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For pregnant women, having a low family income status is associated with late prenatal attendance and an increased risk of adverse outcomes during pregnancy, delivery, and immediately after delivery. However, the influence of the socioeconomic level on maternal and child health may be minimal as long as the health system model is able to neutralise health inequity. For this reason, the objective of this study is to determine the relationship between the socioeconomic level assessed through monthly household income and obstetric and perinatal outcomes in the Spanish Health System, where midwives play a relevant role. To meet this objective, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The final study population was 5942 women. No statistically significant differences with linear trend were found between income level and obstetric and perinatal outcomes after the adjustment by confounding factors (pregnancy composite morbidity, p = 0.447, delivery composite morbidity, p = 0.590, perinatal composite morbidity, p = 0.082, postpartum composite morbidity, p = 0.407). The main conclusion is that, in the current Spanish health system, household income as an indicator of socioeconomic status is not related to perinatal outcomes after the adjustment by confounding factors. These results are likely due to the public model of our health system that serves all citizens on equal footing, although other social and individual factors may have influenced these results

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects ofUCMin newborns

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11–0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41–23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.

Background: Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks’ gestation. Methods: Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. Results: The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks’ gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [−0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [−0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [−0.26 to −0.06]). Conclusions: UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping.

Background The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care. Objective To develop and validate a predictive model of exclusive breastfeeding at hospital discharge. Design Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain. Data sources The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). Results 80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74–0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71–0.77). Conclusions A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge.

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06&ndash, 3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01&ndash, 15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16&ndash, 2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68&ndash, 5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13&ndash, 6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17&ndash, 11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.

Durante más de dos décadas las mujeres occidentales han clasificado la fatiga posparto entre sus cinco principales preocupaciones después del parto. La fatiga posparto no es un simple problema de salud común, en muchas ocasiones tiene un patrón progresivo, y en lugar de resolverse espontáneamente continua más allá de 6 semanas posparto. Aunque son ampliamente conocidas las ventajas de la lactancia materna, existen diferentes factores que influyen en su fracaso; siendo la fatiga posparto uno de ellos relacionado con problemas obstétricos y/o de crianza. A nivel internacional existe una amplia literatura respecto a la fatiga posparto que informan sobre la prevalencia del trastorno, factores de riesgo, consecuencias e intervenciones efectivas para tratarlo; sin embargo, son pocas las que se han abocado a la búsqueda de su relación con la lactancia materna. En España, algunas investigaciones han abordado el tema de la fatiga, pero no existen estudios publicados cuyo objetivo central sea su relación con la lactancia. El objetivo de esta investigación es determinar el efecto de la fatiga sobre el estado y las tasas de lactancia materna al alta y al mes posparto, en las mujeres que den a luz en el Hospital General de Albacete, durante los meses mayo-agosto 2013. Se realizará un estudio de cohortes analítico prospectivo. La recogida de datos se realizará en dos tiempos: T1 antes del alta (mediante un cuestionario autocumplimentado) y T2 al mes posparto (mediante un cuestionario administrado telefónicamente). Se medirá la Fatiga Posparto mediante la Fatigue Assessment Scale, adaptada y validada a nuestro medio, y el Estado de Lactancia Materna (Inicio, Duración y Exclusividad de la Lactancia Materna) mediante un formulario adaptado a la clasificación OMS 2004. Además se confeccionará un registro ex profeso para este estudio donde se recogerán las variables sociodemográficas, clínicas y del recién nacido que describan las características de la muestra. Abstract For more than two decades, western women have mentioned postpartum fatigue among their main worries during the postnatal period. Postpartum fatigue is not a simple health problem, most of the time, it is a progressive pattern which instead of settling, goes on for more than six weeks postpartum. Although breastfeeding advantages are widely known, there are different factors related to its failure, one of them is postpartum fatigue related to obstetric or nursing period problems. Internationally we can find a large number of studies about postpartum fatigue, its prevalence, risk factors or consequences, however only a few of them focus on the connection between fatigue and breastfeeding. In Spain we can find some researches about postpartum fatigue but none of them studied breastfeeding along with fatigue. The aim of this study is to determine the effect of postpartum fatigue above breastfeeding rates when women leave the hospital and one month postpartum, among women delivering at the General Hospital of Albacete from May to August 2013. This is a prospective analytical cohort study. Data collection will be made in two periods of time: T1: Before women leave hospital (they will fill in the questionnaire themselves). T2: One month postmantal ( the questionnaire will be completed in by phone). In order to measure fatigue, we will use the Fatigue Asassement Scale, and for breastfeeding status, we will use a questionnaire using WHO’s definitions. We have also created a record to collect social and clinical variables as well as neonate ones. Palabra Clave: Fatiga; Lactancia Materna; Periodo de Postparto; Recién Nacido, Estudio de Cohortes. Key Words: Fatigue; Breast Feeding; Postpartum Period; Newborn; Cohort Studies.