk of preterm delivery and low birth weight but not with small-for-gestational-age births. However, the prevalence of iron-deficiency anemia (3.5%) explained only a small proportion of preterm deliveries.

5.      Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 2000 May;71(5 Suppl):1280S-4S. This article reviews current knowledge of the effects of maternal anemia and iron deficiency on pregnancy outcome. A considerable amount of information remains to be learned about the benefits of maternal iron supplementation on the health and iron status of the mother and her child during pregnancy and postpartum. Current knowledge indicates that iron deficiency anemia in pregnancy is a risk factor for preterm delivery and subsequent low birth weight, and possibly for inferior neonatal health. Data are inadequate to determine the extent to which maternal anemia might contribute to maternal mortality. Even for women who enter pregnancy with reasonable iron stores, iron supplements improve iron status during pregnancy and for a considerable length of time postpartum, thus providing some protection against iron deficiency in the subsequent pregnancy. Mounting evidence indicates that maternal iron deficiency in pregnancy reduces fetal iron stores, perhaps well into the first year of life. This deserves further exploration because of the tendency of infants to develop iron deficiency anemia and because of the documented adverse consequences of this condition on infant development. The weight of evidence supports the advisability of routine iron supplementation during pregnancy.

6.      ACOG Committee Opinion #196—Vitamin A Supplementation During Pregnancy

7.      ACOG committee opinion #198—Bacterial Vaginosis Screening for Prevention of Preterm Delivery

8.      ACOG Committee Opinion #173—Prevention of Early-Onset Group B Streptococcal Disease in Newborns

9.      ACOG Technical Bulletin #200—Diabetes and Pregnancy

10.  ACOG Practice Bulletin #4—Prevention of Rh D Alloimmunization

11.  ACOG Educational Bulletin #227—Management of Isoimmunization in Pregnancy

Doulas

1.      ACOG Committee Opinion #201—Cultural Competency in Health Care

2.      Campero L, Garcia C, Diaz C, Ortiz O, Reynoso S, Langer A.  “Alone, I wouldn’t have known what to do”: a qualitative study on social support during labor and delivery in Mexico.  Soc Sci Med 1998 Aug;47(3):395-403. This article presents some of the most relevant qualitative results of a trial to evaluate the effects of the provision of psychosocial support to first-time mothers during labor, childbirth and in the immediate postpartum period in a social security hospital in Mexico City. The article focuses on the experiences of mothers who have received psychosocial support from a doula (the term doula is used to identify a woman who provides continuous support to a woman during labor. delivery and the immediate postpartum period) and compares them with the experiences of those women who gave birth following normal hospital routine. Sixteen in-depth interviews were held with women in the immediate post partum period (eight of whom had been accompanied by a doula and eight who had not) before they were discharged from hospital, and the results were analyzed using qualitative techniques. The interviews showed that the women accompanied by a doula had a more positive childbirth experience. The differences between both groups related to their perceptions of the childbirth experience; the treatment they received from hospital staff; the information they were given and how well they understood it; their perception of hospital routines; their feelings about cesarean sections and, spatial and temporal perceptions. The most important difference between the two groups was the way they expressed their feelings about their own labor, their sense of control and their self-perception.

3.      Klaus MH, Kennell JH.  The doula: an essential ingredient of childbirth rediscovered.  Acta Paediatr 1997 Oct;86(10):1034-6. Eleven randomized control trials examined whether additional support by a trained lay person (called a doula), student midwife or midwife, who provides continuous support consisting of praise, encouragement, reassurance, comfort measures, physical contact and explanations about progress during labor, will affect obstetrical and neonatal outcomes. The women were healthy primigravidas at term. Meta-analysis of these studies showed a reduction in the duration of labor, the use of medications for pain relief, operative vaginal delivery, and in many studies a reduction in caesarian deliveries. At 6 weeks after delivery in one study a greater proportion of doula-supported women were breastfeeding, reported greater self-esteem, less depression, a higher regard for their babies and their ability to care for them compared to the control mothers. Observations during labor showed that fathers remained farther away from mothers than doulas, talked and touched less. When the doula was present with the couple during labor the father offered more personal support. The father-to-be' s presence during labor and delivery is important to the mother and father, but it is the presence of the doula that results in significant benefits in outcome.

Breastfeeding

1.      Nakajima H. Breastfeeding: A community responsibility. Press Release WHO/53

2.      ACOG Educational Bulletin #258—Breastfeeding: Maternal and Infant Aspects

Neonatology

1.      Johnson MA, Owers J, Horwood P. Air transport of infants in Newfoundland and Labrador. Can Med Assoc J 1978 Jul 22;119(2):127-34. Air transportation of 33 infants in small unpressurized aircraft over long distances is described. Twenty-six of the infants were transported more than 320 km in environmental temperatures varying from -35 to +21 degrees C. A commercially available incubator was used. Although more than half the infants had a rectal temperature within the normal range at the time of arrival at hospital, 12 infants had rectal temperatures above 37.5 degrees C as a result of efforts to diminish heat loss. Adequate oxygenation of infants at 3000 m in unpressurized aircraft can be difficult. Cold and vibration can affect equipment, and at high altitudes the readings from oxygen analysers may not be true. The use of an expanded transport team, which includes experienced nonmedical personnel, is particularly important in these cases.