Furthermore, the richest women on average spent the highest time of 3. This may also be due to the fact that the selected assets used to estimate wealth quintiles were not discriminatory enough to provide clear distinctions between quintiles. This implies that conclusions drawn on utilization of health services and health-care-seeking behaviour by socio-economic status of women from this study must be done with some caution.
Access has been previously reported by a population-based survey in Ghana, which identified financial and physical access as major problems why women do not seek antenatal care or deliver at health facilities. Financial barriers are known to limit utilization of health services. However in the case of reproductive health, most cost studies have focused on general reproductive health services 2 , 3 , 5 and maternal health services.
In the case of pregnancy-related cost studies, the antenatal services costs range from the risk status of pregnancy, 7 prenatal care, 8 , 9 quality and access to antenatal care 10 and to antenatal examinations and interventions. This study provides data on socio-economic differences in health service cost incurred by pregnant women. The main focus of this study was direct and indirect costs of pregnancy-related health services. The direct cost provides data on the out-of-pocket expenditure on medical and non-medical services according to socio-economic statuses, whilst the indirect costs cover waiting time prior to service provision and income lost for seeking health care.
Such cost data may bring out the cost burden confronting women of different socio-economic statuses when seeking health care.
This is a cross-sectional study which provides a snapshot of differences in cost by the identified socio-economic groups. Longitudinal studies would have provided a more consistent cumulative data.
A larger sample size in terms of coverage of all the sub-districts in the Ga East district would have improved the representativeness and made generalization of these findings in the district more meaningful. Lastly, self-reporting, especially the information on out-of-pocket expenditures and household ownership of assets, may not be accurate due to recall bias and exaggeration.
However, cross-sectional studies have vital roles to play in research. This study has provided data on the cost description and the characteristics associated with it i. The rigorous data collection approach used and the ethical issues considered validate the results obtained from this study. Also eligible women must be encouraged to enrol.
The Ghana Health Services through its Community-based Health Planning Service must carefully structure its home visits to cover education on pregnancy-related health services. Finally, we are grateful to our women respondents, care providers and health care managers of the Madina and Taifa facilities.
Costing of reproductive health services. Int Fam Plann Perspect ; 25 Suppl. Google Scholar. Setting prices for reproductive health services in a public hospital in Guatemala. Cost and efficiency of reproductive health service provision at the facility level in Paraguay. Costs of publicly provided maternity services in Rosario, Argentina.
Salud Publica de Mexico ; 45 : 27 — User fees and maternity services in Ethiopia. Int J Gynecol Obstet ; : — 5.
Stringer M. Personal costs associated with high-risk prenatal care attendance. J Health Care Poor Underserved ; 9 : — Cost analysis of prenatal care using the activity-based costing model: a pilot study. J Perinat Educ ; 8 : 20 — 7. Thomson Healthcare. The healthcare costs of having a baby. Antenatal care in Kosovo quality and access. Banta D. Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture.
Health Policy Plann ; 17 : — British National Health Service's and women's costs of antenatal ultrasound screening and follow-up tests. Ultrasound Obstet Gynecol ; 20 : — Thomas A Monea E. The public cost of pregnancy. Calculation of costs of pregnancy and puerperium related care: experience from a hospital in a low-income country. J Health Popul Nutr ; 28 3 : — Odame EA. MPH thesis. Cost of reproductive health services provided by four CHAG hospitals.
Determinants of antenatal care use in Ghana. J Afr Econ ; 13 : — Agboolah AR. Utilization of antenatal care services in Atwima Nwabiagya District. Arthur E. Wealth and antenatal care use: implications for maternal health care utilisation in Ghana. Health Econ Rev ; 2 : Ghana Demographic and Health Survey Ministry of Health.
Accra : Ministry of Health, Accra , Google Preview. Socioeconomic status is a concept which considers the level of education, income, and occupation of the individual. There is a considerable evidence that low socioeconomic status is linked to obstetrical complications such as preterm deliveries, high rate of caesarean sections and third trimester hemorrhages [ 14 ]. Prior studies suggest that low-income pregnant women were at high risk of poor quality of sleep when compared with high-income pregnant women [ 15 , 16 ].
The spectrum of sleep disorders in developed countries is associated with poor maternal-fetal outcome. It seems that health care providers may overlook sleep disorders as a common complaint during gestation and shortly after delivery.
Understanding sleep patterns during pregnancy may have significant impacts on gestational outcomes [ 17 ]. During pregnancy, poor quality of sleep PQOS and sleep disorders have been associated with hypertensive states like preeclampsia Preeclampsia can occur as early as 20 weeks of gestation, if one is at risk than symptoms usually occurs around 34th week [ 18 , 19 ].
Short sleep duration has also been linked to the development of gestational diabetes, high risk of preterm labor, and cesarean delivery [ 20 , 21 ]. Furthermore, Dolatian et al. Despite data suggesting sleep disturbances among pregnant patients, the influence of socioeconomic status during last months of pregnancy is not clearly understood [ 21 , 23 - 25 ]. This mini review focuses on presenting factors contributing to poor sleep quality among pregnant patients with lower income and socioeconomic statuses, especially during their third trimesters.
The search was limited to studies published up until June We manually searched the reference lists of identified studies. We included all original articles as well as systematic reviews. Our search, after excluding duplicates, non-English articles, non-related citations to key words, and unavailable full text was filtered to 38 articles.
These articles included randomized studies, cross sectional observational studies, quasi experimental studies and case control studies. The sleep time required for a pregnant woman is approximately 7.
The Pittsburg Classification Sleep Quality Index was the most commonly used instrument to measure sleep quality [ 27 ]. These questions focus on assessing the quality of sleep based on duration, disturbances, latency, daytime dysfunction, efficiency, and quality among other characteristics.
There are several factors that affect sleep quality during pregnancy; socioeconomic levels being the only indicator that also affects the quality of life of the pregnant woman. Additionally, when sleep is interrupted by physical-hormonal-psychological changes, one can see poor outcomes in both the woman and the newborn [ 16 ].
Moreover, a recent study reported that premature births and poor health are often observed in women who receive Medicaid [ 29 ]. To further complicate matters, pregnant women with low income have a higher probability of presenting long-term conditions during the gestation process [ 30 ]. Sleeping through the night during pregnancy is crucial for the health of both the mother and the fetus.
At the same time, it is challenging to get sufficient sleep because of interruption by socioeconomic, physical, and psychological factors. According to the Sedov et al. Night awakenings during the third trimester are more frequent due to an uncomfortable muscle-skeletal pain [ 32 ]. Mirroring these observations, Yikar and Nazik also found that the most common complaints during pregnancy are seen in second and third trimester. Furthermore, the symptoms reported during the second and third trimester were fatigue, exhaustion, restless legs, backache, nocturia, depression, and anxiety episodes [ 33 ].
Dolatian et al. Another study showed that pregnant women with Medicaid have a higher probability of C-section or preterm deliveries [ 35 ]. Moreover, Bruce also showed that pregnant women with low socioeconomic status or financial insecurity demonstrate a tendency to have a poor quality of life which affects the health of pregnant women [ 36 ].
Pregnant women with low socio-economic status tend to receive inadequate nutrients [ 37 ]. Another article found how women with lower incomes have poorer diets and consume higher levels of saturated fatty, carbohydrates, soft beverages, or food without adequate nutrients.
An investigation shows how high fatty food consumption, especially in women with overweight physiques, increases the possibility to develop obesity, gestational diabetes, abortion, preeclampsia. There is also a high possibility that the baby will develop diabetes mellitus type 2 in their adulthood [ 38 ]. The European Food Safety Authority recommends that pregnant women have an additional calorie intake in every trimester.
For example, the 1st trimester should be 70 kcal per day, 2nd trimester should be to kcal per day, and 3rd trimester should be kcal per day, to maintain a balance due to increase in demands during pregnancy [ 39 ]. According to the World Health Organization, in order to improve maternal and fetal wellbeing, a balanced intake during gestation must contain the following nutrients: green leafy vegetables, protein fish, salmon, meat , cereal, beans, and nuts [ 40 ].
The salmon contains an elevated quantity of Omega 3 fatty acid, which plays an important role in the brain and retina formation of the fetus and also reduces the possibility of preterm delivery [ 41 ].
Iodine is a micronutrient required for metabolic and hormonal functions during pregnancy. Decreased intake may cause abortion, brain damage in the fetus, or mortality in the perinatal period [ 42 ]. Calcium is involved in fetus development, important for normal birth weight, decreases the risk of premature delivery, and controls blood pressure during pregnancy [ 43 ]. Folic acid consumption is necessary for preventing neuro-tube congenital defects or heart disease, and also helps with adequate placenta formation [ 44 ].
RDA Italy recommends regular intake of these micronutrients for positive benefits during the gestational process: Omega 3 mg , Iodine mg , Calcium mg , Folic acid mg , Vitamin D 15 mg. All these nutrients optimize the requirements during pregnancy [ 39 ].
In this review, we focused on how low socioeconomic status affects the quality of sleep in pregnant women during and after the third trimester of pregnancy. As in our discussion, we suggested that factors involved in the poor quality of sleep during pregnancy are related, and how low socioeconomic levels are associated with poor quality of life.
The controlled trials of high quality though are lacking in these areas. A pregnant woman with a low income who tends to have an inadequate diet may have future health complications for both herself and her fetus.
During pregnancy, the body undergoes physical, hormonal, and physiological changes that are magnified by external factors including low income, poor quality of life, and poor diet. These factors tend to increase the possibility of future health outcomes in both, mother and fetus and can result in preterm labor, low birth weight, preeclampsia, perinatal death, and spontaneous abortion. Further research is needed to evaluate the differences between high- and low-income groups in comparison to their non-pregnant peers.
Clinicians should take advantage of assessing instruments of quality of sleep to identify pregnant women at risk of poor perinatal outcomes. Nutritionists should asses and identify pregnant women with high risk for future poor outcomes. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.
All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.
Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. National Center for Biotechnology Information , U. Journal List Cureus v. Published online Nov Author information Article notes Copyright and License information Disclaimer. Corresponding author. Salim R. Surani moc. Received Nov 4; Accepted Nov This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This article has been cited by other articles in PMC. Furthermore, recent studies have reported extensive food insecurity in Iran. Objectives: The present study aimed at defining the levels of food security and investigating its correlation with socioeconomic factors among pregnant women in city of Rasht Iran in Methods: The present cross sectional study included pregnant women in their 14 to 42 weeks of pregnancy.
The sampling method was convenience, and the data were collected using demographic-obstetrics, socioeconomic factors, and food security status questionnaires through face-to-face interviews.
The data were analyzed using SPSS Results: The results revealed that Conclusions: Considering the high prevalence of food insecurity among pregnant women and its adverse impact on the mother and the fetus, it seems necessary to investigate the level of food security in women during prenatal care and to support pregnant women with food insecurity in particular.
Provision of food, as a basic need of the society, falls within food security domain 1 , and it is among the phenomena that have influenced the worldwide policy- making in the recent years 2. According to food and agriculture organization of the United Nations FAO in , food security is defined as having physical and economical access to enough healthy and nutritious food to meet the needs and food preferences at all times in order to have an active healthy life 3.
Food security has 2 main prerequisites in every society: assurance of availability and accessibility of food, and assurance of ability of the family to obtain food 4. According to the minimum required food, families with food security have access to enough food for the family members based on their age, gender, body size, physical activity, as well for pregnant and lactating women 6.
On the contrary, food insecurity is measured through inadequacy of food and is defined as inadequate intake of food for constant supply of basic energy needs 7. Food insecurity and hunger do not only affect physical health but also might have adverse social and psychological effects. Thus, provision of food security for the society is a major objective of socioeconomic development programs, and food insecurity is rooted in all political, economic, social, and geographical domains 8.
Generally, macroeconomic and social policies influence price changes, income, occupation, and services. Each of these factors can affect family sources for providing food security 9 , Evaluation of food security, especially among women, is of prominent importance because food insecurity in families is associated with deficiencies of micronutrients, fruits, and vegetables among women of childbearing age Nutrition during pregnancy is a major public health concern Therefore, a guarantee to provide nutrients for pregnant women has become a fundamental focus in providing antenatal care Pregnant women are considered as vulnerable groups in the society, thus, their food insecurity might cause side effects during pregnancy.
Numerous studies have confirmed the importance of nutrition during prenatal and neonatal periods, however, very few studies have specifically studied the role of food security during these stages of life To maintain and promote the nutritional health of pregnant women, the following important ways can be used: 1 providing proper educational nutritional programs; 2 developing nutritional standards in health and disease period appropriate to the socioeconomic and cultural characteristics; and 3 performing appropriate interventions to solve problems and nutritional deficiencies of the people to reduce the burden of disease.
Given the lack of studies focusing on food security among pregnant women in Iran, and considering the importance of this issue, the present study aimed at investigating food security and its association with socioeconomic factors among pregnant women in Rasht in The present cross sectional research included pregnant women in their 14 to 42 gestational weeks.
Using convenience sampling, the participants were selected from those women referring to Alzahra hospital in Rasht in Using convenience sampling method, the participants were selected from those women attending to Alzahra hospital in Rasht in Consent was obtained from all the participants, and the aims of the study were explained to them. Furthermore, the participants were assured of the anonymity of the information.
Then, the researcher completed a questionnaire. The data were collected through face-to-face interviews using the following 3 types of questionnaires: demographic-obstetrics, socioeconomic status, and food security status.
This questionnaire had 19 questions about occupational status, level of education of the couple, residence, status of home ownership, the amount of rent or mortgage, house area, family economic status evaluating eight items , family size, number of family members, ethnicity, insurance, receiving food aid, whether being supported by social organizations, monthly income, and total family expenditure.
The economic status was assessed as poor, average, and good by having less than 3 items, 4 to 6 items, and more than 7 items, respectively. The food security status was assessed using an item food security survey developed by the U.
The scoring was based on Bickel et al. The families were categorized as having food security, food insecurity without hunger, food insecurity with moderate hunger, and food insecurity with severe hunger according to their scores.
The reliability of this questionnaire has been confirmed by previous studies in Iran The quantitative data were measured using mean and standard deviation, while qualitative data were assessed using frequency and percentage. The participants aged 16 to 48 years The highest frequency of education level of the participants and their husbands was high school Regarding income level, most of the participants Most of the participants The data on socioeconomic factors showed that most of the participants were homemakers Of the pregnant women, Food insecurity was higher among families without a child younger than 18 years compared to those families with a child older than 18 years The present study reported the prevalence of food insecurity among pregnant women to be This difference might be explained by having children younger than 18 years and the climatic conditions of Rasht.
The prevalence of food security in Shiraz was reported to be Payab et al. Another study found food security among people with gastrointestinal cancer to be A study conducted in Shiraz examined the relationship between food insecurity and metabolic syndrome in women.
The results revealed Hakim et al. Moreover, Dastgiri et al.
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