Characteristics of health behaviours and health status indicators among pregnant women in Slovenia

  • Tina Kek Department of Obstetrics and Gynaecology, University Medical center Ljubljana, Ljubljana
  • Nataša Karas Kuželički Faculty of Pharmacy, University of Ljubljana, Ljubljana
  • Irena Mlinarič Raščan Faculty of Pharmacy, University of Ljubljana, Ljubljana
  • Ksenija Geršak Faculty of medicine, University of Ljubljana, Ljubljana andDepartment of Obstetrics and Gynaecology, University Medical center Ljubljana, Ljubljana
Keywords: pregnancy, medication, health related behavior, socio-demographic characteristics

Abstract

Background: Pregnancy is a period when women reconsider their own health and health related behaviour for the sake of their future child. Along with their health providers, they are faced with a number of risk assessments and decisions, which become far more complex as their effect on two organisms rather than one is at play. This paper provides an overview of possible associations between self-reported health status, health behaviours and socio-demographics during pregnancy.
Methods: Study data were obtained from the case-control research project “Analysis of folate metabolism biomarkers in the risk assessment for neural tube defects, orofacial clefts and congenital heart defects”, which recruited participants from May 2013 to September 2015. Questionnaires about maternal health, health related behaviour and socio-demographic characteristics were completed by 450 women. The data include pregnancies from the 1980s to 2015.
Results: We observed that younger and less educated women more frequently reported positive smoking status during pregnancy, while higher prevalence of folate/multivitamin supplementation was found among more educated, older and nulliparous women. There was a U-shaped distribution of medication intake (over-the-counter and prescribed) with respect to educational level, with the highest intake in mothers with a masters/PhD degree and among those that completed elementary school. Higher medication usage was also reported among older women. With increasing maternal age there was an increase in medication intake, folate/multivitamin intake, as well as incidence of gestational diabetes over the studied time period, with the highest frequencies occurring in later decades. A higher incidence of chronic diseases was observed in a group of multiparous women than among monoparous women.
Conclusions: Considerable socio-demographic disparities exist in health-related behaviour among pregnant women. Improved public health campaigns and individual health care counselling are needed to address specific requirements of socio-demographic groups at higher risks of adverse pregnancy outcomes.

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References

Petersen I, McCrea RL, Lupattelli A, Nordeng H. Women’s perception of risk of adverse fetal pregnancy outcomes: a large-scale multinational study. BML Open. 2015;5(6):e007390.

McDonald K, Amir LH, Davey MA. Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. MNC Public Health. 2011;11 Suppl 5:S5.

Honein MA, Gilboa SM, Broussard CS. The need for safer medication use in pregnancy. Expert Rev Clin Pharmacol. 2013;6(5):453–5.

Thorpe PG, Gilboa SM, Hernandez-Diaz S, Lind J, Cragan JD, Briggs G, et al. Medications in the first trimester of pregnancy: most common exposures and critical gaps in understanding fetal risk. Pharmacoepidemiol Drug Saf. 2013;22(9):1013–8.

Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby AC, Moretti ME, et al. Medicaion use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 2014;4(2):e004365.

Servey J, Chang J. Over-the-counter medications in pregnancy. Am Fam Physician. 2014;90(8):548–55.

Mullally A, Cleary BJ, Barry J, Fahey TP, Murphy DJ. Prevalence, predictors and perinatal outcomes of peri-conceptonal alcohol exposure-retrospective cohort study in an urban obstetric population in Ireland. BMC Pregnancy Childbirth. 2011;11:27.

Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Periconceptional care:caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure. Reprod Health. 2014;11 Suppl 3:S6.

Smedberg J, Lupattelli A, Mårdby AC, Nordeng H. Characteristics of women who continue smoking during pregnancy: a cross-sectional study of pregnant women and new mothers in 15 European countries. BMC Pregnancy Childbirth. 2014;14:213.

European Medicines Agency. Guideline on the Development of Medicinal Products for the Treatment of Smoking. London: European Medicines Agency; 2008.

Raymond N, Beer C, Glazebrook C, Sayal K. Pregnant women’s attitudes towards alcohol consumption. BMC Public Health. 2009;9:175.

Khoushabi F, Shadan MR, Miri A, Sharifi-Rad J. Determination of maternal serum zinc, iron, calcium and magnesium during pregnancy in pregnant women and umbilical cord blood and their association with outcome of pregnancy. Mater Sociomed. 2016;28(2):104–7.

Masoumi SZ, Parsa P, Kazemi F, Soltanian AR, Habib DGS. Investigation of Nutritional Behaviors in the First and Second Trimesters in Pregnant Women Referring to Clinics in Hamadan, Iran, in 2013. Glob J Health Sci. 2016;8(9):261–70.

Soma-Pillay P, Nelson-Piercy, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89–94.

Murthy GVS, Kolli SR, Neogi SB, Singh S, Allagh KP, John N, et al. Mixed-Method Study to Determine the Benefits of Periconceptional Folic Acid Supplementation And Effects of Folic Acid DefIciency in Mothers on Birth Outcomes. JMIR Res Protoc 2016;5(2):e129.

Shaw GM, Nelson V, Carmichael S, Lammer E, Finnell R, Rosenquist T. Maternal Periconceptional Vitamins: Interactions with Selected Factors and Congenital Anomalies? Epidemiology. 2002;13(6):625-30.

Carmichael SL, Nelson V, Shaw GM, Wasserman CR, Croen LA. Socio-economic status and risk of conotruncal heart defects and orofacial clefts. Paediatr Perinat Epidemiol. 2003;17(3):264-71.

Charugundla P. The role of maternal nutrition, risk factor avoidance and gene-environment interactions in orofacial clefting. A master of science in Environmental health Sciences thesis. Los Angeles: University of California; 2013.

Baron R, Manniën J, te Velde SJ, Klomp T, Hutton EK, Brug J. Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: a cross-sectional study. BMC Pregnancy Childbirth. 2015;15:261.

Krajec M, Natek N, Geršak K. Medication use in the postpartum period in Slovenia with regard to breastfeeding. Zdrav Vestn. 2016;85(9):483-90.

Van Calsteren K, Geršak K, Sundseth H, Klingmann I, Dewulf L, Van Assche A, Mahmood T. Position statement from the European Board and College of Obstetrics & Gynaecology (EBCOG): The use of medicines during pregnancy–call for action. Eur J Obstet Gynecol Reprod Biol. 2016;201:189–91.

Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013;42(6):634–43.

Lanting CI, van Wouwe JP, van den Burg I, Segaar D, van der Pal-de Bruin KM. Smoking during pregnancy: trends between 2001 and 2010. Ned Tijdschr Geneeskd. 2012;156(46):A5092.

Aurrekoetxea JJ, Murcia M, Rebagliato M, Fernandez-Somoano A, Castilla AM, Guxens M, et al. Factors associated with second-hand smoke exposure in non-smoking pregnant women in Spain: self-reported exposure and urinary cotinine levels. Sci Total Environ. 2014;470–471:1189–96.

Lu Y, Tong S, Oldenburg B. Determinants of smoking and cessation during and after pregnancy. Health Promot Int. 2001;16(4):355–65.

Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res. 2004;6 Suppl 2:S125-S40.

Al-Sahab B, Saqib M, Hauser G, Tamim H. Prevalence of smoking during pregnancy and associated risk factors among Canadian women: a national survey. BMC Pregnancy Childbirth. 2010;10:24.

Junger M, Japel C, Coté S, Xu Q, Boivin M, & Tremblay R. Smoking and Medication During Pregnancy Predict Repeated Unintentional Injuries in Early Childhood But Not Single Unintentional Injuries. Prev Sci. 2013;14;13–24.

Tekin M, Yıldırım S, Aylanç H, Kaymaz N, Battal F, Topaloğlu N, et al. Does intrauterine tobacco exposure increase the pain perception of newborns? J Pain Res. 2016;9:319–23.

Vieira AR, Orioli IM. Birth order and oral clefts: a meta analysis. Teratology. 2002;66:209–16.

Myers RD, Veale WLJ. The role of sodium an calcium ions in the hypothalamus in the control of body temperature of the unanaesthetized cat. Physiol. 1971;212(2):411-30.

Krapels IP, van Rooij IA, Ocke MC, West CE, van der Horst CM, Steegers-Theunissen RP. Maternal nutritional status and the risk for orofacial cleft offspring in humans. J Nutr. 2004;134(11):3106–13.

De Lucca L, Rodrigues F, Jantsch LB, Neme WS, Gallarreta FMP, Gonçalves TL. Oxidative Profile and δ-Aminolevulinate Dehydratase Activity in Healthy Pregnant Women with Iron Supplementation. Int J Environ Res Public Health 2016;13(5):463.

Murphy VE. Managing asthma in pregnancy. Breathe. 2015;11:258–67.

Kim S, Kim J, Park SY, Um HY, Kim K, Kim Y, et al. Effect of pregnancy in asthma on health care use and perinatal outcomes. J Allergy Clin Immunol. 2015;136(5):1215–23.

O’Keeffe LM, Dahly D L, Murphy M, Greene RA, Harrington JM, Corcoran P, et al. Positive lifestyle changes around the time of pregnancy: a cross-sectional study. BMJ Open. 2016;6(5):e010233.

Kim SY, Kotelchuck M, Wilson HG, Diop H, Shapiro-Mendoza CK,England LJ. Prevalence of adverse pregnancy outcomes, by maternal diabetes status at first and second deliveries, Massachusetts, 1998–2007. Prev Chronic Dis. 2015;12:E218

Tercelj M, Sketelj M. Recommendations for gestational diabetes management in Slovenian diabetes management guidelines[Internet]. Ljubljana: University Medical Centre Ljubljana; 2011 [cited 2016 Nov 13]. Available from: http//endodiab.si/priprocila/smernice-za-vodenje-sladkorne-bolezni/

Ferrara A, Kahn H, Quesenberry C, Riley C, Hedderson M. An Increase in the Incidence of Gestational Diabetes Mellitus: Northern California, 1991–2000. Obstet Gynecol. 2004;103(3):526-33.

Hunt KJ, Schuller KL. The Increasing Prevalence of Diabetes in Pregnancy. Obstet Gynecol Clin North Am. 2007;34(2):173–8.

Paulin S, Kelšin N, Korošec A, Zaletel J, Nadrag P, Zaletel M. Ekonomsko breme sladkorne bolezni v Sloveniji 2012. Ljubljana: Nacionalni inštitut za javno zdravje; 2014.

Berglund SK, García-Valdés L, Torres-Espinola FJ, Segura T, Martínez-Zaldívar C, Aguilar MJ, et al. Maternal, fetal and perinatal alterations associated with obesity, overweight and gestational diabetes: an observational cohort study (PREOBE). BMC Public Health. 2016;16:207.

Kokalj TS, Rejc B, Geršak K. Incidence and prevention of neural tube defects in Slovenia. Eur J Obstet Gynecol Reprod Biol. 2011;156(1):119–20.

Baron R, Manniën J, de Jonge A, Heymans MW, Klomp T, Hutton EK, Brug J. Socio-Demographic and Lifestyle-Related Characteristics Associated with Self-Reported Any, Daily and Occasional Smoking during Pregnancy. PLoS ONE. 2013;8(9):e74197.

Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: nutritional risks and interventions. Reprod Health. 2014;26;11 Suppl 3:S3.

Zeitlin J, Mortensen L, Prunet C, Macfarlane A, Hindori-Mohangoo AD, Gissler M, et al. Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project. BMC Pregnancy Childbirth. 2016;16:15.

Verstappen GMPJ, Smolders LJ, Munster JM, Aarnoudse JG, Hak E. Prevalence and predictors of over-the-counter medication use among pregnant women: a cross-sectional study in the Netherlands. BMC Public Health. 2013;13:185.

Onah MN, Field S, van Heyningen T, Honikman S. Predictors of alcohol and other drug use among pregnant women in a peri-urban South African setting. Int J Ment Health Syst. 2016;10:38.

Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz S. National Birth Defects Prevention Study. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol. 2011;205(1):51.e1–8.

Odalovic M, Vezmar Kovacevic S, Nordeng H, Ilic K, Sabo A, Tasic L. Predictors of the use of medications before and during pregnancy. Int J Clin Pharm. 2013;35(3):408–16.

Refuerzo JS, Blackwell SC, Sokol RJ, Lajeunesse L, Firchau K, Kruger M, Sorokin Y. Use of over-the-counter medications and herbal remedies in pregnancy. Am J Perinatol. 2005;22(6):321–324.

Donati S, Baglio G, Spinelli A, Grandolfo ME. Drug use in pregnancy among Italian women. Eur J Clin Pharmacol. 2000;56(4):323–8.

Olesen C, Thrane N, Henriksen TB, Ehrenstein V, Olsen J. Associations between socio-economic factors and the use of prescription medication during pregnancy: A population-based study among 19,874 Danish women. Eur J Clin Pharmacol. 2006;62(7):547-53.

Stokholm J, Schjørring S, Pedersen L, Bischoff AL, Følsgaard N, Carson CG, et al. Prevalence and Predictors of Antibiotic Administration during Pregnancy and Birth. PLoS ONE. 2013;8(12):e82932.

Makrides M, Crosby DD, Bain E, Crowther CA. Magnesium supplementation in pregnancy. Cochrane Database of Systematic Reviews 2014; CD000937.

Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database of Systematic Reviews 2015; CD004736.

Radin RG, Mitchell AA, Werler MM. Predictors of recall certainty of dates of analgesic medication use in pregnancy. Pharmacoepidemiol Drug Saf. 2013;22(1):25–32.

deJong PCMP, Berns MPH, Duynhoven YTHPv, Nijdam WS, Eskes TKAB, Zielhuis GA. Recall of medication during pregnancy: Validity and accuracy of an adjusted questionnaire. Pharmacoepidemiol Drug Saf. 1995;4(1):23–30.

Goodman MT, Nomura AMY, Wilkens LR, Kolonel LN. Agreement between interview information and physician records on history of menopausal estrogen use. Am J Epidemiol. 1990;131(5):815–25.

West SL, Savitz DA, Koch G, Sheff KL, Strom BL, Guess HA, Hartzema AG. Demographics, health behaviors, and past drug use as predictors of recall accuracy for previous prescription medication use. J Clin Epidemiol. 1997;50(8):975–80.

Cotterchio M, Kreiger N, Darlington G, Steingart A. Comparison of self-reported and physicianreported antidepressant medication use. Annals Epidemiol. 1999;9(5):283–9.

Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2012;156(5):588-600.

Murphy JF, O’Riordan J, Newcombe RG, Coles EC, Pearson JF. Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. The Lancet. 1986;1(8488):992–5.

Devrim E, Tarhan I, Ergüder IB, Durak I. Oxidant/Antioxidant Status of Placenta, Blood, and Cord Blood Samples From Pregnant Women Supplemented With Iron. J Soc Gynecol Investig. 2006;13(7):502–5.

Artama M, Gissler M, Malm H, Ritvanen A. Nationwide register-based surveillance system on drugs and pregnancy in Finland 1996–2006. Pharmacoepidemiol Drug Saf. 2011;20(7):729–38.

Published
2017-09-01
How to Cite
1.
Kek T, Karas Kuželički N, Mlinarič Raščan I, Geršak K. Characteristics of health behaviours and health status indicators among pregnant women in Slovenia. TEST ZdravVestn [Internet]. 1Sep.2017 [cited 26Apr.2024];86(7-8):295-17. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/2490
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Original article