This annual report - Taranaki District Health Board

Antenatal psychosocial assessments, while improving awareness of psychosocialproblems, have not been linked to improved outcomes. Overall, psychosocial interventions aimed at reducing the risk of developing postnataldepression do not reduce the risk of postnatal depression. However, postnatalinterventions for at risk women may be more effective.ConclusionsBeing exposed to a range of social adversities during pregnancy is associated with avariety of adverse pregnancy outcomes which can affect the health and longer termdevelopment of the child. New Zealand has clear social gradients in a number of adversepregnancy outcomes including fetal and infant deaths and babies being born small forgestational age. Ethnic disparities persist, and young women are also at increased risk ofsome adverse outcomes when compared to older women. However, New Zealand has alimited evidence base concerning effective interventions, and the barriers to antenatal carethat need to be overcome, in order to address these disparities. The information that isavailable suggests that some women do not access antenatal care, or that they accesscare late, that some women struggle to find a midwife, and that issues remain with thetransition from LMC care to early childhood services.High quality maternity care, with early booking and good continuity of care through thepregnancy to early childhood however, is widely recognised as being important inimproving outcomes for women and their babies [139]. Internationally, a large number ofreviews and guidelines have examined the effectiveness of interventions aimed at meetingthe needs of pregnant women experiencing adversity. Although services offered inpregnancy are unlikely to be powerful enough to overcome the cumulative effects of alifetime lived with multiple social adversities, a number of interventions show promise inimproving outcomes for vulnerable pregnant women and their babies [247]. The reviewabove suggests that these may include: Group antenatal care for socioeconomically disadvantaged women and young women,in which groups of eight to 12 women meet regularly with a stable group leader, usuallya midwife, for antenatal care, education and relationship building. For young women: multi-agency approaches targeted at young parents; nutritionalprogrammes as an adjuncts to routine care; educational and career developmentinterventions; parenting programmes; and the provision of accessible child care. For women who use alcohol and/or other drugs during pregnancy coordination and colocationof antenatal care, drug treatment services and social services; briefinterventions in pregnant women who are not dependent on alcohol or consume alcoholat low to moderate levels; and smoking cessation interventions. For women exposed to family violence: integration of substance misuse treatment;advocacy interventions; and staff training.However, a number of interventions were not supported by the current literature, including: The provision of additional social supports with the aim of improving pregnancyoutcomes Home visits for pregnant or postpartum women with alcohol and/or other drug problems Nicotine replacement therapy in pregnancy Antenatal psychosocial interventions aimed at reducing the risk of postnatal depression.In-Depth Topic: Adversity in Pregnancy - 305