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" Those who cannot remember the past are condemned to repeat it. " This maxim underscores the importance of historical awareness in medicine, particularly for obstetricians and gynecologists (ObGyns). ObGyns significantly impact societal health through their care for pregnant women, fetuses, and newborns, uniquely positioning them to advocate for health initiatives with lasting societal benefits. Despite its importance, the history of medicine is underrepresented in medical curricula, missing opportunities to foster critical thinking and ethical decision-making. In today's climate of threatened reproductive rights, vaccine misinformation, and harmful ideologies, it is imperative for ObGyns to champion comprehensive historical education. The history of medicine, particularly in relation to societal issues - such as racism, discrimination, genocides, pandemics, and wars - provides valuable context for addressing challenges like maternal mortality, reproductive rights, vaccine hesitancy, and ethical issues. Understanding historical milestones and notable ethical breaches, such as the Tuskegee Study and the thalidomide tragedy, informs better practices and safeguards patient rights. Technological advancements in hygiene, antibiotics, vaccines, and prenatal care have revolutionized the field, yet contemporary ObGyns must remain vigilant about lessons learned from past challenges and successes. Integrating historical knowledge into medical training enhances clinical proficiency and ethical responsibility, fostering innovation and improving health outcomes. By reflecting on historical achievements and their impacts, current and future ObGyns can advance the field, ensuring comprehensive and ethically sound approaches to patient care. This paper highlights the crucial role of historical knowledge in shaping modern ObGyn practices, advocating for its integration into medical education to address contemporary health challenges and ethical considerations., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: Men's participation is imperative for improving antenatal care (ANC) access and mother and child health outcomes in sub-Saharan Africa (SSA). Research looking at improving men's participation in ANC often focuses on their instrumental and psychosocial roles and on biomedical ANC systems. There is limited understanding of how context-specific cultural experiences of fatherhood influence men's participation in ANC within broader communal support networks and across different ANC systems in SSA. Against this background, and to understand how local communities in SSA conceive men's participation in ANC, a scoping review will be undertaken to synthesise existing literature around local cultural experiences of fatherhood and men's participation in ANC in rural settings in SSA., Methods and Analysis: The classical scoping review methodology developed by Arksey and O'Malley will be used to conduct the scoping review described above. Empirical studies published between 1 January 2000 and 31 August 2024 will be systematically searched for in key online databases (eg, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, African Index Medicus, African Journals Online) and grey literature (eg, reports from key organisations like UNICEF and the WHO). Literature reviews, personal opinion articles and theoretical or conceptual articles that do not systematically analyse data, and non-English texts, will be excluded. Data will be extracted from the included texts in the form of study characteristics, which will be analysed using descriptive statistics, and key issues to be analysed thematically., Ethics and Dissemination: No ethical approvals are needed for this scoping review since data will be abstracted from already-published literature and no additional data will be collected. The findings will be shared with policymakers, practitioners, researchers, students and local communities through peer-reviewed journal publication(s), conference presentations, public lectures and policy-focused stakeholder and community meetings in and outside SSA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Emergency nursing in Gaza's war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to lack of access to menstrual products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions has led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women's health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women's health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients., (Copyright © 2024 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: Pregnant patients were a significant population to consider during the pandemic, given the impact of SARS-CoV-2 infection on obstetric outcomes. While COVID testing was a central pillar of infection control, it became apparent that a subset of the population declined to test. At the same time, data emerged about pregnant persons also declining testing. Yet, it was unknown why pregnant patients declined tests and if those reasons were similar or different from those of the general population. We conducted this study to explore pregnant patients' attitudes, access, and utilization of COVID-19 testing to support healthcare for infection prevention management for this unique and medically complex population., Methods: We conducted a qualitative study of patients who were currently or recently pregnant during the early stages of the pandemic and received outpatient prenatal care at one of the participating study sites. An interview guide was used to conduct in-depth telephone interviews. Coding was performed using NVivo, and analysis was conducted using Grounded Theory., Results: The average age of the participants (N = 37) was 32 (SD 4.21) years. Most were < 35 years of age (57%) and self-described as White (68%). Qualitative analysis identified themes related to barriers to COVID-19 testing access and use during pregnancy, including concerns about test accuracy, exposure to COVID-19 in testing facilities, isolation and separation during labor and delivery, and diminished healthcare quality and patient experience., Conclusions: The implementation of widespread and universal COVID testing policies did not address the unique needs and challenges of pregnant patients as a medically complex population. It is important to understand the reasons and implications for pregnant patients who declined COVID testing during the current pandemic to inform strategies to prevent infection spread in future public health emergencies., (© 2024. The Author(s).)

The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional community health workers (CHWs) and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-5 mortality halved, over 3 years compared with baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-5 mortality, compared with the control arm. We aimed to explain these results by examining implementation, mechanisms and context in both arms We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: As the Sustainable Development Goal 3.2.1 deadline (2030) approaches, rapidly reducing under-5 mortality (U5M) gains more prominence. However, initiatives or interventions that aided Bangladesh in achieving Millennium Development Goal 4 showed varied effectiveness in reducing certain cause-specific U5M. Therefore, this study aimed to examine the predictors of the key cause-specific mortalities., Methods: This cross-sectional study was conducted using the Bangladesh Demographic and Health Survey 2011 and 2017-18 data. Cause-specific U5M was examined using multilevel multinomial mixed-effects analyses, and overall/all-cause U5M was examined using multilevel mixed-effects analyses. The respective estimates were compared., Results: The cause-specific analysis revealed that pneumonia and prematurity-related U5M were significantly associated with antenatal care and postnatal care, respectively. However, analysis of overall/all-cause U5M did not reveal any significant association with health services. Twins or multiples had a greater risk of mortality from preterm-related conditions (adjusted Relative Risk Ratio (aRRR): 38.01, 95% CI: 19.08-75.7, p < .001), birth asphyxia (aRRR: 6.52, 95% CI: 2.51-16.91, p < .001), and possible serious infections (aRRR: 11.12, 95% CI: 4.52-27.36, p < .001) than singletons. Children born to mothers 18 years or younger also exhibited a greater risk of mortality from these three causes than children born to older mothers. This study also revealed an increase in the predicted risk of prematurity-related mortality in the 2017-18 survey among children born to mothers 18 years or younger, children born to mothers without any formal education, twins or multiples and children who did not receive postnatal care., Conclusions: This research provides valuable insights into accelerating U5M reduction; a higher risk of preterm-related death among twins underscores the importance of careful monitoring of mothers pregnant with twins or multiples through the continuum of care; elevated risk of death among children who did not receive postnatal care, or whose mothers did not receive antenatal care stresses the need to strengthen the coverage and quality of maternal and neonatal health care; furthermore, higher risks of preterm-related deaths among the children of mothers with low formal education or children born to mothers 18 years or younger highlight the importance of more comprehensive initiatives to promote maternal education and prevent adolescent pregnancy., (© 2024. The Author(s).)

Background: Malaria in pregnancy (MiP) is a preventable condition leading to maternal and neonatal morbidity and mortality. Invariably, with all the knowledge about the serious consequences of MiP for the woman, the unborn child, and the neonate, the uptake of Intermittent Preventive Treatment of Malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is low in most malaria-endemic countries, including Ghana. This study sought to examine the uptake and service user predictors of the implementation of IPTp-SP after the policy upgrade in 2014., Methods: This cross-sectional survey was carried out in two selected districts in the Volta Region. The study participants were randomly selected from communities within Nkwanta North and North Tongu District. A total of 438 mothers who have delivered in the past 24 months were selected for the study. The women were interviewed on their background, knowledge, and attitude toward the use of IPTp-SP using a structured questionnaire. Multiple logistic regression was done to determine the factors that influence the demand for IPTp-SP. The results were presented in the form of tables., Results: The mean number of antenatal care (ANC) attendance was 5 (SD:2.6) visits per client, with 262 (59.82%) of them getting the 3+ doses of IPTp-SP. Also, a significant 44 (10.1%) of the mothers did not receive any dose of IPTp-SP. Respondents who attended antenatal clinics 4-7 times had 7 (CI:3.9-12.3) times higher uptake of 3+ doses of IPTp-SP as compared to others who attended less than 4 visits. Similarly, women who had 8 or more visits had a 16.1 (CI: 5.9-43.6) times higher chance of getting more than 2 doses of IPTp-SP compared with others who had fewer than 4 attendances., Conclusion: The uptake of 3+ doses of IPTp-SP is still lower than the global target of 80%. Thus, the need for innovative interventions aimed at improving antenatal attendance and early booking for IPTp-SP are recommended., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Asem et al. 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.)

Food insecurity (FI) is a critical issue in developing countries, particularly in low-resource settings, where it can worsen women's mental health. Psychosocial factors such as low household income, limited education, multiparity, and vulnerability are linked to depressive symptoms during pregnancy. Additionally, the family environment influences parental practices, which may impact mental health. This study evaluates the association of socioeconomic factors, parental practices, FI risk, and home visit frequency with depressive symptoms in pregnant women enrolled in the Happy Child Program (Programa Criança Feliz-PCF) in the Federal District, Brazil. In this cross-sectional study, 132 pregnant women monitored by PCF from May to July 2023 were assessed using a self-administered questionnaire for socioeconomic data, the two-item Triage for Food Insecurity (TRIA) instrument for FI risk, the Scale of Parental Beliefs and Early Childhood Care Practices, and the Beck Depression Inventory-II for depressive symptoms. Most participants were multiparous (87.9%), had low income (under 200 USD/month; 80.8%), presented depressive symptoms (67.4%) and were at risk of FI (81.8%). About half demonstrated adequate parental practices (50.8%) and received four home visits per month during pregnancy (54.5%). Women who received four PCF home visits had a lower prevalence of depressive symptoms compared to those with fewer visits (PR 0.76, 95% CI 0.59-0.98). No significant association was found between FI or parental practices and depressive symptoms. These findings suggest that the PCF home-visiting program may strengthen vulnerable families, support social networks, and improve mental health during pregnancy. Additionally, the results of this study highlight the need for targeted interventions aimed at reducing food insecurity and promoting mental health during pregnancy, particularly among socially vulnerable populations. Furthermore, they reinforce the importance of expanding access to home-visiting programs as an effective strategy to improve maternal mental health and well-being, while fostering healthier prenatal environments for both mothers and their children.

Background: Literature shows that pregnant women are more susceptible to dental caries due to several reasons, including changes in salivary flow, reduced pH in the oral cavity, and sugary dietary cravings. The unmet need for care is of special concern, as the failure to obtain treatment can affect the health status of the mother and her unborn child., Objectives: To determine dental caries status and treatment needs among pregnant women attending antenatal clinics in the Dar-es-Salaam region., Materials and Methods: A descriptive cross-sectional hospital-based study was conducted among 461 pregnant women aged 14-47 years. Informed consent was obtained from participants during data collection. Dental caries status and treatment need were diagnosed according to the WHO criteria. The Data collected was cleaned and analyzed using SPSS version 23.0 software for generating frequency distribution tables, chi-square tests, and logistic regression analysis. The Confidence Interval was 95% (p < 0.05)., Results: The overall prevalence of dental caries was 69%, with a mean DMFT score of 2.86 (± 3.39). Untreated dental decay was observed in 60.5% of study participants, which needed more restorative treatment (fillings & RCT) than a tooth extraction. Caries experiences differed significantly among the pregnant women in various gravidity. In logistic regression, dental caries experience was significantly higher among multigravida respondents (p-values = 0.04) (OR: 1.840, CI 1.021-3.319)., Conclusion: This study demonstrated a high level of dental caries experience and the presence of treatment needs. Multiple pregnancies were a major factor that contributed to high levels of dental caries., (© 2024. The Author(s).)

Routine antenatal care includes history, examination, and several standard laboratory tests. Other than the original objectives, the generated data is seldom utilised for screening for adverse obstetric and perinatal outcomes. Although new approaches and sophisticated tests improve prediction of complications such as pre-eclampsia, these may not be available globally. Maternal age, race/ethnicity, anthropometry, and method of conception can influence the occurrence of pregnancy complications. The importance of medical and obstetric history is well documented but often ignored. Routine test results including blood picture, hepatitis B and rubella serology, and sexually transmitted diseases, have additional health implications. The awareness of, and the ability to utilise, available antenatal data and tests in obstetric management will enhance individualised obstetric risk assessment thus facilitating the targeting of high-risk gravidae for further management, including the use of specific and technology-driven tests where available, and close monitoring and treatment, in a cost-effective manner., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes., Methods and Findings: The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] -3.55; (95% confidence intervals [95% CIs]): -4.88, -2.22, p < 0.001), at risk of depression (aCoef. -3.02; 95% CIs: -5.61, -0.43, p = 0.023), those with warning signs (aCoef. -2.84; 95% CIs: -4.65, -1.03, p = 0.003), common pregnancy discomforts (aCoef. -1.91; 95% CIs: -3.81, -0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. -7.58; 95% CIs: -10.21, -4.95, p < 0.001 and 15 to 19 minutes: aCoef. -2.73; 95% CIs: -4.79, -0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. -5.15; 95% CIs: -7.64, -2.66, p < 0.001 and aCoef. -5.33; 95% CIs: -7.85, -2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses., Conclusions: We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care., Competing Interests: MEK is a member of the Editorial Board of PLOS Medicine. SVD, CQF, MPC, DPM, VMG, LRGC, MCCM, VMG, MARG, GEA, CEPR, CAPA, and ASD are employed by the IMSS, yet IMSS played no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. RPC and CA have declared that no competing interests exist., (Copyright: © 2024 Doubova et al. 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.)

Background: Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period., Methods: 8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively., Results: Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period., Conclusion: This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes., (© 2024. The Author(s).)

Background: The importance of prenatal care is undeniable, as pregnant persons who receive on-time, adequate prenatal care have better maternal and infant health outcomes compared with those receiving late, less than adequate prenatal care. Previous studies assessing the relationship between neighborhood factors and maternal health outcomes have typically looked at singular neighborhood variables and their relationship with maternal health outcomes. In order to examine a greater number of place-based risk factors simultaneously, our analysis used a unique neighborhood risk index to assess the association between cumulative risk and prenatal care utilization, which no other studies have done., Methods: Data from Rhode Island Vital Statistics for births between 2005 and 2014 were used to assess the relationship between neighborhood risk and prenatal care utilization using two established indices. We assessed neighborhood risk with an index composed of eight socioeconomic block-group variables. A multivariate logistic regression model was used to examine the association between adequate use and neighborhood risk., Results: Individuals living in a high-risk neighborhood were less likely to have adequate or better prenatal care utilization according to both the APNCU Index (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.87-0.95) and the R-GINDEX (aOR 0.88, 95% CI 0.85-0.91) compared with those in low-risk neighborhoods., Conclusion: Understanding the impact of neighborhood-level factors on prenatal care use is a critical first step in ensuring that underserved neighborhoods are prioritized in interventions aimed at making access to prenatal care more equitable., (© 2024 Wiley Periodicals LLC.)

Objective: In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well-being is performed in obstetrician-led care. An innovative initiative was started to evaluate whether aCTG for specific indications-reduced fetal movements, external cephalic version, or postdate pregnancy-is feasible in non-obstetrician-led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter- and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG., Method: This was a prospective study among 47 Dutch primary care midwives, hospital-based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement., Results: The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86-0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency)., Conclusion: The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women., (© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Objective: To describe the unique challenges faced by rural pregnant women with intersecting substance use disorder (SUD) and unmet social needs., Design: Secondary qualitative data analysis with an analytic expansion approach., Setting: Hospital system in northern New England., Participants: Four rural women with food insecurity who were in recovery for SUD (three were pregnant and one had given birth in the past 15 weeks)., Methods: In the primary qualitative descriptive study, we interviewed 14 women about their experience of food insecurity during the perinatal period, including facilitators and barriers to being screened and accessing referrals for food insecurity and other social needs during prenatal care. This secondary analysis centered on the perspectives of four participants who reflected specifically on receiving material and mental health support through the integration of prenatal care and SUD treatment., Results: Rural women with SUD who experience social needs during pregnancy have difficulty accessing appropriate prenatal care and maintaining treatment engagement due to intersecting factors (e.g., food and housing insecurity and transportation) and psychological (e.g., mental health challenges, social isolation, and stigma) factors. Participants emphasized the importance of integrating social support within prenatal and substance use care to promote physical and mental health and engagement in SUD treatment., Conclusion: In line with The Joint Commission's 2022 policy recommendations for universal social determinants of health screening, we support one-stop clinical and social care for pregnant women who face intersecting barriers to health, such as SUD and unmet social needs. Nurses can play an important role in care coordination for people with complex medical and social determinants of health screening needs. This approach is especially relevant to rural areas, where food, housing, and transportation insecurity rates are greater than nonrural areas., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women's decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women's decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda., Methods: A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts., Results: Most women were aged 20-34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 - 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 - 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 - 0.7, p = 0.002)., Conclusion: Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use., Objective: Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences., Design: Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy., Findings: We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported., Conclusions: Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified., Competing Interests: Declaration of competing interest The authors have no conflicting interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Problem: Lack of opportunity for breech training and clinical experience reduced professional confidence and expertise in supporting vaginal breech birth., Background: OptiBreech collaborative care is a care pathway for breech presentation at term that aims to enable improve safety through person-centred care and improved training opportunities for maternity professionals, within dedicated clinics and intrapartum support. In feasibility work, barriers and facilitators to team implementation were observed by team members., Aim: This study sought to describe factors affecting optimal future implementation and safety of OptiBreech care., Methods: Semi-structured interviews were conducted with staff members at 13 OptiBreech trial sites (17 midwives and 4 obstetricians, n=21), via video conferencing software. The Theoretical Domains Framework (TDF) was used to identify factors impacting team implementation. Themes identified in the TDF were refined in reflexive discussion and grouped into key facilitators, key barriers, and dynamic factors (which span both barriers and facilitators). The interviews were then coded, analysed, and interpreted according to the refined framework., Findings: The key facilitators were broadly categorised within skill development, beliefs about capabilities, and social support from the wider multidisciplinary team. Key barrier categories were resources, social obstacles, and fears about consequences. Dynamic factor categories were individual responsibility, training, and attending births., Conclusion: While some factors affecting implementation were specific to the individuals and cultures of certain Trusts, recommendations emerged from analysis that are more widely applicable across multiple settings. These should be considered going forward for future service implementation, and in the next stage of OptiBreech clinical trials., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes., Method: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain., Results: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences., Discussion: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: There is currently a heightened need for perinatal medical services to timely recognize and accurately meet the psychological needs of pregnant women. Psychological disturbances a mother experiences during pregnancy, such as depression and anxiety, can be later associated with inadequate maternal capacity for antenatal care for herself and the baby, and may lead to subsequent mental health problems later in the mother's life. Routine prenatal assessment could significantly benefit from being proactively enriched with early prevention mental health screening tools to assess, appropriately manage vulnerable populations, and subsequently implement preventive actions., Methods: 178 pregnant women, under routine prenatal medical assessment, were measured regarding depressive symptomatology and stress, through the use of two validated psychometric tools (the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS-14))., Results: Heightened perceived stress and depressive symptomatology levels were associated with younger maternal age, an obstetrical record of more than one births and a history of abortion. Results additionally showed a connection between the requirement for a psychiatric referral-based on the levels of symptomatology recorded through the psychometric assessment and a clinical interview-and currently running the earlier stages (weeks) of pregnancy., Conclusion: Our revised proposed prenatal screening protocol for depression and stress suggests an amplified follow-up assessment including all pregnant women scoring high in both depression and in perceived stress, regardless of previous history of prenatal depression or of suicidality, to detect earlier or less manifest expressions of distress during pregnancy, in vulnerable perinatal populations., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The aim of this research was to examine the association between perceived quality of care during the COVID-19 pandemic and the modality of maternity care visits, virtual or in-person., Methods: This study utilized an online nationwide survey about experiences in prenatal and postpartum care between 18 April and 6 August 2020. Perceived quality of care was categorized into worse care, better, or the same care as compared to before the pandemic. Barriers were categorized into five groups: (1) concern for the privacy of health information, (2) not having a private or quiet place, (3) lack of physical exam or measurements, (4) quality of care, and (5) technology issues. Data analyses included bivariate analyses and multivariate logistic regression., Results: The majority (75.3%) of modified visits utilized telemedicine. Over half of the women took at-home measurements and the majority were successful. Barriers to care included a lack of a quiet or private space to conduct their visit. Women expressed concerns about a lack of measurements and a lower quality of care. Women who received telemedicine visits perceived worse care as compared to women who received in-person care visits (OR = 5.62; 95% CI 5.01-6.31)., Discussion: Previous studies have shown that pregnant patients are generally satisfied with virtual care during the pandemic. This study provides insight from a large nationwide sample of women and geographic variation in satisfaction and perceived quality. These findings highlight barriers and potential solutions to improving patients' perceived quality of virtual maternity care, and thus future uptake of high-quality, virtual care., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Toxoplasmosis is potentially avoidable, treatable, and curable by simple and direct preventive measures. Knowledge, attitudes, and practices (KAP) assessments concerning gestational toxoplasmosis were evaluated in a cohort of pregnant women from Armenia-Quindío (Colombia, South America)., Methods: This cross-sectional descriptive KAP-type study was performed with informed consent between October 2021 and March 2022. The intervention involved a ten-minute talk administered by prenatal clinic nurses to pregnant women. This took place in the public health clinic RedSalud and the private clinic Happy Maternity with a post-KAP survey after pregnancy., Results: The findings of the initial KAP survey revealed that approximately 42.8 % of the 250 mothers surveyed had IgG anti-T. gondii antibodies present. A strong correlation was observed between a lower frequency of antibodies and a higher level of education. Following an educational intervention, 73 seronegative women demonstrated a significant improvement in their knowledge and behavior. Among the 111 mothers who received the intervention, 42 (37 %) were followed until delivery. Unfortunately, their level of compliance with prenatal serological follow-up was lower compared to previous historical records of cohort of mothers in the same health center during pre-pandemic periods. No seroconversion occurred, although the small number of cases makes the outcome inconclusive with respect to statistical significance., Conclusions: Education plays a crucial role in imparting valuable knowledge and fostering effective practices. It holds significant potential to prevent toxoplasmosis in pregnant seronegative mothers. Prenatal check-ups have proven to be a critical determinant in leveraging the benefits of education for seronegative mothers. Reporting and observed behaviors differed, identifying areas for improvement., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Poor oral health is associated with adverse health, social and economic consequences for pregnant women. While dental professionals promote good oral health within the dental practice context, more broadly, women in the antenatal period face poor oral health outcomes. Therefore, this study explored dental professionals' perceptions of their role in managing the oral health of pregnant women and identified the barriers and facilitators to improving maternal oral health., Methods: This study employed a descriptive qualitative method utilizing semi-structured interviews. Convenience and snowball sampling were used to recruit 13 dental professionals from Tasmania, Australia, comprising dentists (n = 10), oral health therapists (n = 2) and dental therapist (n = 1). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis., Results: Three major themes were constructed from the interviews: (1) dental professionals' oral health care of women during pregnancy; (2) perceived challenges to maternal oral health; and (3) proposed strategies to improve maternal oral health., Conclusions: Findings suggest dental professionals' competence in maternal oral health, but that several barriers, such as dental care access and maternal factors, hinder oral health outcomes. To address these barriers, oral health policies that support interprofessional collaboration, professional training and evaluation of existing community oral health programmes are needed. © 2024 Australian Dental Association., (© 2024 The Authors. Australian Dental Journal published by John Wiley & Sons Australia, Ltd on behalf of Australian Dental Association.)

Background: More women are experiencing pregnancy with two or more long-term health conditions such as hypertension, depression or HIV (MLTC). Care can be complex and include multiple teams, health professionals and services. The type and range of maternity care models for these women and the role of the midwife within such models is unknown., Aim: To provide an overview of the literature on models of care for pregnant, birthing, and postnatal women with MLTC and the role of the midwife., Methods: We conducted a scoping review guided by the Joanna Briggs Institute scoping review methodology. Five databases MEDLINE, CINAHL Plus, PsycINFO, EMBASE and The Maternity and Infant Care database were searched from inception until August 2022. A total of 3458 titles and abstracts and 56 full text papers were screened independently by two researchers. Data was extracted from five papers and synthesised narratively., Findings: Multidisciplinary care models are described or recommended in all five papers. Midwives have a varied and core role in the multidisciplinary care of women with MLTC., Discussion: Models of care for those with MLTC covered part or all the maternity journey, primarily antenatal and postnatal care. A focus on delivering high-quality holistic care throughout the maternity journey, including postnatally is needed. There is a lack of evidence on how midwifery continuity of care models may impact experiences of care and outcomes for this group., Conclusion: There is a lack of empirical evidence on how best to provide midwifery and multi-disciplinary care for those with MLTC and a need for research to understand this., Inclusivity Statement: Our aims refer to 'pregnant, birthing, and postnatal women and birthing people with MLTC'. We acknowledge that not all those accessing maternity services will identify as a woman. We continually strive to ensure that our research and public involvement is inclusive and sensitive to the needs of everyone. Our search terms did not narrow to either women or birthing people specifically and used broad terms of pregnancy, antenatal, prenatal, childbirth and postnatal care. All included papers use the term woman or women throughout therefore, we have used this terminology when describing their findings. Where the term 'woman' is used this should be taken to include women and people who do not identify as women but are pregnant or have given birth. This builds on our Patient and Public Involvement and Engagement work which has highlighted the need to use inclusive language., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem: Despite increasing interest in Group Care worldwide, implementation is challenging., Background: Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care., Aim: We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges., Methods: Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams., Findings: We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework., Conclusion: Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC., Methods and Findings: This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases., Conclusions: In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester., Competing Interests: MEK is a member of the PLOS Medicine Editorial Board., (Copyright: © 2024 Arsenault et al. 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.)

Chagas [shah-guhs] disease, caused by the Trypanosoma cruzi parasite, presents a growing concern for health care providers overseeing perinatal care in the United States due to existing and expanding vector-borne transmission and population migration. This life-threatening disease can be transmitted vertically during pregnancy, although adequate testing and treatment can effectively reduce morbidity and mortality caused by Chagas disease. This article presents an overview of the disease burden in the United States and its implications for perinatal care providers including recommended testing and treatment practices and the information needed for patient education and shared decision-making regarding the management of care for individuals at risk of Chagas disease. Being informed about Chagas disease and its implications is needed for all individuals providing perinatal care and is especially critical for those overseeing the care of refugee and immigrant populations., (© 2024 by the American College of Nurse‐Midwives.)

Background: Urinary incontinence (UI) is defined as any involuntary leakage of urine. UI during pregnancy is a common health problem worldwide with prevalence ranging from 11.4 to 84.5%. In Ethiopia there has been limited research conducted on UI among pregnant women. The purpose of this study was to investigate the prevalence of UI, factors associated with UI and the impact on quality of life in pregnant women., Method: Cross-sectional study was conducted from December 1, 2022 to April 30, 2023. A total of 279 pregnant women attending Antenatal care were included. Data was entered into Epi-data version 3.1 and then exported to SPSS version 26 for cleaning and analysis. Chi-square test and logistic regression were done to look for factors associated with UI. We used 95% confidence interval of crude and adjusted odds ratios for analysis. Those variables with P-value < 0.05 were declared to be statistically significant., Result: Overall prevalence of UI was 18.6% (n = 52). Prevalence of each type of UI during pregnancy was 9.3% for Stress UI, 5% for Urge UI and 4.3% for mixed UI. Of all participants having UI, 2(3.8%) were having UI prior to pregnancy, while 3(5.8%), 16(30.7%) and 31(59.6) have encountered during first, second and third trimester respectively. Three fourth of the participants 38(73.1%) doesn't seek treatment for their UI. Presence of history of UI [AOR = 38.1, 95%CI: (7.95, 182.75)], previous history of instrumental delivery [AOR = 7.4, 95%CI: (3.05, 18.04)] and history of alcohol intake [AOR = 17.0, 95%CI: (1.49, 194.41)] were found to be significantly associated with UI while moderate severity UI [AOR = 12.9, 95%CI (1.46, 113.28)] and severe UI [AOR = 27, 95%CI (1.98, 138.38)] were significantly associated with Poor quality of life at p-value of < 0.05. Based on severity score UI was moderate in 34 (65.4%) and severe in 8 (15.4%) of the participants., Conclusion: UI affects one fifth of pregnant women (18.6%) and Stress UI is the most common type of UI during pregnancy. Previous history of UI, instrumental delivery and alcohol intake were found to be risk factors for UI. Pregnant women have to be advised to avoid or reduce alcohol consumption and to seek treatment for their problem. Follow up throughout pregnancy and postpartum period is very important to plan for further management of UI., (© 2024. The Author(s).)

Background: Intermittent fasting, such as during Ramadan, is prevalent among pregnant women. However, the association between Ramadan during pregnancy and offspring health along the life course has not been fully established., Objective and Rationale: Fetal programming research indicates that prenatal exposures, particularly during early pregnancy, can cause long-term structural and physiological changes that adversely affect offspring health. Our objective was to systematically identify and assess the evidence regarding Ramadan during pregnancy., Search Methods: A total of 31 studies were sourced from PubMed, EMBASE, Web of Science, and EconLit. Included studies evaluated outcomes in individuals with prenatal Ramadan exposure, compared to unexposed Muslim controls. Main outcomes were birth weight, gestational length, and sex ratio in newborns; height, mortality, and cognition in children; and disabilities, chronic diseases, and human capital accumulation in adults. Each study was evaluated for risk of bias. The overall quality of evidence was appraised using the GRADE system. Random-effects meta-analyses were conducted for outcomes analyzed in at least three primary studies., Outcomes: The initial search identified 2933 articles, 1208 duplicates were deleted. There were 31 publications fulfilled the eligibility criteria for the qualitative synthesis; 22 studies were included in meta-analyses. The overall quality of the evidence was low to moderate and differed by study design and outcome. Among newborns, prenatal Ramadan exposure was not associated with birth weight (mean difference (MD) -3 g (95% CI -18 to 11; I2 = 70%) or the likelihood of prematurity (percentage point difference (PPD) 0.19 (95% CI -0.11 to 0.49; I2 = 0%)). The probability that the newborn is male was reduced (PPD -0.14 (95% CI -0.28 to -0.00; I2 = 0%)). This potentially reflects sex-specific mortality rates resulting from adverse in utero circumstances. In childhood, the exposed performed slightly poorer on cognitive tests (MD -3.10% of a standard deviation (95% CI -4.61 to -1.58; I2 = 51%)). Height among the exposed was reduced, and this pattern was already visible at ages below 5 years (height-for-age z-score MD -0.03 (95% CI -0.06 to -0.00; I2 = 76%)). A qualitative literature synthesis revealed that childhood mortality rates were increased in low-income contexts. In adulthood, the prenatally exposed had an increased likelihood of hearing disabilities (odds ratio 1.26 (95% CI 1.09 to 1.45; I2 = 32%)), while sight was not affected. Other impaired outcomes included chronic diseases or their symptoms, and indicators of human capital accumulation such as home ownership (qualitative literature synthesis). The first trimester emerged as a sensitive period for long-term impacts., Wider Implications: Despite the need for more high-quality studies to improve the certainty of the evidence, the synthesis of existing research demonstrates that Ramadan during pregnancy is associated with adverse offspring health effects in childhood and especially adulthood, despite an absence of observable effects at birth. Not all health effects may apply to all Muslim communities, which are diverse in backgrounds and behaviors. Notably, moderating factors like daytime activity levels and dietary habits outside fasting hours have hardly been considered. It is imperative for future research to address these aspects., Registration Number: PROSPERO (CRD42022325770)., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID-19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia., Methods: A cross-sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post-traumatic stress, satisfaction, and expectations with maternity care., Results: A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL-C score consistent with probable post-traumatic stress disorder. Unexpected ultrasound findings or a high PCL-C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post-traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL-C score., Discussion: The prevalence of post-traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post-trauma symptoms and consider trauma-responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post-trauma and distress-related symptoms., (© 2024 The Author(s). Birth published by Wiley Periodicals LLC.)

Background: Pregnant women with obesity face heightened focus on weight during pregnancy due to greater risk of medical complications. Closer follow-up in maternety care may contribute to reduce risk and promote health in these women. The aim of this study was to gain a deeper insight in how pregnant women with obesity experience encounters with healthcare providers in maternity care. How is the received maternity care affected by their weight, and how do they describe the way healthcare providers express attitudes towards obesity in pregnancy?, Methods: We conducted in-depth interviews with 14 women in Trøndelag county in Norway with pre-pregnancy BMI of ≥ 30 kg/m 2 , between 3 and 12 months postpartum. The study sample was strategic regarding age, relationship status, education level, obesity class, and parity. Themes were developed using reflexive thematic analysis. The analysis was informed by contextual information from a prior study, describing the same participants' weight history from childhood to motherhood along with their perceptions of childhood quality., Results: This study comprised of an overarching theme supported by three main themes. The overarching theme, Being pregnant with a high BMI: a vulnerable condition, reflected the challenge of entering maternity care with obesity, especially for women unprepared to be seen as "outside the norm". Women who had grown up with body criticism and childhood bullying were more prepared to have their weight addressed in maternity care. The first theme, Loaded conversations: a balancing act, emphasizes how pregnant women with a history of body criticism or obesity-related otherness proactively protect their integrity against weight bias, stigma and shame. The women also described how some healthcare providers balance or avoid weight and risk conversations for the same reasons. Dehumanization: an unintended drawback of standardized care makes apparent the pitfalls of prioritizing standardization over person-centered care. Finally, the third theme, The ambivalence of discussing weight and lifestyle, represent women's underlying ambivalence towards current weight practices in maternity care., Conclusions: Our findings indicate that standardized weight and risk monitoring, along with lifestyle guidance in maternity care, can place the pregnant women with obesity in a vulnerable position, contrasting with the emotionally supportive care that women with obesity report needing. Learning from these women's experiences and their urge for an unloaded communication to protect their integrity highlights the importance of focusing on patient-centered practices instead of standardized care to create a safe space for health promotion., (© 2024. The Author(s).)

Congenital heart disease (CHD) represents a significant challenge in prenatal care due to low prenatal detection rates. Artificial Intelligence (AI) offers promising avenues for precise CHD prediction. In this study we conducted a systematic review according to the PRISMA guidelines, investigating the landscape of AI applications in prenatal CHD detection. Through searches on PubMed, Embase, and Web of Science, 621 articles were screened, yielding 28 relevant studies for analysis. Deep Learning (DL) emerged as the predominant AI approach. Data types were limited to ultrasound and MRI sequences mainly. This comprehensive analysis provides valuable insights for future research and clinical practice in CHD detection using AI applications.

Background: Pregnancy among women infected with HIV is classified as a high-risk pregnancy. While previous research has indicated an elevated likelihood of preterm birth, low birth weight, and early gestational age in infants born to mothers with HIV, the correlation between maternal HIV infection and different neonatal results remains unclear., Objective: This study aims to investigate the impact of maternal HIV infection on after-birth neonatal outcomes using machine learning (ML) and statistical methods., Methods: A case-control study is conducted through a three-stage process: Initially, the outcomes among newborns from HIV-positive mothers are identified through a combination of literature review and expert survey. Subsequently, data are paired at a 1:2 ratio based on gestational age with infants from HIV-positive mothers (n=48) compared to HIV-negative mothers (n=96) as the control group. Finally, various feature selection techniques are applied to identify outcomes that exhibit significant differences between the two groups., Results: The statistical analysis showed that the rate of addiction among HIV-positive mothers is higher than that of the HIV-negative group. The need for mechanical ventilation and duration of ventilator-assisted breathing in infants born to HIV-positive mothers are significantly higher than in infants born to HIV-negative mothers. Moreover, based on feature selection methods, increasing the need for mechanical ventilation and reducing surfactant administration were two important outcomes., Conclusions: To investigate the impact of maternal HIV infection on neonatal outcomes, various statistical and machine learning-based feature selection techniques were implemented, and the results showed that the presented methods can be utilized to examine the potential impacts of different diseases contracted by the mother on the infant., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Congenital rubella syndrome (CRS) is a serious condition with a high rate of morbidity. It is currently a rare disorder, especially in developed countries, because of universal vaccination campaigns. However, it remains a public health concern in developing countries. Here, we report a case of congenital rubella syndrome in a mother who did not receive any prenatal care or had a known history of vaccination. He is a term male infant, and the infant's positive rubella IgM confirmed the diagnosis. The baby had a bilateral cataract, convulsions, Patent ductus arteriosus (PDA)-related cardiomegaly, and bilateral hearing loss. The only known preventive measure for congenital rubella syndrome is vaccination., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Ismail et al.)

Background: As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana., Methods: We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks' gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale., Results: 1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19-32% in the I-ANC group vs. 19-73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2-20% in the G-ANC group (p < 0.001)., Conclusions: G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted., Trial Registration: ClinicalTrials.gov Identifier: NCT04033003 (25/07/2019)., Protocol Available: Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ ., (© 2024. The Author(s).)

Background: Following a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time., Methods and Findings: We conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother-infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother-infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference -2.6% [95% confidence interval (CI): -3.7, -1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference -7.5% [95% CI: -8.8, -6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group., Conclusions: These findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women., Competing Interests: EAB did consultancy for scientific engagement for MSD and Loreal foundation and Viiv., (Copyright: © 2024 Odhiambo et al. 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.)

Background: Iron and folic acid supplementation have been recommended in pregnancy for anaemia prevention, and may improve other maternal, pregnancy, and infant outcomes., Objectives: To examine the effects of daily oral iron supplementation during pregnancy, either alone or in combination with folic acid or with other vitamins and minerals, as an intervention in antenatal care., Search Methods: We searched the Cochrane Pregnancy and Childbirth Trials Registry on 18 January 2024 (including CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO's International Clinical Trials Registry Platform, conference proceedings), and searched reference lists of retrieved studies., Selection Criteria: Randomised or quasi-randomised trials that evaluated the effects of oral supplementation with daily iron, iron + folic acid, or iron + other vitamins and minerals during pregnancy were included., Data Collection and Analysis: Review authors independently assessed trial eligibility, ascertained trustworthiness based on pre-defined criteria, assessed risk of bias, extracted data, and conducted checks for accuracy. We used the GRADE approach to assess the certainty of the evidence for primary outcomes. We anticipated high heterogeneity amongst trials; we pooled trial results using a random-effects model (average treatment effect)., Main Results: We included 57 trials involving 48,971 women. A total of 40 trials compared the effects of daily oral supplements with iron to placebo or no iron; eight trials evaluated the effects of iron + folic acid compared to placebo or no iron + folic acid. Iron supplementation compared to placebo or no iron Maternal outcomes: Iron supplementation during pregnancy may reduce maternal anaemia (4.0% versus 7.4%; risk ratio (RR) 0.30, 95% confidence interval (CI) 0.20 to 0.47; 14 trials, 13,543 women; low-certainty evidence) and iron deficiency at term (44.0% versus 66.0%; RR 0.51, 95% CI 0.38 to 0.68; 8 trials, 2873 women; low-certainty evidence), and probably reduces maternal iron-deficiency anaemia at term (5.0% versus 18.4%; RR 0.41, 95% CI 0.26 to 0.63; 7 trials, 2704 women; moderate-certainty evidence), compared to placebo or no iron supplementation. There is probably little to no difference in maternal death (2 versus 4 events, RR 0.57, 95% CI 0.12 to 2.69; 3 trials, 14,060 women; moderate-certainty evidence). The evidence is very uncertain for adverse effects (21.6% versus 18.0%; RR 1.29, 95% CI 0.83 to 2.02; 12 trials, 2423 women; very low-certainty evidence) and severe anaemia (Hb < 70 g/L) in the second/third trimester (< 1% versus 3.6%; RR 0.22, 95% CI 0.01 to 3.20; 8 trials, 1398 women; very low-certainty evidence). No trials reported clinical malaria or infection during pregnancy. Infant outcomes: Women taking iron supplements are probably less likely to have infants with low birthweight (5.2% versus 6.1%; RR 0.84, 95% CI 0.72 to 0.99; 12 trials, 18,290 infants; moderate-certainty evidence), compared to placebo or no iron supplementation. However, the evidence is very uncertain for infant birthweight (MD 24.9 g, 95% CI -125.81 to 175.60; 16 trials, 18,554 infants; very low-certainty evidence). There is probably little to no difference in preterm birth (7.6% versus 8.2%; RR 0.93, 95% CI 0.84 to 1.02; 11 trials, 18,827 infants; moderate-certainty evidence) and there may be little to no difference in neonatal death (1.4% versus 1.5%, RR 0.98, 95% CI 0.77 to 1.24; 4 trials, 17,243 infants; low-certainty evidence) or congenital anomalies, including neural tube defects (41 versus 48 events; RR 0.88, 95% CI 0.58 to 1.33; 4 trials, 14,377 infants; low-certainty evidence). Iron + folic supplementation compared to placebo or no iron + folic acid Maternal outcomes: Daily oral supplementation with iron + folic acid probably reduces maternal anaemia at term (12.1% versus 25.5%; RR 0.44, 95% CI 0.30 to 0.64; 4 trials, 1962 women; moderate-certainty evidence), and may reduce maternal iron deficiency at term (3.6% versus 15%; RR 0.24, 95% CI 0.06 to 0.99; 1 trial, 131 women; low-certainty evidence), compared to placebo or no iron + folic acid. The evidence is very uncertain about the effects of iron + folic acid on maternal iron-deficiency anaemia (10.8% versus 25%; RR 0.43, 95% CI 0.17 to 1.09; 1 trial, 131 women; very low-certainty evidence), or maternal deaths (no events; 1 trial; very low-certainty evidence). The evidence is uncertain for adverse effects (21.0% versus 0.0%; RR 44.32, 95% CI 2.77 to 709.09; 1 trial, 456 women; low-certainty evidence), and the evidence is very uncertain for severe anaemia in the second or third trimester (< 1% versus 5.6%; RR 0.12, 95% CI 0.02 to 0.63; 4 trials, 506 women; very low-certainty evidence), compared to placebo or no iron + folic acid. Infant outcomes: There may be little to no difference in infant low birthweight (33.4% versus 40.2%; RR 1.07, 95% CI 0.31 to 3.74; 2 trials, 1311 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. Infants born to women who received iron + folic acid during pregnancy probably had higher birthweight (MD 57.73 g, 95% CI 7.66 to 107.79; 2 trials, 1365 infants; moderate-certainty evidence), compared to placebo or no iron + folic acid. There may be little to no difference in other infant outcomes, including preterm birth (19.4% versus 19.2%; RR 1.55, 95% CI 0.40 to 6.00; 3 trials, 1497 infants; low-certainty evidence), neonatal death (3.4% versus 4.2%; RR 0.81, 95% CI 0.51 to 1.30; 1 trial, 1793 infants; low-certainty evidence), or congenital anomalies (1.7% versus 2.4; RR 0.70, 95% CI 0.35 to 1.40; 1 trial, 1652 infants; low-certainty evidence), comparing iron + folic acid supplementation to placebo or no iron + folic acid. A total of 19 trials were conducted in malaria-endemic countries, or in settings with some malaria risk. No studies reported maternal clinical malaria; one study reported data on placental malaria., Authors' Conclusions: Daily oral iron supplementation during pregnancy may reduce maternal anaemia and iron deficiency at term. For other maternal and infant outcomes, there was little to no difference between groups or the evidence was uncertain. Future research is needed to examine the effects of iron supplementation on other maternal and infant health outcomes, including infant iron status, growth, and development., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Prenatal alcohol exposure (PAE) is one of the leading causes of preventable developmental disabilities. A lack of objective screening methods results in an under-recognition of the phenomenon. Phosphatidylethanol (PEth) is a specific ethanol biomarker that reveals alcohol intake up to several weeks after alcohol use. So far, PEth has mostly been a tool for detecting moderate and heavy drinking. With lower PEth cut-offs, revealing even minor prenatal alcohol consumption is possible. We aimed to find out if a sensitive method for PEth analysis would give additional information about PAE and to assess the cut-off value for a positive alcohol result in prenatal screening., Methods: The study was an observational study of 3000 anonymous blood samples collected from the Helsinki University Hospital Diagnostic Center between June and September 2023. The Finnish Red Cross Blood Service received the samples originally for blood group typing and antibody screening as part of the prenatal blood screening program. We developed a sensitive PEth 16:0/18:1 analysis method using ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) equipment after liquid-liquid extraction of PEth from whole blood. The lower limit of quantification was 1 ng/mL., Results: PEth was ≥2 ng/mL in 5.2% of the cases, ≥8 ng/mL in 2.0%, and ≥20 ng/mL in 1.0%. The detection time of PEth can be several weeks, especially with low PEth concentrations and after heavy alcohol consumption. It remained unknown whether the positive PEth tests resulted from drinking deliberately during pregnancy or before pregnancy recognition., Conclusions: We suggest adding PEth 16:0/18:1 to a routine prenatal blood screening program with a cut-off of 2 ng/mL-and in positive cases, clinical evaluation and retesting in 2-4 weeks. In clinical settings, information on gestational week and alcohol consumption before pregnancy is relevant and needs to be considered when interpreting low PEth concentrations., (© 2024 The Author(s). Alcohol, Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Background: Small for gestational age (SGA) neonates are known to be at an elevated risk for neonatal morbidity. Despite this, there is a growing array of proposed size standards for identifying SGA fetuses. Given the inherent differences in design, acquisition methods, and the characteristics of the populations they represent, the generalizability of these standards to diverse populations remains uncertain., Introduction: This study aimed to assess variations in rates of SGA and severe SGA using six distinct size standards: Hadlock, Fetal Medicine Foundation (FMF), World Health Organization (WHO), Intergrowth-21 (IG-21), and two locally derived population-based size standards. The objective was to examine the differences in SGA and severe SGA rates among these size standards., Methods: A retrospective cohort study was conducted, encompassing all singleton deliveries in two tertiary referral hospital campuses with an annual birth count exceeding 10,000, from January 2019 to July 2022. SGA and severe SGA were defined as birthweights below the 10th or 3rd percentile, respectively, based on each growth standard. The study design included details on the setting, subjects (singleton deliveries), and the chosen size standards. Comparative analyses were performed to assess variations in SGA and severe SGA rates among these size standards., Results: Our study analyzed 32,912 singleton deliveries. We found that the choice of growth standard significantly impacted the rates of both SGA and severe SGA infants. Notably, the WHO criteria identified 5,548 (16.9 %) fetuses as SGA, compared to only 1,716 (5.2 %) using the INTERGROWTH-21 standard (p < 0.001). Similarly, for severe SGA, the FMF charts classified 2098 (6.37 %) infants, significantly higher than the 320 (1 %) identified by Dolberg's local population-based charts (p < 0.001)., Conclusion: Our study demonstrates a significant variety of SGA and severe SGA rates using different size standards. Therefore, the decision on the size standards in use is critical given the significant influence on clinical management., Synopsis: There are significant variations in SGA and Severe SGA rates depending on the chosen size standard., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting., Design: Prospective cohort., Methods: Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving antenatal care were enrolled and given a choice to retest with HB-HIVST or CB-RDT. Women were asked to retest between 36 weeks gestation and 1-week post-delivery if the last HIV test was <24 weeks gestation or at 6 weeks postpartum if ≥24 weeks gestation, and self-report on retesting at a 14-week postpartum., Results: Overall, 994 women enrolled and 33% (n = 330) selected HB-HIVST. HB-HIVST was selected because it was private (n = 224, 68%), convenient (n = 211, 63%), and offered flexibility in the timing of retesting (n = 207, 63%), whereas CB-RDT was selected due to the trust of providers to administer the test (n = 510, 77%) and convenience of clinic testing (n = 423, 64%). Among 905 women who reported retesting at follow-up, 135 (15%) used HB-HIVST. Most (n = 595, 94%) who selected CB-RDT retested with this strategy, compared to 39% (n = 120) who selected HB-HIVST retesting with HB-HIVST. HB-HIVST retesting was more common among women with higher household income and those who may have been unable to test during pregnancy (both retested postpartum and delivered <37 weeks gestation) and less common among women who were depressed. Most women said they would retest in the future using the test selected at enrollment (99% [n = 133] HB-HIVST; 93% [n = 715] CB-RDT-RDT)., Conclusions: While most women preferred CB-RDT for maternal retesting, HB-HIVST was acceptable and feasible and could be used to expand HIV retesting options., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Drake et al. 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.)

Pre-eclampsia and eclampsia are the second leading causes of maternal mortality and morbidity. It also results in high perinatal mortality and morbidity. Since eclampsia is preceded by preeclampsia and shows the progression of the disease, they share the same pathogenesis and determining factors. The purpose of this study was to determine determinants of preeclampsia, since it is essential for its prevention and/or its associated consequences. An unmatched case-control study was conducted from September 1-30, 2023 among women who gave birth from June 1, 2020, to August 31, 2023, at Hiwot Fana Comprehensive Specialized University Hospital. Women who had preeclampsia were considered cases, while those without were controls. The sample size was calculated using EPI Info version 7 for a case-control study using the following assumptions: 95% confidence interval, power of 80%, case-to-control ratio of 1:2, and 5% non-response rate were 305. Data was collected using Google Form, and analyzed using SPSS version 26. Variables that had a p-value of < 0.05 on multivariable logistic regression were considered statistically significant, and their association was explained using an odds ratio at a 95% confidence interval. A total of 300 women (100 cases and 200 controls) with a mean age of 24.4 years were included in the study. Rural residence (AOR 2.04, 95% CI 1.10-3.76), age less than 20 years (AOR 3.04, 95% CI 1.58-5.85), history of hypertensive disorders of pregnancy (AOR 5.52, 95% CI 1.76-17.33), and no antenatal care (AOR 2.38, 95% CI 1.19-4.75) were found to be the determinants of preeclampsia. We found that living in a rural areas, previous history of preeclampsia, no antenatal care, and < 20 years of age were significantly associated with preeclampsia. In addition to previous preeclampsia, younger and rural resident pregnant women should be given attention in preeclampsia screening and prevention., (© 2024. The Author(s).)

The aim of the current study was to assess the influence of maternal weight gain in different clinical gestational conditions on the child's weight at pre-school age. This was a longitudinal observational study of a prospective and controlled multiple cohort of 372 mother-child pairs with four causal groups of different adverse intrauterine environments (smoking, diabetic, hypertensive and intrauterine growth-restricted pregnant women) and a control group, in the period of, from 2011 to 2016 in three hospitals in Porto Alegre (Brazil). Sociodemographic, prenatal and perinatal data were analysed. Gestational weight gain (GWG) was categorised as 'insufficient', 'adequate' and 'excessive'. The generalised estimation equations (GEE) model was used to assess changes in the z-score of the child's body mass index from birth to pre-school age according to the GWG and gestational group. The child's GWG and weight gain were adjusted for maternal age and education, marital status, family income, pregnancy planning, number of children, prepregnancy BMI, prenatal consultations and type of delivery. A triple interaction effect was observed involving the gestational group, weight gain and study time (p = 0.020) through an adjusted model. Maternal weight gain above the recommended is associated with a significant increase in the child's z - BMI score over time, except for children from pregnant smokers. Children from diabetic mothers , hypertensive mothers and the control group who had a weight gain above that recommended during pregnancy changed their nutritional status from eutrophic to overweight, becoming obese in the DM and hypertension groups and overweight in control. Monitoring of the GWG, especially in the presence of hypertensive diseases and DM, should be effective to prevent children from developing overweight or obesity in pre-school age with an important impact on health conditions in the future., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality  ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15-49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35-49 years (AOR = 1.16; 95% CI = 1.09-1.24), higher education (AOR = 2.84; 95% CI = 2.69-2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49-1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04-3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89-0.95) and 2-4 birth order (AOR = 0.86; 95% CI = 0.83-0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74-0.8), and big problem - distance to health facility (AOR = 0.63; 95% CI: 0.53-0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32-25.08) and Maldives (AOR: 33.33; 95% CI: 31.06-35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia., (© 2024. The Author(s).)

Objective: We review the prevalence of allergic diseases in children across prenatal exposures to heavy metals., Methods: This systematic review and meta-analysis is registered in the PROSPERO database (CRD42023478471). A comprehensive search of PubMed, Web of Science, Medline and Cochrane library was conducted from the database inception until 31 October 2023. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the quality of included studies. We used a random-effects model to summarize the effects from the studies., Results: A total of 16 studies were included, 120,065 mother-child pairs enrolled. The NOS scores indicated that the quality of the literature included in the study was of a high standard., Conclusion: The final results indicate that prenatal exposure to Pb increased the incidence of wheeze and Eczema in infants, and exposure to Ni and CD increased the incidence of AD in infants.

Background: Co-infections involving human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis pose significant public health problems during pregnancy. It can increase the risk of adverse outcomes for both the woman and the infant more than each infection alone does. However, the magnitude of these co-infections remains insufficiently documented. Hence, this study aimed to determine the seroprevalence of HIV, HBV, and syphilis co-infections and associated risk factors among pregnant women attending antenatal care in Amhara region referral hospitals in northern Ethiopia., Methods: A hospital-based cross-sectional study was conducted in Amhara regional state referral hospitals from January 1 to February 30, 2024, among 606 pregnant women. Pregnant women were selected using a systematic random sampling technique. An interviewer-administered questionnaire and chart review were used to collect data. Data were analyzed in SPSSV26.0. Descriptive statistics were used to determine the magnitude of co-infections, and binary logistic regression was used to determine associated factors. Variables with a P-value < 0.05 were used to declare statistical significance., Result: Overall, 4.1% (95% CI: 2.7, 6.1) of pregnant women were co-infected. The prevalence of specific co-infections was 2% (95% CI: 1, 3.5) for HIV/HBV, 1.3% (95% CI: 0.6, 2.6) for HIV/syphilis, and 0.8% (95% CI: 0.3, 1.9) for HBV/syphilis. No cases of triple co-infection were observed. Women with a history of unsafe sex (AOR = 8.2, 95% CI: 1.5, 16.7) and incarceration (AOR = 9.3, 95% CI: 1.6, 20.8) were associated with HIV/syphilis co-infection. For HIV/HBV co-infection, contact with jaundice patients (AOR = 5.5, 95% CI: 1.3, 22.5) and women with a history of STIs (AOR = 4.6, 95% CI: 1.4, 14.9) was significantly associated. Women with STI history (AOR = 6.3, 95% CI: 1.2, 15.9) were also significantly associated with HBV/syphilis co-infection., Conclusion: Despite the government's elimination efforts, a relatively high prevalence of coinfections with the infections studied was found among pregnant women. Therefore, HIV, HBV, and syphilis testing and treatment packages should be strengthened by targeting pregnant women with a history of STIs, contact with patients with jaundice, a history of incarceration, and unsafe sex., Competing Interests: the authors have declared that no competing interests exist, (Copyright: © 2024 Anteneh et al. 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.)

Background: Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW., Purpose: To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set., Methods: Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women)., Results: Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women., Conclusions: Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Objective: Few comparisons have been implemented between different prenatal care utilization indices and their effects on adverse outcomes. This study investigated the appropriateness of Chinese antenatal care (ANC) regulations and compared Chinese and American adequacy of prenatal care utilization (APNCU) scores., Methods: From 2010 to 2022, the medical records of 60,114 pregnant women were collected from the electronic medical record system (EMRS) in Zhoushan, China. ANC utilization was measured using the APNCU score and five times antenatal care (ANC5). Birth weight outcomes, including small for gestational age (SGA) and large for gestational age (LGA), low birth weight (LBW), macrosomia, birth weight, and preterm birth (PTB), were utilized as outcomes. Multinomial, linear, and logistic regression were used to analyze the association of ANC5 and APNCU with outcomes, respectively. Crossover analysis was implemented to compare the interaction between ANC5 and APNCU on the outcomes., Results: Women who received inadequate prenatal care had increased odds for PTB (ANC5: odds ratio (OR) = 1.12, 95% confidence interval (95%CI) = 1.03-1.21; APNCU: OR = 1.18, 95%CI: 1.07-1.29), delivering SGA infants (ANC5: OR = 1.13, 95%CI = 1.07-1.21; APNCU: OR = 1.11, 95%CI = 1.03-1.20). Crossover analysis revealed that inadequate prenatal care in APNCU only was significantly associated with an increased risk of PTB (OR = 1.48, 95%CI: 1.26-1.73)., Conclusion: Women with inadequate prenatal care in ANC5 or APNCU were more likely to suffer from adverse birth outcomes, including PTB, birth weight loss, SGA, and LBW. It indicated that adequate prenatal care is necessary for pregnant women. However, there were interactions between ANC5 and APNCU on PTB, with inadequate prenatal care use by APNCU showing the highest risk of PTB. This indicates that APNCU would be a better tool for evaluating prenatal care use., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhou, Yang, Chi, Cheng, Alifu, Qiu, Huang, Zhang, Ainiwan, Zhuang, Liu, Chen and Yu.)

Background: Birth preparedness and complication readiness is a holistic approach that empowers mothers and families with the knowledge, attitude, and resources to alleviate potential challenges during childbirth. Despite its benefits, husbands' participation in maternal care differs significantly between countries and regions. There is a lack of previous studies that look at husbands' responses to birth preparedness and complication readiness in the research area. Thus, the primary goal of this study is to find out how husbands who have wives with infants under 12 months old feel about birth preparation, readiness for problems, and its associated factors., Methods: A community-based cross-sectional study design was conducted from May 30 to July 29, 2022. Simple random sampling was employed to select 499 husbands. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. Data entry and analysis were performed using Epi Data version 4.6 and SPSS version 25, respectively. We used multivariable logistic regression to find statistically significant factors. P-values less than 0.05, 95% confidence intervals, and adjusted odds ratios are used to declare statistical significance. The findings were shown in figures, tables, and text., Results: The study found that 55.9% (95% CI: 51.4 to 61.4%) of husbands responded to birth preparedness and complication readiness. This response was significantly associated with being employed (AOR = 3.7, 95% CI: 2.27-5.95), engaging in self-business (AOR = 5.3, 95% CI: 2.34-12.01), having wives who delivered in health facilities (AOR = 7.1, 95% CI: 3.92-12.86), accompanying wives for antenatal care (AOR = 2.2, 95% CI: 1.39-3.56), possessing good knowledge of danger signs during labor (AOR = 2.0, 95% CI: 1.08-3.74) and the postnatal period (AOR = 7.1, 95% CI: 3.14-16.01). Interestingly, residents living near a health facility (AOR = 0.6, 95% CI: 0.39-0.97) were less likely to respond., Conclusion: The present study found that nearly 6 out of 10 husbands actively responded in terms of birth preparedness and complication readiness. While husbands in this study showed some involvement in birth preparedness and complications, it is good when compared to studies carried out nationally. To improve this, educating husbands by focusing on the danger signs and their role in childbirth is recommended., (© 2024. The Author(s).)

Objectives: The objectives of this study are to describe couples' experiences and perceived barriers to participation in the CenteringPregnancy model in southeast of China and to understand whether smartphones could play a potential role in this model., Design: This study employed a descriptive phenomenological qualitative study using semistructured dyadic interviews with women and their partners. The interviews were audiotaped, transcribed verbatim and subjected to thematic analysis., Setting: This study was conducted in two pilot prenatal clinics in southern China., Participants: A purposive sample of 13 couples who underwent smartphone-assisted CenteringPregnancy were recruited. Data were collected until saturation through semistructured dyadic interviews between December 2022 and March 2023., Results: The study yielded four primary themes: (1) motivation for participation, (2) acceptance of CenteringPregnancy, (3) barriers and suggestions and (4) support for smartphone use of CenteringPregnancy., Conclusions: CenteringPregnancy was well received by couples. Couples can access additional medical care and engage in intensive social interactions assisted by smartphones. However, certain objective challenges need to be acknowledged, including inadequate activity space, high demand for knowledge by couples and inflexible time for employed partners. Moreover, the risk that smartphones can lead to false expectations among couples needs to be noted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Preterm birth, which is child delivery before 37 weeks of pregnancy, is the primary cause of perinatal mortality worldwide. Preterm birth remains a major public health challenge in Rwanda, affecting approximately 13.8% of birth. The World Health Organization estimates that 15 million babies are born prematurely each year. While the association between periodontitis and preterm deliveries is increasingly recognized, little is known about this link in Rwanda. This policy brief aims to bridge this knowledge gap by presenting the findings of a recent study investigating the prevalence of periodontitis among pregnant women in Rwanda and its association with preterm deliveries. This policy brief also aims to inform and guide decision making towards incorporating periodontal screening into the antenatal care package in Rwanda. This has the potential to improve pregnancy outcomes and contribute to improved oral health in the future., Policy Outcome and Implications: Contemporary evidence has shown a six-fold increased risk of preterm delivery for women with periodontitis in Rwanda, with a concerningly high prevalence (60%) among pregnant women. Additionally, nurses working in antenatal clinics displayed insufficient knowledge about gum disease., Actionable Recommendations: The adoption of basic periodontal screening within existing antenatal care packages is recommended. This, coupled with nurse training and public awareness campaigns, can empower women and healthcare professionals to prioritize oral health for better pregnancy outcomes., Conclusions: Integrating periodontal screening into antenatal care has the potential to significantly reduce preterm deliveries and contribute to a healthier future generation in Rwanda., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Uwambaye P and Kanmodi KK.)