Michael Helewa - Academia.edu (original) (raw)

Papers by Michael Helewa

The American Journal of Clinical Nutrition

Background Reports on the adequacy of vitamin D status of pregnant women are not available in Can... more Background Reports on the adequacy of vitamin D status of pregnant women are not available in Canada. Objectives The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada. Methods Pregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested...

Clinical Biochemistry, 2011

Methods: Surplus serum samples collected from outpatient clinic children of 0-18 years of age wer... more Methods: Surplus serum samples collected from outpatient clinic children of 0-18 years of age were pooled into a single pool along with age-group specific pools. Following baseline measurement, each pool was aliquoted and kept frozen at − 80°C until analysis. Samples were analyzed at monthly intervals over a 10-13-month period and each aliquot was subject to one freeze-thaw cycle before analysis. Sample analysis was performed on VITROS® Chemistry System, COBAS INTEGRA® 400 Plus, and IMMULITE® 2500 analyzers. Values obtained at monthly intervals were compared to baseline measurement and examined for trends over time. Result: A majority of analytes measured in this study (e.g. electrolytes, glucose, enzymes, insulin, GH, IGF-1, vitamin B12) showed no significant change relative to baseline and no significant trend over time after up to 13 months of storage at −80°C. PTH showed a 27.2% decline after 10 months of storage with most of the decline evident after the first 2 months. Most analytes showed variability over time, which is thought to reflect method and instrument variability rather than the change in analyte stability. Conclusions: Serum samples do not require immediate testing for reference intervals determination for most of the common analytes, with possible exception of PTH.

Journal of Perinatology

To assess the association between time of birth and mortality among preterm infants. Population-b... more To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant. Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy... more OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and cl...

LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee ... more LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee proliferent depuis 20 ans. La plupart de ces recherches se font sous forme d’etudes par observation longitudinale, d’etudes par observation transversale et d’etudes cas–temoin. L’etude decrite par le Dr Michel Labrecque et ses collegues dans le present numero (page 797) allie une conception longitudinale et transversale et l’on examine minutieusement un vaste eventail de facteurs de confusion. Labrecque et ses collaborateurs concluent qu’il y a une association solide entre l’episiotomie mediale et des lacerations du perinee du troisieme et du quatrieme degres. Meme si des etudes controlees randomisees ont demontre que, pour chaque patiente, l’episiotomie accroit le risque de dechirure grave du perinee, l’adoption d’une politique de pratique restreinte n’a pas eu pour effet de reduire l’incidence des dechirures perineales. Comme les avantages de l’episiotomie n’ont pas ete demontres, on n...

The Journal of Pediatrics

American Journal of Obstetrics and Gynecology

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease

Pregnancy Hypertension

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Journal of Obstetrics and Gynaecology Canada

Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees ... more Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees dans le cadre de la directive clinique redigee par le groupe de travail canadien sur les troubles hypertensifs de la grossesse et publiee dans Pregnancy Hypertension (http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext), en vue d'offrir une approche raisonnable envers le diagnostic, l'evaluation et la prise en charge des troubles hypertensifs de la grossesse. Resultats La litterature publiee a ete recuperee par l'intermediaire de recherches menees dans Medline, CINAHL et The Cochrane Library en mars 2012 au moyen d'un vocabulaire controle (p. ex. « pregnancy », « hypertension », « pre-eclampsia », « pregnancy toxemias ») et de mots cles (p. ex. « diagnosis », « evaluation », « classification », « prediction », « prevention », « prognosis », « treatment », « post-partum follow-up ») appropries. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles rediges en anglais ou en francais entre janvier 2006 et fevrier 2012. Les recherches ont ete mises a jour de facon reguliere et integrees a la directive clinique jusqu'en septembre 2013. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs La qualite des resultats est evaluee au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs (Tableau).

Journal of Obstetrics and Gynaecology Canada, 2016

Journal of Obstetrics and Gynaecology Canada, 2005

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In P... more To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In Pregnancy Study) (NCT01192412). Design: Quantitative and qualitative analysis of questionnaire responses. Setting: International randomised trial (94 sites, 15 countries). Population/sample: 911 (92.9%) women randomised to 'tight' (target diastolic blood pressure, 85 mmHg) or 'less tight' (target diastolic blood pressure, 100 mmHg) who completed questionnaires. Methods: A questionnaire was administered at $6-12 weeks postpartum regarding post-discharge morbidity and views about trial participation. Questionnaires were administered by the site coordinator, and contact was made by phone, home or clinic visit; rarely, data was collected from medical records. Quantitative analyses were Chi-square or Fisher's exact test for categorical variables, mixed effects multinomial logistic regression to adjust for confounders, and p < 0.001 for statistical significance. NVivo software was used for thematic analysis of women's views. Main outcome measures: Satisfaction, measured as willingness to have the same treatment in another pregnancy or recommend that treatment to a friend. Results: Among the 533 women in 'tight' (N = 265) vs. 'less tight' (N = 268) control who provided comments for qualitative analysis, women in 'tight' (vs. 'less tight') control made fewer positive comments about the amount of medication taken (5 vs. 28 women, respectively) and intensity of BP monitoring (7 vs. 17, respectively). However, this did not translate into less willingness to either have the same treatment in another pregnancy (434, 95.8% vs. 423, 92.4%, respectively; p = 0.14) or recommend that treatment to a friend (435, 96.0% and 428, 93.4%, respectively; p = 0.17). Importantly, although

Obstet Gynecol Surv, 1994

To evaluate the safety, acceptability and cost of a community-based home-care program for the man... more To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia.

Journal of Obstetrics and Gynaecology Canada, 2016

Objective: The purpose of this guideline is to provide guidance for the intrapartum management of... more Objective: The purpose of this guideline is to provide guidance for the intrapartum management of spontaneous labour, whether normal or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes. Evidence: Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. The duration of the first stage of labour increases with maternal age and body mass index. (II-2) 2. In low-risk nulliparous women in the active phase of labour (i.e., equal to or greater than 4 cm dilatation), progress of cervical dilatation greater than or equal to 0.5 cm/hour is considered normal. (II-2)

Acta obstetricia et gynecologica Scandinavica, Jul 24, 2016

For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy... more For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48hr, or birthweight <10th centile) or maternal outcomes (severe hypertension, pre-eclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by Akaike information criterion. For face validity, these variables were forced into the model: treatment group ('less tight' or 'tight'…

Journal of Obstetrics and Gynaecology Canada, 2011

SAGE Open Medicine, 2015

The objective of this qualitative descriptive study was to explore the perceptions of women livin... more The objective of this qualitative descriptive study was to explore the perceptions of women living in inner-city Winnipeg, Canada, about barriers, facilitators, and motivators related to their use of prenatal care. Methods: Individual, semi-structured interviews were conducted in person with 26 pregnant or postpartum women living in inner-city neighborhoods with high rates of inadequate prenatal care. Interviews averaged 67 min in length. Recruitment of participants continued until data saturation was achieved. Inductive content analysis was used to identify themes and subthemes under four broad topics of interest (barriers, facilitators, motivators, and suggestions). Sword's socio-ecological model of health services use provided the theoretical framework for the research. This model conceptualizes service use as a product of two interacting systems: the personal and situational attributes of potential users and the characteristics of health services. Results: Half of the women in our sample were single and half self-identified as Aboriginal. Participants discussed several personal and system-related barriers affecting use of prenatal care, such as problems with transportation and child care, lack of prenatal care providers, and inaccessible services. Facilitating factors included transportation assistance, convenient location of services, positive care provider qualities, and tangible rewards. Women were motivated to attend prenatal care to gain knowledge and skills and to have a healthy baby. Conclusion: Consistent with the theoretical framework, women's utilization of prenatal care was a product of two interacting systems, with several barriers related to personal and situational factors affecting women's lives, while other barriers were related to problems with service delivery and the broader healthcare system. Overcoming barriers to prenatal care and capitalizing on factors that motivate women to seek prenatal care despite difficult living circumstances may help improve use of prenatal care by inner-city women.

European Journal of Epidemiology

The American Journal of Clinical Nutrition

Background Reports on the adequacy of vitamin D status of pregnant women are not available in Can... more Background Reports on the adequacy of vitamin D status of pregnant women are not available in Canada. Objectives The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada. Methods Pregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested...

Clinical Biochemistry, 2011

Methods: Surplus serum samples collected from outpatient clinic children of 0-18 years of age wer... more Methods: Surplus serum samples collected from outpatient clinic children of 0-18 years of age were pooled into a single pool along with age-group specific pools. Following baseline measurement, each pool was aliquoted and kept frozen at − 80°C until analysis. Samples were analyzed at monthly intervals over a 10-13-month period and each aliquot was subject to one freeze-thaw cycle before analysis. Sample analysis was performed on VITROS® Chemistry System, COBAS INTEGRA® 400 Plus, and IMMULITE® 2500 analyzers. Values obtained at monthly intervals were compared to baseline measurement and examined for trends over time. Result: A majority of analytes measured in this study (e.g. electrolytes, glucose, enzymes, insulin, GH, IGF-1, vitamin B12) showed no significant change relative to baseline and no significant trend over time after up to 13 months of storage at −80°C. PTH showed a 27.2% decline after 10 months of storage with most of the decline evident after the first 2 months. Most analytes showed variability over time, which is thought to reflect method and instrument variability rather than the change in analyte stability. Conclusions: Serum samples do not require immediate testing for reference intervals determination for most of the common analytes, with possible exception of PTH.

Journal of Perinatology

To assess the association between time of birth and mortality among preterm infants. Population-b... more To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant. Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy... more OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and cl...

LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee ... more LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee proliferent depuis 20 ans. La plupart de ces recherches se font sous forme d’etudes par observation longitudinale, d’etudes par observation transversale et d’etudes cas–temoin. L’etude decrite par le Dr Michel Labrecque et ses collegues dans le present numero (page 797) allie une conception longitudinale et transversale et l’on examine minutieusement un vaste eventail de facteurs de confusion. Labrecque et ses collaborateurs concluent qu’il y a une association solide entre l’episiotomie mediale et des lacerations du perinee du troisieme et du quatrieme degres. Meme si des etudes controlees randomisees ont demontre que, pour chaque patiente, l’episiotomie accroit le risque de dechirure grave du perinee, l’adoption d’une politique de pratique restreinte n’a pas eu pour effet de reduire l’incidence des dechirures perineales. Comme les avantages de l’episiotomie n’ont pas ete demontres, on n...

The Journal of Pediatrics

American Journal of Obstetrics and Gynecology

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease

Pregnancy Hypertension

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Journal of Obstetrics and Gynaecology Canada

Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees ... more Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees dans le cadre de la directive clinique redigee par le groupe de travail canadien sur les troubles hypertensifs de la grossesse et publiee dans Pregnancy Hypertension (http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext), en vue d'offrir une approche raisonnable envers le diagnostic, l'evaluation et la prise en charge des troubles hypertensifs de la grossesse. Resultats La litterature publiee a ete recuperee par l'intermediaire de recherches menees dans Medline, CINAHL et The Cochrane Library en mars 2012 au moyen d'un vocabulaire controle (p. ex. « pregnancy », « hypertension », « pre-eclampsia », « pregnancy toxemias ») et de mots cles (p. ex. « diagnosis », « evaluation », « classification », « prediction », « prevention », « prognosis », « treatment », « post-partum follow-up ») appropries. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles rediges en anglais ou en francais entre janvier 2006 et fevrier 2012. Les recherches ont ete mises a jour de facon reguliere et integrees a la directive clinique jusqu'en septembre 2013. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs La qualite des resultats est evaluee au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs (Tableau).

Journal of Obstetrics and Gynaecology Canada, 2016

Journal of Obstetrics and Gynaecology Canada, 2005

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In P... more To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In Pregnancy Study) (NCT01192412). Design: Quantitative and qualitative analysis of questionnaire responses. Setting: International randomised trial (94 sites, 15 countries). Population/sample: 911 (92.9%) women randomised to 'tight' (target diastolic blood pressure, 85 mmHg) or 'less tight' (target diastolic blood pressure, 100 mmHg) who completed questionnaires. Methods: A questionnaire was administered at $6-12 weeks postpartum regarding post-discharge morbidity and views about trial participation. Questionnaires were administered by the site coordinator, and contact was made by phone, home or clinic visit; rarely, data was collected from medical records. Quantitative analyses were Chi-square or Fisher's exact test for categorical variables, mixed effects multinomial logistic regression to adjust for confounders, and p < 0.001 for statistical significance. NVivo software was used for thematic analysis of women's views. Main outcome measures: Satisfaction, measured as willingness to have the same treatment in another pregnancy or recommend that treatment to a friend. Results: Among the 533 women in 'tight' (N = 265) vs. 'less tight' (N = 268) control who provided comments for qualitative analysis, women in 'tight' (vs. 'less tight') control made fewer positive comments about the amount of medication taken (5 vs. 28 women, respectively) and intensity of BP monitoring (7 vs. 17, respectively). However, this did not translate into less willingness to either have the same treatment in another pregnancy (434, 95.8% vs. 423, 92.4%, respectively; p = 0.14) or recommend that treatment to a friend (435, 96.0% and 428, 93.4%, respectively; p = 0.17). Importantly, although

Obstet Gynecol Surv, 1994

To evaluate the safety, acceptability and cost of a community-based home-care program for the man... more To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia.

Journal of Obstetrics and Gynaecology Canada, 2016

Objective: The purpose of this guideline is to provide guidance for the intrapartum management of... more Objective: The purpose of this guideline is to provide guidance for the intrapartum management of spontaneous labour, whether normal or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes. Evidence: Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015. Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. The duration of the first stage of labour increases with maternal age and body mass index. (II-2) 2. In low-risk nulliparous women in the active phase of labour (i.e., equal to or greater than 4 cm dilatation), progress of cervical dilatation greater than or equal to 0.5 cm/hour is considered normal. (II-2)

Acta obstetricia et gynecologica Scandinavica, Jul 24, 2016

For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy... more For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48hr, or birthweight <10th centile) or maternal outcomes (severe hypertension, pre-eclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by Akaike information criterion. For face validity, these variables were forced into the model: treatment group ('less tight' or 'tight'…

Journal of Obstetrics and Gynaecology Canada, 2011

SAGE Open Medicine, 2015

The objective of this qualitative descriptive study was to explore the perceptions of women livin... more The objective of this qualitative descriptive study was to explore the perceptions of women living in inner-city Winnipeg, Canada, about barriers, facilitators, and motivators related to their use of prenatal care. Methods: Individual, semi-structured interviews were conducted in person with 26 pregnant or postpartum women living in inner-city neighborhoods with high rates of inadequate prenatal care. Interviews averaged 67 min in length. Recruitment of participants continued until data saturation was achieved. Inductive content analysis was used to identify themes and subthemes under four broad topics of interest (barriers, facilitators, motivators, and suggestions). Sword's socio-ecological model of health services use provided the theoretical framework for the research. This model conceptualizes service use as a product of two interacting systems: the personal and situational attributes of potential users and the characteristics of health services. Results: Half of the women in our sample were single and half self-identified as Aboriginal. Participants discussed several personal and system-related barriers affecting use of prenatal care, such as problems with transportation and child care, lack of prenatal care providers, and inaccessible services. Facilitating factors included transportation assistance, convenient location of services, positive care provider qualities, and tangible rewards. Women were motivated to attend prenatal care to gain knowledge and skills and to have a healthy baby. Conclusion: Consistent with the theoretical framework, women's utilization of prenatal care was a product of two interacting systems, with several barriers related to personal and situational factors affecting women's lives, while other barriers were related to problems with service delivery and the broader healthcare system. Overcoming barriers to prenatal care and capitalizing on factors that motivate women to seek prenatal care despite difficult living circumstances may help improve use of prenatal care by inner-city women.

European Journal of Epidemiology