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Prenatal care in the Commonwealth of the Northern Mariana Islands

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Abstract

Adequacy of prenatal care is assessed in this retrospective analysis of the births occurring in the Commonwealth of the Northern Mariana Islands (CNMI) from 1986 - 1996. Overall, adequacy of prenatal care has not changed significantly, despite a large increase in population and births. Adequacy was measured by assessing trimester of prenatal care onset as well as total number of visits. 'Adequate' prenatal care, defined as onset of care in 1st or 2nd trimester and at least 7 prenatal clinic visits, was received by less than half of the mothers delivering in the CNMI. Early (1 trimester) prenatal care was received by less than 2 of all mothers. Most indicators of 'adequate' prenatal care are significantly worse in the CNMI than in the U.S. or Guam.
... USAPI [54][55][56][57][58] (CNMI [57,58], Palau [56], and RMI [54,55]), 7 (21.2%) studies were from New Zealand [59][60][61][62][63][64][65], 2 (6.1%) studies were from Australia [66,67], 4 (12.1%) ...
... USAPI [54][55][56][57][58] (CNMI [57,58], Palau [56], and RMI [54,55]), 7 (21.2%) studies were from New Zealand [59][60][61][62][63][64][65], 2 (6.1%) studies were from Australia [66,67], 4 (12.1%) ...
... Seven (17.1%) studies used last menstrual period (LMP) only [45,47,48,56,60,78,79] and seven (17.1%) used clinical/ obstetric estimates [43,46,50,57,59,74,81]. In two (4.9%) studies [58,64], GA was determined by the obstetric care provider at birth; two (4.9%) studies used ultrasound [68,76] and one used Dubowitz assessment [69] (2.4%). The remaining three studies [42,71,75] (7.3%) used a combination of ultrasound, LMP, and/or clinical estimate. ...
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The epidemiology of preterm birth among Pacific Islanders is minimally understood. The purpose of this study was to estimate pooled prevalence of preterm birth among Pacific Islanders and to estimate their risk of preterm birth compared to White/European women. We searched MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Library, CINAHL, Global Health, and two regional journals in March 2023. Observational studies were included if they reported preterm birth-related outcomes among Pacific Islanders. Random-effects models were used to estimate the pooled prevalence of preterm birth with 95% confidence interval (CI). Bayes meta-analysis was conducted to estimate pooled odds ratios (OR) with 95% highest posterior density intervals (HPDI). The Joanna Briggs Institute checklists were used for risk of bias assessment. We estimated preterm birth prevalence among Pacific Islanders in the United States (US, 11.8%, sample size [SS] = 209,930, 95% CI 10.8%-12.8%), the US-Affiliated Pacific Islands (USAPI, SS = 29,036, 6.7%, 95% CI 4.9%-9.0%), New Zealand (SS = 252,162, 7.7%, 95% CI 7.1%-8.3%), Australia (SS = 20,225, 6.1%, 95% CI 4.2%-8.7%), and Papua New Guinea (SS = 2,647, 7.0%, 95% CI 5.6%-8.8%). Pacific Islanders resident in the US were more likely to experience preterm birth compared to White women (OR = 1.45, 95% HPDI 1.32–1.58), but in New Zealand their risk was similar (OR = 1.00, 95% HPDI 0.83–1.16) to European women. Existing literature indicates that Pacific Islanders in the US had a higher prevalence of preterm birth and experienced health inequities. Learning from New Zealand’s culturally-sensitive approach to health care provision may provide a starting point for addressing disparities. The limited number of studies identified may contribute to higher risk of bias and the heterogeneity in our estimates; more data is needed to understand the true burden of preterm birth in the Pacific region.
... Of the 32 articles reviewed, 3 focus on the RMI, 36-38 3 on the FSM or migrants from the FSM, 39-41 3 on the CNMI, [42][43][44] and only 1 on the ROP. 45 Kiribati is the focus of 5 articles, 46-50 but all of these are written by the same researcher based on data from her dissertation and subsequent research. ...
... 36,[54][55][56]58,61,66,67 Additionally, chart reviews were conducted for 3 articles. 39,43,44 Eleven articles presented primary quantitative data collected through surveys and structured interviews. 38,40,42,45,51,57,59,62,63,65 Six articles consisted of in-depth, semi-structured interviews, 36 ...
... Pacific Health Dialog appears to be the main venue for research related to Micronesian SRH, publishing 9 of the reviewed articles. 36,39,[42][43][44]60,[65][66][67] The Journal of the Polynesian Society published 2 articles that fit the criteria, 46,50 and the other 21 articles come from 21 different journals. There were no articles from the Asia Pacific Journal of Public Health. ...
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Introduction: Recent evidence of negative sexual and reproductive health (SRH) outcomes for Micronesian migrants warrants a review of what is currently known about Micronesian SRH beliefs, customs, behaviors, outcomes, and access to SRH services. Methods: A systematic literature review employing the matrix method was conducted using the same key terms for 8 databases. Peer-reviewed articles published between 1990 and 2010 were abstracted for several key components, including topics, methodology, and other important elements necessary to assess major findings, strengths, and weaknesses. Results: Thirty-two articles matched the inclusion criteria for review. Of these articles, the major research of interest was behavior relating to sexual risk behavior, pregnancy, health care seeking, and HIV/AIDS for various populations throughout Micronesia. Study populations ranged from pregnant women seeking prenatal care to students in high school. Conclusion: No cohesive body of SRH literature exists for one topic or one community within Micronesia to date.
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