A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran

Maternal morbidity and mortality continue to exert a severe toll on mothers worldwide and bring into sharp focus the quality of maternal health care especially in developing countries. This cohort study compared the outcome of maternal health care from two programs, one with preconception care, lowe...

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Main Author:	Jourabchi, Zinat
Format:	Thesis
Language:	English
Published:	2012
Subjects:	Cohort Studies
Online Access:	http://psasir.upm.edu.my/id/eprint/25721/1/FPSK%20p%202012%209%20edited%20IR.pdf
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spelling	my-upm-ir.257212018-11-15T07:41:26Z A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran 2012-06 Jourabchi, Zinat Maternal morbidity and mortality continue to exert a severe toll on mothers worldwide and bring into sharp focus the quality of maternal health care especially in developing countries. This cohort study compared the outcome of maternal health care from two programs, one with preconception care, lower number of prenatal care visits, a formalized referral process and postpartum care named integrated maternal health care (IMHC) and the other without these characteristics (Standard program). The main objective of study was aimed at evaluating the impact of these programs on gestational complications and birth outcomes in two cities of Qazvin Province, Iran. Alvand City started the new program or IMHC (with preconception care) in 2007. Of 940 mothers (16-35 years of age) screened at eight maternal care health clinics in each city, 484 were found to be eligible for study. Of these, 450 mothers consented and were followed up from the time of registration at the maternal health care clinic until six weeks after delivery. Of the 450 mothers, 147 (63.4%) had preconception care, all of whom resided in Alvand city. In the IMHC, the number of prenatal care visits were less than in the standard program (a mean of 5 versus 9 visits, p = 0.001). During first and second trimesters, proportionately more referrals of pregnant mothers to specialized care were made in the IMHC (25.5 % in the first trimester and 39.4% in the second trimester for Alvand and 6.8 % and 12.9 % respectively for Qazvin) (p<0.05). Anemia during pregnancy was significantly more in the IMHC for the second and third trimesters (p<0.05). Gestational hypertension was significantly lower in the IMHC during second and third trimesters (p<0.05). Rate of low birth weight «2500gr) was 11.0 % in the standard program versus 6.9 % in the IMHC. Preterm birth « 37 week) was significantly less in the IMHC program and most maternal and neonatal complications were less in the IMHC as well. Neonatal mortality was not significantly different (p<0.05). No maternal mortality reported in any group. In addition, there was a significant association between type of program and the risk of the gestational hypertension. The risk of gestational hypertension in the IMHC was significantly lower than in women in the standard program (adjusted OR=0.164; 95% CI =0.053, 0.506). Moreover, an association was observed between type of program and the risk of the birth outcomes. There was less risk of preterm birth (OR= 0.478; 95% CI= 0.240, 0.952), maternal complication (OR= 0.532; 95% CI=0.344, 0.823) and neonatal complication (OR= 0.503; 95% CI= 0.318, 0.796) in IMHC program. Preconception care had the significant association with gestational hypertension, preterm labor, preterm birth, low birth weight, maternal complication and neonatal complication. The findings of the present study indicated advantages of a new program (IMHC) that associated with lower rate of gestational complication or adverse birth outcomes. Therefore, it is necessary to emphasize benefits of IMHC, including the preconception care, low number of prenatal visits, formulized referral process and postpartum care. Cohort Studies 2012-06 Thesis http://psasir.upm.edu.my/id/eprint/25721/ http://psasir.upm.edu.my/id/eprint/25721/1/FPSK%20p%202012%209%20edited%20IR.pdf text en public doctoral Universiti Putra Malaysia Cohort Studies Faculty of Medicine and Health Science
institution	Universiti Putra Malaysia
collection	PSAS Institutional Repository
language	English
topic	Cohort Studies
spellingShingle	Cohort Studies Jourabchi, Zinat A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
description	Maternal morbidity and mortality continue to exert a severe toll on mothers worldwide and bring into sharp focus the quality of maternal health care especially in developing countries. This cohort study compared the outcome of maternal health care from two programs, one with preconception care, lower number of prenatal care visits, a formalized referral process and postpartum care named integrated maternal health care (IMHC) and the other without these characteristics (Standard program). The main objective of study was aimed at evaluating the impact of these programs on gestational complications and birth outcomes in two cities of Qazvin Province, Iran. Alvand City started the new program or IMHC (with preconception care) in 2007. Of 940 mothers (16-35 years of age) screened at eight maternal care health clinics in each city, 484 were found to be eligible for study. Of these, 450 mothers consented and were followed up from the time of registration at the maternal health care clinic until six weeks after delivery. Of the 450 mothers, 147 (63.4%) had preconception care, all of whom resided in Alvand city. In the IMHC, the number of prenatal care visits were less than in the standard program (a mean of 5 versus 9 visits, p = 0.001). During first and second trimesters, proportionately more referrals of pregnant mothers to specialized care were made in the IMHC (25.5 % in the first trimester and 39.4% in the second trimester for Alvand and 6.8 % and 12.9 % respectively for Qazvin) (p<0.05). Anemia during pregnancy was significantly more in the IMHC for the second and third trimesters (p<0.05). Gestational hypertension was significantly lower in the IMHC during second and third trimesters (p<0.05). Rate of low birth weight «2500gr) was 11.0 % in the standard program versus 6.9 % in the IMHC. Preterm birth « 37 week) was significantly less in the IMHC program and most maternal and neonatal complications were less in the IMHC as well. Neonatal mortality was not significantly different (p<0.05). No maternal mortality reported in any group. In addition, there was a significant association between type of program and the risk of the gestational hypertension. The risk of gestational hypertension in the IMHC was significantly lower than in women in the standard program (adjusted OR=0.164; 95% CI =0.053, 0.506). Moreover, an association was observed between type of program and the risk of the birth outcomes. There was less risk of preterm birth (OR= 0.478; 95% CI= 0.240, 0.952), maternal complication (OR= 0.532; 95% CI=0.344, 0.823) and neonatal complication (OR= 0.503; 95% CI= 0.318, 0.796) in IMHC program. Preconception care had the significant association with gestational hypertension, preterm labor, preterm birth, low birth weight, maternal complication and neonatal complication. The findings of the present study indicated advantages of a new program (IMHC) that associated with lower rate of gestational complication or adverse birth outcomes. Therefore, it is necessary to emphasize benefits of IMHC, including the preconception care, low number of prenatal visits, formulized referral process and postpartum care.
format	Thesis
qualification_level	Doctorate
author	Jourabchi, Zinat
author_facet	Jourabchi, Zinat
author_sort	Jourabchi, Zinat
title	A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
title_short	A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
title_full	A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
title_fullStr	A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
title_full_unstemmed	A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran
title_sort	cohort study comparing the new maternal health care program with the standard program in qazvin province, iran
granting_institution	Universiti Putra Malaysia
granting_department	Faculty of Medicine and Health Science
publishDate	2012
url	http://psasir.upm.edu.my/id/eprint/25721/1/FPSK%20p%202012%209%20edited%20IR.pdf
_version_	1747811528495595520

A cohort study comparing the new maternal health care program with the standard program in Qazvin Province, Iran

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