Importance of Pre-pregnancy Counseling in Iran: Results from the High Risk Pregnancy Survey 2012

Document Type: Original Article

Authors

1 Department of Population and Family Health, Ministry of Health and Medical Education, Tehran, Iran

2 Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

Abstract

 
Background
To identify the prevalence of behavioural (Pre-pregnancy), obstetrical and medical risks of pregnancy in Iranian women.
 
Methods
A total of 2993 postpartum women who delivered in 23 randomly selected hospitals of six provinces were enrolled in this nationwide cross-sectional study. A structured questionnaire was completed based on interviewees’ self-reports and medical record data, consisting of socio-demographic characteristics, behavioural, obstetrical and medical risks, before and during pregnancy.
 
Results
Less than 6.0% had no health insurance and 5.0% had no prenatal visit before labour. Unintended pregnancy was reported by 27.5% of women. Waterpipe and/or cigarette smoking was reported by 7.1% of them and 0.9% abused opiates during pregnancy. Physical abuse by husband in the year before pregnancy occurred in 7.5% of participants. The rate of cesarean section was 50.4%. Preterm birth, low birth weight, and stillbirth were seen in 6.8, 7.7, and 1.2% of deliveries respectively. The most frequent medical risk factors were urinary tract infection (32.5%), anemia (21.6%), and thyroid disease (4.1%).
 
Conclusion
More effort should be devoted by health policymakers to the establishment of a preconception counselling (health education and risk assessment) and surveillance system; although obstetrical and medical risks should not be neglected too.

Keywords

Main Subjects


1. WHO, UNICEF, UNFPA, World Bank. Trends in maternal mortality: 1990 to 2008. Geneva: WHO; 2010. doi: 10.1017/S0021932002242832
2. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet 2006; 368: 1189–200. doi: 10.1016/s0140-6736(06)69380-x
3. Filippi V, Ronsmans C, Campbell OMR, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: the broader context and a call for action. Lancet 2006; 368: 1535–41. Doi: 10.1016/S0140-6736(06)69384-7
4. Azemikhah A, Amirkhani MA, Jalilvand P, Emami Afshar N, Radpooyan L, Changizi N. Maternal mortality surveillance system in Iran. Iran J Public Health 2009; 38: 90–2.
5. D’Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, et al. Preconception and interconception health status of women who recently gave birth to a live-born infant—pregnancy risk assessment monitoring system (PRAMS),United States, 26 reporting areas, 2004. MMWR 2007; 56:1-35.
6. Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RM, Veldhuijzen IM, Bennebroek Gravenhorst J, Buitendijk SE. Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008; 115: 570–8. doi: 10.1111/j.1471-0528.2007.01580.x
7. Yassin SA, Gamal El-Deen AA, Emam MA, Omer AK. The profile of high-risk pregnancy in El-Mansoura city. J Egypt Public Health Assoc 2005; 80: 687–706.
8. Prual A, Toure A, Huguet D, Laurent Y. The quality of risk factor screening during antenatal consultations in Niger. Health Policy Plan 2000; 15: 11–6. doi: 10.1093/heapol/15.1.11
9. Rashidian A. [Iran’s Multiple Indicator Demographic and Health Survey(IrMIDHS)]. Tehran: Ministry of Health and Medical Education; 2010.
10. Cunningham FG, Leveno KJ, Bloom SL. Prenatal care. In: Cunnigham FG, Leveno KL, Bloom SL, Hauth J, Rouse D, Spong C, eds. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010.
11. Yu JW, Tian GL, Tang ML. Two new models for survey sampling with sensitive characteristic: design and analysis. Metrika 2008; 67: 251–63. doi: 10.1007/s00184-007-0131-x
12. Al-Farsi YM, Brooks DR, Werler MM, Cabral HJ, Al-Shafei MA, Wallenburg HC. Effect of high parity on occurrence of anemia in pregnancy: a cohort study. BMC Pregnancy Childbirth 2011; 11: 7. doi: 10.1186/1471-2393-11-7
13. Bencaiova G, Burkhardt T, Breymann C. Anemia—prevalence and risk factors in pregnancy. Eur J Intern Med 2012; 23: 529–33. doi: 10.1016/j.ejim.2012.04.008
14. Devries KM, Kishor S, Johnson H, Stöckl H, Bacchus LJ, Garcia-Moreno C, et al. Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reprod Health Matters 2010; 18: 158–70. doi: 10.1016/s0968-8080(10)36533-5
15. Salari Z, Nakhaee N. Identifying types of domestic violence and its associated risk factors in a pregnant population in Kerman hospitals, Iran. Asia-Pacific J Public Health 2008; 20: 49–55. Doi: 10.1177/1010539507308386
16. Mirahmadizadeh A, Nakhaee N. Prevalence of waterpipe smoking among rural pregnant women in Southern Iran. Med Princ Pract 2008; 17: 435–9. doi: 10.1159/000151563
17. Nakhaee N, Divsalar K, Meimandi MS, Dabiri S. Estimating the prevalence of opiates use by unlinked anonymous urine drug testing: A pilot study in Iran. Subs Use Misuse 2008; 43: 513–20. doi: 10.1080/10826080701772348
18. Motlaq ME, Eslami M, Yazdanpanah M, Nakhaee N. Contraceptiveuse and unmet need for family planning in Iran. Int J Gynaecol Obstet 2013; 121: 157–61. doi: 10.1016/j.ijgo.2012.11.024
19. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J Epidemiol 2004; 159: 475–80. doi: 10.1093/aje/kwh070
20. Henshaw SK, Singh S, Haas T. The Incidence of Abortion Worldwide. Int Fam Plann Persp 1999; 25: S30–8. doi: 10.2307/2991869
21. Torricelli M, Voltolini C, De Bonis M, Vellucci FL, Conti N, Severi FM, et al. The identification of high risk pregnancy: a new challenge in obstetrics. J Matern Fetal Neonatal Med 2012; 25: 2–5. doi: 10.3109/14767058.2012.664355
22. Ferrara A. Increasing prevalence of gestational dabetes mellitus: a public health perspective. Diabetes Care 2007; 30: S141–6. doi: 10.2337/dc07-s206
23. Hirayama F, Koyanagi A, Mori R, Zhang J, Souza JP, Gülmezoglu AM. Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study. BJOG 2012; 119: 340–7. doi: 10.1111/j.1471-0528.2011.03210.x
24. Kim LH, Caughey AB, Laguardia JC, Escobar GJ. Racial and ethnic differences in the prevalence of placenta previa. J Perinatol 2012; 32: 260–4. doi: 10.1038/jp.2011.86
25. Bruno B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993-2005 : WHO global database on anaemia. Geneva: WHO; 2008. doi: 10.1017/s1368980008002401
26. Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, et al. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran. Diabet Care 2008; 31: 96–8. doi: 10.2337/dc07-0959