Feyer, L.S. (Larissa) (2018) Multidisciplinary Antenatal Care for Vulnerable Women - A Retrospective Observational Case Control Study. thesis, Medicine.
Full text available on request.Abstract
Background: Vulnerable pregnant women show a wide variety of psychosocial and psychiatric problems and thus require more individually tailored health care. The Psychiatric, Pediatric, Obstetric and Psychology (POPP) outpatient clinic at the Medisch Centrum Leeuwarden (MCL) aims to provide this care. Pregnancy outcomes of patients treated at the MCL POPP clinic have not yet been studied. Aim: The aim of this study was to compare the pregnancy outcomes of the POPP population to the general pregnant population that gave birth in the MCL. Additionally, correlations were analysed between psychiatric and/or psychosocial factors and pregnancy outcomes within the POPP population. Pregnancy outcomes that were studied included the gestational age at birth, preterm birth, induced labour, operative deliveries, pain medication, birth weight, small for gestational age (SGA), perinatal death, observation after delivery and neonatal intensive care admission (NICU). Additionally, two combined outcome variables were studied: obstetrical interventions and adverse pregnancy outcomes. Methods: The study was conducted among all POPP patients who gave birth at the MCL between April 2016 and October 2017 (n = 166). In the first part of the analysis, data of the POPP population was compared to the data of the general pregnant population that gave birth in the MCL, retrieved from the Perined-Insight data of 2015 (n = 1523). In the second part of the analysis, data of POPP subgroups with certain characteristics were compared with the total POPP population. Statistical analysis was performed using SPSS 24. Pearson Chisquared test and the Fisher’s exact test were used to compare outcomes among different groups. The odds ratio (OR) was calculated to estimate the effect size of the results. The t-test for two independent samples was used for continuous outcomes with a normal distribution. Results: Compared to the general population the mean gestational age at birth in the POPPpopulation was lower (38 + 5 vs. 39 + 1 weeks, p = 0.033), the odds for induced labor were 3.323 times higher (p < 0.000) and the odds for small for gestational age (SGA) were 2.199 times higher (p = 0.047). Regarding the subgroups of the POPP population, a significant correlation was found between cannabis use and preterm delivery (p = 0.009, OR = 7.889). Women with anxiety disorders were associated with an increased risk for secondary cesarean section (CS) (p = 0.037, OR = 2.738). Women with personality disorder had an increased risk for obstetrical interventions (p = 0.045, OR = 6.602) and a similar risk was found in women that used selective serotonin reuptake inhibitors (SSRIs) (p = 0.022, OR = 2.642). A significantly lower birth weight was found in babies of cigarette smokers (p = 0.000), drug (p = 0.012) and alcohol users (p = 0.001). Conclusion: Babies of MCL POPP patients have a lower gestational age at birth, labor is more frequently induced and babies are at higher risk of being SGA compared to the general population that gave birth in the MCL. No differences were found for other outcomes such as preterm delivery, birth weight or perinatal death. Some subgroups within the POPPpopulation may be more at risk than others (preterm delivery, secondary CS, obstetrical interventions and lower birth weight), although this requires further study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Postma, Dr. I. and and and Stekelenburg, Prof. Dr. J. and Department of Obstetrics and Gynecology and Medisch Centrum Leeuwarden (MCL), Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1488 |
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