Karen Glover

Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a cross-sectional, population-based study

Objectives Indigenous women continue to experience rates of stillbirth, preterm birth and low birth weight, two to three times higher than other women in high-income countries. The reasons for disparities are complex and multifactorial. We aimed to assess the extent to which adverse birth outcomes are associated with maternal cannabis use and exposure to stressful events and social health issues during pregnancy. Design/setting Cross-sectional, population-based survey of women giving birth to Aboriginal babies in South Australia, July 2011–June 2013. Data include: maternal cannabis use, exposure to stressful events/social health issues, infant birth weight and gestation. Participants 344 eligible women with a mean age of 25 years (range 15–43 years), enrolled in the study. Participants were representative in relation to maternal age, infant birth weight and gestation. Results 1 in 5 women (20.5%) used cannabis during pregnancy, and 52% smoked cigarettes. Compared with mothers not using cannabis or cigarettes, mothers using cannabis had babies on average 565 g lighter (95% CI −762 to −367), and were more likely to have infants with a low birth weight (OR=6.5, 95% CI 3.0 to 14.3), and small for gestational age (OR=3.8, 95% CI 1.9 to 7.6). Controlling for education and other social characteristics, including stressful events/social health issues did not alter the conclusion that mothers using cannabis experience a higher risk of negative birth outcomes (adjusted OR for odds of low birth weight 3.9, 95% CI 1.4 to 11.2). Conclusions The findings provide a compelling case for stronger efforts to address the clustering of risk for adverse outcomes in Aboriginal and Torres Strait Islander communities, and point to the need for antenatal care to address broader social determinants of adverse perinatal outcomes. Integrated responses—collaboratively developed with Aboriginal communities and organisations—that focus on constellations of risk factors, and a holistic approach to addressing social determinants of adverse birth outcomes, are required.

Improving Access to Antenatal Care for Aboriginal Women in South Australia: Evidence from a Population-Based Study.

INTRODUCTION Aboriginal and Torres Strait Islander women are two to three times more likely to experience adverse maternal and perinatal outcomes than non-Aboriginal women in Australia. Persisting health inequalities are at least in part explained by late and/or inadequate access to antenatal care. METHODS This study draws on data collected in a population-based study of 344 women giving birth to an Aboriginal infant between July 2011 and June 2013 in South Australia to investigate factors associated with engagement in antenatal care. RESULTS About 79.8 percent of mothers accessed antenatal care in the first trimester of pregnancy, and 90 percent attended five or more antenatal visits. Compared with women attending mainstream regional services, women attending regional Aboriginal Family Birthing Program services were more likely to access antenatal care in the first trimester (Adj OR 2.5 [1.0-6.3]) and markedly more likely to attend a minimum of five visits (Adj OR 4.3 [1.2-15.1]). Women attending metropolitan Aboriginal Family Birthing Program services were also more likely to attend a minimum of five visits (Adj OR 12.2 [1.8-80.8]) compared with women attending mainstream regional services. Women who smoked during pregnancy were less likely to attend a visit in the first trimester and had fewer visits. CONCLUSIONS Scaling up of Aboriginal Family Birthing Program Services in urban and regional areas of South Australia has increased access to antenatal care for Aboriginal families. The involvement of Aboriginal Maternal Infant Care workers, provision of transport for women to get to services, and outreach have been critical to the success of this program.

‘Partnerships are crucial’: an evaluation of the Aboriginal Family Birthing Program in South Australia

Objectives: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA).

Primary health care for Aboriginal women and children in the year after birth: findings from a population-based study in South Australia

Objective: To investigate the extent to which Aboriginal women access primary care for themselves and their infant in the year after childbirth.