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Background: Hypertensive disorders of pregnancy (HDP) remain a primary contributor for maternal and perinatal death and results in long-term health risks for both the mother and child. Heterogeneous studies have evaluated the possible benefit of low dose aspirin (50 to 150 mg per day) in pregnancy to minimize the risk of HDP. Objective: To assess the impact of low-dose Aspirin (LDA) starting in early pregnancy on delaying preterm hypertensive disorders of pregnancy. Methodology: This was a non-prespecified secondary analysis of a randomized masked trial of Low-dose Aspirin (LDA). Nulliparous singleton pregnancies between 6 weeks and 0 days and 13 weeks 6 days in 6 low- middle income countries (Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, Zambia) enrolled in the ASPIRIN Trial were included. The incidence of HDP at delivery at three gestational age periods (< 37 weeks) between women who were randomized to Aspirin or Placebo. Women were included if they were randomized and had an outcome at or beyond 20 weeks (Modified Intent to Treat). Results: Amongst the 11,976 pregnancies, LDA did not significantly lower HDP at delivery. Conclusion: In low-risk nulliparous singleton pregnancies, early administration of LDA resulted in lower rates of preterm HDP and delivery before 34 and 37 weeks. LDA works in part by delaying HDP.

Multiple factors influence infant and child neurodevelopment in low resource settings. In offspring of participants in the preconception maternal nutrition trial, Women First (WF), we examined the impact of providing a preconception (Arm 1) or prenatal (Arm 2) nutrient supplement (compared to controls, Arm 3) on neurodevelopmental outcomes at 24 months; predictors of neurodevelopment scores; and associations of infant anthropometrics with neurodevelopmental scores. Follow‐up visits for anthropometry were conducted at 6‐, 12‐, 18‐ and 24‐month of age. At 24‐months, in a randomized subset, the Bayley Scales of Infant Development, 3rd edition (BSID‐III), including cognitive, motor and social‐emotional subscales, and the Family Care Indicators (FCI) questionnaire, assessing family and home environment, were completed. Multiple covariates (intervention arm, site, maternal sociodemographic characteristics, FCI subscales, birthweight and 6–24 months' change in anthropometry z‐scores, (e.g., ΔLAZ6–24) were evaluated by linear regression to predict BSID‐III outcomes and to assess associations of anthropometric changes with BSID‐III scores. The analysis consisted of 1386 infants (n = 441, 486, 459 for Arms 1, 2 and 3, respectively). None of the domain‐specific BSID‐III subscale scores differed by maternal intervention arm. Four covariates significantly predicted (p ≤ 0.01) all 3 BSID‐III subscales: secondary maternal education, ΔLAZ6–24, birthweight >2500 g, and FCI play materials. Linear growth was associated with all domains of neurodevelopment. The results underscore the multi‐dimensional aspects of child development represented by the nurturing care framework, including prenatal maternal nutrition, post‐natal growth, maternal education for responsive caregiving and opportunities for early learning. Key messages: Preconception and prenatal maternal nutrition is important to ensure adequate fetal growth and healthy birthweight.Preconception and prenatal maternal nutritional supplementation was not associated with young child neurodevelopment but has been shown to improve post‐natal growth.Post‐natal linear growth is consistently associated with offspring neurodevelopment at 24 months.Maternal education to foster responsive caregiving, and opportunities for early learning in the home also positively impact offspring neurodevelopmental outcomes.These findings underscore the importance of multi‐dimensional aspects essential for children to reach their full developmental potential. [ABSTRACT FROM AUTHOR]

Objectives: Antibiotic use is increasing in low- and middle-income countries (LMIC); however, few studies have examined the rates of use in a population. The use of antibiotics for liveborn infants in LMIC was examined. Design: The study, a planned prospective, observational secondary analysis of the A-PLUS randomised controlled trial of azithromycin, was conducted in Global Network sites in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, the Democratic Republic of Congo and Guatemala. The analyses included liveborn infants of women planning a vaginal delivery who were enrolled in the A-PLUS trial. Methods: Data were collected on liveborn infants related to non-study antibiotic use in two time-periods: (i) after delivery while in the facility, and (ii) after discharge until 42 days post-partum. Antibiotic use was also examined in preterm and term infants. The most commonly used antibiotics were classified into three groups: penicillins, cephalosporins and aminoglycosides. Antibiotics used in <1% of infants are not presented. Results: Of the 29,354 eligible infants in the study, 2224 (7.6%, 95% CI 7.3–7.9) received non-study antibiotics in the facility after delivery, and 3847 (13.1%, 95% CI 12.7–13.5) received non-study antibiotics after facility discharge until Day 42. In the facility, antibiotics were given to newborns more frequently in sites in Asia and less frequently in sites in Africa and Guatemala. Similarly, after facility discharge, infants were more likely to receive antibiotics in the Asian sites and less so in the African sites and Guatemala. In the facilities, antibiotics were used predominately for prophylaxis (70.7%) but after facility discharge antibiotics were given more often for treatment (56.8%). Preterm infants received more non-study antibiotics than term infants. The antibiotics used varied substantially by time-period and site but, in general, penicillins, cephalosporins and aminoglycosides were the antibiotic categories used more frequently. Conclusions: Across the Global Network sites, which represent a range of LMIC, nearly 8% of infants received non-study antibiotics more often for prophylaxis, with 13% of infants receiving non-study antibiotics following hospital discharge. With concerns about increasing antimicrobial resistance worldwide, further attention should be given to appropriate antibiotic use. [ABSTRACT FROM AUTHOR]

Two billion people worldwide suffer from anemia, with reproductive-age women being disproportionately affected. Iron plays a crucial role in cellular function and impacts cognition, physical function, and quality of life. Iron deficiency (ID) and iron deficiency anemia (IDA) are associated with adverse effects on pregnancy and fetal development. Oral iron supplementation has been the standard treatment for decades, often producing sub-optimal outcomes. Many babies are still being born with ID and suffer adverse sequelae due to inadequate iron levels in the mothers. Is it time to consider a broad scale-up of parenteral iron as a new standard of care? [ABSTRACT FROM AUTHOR]

Objective: To understand trends in the knowledge, attitudes and practices (KAP) of pregnant women related to COVID‐19 in seven low‐ and middle‐income countries. Design: Multi‐country population‐based prospective observational study. Setting: Study sites in Bangladesh, the Demographic Republic of Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. Population: Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR). Methods: Pregnant women enrolled in the MNHR were interviewed to assess their KAP related to COVID‐19 from September 2020 through July 2022 across all study sites. Main outcome measures: Trends of COVID‐19 KAP were assessed using the Cochran–Armitage test for trend. Results: A total of 52 297 women participated in this study. There were wide inter‐country differences in COVID‐19‐related knowledge. The level of knowledge of women in the DRC was much lower than that of women in the other sites. The ability to name COVID‐19 symptoms increased over time in the African sites, whereas no such change was observed in Bangladesh, Belagavi and Guatemala. All sites observed decreasing trends over time in women avoiding antenatal care visits. Conclusions: The knowledge and attitudes of pregnant women related to COVID‐19 varied substantially among the Global Network sites over a period of 2 years; however, there was very little change in knowledge related to COVID‐19 over time across these sites. The major change observed was that fewer women reported avoiding medical care because of COVID‐19 across all sites over time. [ABSTRACT FROM AUTHOR]

Objective: Growing evidence suggests that environmental heat stress negatively influences fetal growth and pregnancy outcomes. However, few studies have examined the impact of heat stress on pregnancy outcomes in low‐resource settings. We combined data from a large multi‐country maternal–child health registry and meteorological data to assess the impacts of heat stress. Design: Retrospective cohort study. Setting: Three sites based in south Asia as part of the Global Network for Women's and Children's Health research in India (Belagavi and Nagpur) and Pakistan (Thatta). Population or Sample: Data from women enrolled between 2014 and 2020 in the Global Network's Maternal Newborn Health Registry (MNHR), a prospective, population‐based registry of pregnancies, were used. Methods: A total of 126 273 pregnant women were included in this analysis. Daily maximal air temperatures (Tmax) were acquired from local meteorological records. Associations between averages of daily maximal temperatures for each trimester and main outcomes were analysed using a modified Poisson regression approach. Main outcomes measures: Incidence of stillbirth, preterm birth, low birthweight (<2500 g) or evidence of pregnancy hypertension or pre‐eclampsia. Results: In the overall cohort, risk of preterm birth was positively associated with greater temperature in the second trimester (relative risk [RR] 1.05, 95% CI 1.02–1.07, p = 0.0002). Among individual sites, the risk of preterm birth was greatest in Nagpur (RR 1.07, 95% CI 1.03–1.11, p = 0.0005) and associated with second‐trimester temperature. The overall risk of low birthweight was associated with ambient temperature in second trimester (RR 1.02, 95% CI 1.01–1.04, p = 0.01). The risk for LBW was associated with first‐trimester heat in Thatta and with second‐trimester heat in Nagpur. Finally, the overall risk of gestational hypertensive disease was associated with greater temperature in the third trimester among all sites (RR 1.07, 95% CI 1.02–1.12, p = 0.005) and was particularly significant for Nagpur (RR 1.13, 95% CI 1.05–1.23, p = 0.002). These findings highlight the increased risk of detrimental obstetric and neonatal outcomes with greater temperature. Conclusion: In a multi‐country, community‐based study, greater risk of adverse outcomes was observed with increasing temperature. The study highlights the need for deeper understanding of covarying factors and intervention strategies, especially in regions where high temperatures are common. [ABSTRACT FROM AUTHOR]

Objective: Peer counsellors are effective in addressing a variety of health challenges, including exclusive breastfeeding (EBF). Providing education and support from a person of similar background and experience has been an important adjunct to the practice of health workers for the past 50 years. Design: It is an exploratory qualitative study. Population or Sample: Twenty‐two peer counsellors. Setting: In‐depth Interview in the community. Methods: To better understand the experiences of these important health workers, we conducted qualitative interviews with 22 peer counsellors who participated in a research study in Belagavi District, Karnataka, India. Transcripts of the interviews were organised and assigned codes by the research team. Main outcome measures: Experience of Peer counsellor's role in the community to improve breastfeeding practices. Results: Peer counsellors had a good understanding of the larger study and of their role. Analysis of the transcripts identified three themes: personal satisfaction; the effect on the larger circle of family and community; and ideas for future programming. The positive experiences and the ability of peers to be trained in counselling women around EBF support their use in breastfeeding support and other areas of health education. Conclusions: The women from the community who served as peer counsellors were enthusiastic and satisfied about their work, which provided them with opportunities to do meaningful community work outside of their household routines. Use of the peer counsellor model to deliver a specific objective like improvement in EBF rates, immunisation or mental health in integration with healthcare providers can help in achieving desired goals. [ABSTRACT FROM AUTHOR]

With the paucity of data available regarding COVID‐19 in pregnancy in low‐ and middle‐income countries (LMICs), near the start of the pandemic, the Global Network for Women's and Children's Health Research, funded by the National Institute of Child Health and Human Development (NICHD), initiated four separate studies to better understand the impact of the COVID‐19 pandemic in eight LMIC sites. These sites included: four in Asia, in Bangladesh, India (two sites) and Pakistan; three in Africa, in the Democratic Republic of the Congo (DRC), Kenya and Zambia; and one in Central America, in Guatemala. The first study evaluated changes in health service utilisation; the second study evaluated knowledge, attitudes and practices of pregnant women in relationship to COVID‐19 in pregnancy; the third study evaluated knowledge, attitude and practices related to COVID‐19 vaccination in pregnancy; and the fourth study, using antibody status at delivery, evaluated changes in antibody status over time in each of the sites and the relationship of antibody positivity with various pregnancy outcomes. Across the Global Network, in the first year of the study there was little reduction in health care utilisation and no apparent change in pregnancy outcomes. Knowledge related to COVID‐19 was highly variable across the sites but was generally poor. Vaccination rates among pregnant women in the Global Network were very low, and were considerably lower than the vaccination rates reported for the countries as a whole. Knowledge regarding vaccines was generally poor and varied widely. Most women did not believe the vaccines were safe or effective, but slightly more than half would accept the vaccine if offered. Based on antibody positivity, the rates of COVID‐19 infection increased substantially in each of the sites over the course of the pandemic. Most pregnancy outcomes were not worse in women who were infected with COVID‐19 during their pregnancies. We interpret the absence of an increase in adverse outcomes in women infected with COVID‐19 to the fact that in the populations studied, most COVID‐19 infections were either asymptomatic or were relatively mild. [ABSTRACT FROM AUTHOR]

This document is a summary of the articles presented at the Third International Conference on Maternal, Newborn and Child Health, which focused on translating research evidence into practice. The conference, held in India, featured presentations from researchers, funders, and policymakers from around the world. The articles in this supplement cover a wide range of topics, including placental studies, stillbirth and neonatal mortality, antenatal corticosteroid use, maternal and neonatal nutrition, infant feeding practices, iron deficiency anemia, climate change and pregnancy outcomes, and the impact of COVID-19 on pregnancy. The research presented in these articles aims to improve maternal, neonatal, and child health outcomes in low-resource settings. [Extracted from the article]

Objective: To determine the relation of COVID‐19 symptoms to COVID‐19 antibody positivity among unvaccinated pregnant women in low‐ and middle‐income countries (LMIC). Design: COVID‐19 infection status measured by antibody positivity at delivery was compared with the symptoms of COVID‐19 in the current pregnancy in a prospective, observational cohort study in seven LMICs. Setting: The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population‐based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (Belagavi and Nagpur sites) and Guatemala. Population: Pregnant women enrolled in the ongoing pregnancy registry at study sites. Methods: Data on COVID‐19 symptoms during the current pregnancy were collected by trained staff between October 2020 and June 2022. COVID‐19 antibody testing was performed on samples collected at delivery. The relation between COVID‐19 antibody positivity and symptoms was assessed using generalised linear models with a binomial distribution adjusting for site and symptoms. Main outcome measures: COVID‐19 antibody status and symptoms of COVID‐19 among pregnant women. Results: Among 19 218 non‐vaccinated pregnant women who were evaluated, 14.1% of antibody‐positive women had one or more symptoms compared with 13.4% in antibody‐negative women. Overall, 85.3% of antibody‐positive women reported no COVID‐19 symptoms during the present pregnancy. Reported fever was significantly associated with antibody status (relative risk [RR] 1.10, 95% CI 1.03–11.18; P = 0.008). A multiple variable model adjusting for site and all eight symptoms during pregnancy showed similar results (RR 1.13, 95% CI 1.04–1.23; P = 0.012). None of the other symptoms was significantly related to antibody positivity. Conclusions: In a population‐based cohort in LMICs, unvaccinated pregnant women who were antibody‐positive had slightly more symptoms during their pregnancy and a small but significantly greater increase in fever. However, for prevalence studies, evaluating COVID‐19‐related symptoms does not appear to be useful in differentiating pregnant women who have had a COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Over 50% of pregnant women are anemic and the majority of these are iron deficient. Micronutrient deficiency, the symptom of heavy menstrual bleeding in nonpregnant individuals, and loss of blood associated with pregnancy and obstetric delivery contribute to iron deficiency (ID). Poor outcomes with low maternal iron can affect not only the pregnancy but can also have major bearings on the offspring. Correction of ID and iron deficiency anemia (IDA) in pregnant and prepregnant populations with single‐dose intravenous iron supplementation may offer improved outcomes. A harmonization process that incorporates all major randomized controlled trials studying the use of single‐dose IV iron compared with oral iron may suggest actions for changing the global trajectory of ID/IDA for women and girls of reproductive age. Synopsis: Emerging science proposing single‐dose intravenous iron supplementation may change the global trajectory of iron deficiency and iron deficiency anemia in women and girls of reproductive age. [ABSTRACT FROM AUTHOR]

Objectives This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India. Methods The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities. Results 17,754 Intervention births and 15,954 control births weighing [greater than or equal to]1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95 % CI 0.34-1.06, p = 0.076) as was the PMR (OR 0.74, 95 % CI 0.46-1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures. Conclusions for Practice The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery., Author(s): Shivaprasad S. Goudar [sup.1] , Richard J. Derman [sup.2] , Narayan V. Honnungar [sup.1] , Kamal P. Patil [sup.1] , Mallaiah K. Swamy [sup.1] , Janet Moore [sup.3] , [...]