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Aims/BackgroundDesign/MethodsResultsConclusionsPerinatal loss may cause intense distress even psychiatric issues, affecting the woman’s quality of life. Attachment may provide a useful perspective in understanding the outcomes of the mourning process. Thus, the objectives of the present study were to evaluate perinatal grief symptoms and the psychological and general quality of life among 137 Italian women (mean age 36,9. ± 6,88 years old) in relation to attachment, specifically measured through parental care and control.About 79.6% of the participants had miscarriages and 20.4% had stillbirths. About 45.3% were childless. The women completed the Parental Bonding Instrument, the Perinatal Grief Scale and the Psychosocial General Well-Being Index online most frequently between 3 and 6 months (56.2%) after the perinatal loss.All the study participants showed intense grief and severe grief reactions to loss. Moreover, women experiencing optimal bonding towards their own mothers had a more positive effect on perinatal grief and psychological and general quality of life.Attachment-based, tailored interventions for women who have experienced perinatal loss should improve their psychological and overall quality of life. [ABSTRACT FROM AUTHOR]

AbstractTrial RegistrationStillbirth and neonatal death are devastating pregnancy outcomes with enduring psychosocial and emotional effects on parents and families. Families need appropriate support, yet access to services is often limited. In a randomized controlled trial, we evaluated the efficacy and acceptability of a self-guided internet-based perinatal grief program, Living with Loss (LWL), to support coping and wellbeing among bereaved parents following perinatal death. Eligible parents, largely mothers, were recruited online and randomized to the intervention arm (n = 48) or a care-as-usual (CAU) control arm (n = 47). The LWL program comprised six internet-based modules completed over 8 weeks. The primary outcome was psychological distress; secondary outcomes were perinatal grief intensity, anxiety, depression, and program satisfaction and acceptability. The LWL program reduced psychological distress at post-program compared with CAU. The program had moderate adherence rates and high program satisfaction. There were no differences in the secondary outcomes, and the effect on psychological distress was not sustained at 3-month follow-up. This study provides preliminary evidence for the utility of an internet-based perinatal grief support program to reduce psychological distress in the shorter term among bereaved parents. Further research is needed to determine how psychological distress can be minimized in the longer term, and whether self-guided internet-based support is effective for bereaved fathers and extended family members. Further research is also needed to investigate the effectiveness of the program in real-world settings.Australian New Zealand Clinical Trials Registry, ACTRN12621000631808, registered prospectively on 27/05/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381231&isReview=true [ABSTRACT FROM AUTHOR]

In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death. [ABSTRACT FROM AUTHOR]

The term ‘disenfranchised grief’ is increasingly being used to designate grief experiences that are overlooked by wider society. In the French context, this term has overwhelmingly been applied to perinatal loss. Focusing on medical termination (IMG), a somewhat liminal category of perinatal loss, this article considers the doubly disenfranchised experience of paternal grief in such circumstances. While IMG-related grief is, in itself, disenfranchised, not least because it lacks societal recognition, paternal grief following IMG is doubly so, since the male voice is seldom heard. Taking as its focus Pater dolorosa (2019), author and journalist Jérémie Szpirglas’ narrative of medical termination, this article will consider the value of the term ‘disenfranchised grief’ in naming the experience of grief to which Szpirglas’ text attests; the capacity of the text to give voice to that experience and to offer a textual transposition of it; and the role of male grief writing following medical termination in beginning to carve out an alternative space for the sharing of a grief experience that defies established social norms. The article will therefore suggest, in line with Rita Felski’s argument, that ‘a literary text could know as much, or more, than a theory’, particularly when it comes to individual experiences of grief. [ABSTRACT FROM AUTHOR]

The use of alprazolam in pregnancy can adversely affect maternal and neonatal health. This study examined neonatal outcomes following exposure to alprazolam in pregnancy. Women prescribed alprazolam during pregnancy (n = 48) between 2014 and 2018 were identified from routinely-collected state administrative prescribing records and perinatal data. Two comparison groups of women; 1) prescribed alprazolam outside of pregnancy (n = 96) and 2) women never prescribed alprazolam (n = 96) were also identified. The health of women and their children was examined using administrative hospital, mortality and perinatal data and compared to the comparison groups using generalized linear models. Prenatal alprazolam exposure was not associated with a reduction in average birth weight or gestational age. However, neonates prenatally exposed to alprazolam were more likely be classified as having low birth weight for gestational age compared with alprazolam comparison group (OR: 4.46, 95% CI: 1.54–12.95) and the non-alprazolam comparison group (OR: 3.27, 95% CI: 1.22–8.79). There were no cases of perinatal mortality or floppy baby syndrome in alprazolam-exposed neonates. While the use of alprazolam during pregnancy was not associated with an increased risk of severe adverse neonatal outcomes (e.g. perinatal mortality), it was associated with neonates being born with a low birth weight for gestational age. [ABSTRACT FROM AUTHOR]

Background: The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. Objective: To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. Methods: From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n=160), liver disease (n=164), and AHP (n=650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. Results: The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100 µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p=0.03). Conclusions: If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100 µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered. [ABSTRACT FROM AUTHOR]

This paper explores the cultural conceptualisation of children's social identity and status through memorialisation, based on the study of children's grave markers and plots in five South Australian cemeteries (from colonisation to the present), with an age range from infant (including stillborn) to 20 years. The idea of childness, the differing conception of being or being labelled a child, was used as a measure to identify the degree of variation in child identity realised by child-only and family grave markers, showing both change and continuity in the representation of children through family choices of form, style, wording, motif, spatial arrangement and grave furniture. Archaeological evidence of childness was observed through representations of smallness, innocence, domesticity, play, temporality and the distinct emotional nature of the parent-child relationship. Notably in the latter period of study, within the context of lower child mortality, revised understandings of child identity and status were observed representing the social re-evaluation of prenatally deceased and stillborn children. [ABSTRACT FROM AUTHOR]

After experiencing my own miscarriage, I was told by a pro-life advocate that the miscarriage should be easy for me to "get over" because, as a pro-choice advocate, I didn't regard embryos or fetuses as persons. While such a comment can be attributed to ignorance, it is true that the pro-choice community in general has been reluctant to acknowledge grief after pregnancy loss, whether through miscarriage, stillbirth, or abortion. In this paper, I argue that it is imperative that abortion rights advocates acknowledge the ambivalence and grief that can follow abortions and that they help create feminist, women-centered ways of addressing and alleviating any negative post-abortion feelings. [ABSTRACT FROM AUTHOR]

Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women's psychological health in pregnancy subsequent to loss. This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy – and in grief. [ABSTRACT FROM AUTHOR]

This study addresses research gaps regarding the impact of professional bereavement photography for perinatal loss. Utilizing a mixed-methods research design, 504 parents completed an online survey measuring their attitudes toward bereavement photography and its impact. Thirty-one parents participated in semi-structured interviews. The results indicate a high level of acceptability and satisfaction for professional bereavement photography by parents (including those from more diverse backgrounds). Data triangulation confirmed that photos are valuable in enfranchising grief, validating parental and babies' identities and facilitating connections with others. Significant correlations were found for sharing of photos with both positive attitudes toward photography and for continuing bonds. The expression of continuing bonds in public social media spaces suggests increased social acceptance and validation for grieving perinatal losses. The findings from this study further inform practice guidelines for supporting perinatal loss. [ABSTRACT FROM AUTHOR]

Recent years have seen a shift in the number of bereavement studies examining daily grief processes, but our knowledge is still limited due to the lack of dyadic research. In this paper, we explored the change in mental health in the course of a seven-day dyadic diary with bereaved couples who lost their child during pregnancy, labor, or afterward. We conducted dyadic latent growth curve analyses. In the bereaved parents who experienced a pregnancy loss, we found reduced grief (for both partners) and anxiety symptoms (only for women) and no changes in depression symptoms or personal strength levels across the diary days. In the bereaved parents who lost their child during labor or afterward, both partners' grief and depression symptoms and women's anxiety symptoms stayed stable, men's anxiety symptoms decreased, but women experienced a decline in their personal strength. Overall, negative aspects of mental health showed no sign of a dyadic diary's harm to the bereaved parents and even pointed to increased mental health in some respects during the study. However, a feeling of reduced capacity to deal with difficulties during the diary was also observed in women. Our findings indicated that both negative and positive aspects of mental health should be considered to evaluate the impact of diary studies on the participants. [ABSTRACT FROM AUTHOR]

Perinatal death is a frequent event that affects one in five pregnancies in western countries. It disrupts parents’ different life spheres, including their work. Fathers, more specifically, usually return to work quickly after their loss. Given the significant psychological impacts of this traumatic experience, they are likely to engage in presenteeism, i.e. reporting to work while still mourning their loss and experiencing psychological distress. However, few studies have documented this phenomenon. To fill this gap, the present study seeks to understand the nature, underlying motivations and perceived repercussions of presenteeism in fathers returning to work following a perinatal death. Semi-structured interviews were conducted with 41 fathers who experienced an early or late perinatal death. Thematic analysis indicates that many fathers returned to work while still experiencing acute symptoms of psychological distress and thus engaged in presenteeism. For most fathers, presenteeism was involuntary and associated with working conditions beyond their control (e.g. workload, lack of paid leave). However, some participants returned to work out of intrinsic interest. Fathers perceived that their act of presenteeism affected them personally, as well as their organization, and their family (i.e. spouse, other children). [ABSTRACT FROM AUTHOR]

Perinatal loss is a traumatic and stressful experience with a significant emotional toll on the physical and psychological wellbeing of the healthcare professionals. We included 216 healthcare professionals working in an obstetrics-gynecology service or neonatal intensive care unit in a cross-sectional study and aimed to analyze the possible association between the healthcare professionals' level of professional quality of life, their coping with death competence, and their personal and work-related characteristics. Compassion fatigue and burnout did not correlate significantly with healthcare professionals' personal and work-related characteristics. Formal training was strongly associated with high levels of compassion satisfaction and coping with death competence. A low level of coping with death competence was found in women and in younger healthcare professionals, those who are single, and with little professional experience. Self-care activities and hospital support systems can be effective resources in coping with death. [ABSTRACT FROM AUTHOR]

Research into the use of bereavement photography is limited and the experiences of volunteer photographers remains understudied. For families with perinatal loss, bereavement photography allows for lasting mementos of a child and facilitates the maintenance of continuing bonds. This study investigated bereavement photographers' reasons for volunteering, factors predicting their compassion satisfaction, and the support and retention of volunteer photographers. Utilizing a mixed methods design, 141 Australian and New Zealand volunteer bereavement photographers completed the Volunteer Motivation Inventory. The strongest motivators for volunteering related to Values, Reciprocity and Recognition. The results concur with other research showing altruistic motivation has the greatest influence on becoming a volunteer in end of life services. Moderate to high levels of Compassion Satisfaction were found on the Professional Quality of Life Scale Version 5. Support from the volunteering organization and a higher number of photography sessions with families predicted higher Compassion Satisfaction. Additionally, 31 photographers participated in semi-structured interviews. Motivators for volunteering identified by the thematic analysis were: Giving Back, Being Appreciated, Healing Past Grief, and Satisfaction with the Organization. Overall, the findings suggested that providing sensitive supportive care, experiencing positive interactions with families, feeling supported, and having a sense of purpose led to higher levels of CS. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey. This was a cross-sectional study and included a total of 2025. Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection. In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001). The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country. [ABSTRACT FROM AUTHOR]

To explore associations between manifest anxiety (Taylor's Manifest Anxiety Scale, TMAS), major obstetric and demographic features and maternal-fetal attachment (MFA) (Maternal Antenatal Attachment Scale, MAAS) in women with previous miscarriages. One hundred pregnant women with previous miscarriages, having uncomplicated singleton pregnancy, not receiving any medications, and conceived in a natural manner. Ages ranged between 19 and 47 years, gestational age between 4 and 35 weeks. Hierarchical multiple linear regression, Kruskal–Wallis test, and ANCOVA were used in data analysis. Maternal age, gestational age, previous abortions, parity, maternal education, and marital status in combination contributed significantly to the regression model in prediction of the MAAS quality and intensity scores. Adding the TMAS score accounted for an additional 17% of variation in the MAAS quality score, and the change in R2 was significant. There was a negative relationship between the TMAS and the MAAS quality scores. The TMAS score did not contribute to prediction of the MAAS intensity. The highest TMAS values were in the women having anxious, ambivalent or affectless preoccupation. Prevention of negative consequences of poor quality of MFA in women with previous miscarriages should include early screening for manifest anxiety. [ABSTRACT FROM AUTHOR]

Associations between fear of childbirth (FOC), diagnosis and symptoms of adjustment disorder (AD), and dispositional optimism as a personal resource were compared between women who experienced miscarriage versus stillbirth (N = 204). Severity of AD symptoms was higher among the women following stillbirth Severity of FOC components did not differ between the two groups. No differences were found between the women who experienced miscarriage versus stillbirth in the associations between dispositional optimism and FOC or between dispositional optimism and AD. Healthcare providers should acknowledge that although types of reproductive losses may differ, FOC did not differ following both miscarriage and stillbirth. [ABSTRACT FROM AUTHOR]

Up to 39% of women who experience perinatal bereavement proceed to develop Post-Traumatic-Stress-Disorder (PTSD), with this large proportion meriting treatment. Before setting-up a treatment service for postnatal women who are experiencing psychological trauma, it is important to identify what therapies have been used in-the-past to address this problem. To scope for research that has implemented therapies to treat psychological trauma post perinatal bereavement, for potential inclusion in a flexible treatment package. A scoping review mapped coverage, range, and type of research that has reported on prior therapies used to treat psychological trauma post perinatal bereavement. Due to the dearth of papers that directly addressed perinatal bereavement, we widened the scope of the review to view what treatments had been used to treat psychological trauma post-childbirth. Out of 23 studies that report on effectiveness of therapies used to treat psychological trauma post-childbirth, only 4-focused upon treating PTSD post perinatal bereavement (3 effective/1 ineffective). Successful treatments were reported by Kersting et al. (2013), who found CBT effective at reducing PTSD symptoms post-miscarriage, termination for medical reasons, and stillbirth (n = 33 & n = 115), and Navidian et al. (2s017)) found that 4-sessions of grief-counselling reduced trauma symptoms post-stillbirth in (n = 50) women. One study by Huberty et al. (2020found on-line yoga to be ineffective at reducing PTSD symptoms post-stillbirth. A dearth of research has explored effectiveness of therapies for treating psychological trauma post perinatal bereavement and post-childbirth, with need to develop and test a research informed flexible counselling package. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly impacted the rituals and practices surrounding death, dying, and grief worldwide. This study examines how the pandemic has influenced grief and rituals of parents who have lost a child. Using an explanatory sequential research design, this mixed-methods study collected quantitative data through an online survey and qualitative data from in-depth interviews and open-ended survey questions. A total of 112 parents completed the survey, and eight parents participated in the in-depth interviews. The merged results demonstrated that the pandemic had a severe impact on all the rituals associated with the death of a child. However, most parents felt able to say goodbye to their child in the best possible way. The merged findings also show that most parents experienced a high level of grief after the death of their child, particularly mothers, whereby their grief was negatively impacted by pandemic restrictions and lack of social support. The viewing of the deceased child was associated with lower levels of grief, while upsetting viewings, establishing a digital memory page, not wanting a memorial, and conducting an alternative service were associated with higher levels of grief. Higher levels of grief, including unexpected death, female gender, lower educational attainment, and living in rural areas, were associated with higher levels of grief. Our findings highlight the need for follow-up care during and after a pandemic. [ABSTRACT FROM AUTHOR]

Pregnancy is an important period in a woman's life and the end of this exciting journey with loss causes deep sadness and grief in the mother. Culture is an important factor affecting the individual's reaction to loss. Many cultures are known to have certain rituals or traditions that provide support and reassurance during the grieving process. The aim of this study was to explore the perceptions of women who experienced pregnancy loss about their cultural beliefs and coping methods related to the mourning period. A qualitative design was used in the study with 21 women. Data were collected by conducting in-depth, semi-structured, face-to-face interviews using a pilot-tested interview guide. Three themes emerged from the qualitative data: (i) cultural reaction to prenatal loss; (ii) religious and spiritual practices; and (iii) coping strategies with prenatal loss. The identification of cultural factors in the bereavement process can guide researchers in the development of measurement tools related to the bereavement process, but more research is needed to reveal women's perspectives and more cultural practices. [ABSTRACT FROM AUTHOR]

We report the development and assessment of a novel coding framework in the context of research into neonatal end-of-life decision making conversations. Data comprised 27 formal conversations between doctors and parents of critically ill babies, recorded in two neonatal intensive care units. The coding framework was developed from a qualitative analysis of the recordings using the method of conversation analysis (CA). Codes underpinned by our qualitative analysis had in the main moderate to strong agreement (inter-rater reliability) between coders; three codes had lower agreement reflecting the use of euphemisms for death and disability. Coding these interactions confirmed the significance of the doctors' talk in terms of parental involvement in decision-making, whilst highlighting areas warranting further qualitative analysis. This quantifiable representation provides a novel outcome based on evidence that is internal to the conversation rather than influenced by other factors related to the baby's care or outcome. [ABSTRACT FROM AUTHOR]

Parents who have a baby receiving care in the Neonatal Intensive Care Unit (NICU) likely all experience emotional distress and are at elevated risk of experiencing trauma. The NICU environment is a potential source of traumatic stress for parents and often the risk for neonatal death is substantial. While the stressors facing parents are considerable, the effects can be minimized through implementation of trauma-informed care. The Family Guidance Tool was developed to help parents and healthcare professionals in a NICU setting utilize a strengths-based approach to create an atmosphere of mutual trust and understanding while encouraging the family to be the guide. This practical tool shows promise to mitigate stress often experienced by parents in a NICU setting. [ABSTRACT FROM AUTHOR]

Most of the research on human milk donations after prenatal loss has focused on donations to milk banks in which donors and recipients are anonymous to each other. In contrast, in this Israel-based study, we focus on an ongoing, direct interaction between a bereaved donor and recipients who adopted a new baby. We conducted a relational autoethnography, wherein multiple researchers present their life experiences and interpersonal contexts and meanings. We suggest that directed, interactional bereaved milk donation allows both parties to assign symbolic meanings to the milk, which may help their grieving process and can create relational healing. [ABSTRACT FROM AUTHOR]

We aim to understand parents' experiences and satisfaction with perinatal autopsy. Seventeen participants whose babies had an autopsy within the past 3 years completed the survey and seven were interviewed. A mixed methods design was used. "Looking for Answers" was the overall parent perspective of seeking autopsy. Two categories with themes were identified: (1) Experiencing Loss (themes: Personal stories and Emotional responses) and (2) Interacting with the Health Care System (themes: Care received, Communication and Autopsy process). Satisfaction scores with autopsy process were positive; however, participants' stories revealed fragmented care and healthcare communications that contributed to dissatisfaction, complicated grief, and trauma. [ABSTRACT FROM AUTHOR]

This article explores the contexts, processes and motivations behind the administration of sedatives (minor tranquilisers) in the time around perinatal loss. Using a mixed methods design, an online survey of 796 women and 13 narrative interviews were conducted. The participants had experienced a stillbirth or termination of pregnancy from 16 weeks or a neonatal death in Spanish hospitals. The quantitative (univariate and CHAID decision-tree) and qualitative (narrative-linguistic) analysis found that sedative administration was pervasive across care contexts and appears to be naturalised despite contradicting practice recommendations. Sedative administration was associated with emotional control and avoidance of loss, lack of accompaniment and on occasion with managing disruptive patients. Lack of informed consent was very common, with little explanation of side-effects prior to administration. In the participants' narratives, health professionals tended to construct sedatives as benign, but for some women the effects were counterproductive to loss and grief and related to persistent regrets about decisions. The study concludes that, in the context of perinatal loss, sedative administration was highly integrated into the fabric of medicalised care. As a socio-political and cultural practice underscored by gender-based care dynamics, there seems to be an imbalance between benefit and risk to women's welfare. [ABSTRACT FROM AUTHOR]

Introduction:Fusobacterium nucleatum is a gram-negative anaerobe, a constituent of the oral microflora, responsible for chronic periodontal diseases. Case Report: We describe a preterm infant with premature rupture of membranes at 23 weeks of gestational age due to F. nucleatum. The newborn died soon after birth. Placental histopathology showed severe necrotizing chorioamnionitis and funisitis with gram-negative bacilli. After autopsy, F. nucleatum was microbiologically isolated from the lung. The mother had dental hygiene 1 day before delivery, presenting mild and diffuse gingivitis. At admission, she had leukocytosis, foul-smelling vaginal discharge, but no fever. Conclusion: This case highlights the possibility of F. nucleatum spreading from oral cavity after a dental procedure to the placenta with chorioamnionitis and fetal infection. This raises the question of whether dental procedures during pregnancy should be accompanied by prophylactic antibiotics. [ABSTRACT FROM AUTHOR]

Helpful workplace support strategies and accommodations (WSSA) for bereaved parents returning to work was assessed via comprehensive search of databases from 1990 to January 21, 2022. Eleven of 45 qualitative articles met inclusion. Bereaved parents often felt returning to work provided a coping strategy for and/or distraction from grief; however, some received insensitive comments by employer/coworkers. Helpful WSSA included flexibility on date to return to work and schedule. In conclusion, due to the intensity of their grief, bereaved parents benefit from a workplace offering individualized time off for bereavement and workplace accommodations to address potential difficulty meeting prior productivity demands. [ABSTRACT FROM AUTHOR]

Bereavement photography has been recognized as an important tool to create memories and as a support service for parents experiencing perinatal loss. This paper explores the impact of volunteering on posttraumatic growth among photographers working with parents impacted by stillbirth. Using a mixed-methods design, 141 Australian and New Zealand volunteer bereavement photographers were recruited. Higher number of losses experienced by photographers were correlated with a higher level of posttraumatic growth. Volunteering was associated with an enhanced understanding of loss, increased empathy for bereaved parents, developing effective coping skills and a renewed appreciation of photography. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

One of the common undesirable outcomes of pregnancy is perinatal loss. Healthcare systems strive to reduce the incidence of perinatal loss but typically little attention is on the experiences of bereaved mothers following perinatal loss, particularly in low and middle-income countries where such deaths are common. This research explored the lived experiences of mothers with perinatal loss in the Kumasi metropolis, Ghana. A qualitative design was used to explore the experiences of nine (9) bereaved mothers from the Komfo Anokye Teaching Hospital's postnatal ward and the Mother and Baby Unit. Data were collected through face-to-face interviews using a semi-structured interview guide, audio-recorded, and thematically analyzed. One major finding was that mothers restricted mourning their dead babies based on fear of recurrent perinatal loss and traditional beliefs on delayed return to fertility. Mothers blamed healthcare providers for their loss due to their concerns about care received. Gaps in communication flow from healthcare professionals to bereaved mothers were commonly identified as mothers struggled to make meaning of their loss and coped with cultural restrictions and beliefs. Healthcare professionals must explore mothers' concerns and "gut-feelings," and pay attention to their communication needs following perinatal loss. [ABSTRACT FROM AUTHOR]

An editorial is presented on protecting the privacy of the bereaved parents. Topics include having the unique opportunity to collect data on the trajectory of families experiencing stillbirth, sometimes even before it occurs; and rendering their experience invisible and reinforcing the social taboo surrounding perinatal bereavement.

The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period. [ABSTRACT FROM AUTHOR]

As women's labor participation has increased, the fertility rate has decreased. However, there is little research addressing economic well-being among females and the effect of females' economic well-being on the fertility rate. Through this study, we examines the effects of females' economic well-being on fertility and differences in the association across ethnicity/race. The National Longitudinal Survey of Youth 1979 was used. 3734 females were selected for the final sample. The sample consists of 1834 non-Hispanic Whites, 1175 African Americans, and 725 Hispanics. Ordinary Linear Regression Analyses and Logistic Regression Analyses were conducted. There were ethnic/racial disparities in economic well-being amongst females. Poverty was positively associated with both having more children and higher numbers of miscarriages/stillbirths. Interaction effects were found: African Americans and Hispanics moderated the association between poverty and number of children. This research contributes to further understanding ethnic/racial disparities between females' economic well-being and fertility. [ABSTRACT FROM AUTHOR]

Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH. We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched. The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described. The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis. [ABSTRACT FROM AUTHOR]

Congenital pulmonary airway malformations (CPAMs) are rare sporadic lesions frequently associated with poor fetal prognosis. Type 3 CPAMs are characterized by small hyperechogenic cysts (<5 mm). Hydrops often develops secondarily, and the fetal survival rate is approximately 5% in this setting. We present a case of a large type 3 CPAM complicated by fetal hydrops. The lesion was detected at 19 gestational weeks (GW) and confirmed by fetal MRI at 29 GW. At 22 GW, a course of maternal steroids was given as a possible treatment of type 3 CPAM. Peritoneal-amniotic shunt was placed twice to reduce fetal ascites, with unsatisfactory results. Similarly, polyhydramnios was relieved by two amnioreductions, but redeveloped soon after. A baby girl was delivered spontaneously at 33 GW and received a two-stage partial lobectomy in the first three months of life. Desaturations necessitated challenging invasive oscillatory ventilation between stages. Her outcome is unexpectedly positive and she may expect a good quality of life. She now approaches one year of age, with near-to-normal growth and developmental milestones. Type 3 CPAMs complicated by fetal hydrops are associated with high perinatal mortality. While open fetal surgery remains a viable option in select specialist centers, antenatal interventions are typically ineffective. The survival of this infant can be attributed to prenatal management and early postnatal surgical intervention. The lack of guidelines for ventilation in this setting was a significant challenge for neonatal intensivists. Multidisciplinary vigilance and collaboration with frequent specialist follow ups were the key to success for both mother and child. [ABSTRACT FROM AUTHOR]

This meta-analysis aims to review the effect of serial transabdominal amnioinfusion (TAI) on short-term and long-term perinatal outcomes in mid-trimester preterm premature rupture of membranes (PPROM). Literature searches of PubMed, Web of Sciences, Scopus, and Cochrane Library were performed from their inception to April 2022. Studies comparing conventional treatment with serial TAI in women with proven PPROM at less than 26 + 0 weeks of gestation with oligohydramnios were included. Studies that included oligohydramnios due to other reasons such as fetal growth retardation or renal anomalies were excluded. Risk of bias in observational studies was assessed using the tool of the Cochrane Review group identified as risk of bias in non-randomized studies – of interventions. The risk of bias assessments for RCTs were performed according to the Cochrane risk-of-bias tool for randomized trials. An I2 score was used to assess the heterogeneity of included studies. The analyses were performed by using random-effect model, and the results were expressed as relative risk (RR) or mean difference with 95% confidence intervals (CIs). Overall, eight relevant studies including five observational studies (n = 252; 130 women allocated to the intervention) and three RCTs (n = 183; 93 women allocated to the intervention) were eligible. The pooled latency period was 21.9 days (95% CI, 13.1–30.8) and 5.8 days (95% CI, −11.6–23.2) longer in the TAI group in the observational studies and RCTs, respectively. The perinatal mortality rate reduced in the intervention group when tested in observational studies (RR 0.68; 95% CI, 0.51–0.92), but not in RCTs (RR 0.79; 95% CI, 0.56–1.13). The rate of long-term healthy survival was higher in the children whose mothers were treated with the TAI (35.7%) than those were treated with the standard management (28.6%) (RR 1.30, 95% CI 0.47–3.60, "best case scenario"). The efficacy of serial TA on early PPROM associated morbidity and mortality is not attested. Additional randomized control trials with adequate power are needed. [ABSTRACT FROM AUTHOR]

In a critical obstetric situation, the time interval between the decision of performing a caesarean section (CS) and delivery can influence maternal and newborn outcomes. In Somaliland, consent for surgical procedures, such as CS needs to be sought from family members. To determine the association between a delay in performing a CS and severe maternal and newborn outcomes in a national referral hospital in Somaliland. The type of barriers leading to delayed performance of CS after a doctor's decision were also explored. Women were followed from the time of decision to perform CS until discharge from the hospital between 15 April 2019 and 30 March 2020. No delay was defined as < 1 hour and delayed CS was defined as 1–3 hours and >3 hours from decision of CS to delivery. Information was collected on barriers leading to delayed CS and maternal and newborn outcomes. Data was analysed using binary and multivariate logistic regression. Overall, 1255 women were recruited from a larger cohort of 6658 women. A delay in CS >3 hours was associated with higher odds of severe maternal outcomes (aOR 1.58, 95% CI [1.13–2.21]). On the contrary, delay in performing a CS >3 hours was associated with lower odds of stillbirth (aOR 0.48, 95% CI [0.32–0.71]) compared to women without delay. Further, family decision-making for consent was the most important barrier leading to delays of >3 hours as compared to financial factors and barriers related to healthcare providers (48% vs 26% and 15%, respectively, p < 0.001). In this setting, delay in performing CS >3 hours was associated with higher risk of severe maternal outcomes. A standardised system of performing a CS by primarily addressing the barriers associated with family decision-making, financial aspects and healthcare providers is needed. [ABSTRACT FROM AUTHOR]

There are a variety of constraints to accessing social support following pregnancy loss that can negatively impact women. Being able to seek and receive needed social support following pregnancy loss may be further complicated by the ongoing COVID-19 pandemic. The current study explored the experiences and impact of the COVID-19 pandemic on women who have experienced miscarriage or stillbirth. Results showed that the pandemic exacerbated women's feelings of grief, trauma, depression and anxiety. These findings indicate that addressing the mental health needs of women who have experienced pregnancy loss during the pandemic should be evaluated and addressed. [ABSTRACT FROM AUTHOR]

Women's choice of birth following a cesarean delivery either includes a trial of elective repeat cesarean section (ERCS) or a trial of labor after cesarean (TOLAC). No comprehensive overview or systematic summary is currently available. EMBASE, PubMed, and the Cochrane Library databases were searched from inception to 1 February 2020. Studies reporting the safety of TOLAC and ERCS in pregnant women with prior cesarean delivery were included. Statistical analysis was performed using RevMan 5.3 and Stata 15.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were adopted as the effective measures. A total of 13 studies covering 676,532 cases were included in this meta-analysis. The results demonstrated that the rates of uterine rupture (OR = 3.35, 95%CI [1.57, 7.15], I2 = 81%), neonatal asphyxia (OR = 2.32, 95%CI [1.76, 3.08], I2 = 0%) and perinatal death (OR = 1.71, 95%CI [1.29, 2.25], I2 = 0%) were higher in the TOLAC group compared with the ERCS group. The rates of peripartum hysterectomy (OR = 0.70, 95%CI [0.44, 1.11], I2 = 62%), blood transfusion (OR = 1.24, 95%CI [0.72, 2.12], I2 = 95%), and puerperal infection (OR = 1.11, 95%CI [0.77, 1.60], I2 = 95%) showed no significant differences between the two groups. TOLAC is associated with a higher risk of uterine rupture, neonatal asphyxia, and perinatal death compared with ERCS. Nevertheless, it should be noted that the risks of all complications were small in both groups. This information is important for healthcare providers and women choosing the delivery type. [ABSTRACT FROM AUTHOR]

Aim: The early detection of small-for-gestational age (SGA) fetuses and newborns is pivotal in the prevention of perinatal mortality. Objectives: To compare the predictive capability of performing ultrasound-based estimated fetal weight (EFW) at 32 versus 36 weeks’ gestation on the detection rate of SGA fetuses and SGA newborns at delivery, and to find a better cutoff level to consider a fetus at risk of being born small. Material and methods: Nine hundred fifteen low-risk pregnant women were assessed at both 32 and 36 weeks’ gestation. EFW centile was calculated in both occasions. The rate of SGA fetuses was compared. SGA fetuses were considered when both abdominal circumference (AC) and EFW were below the 10th centile from a total of 488 delivered at our Hospital. Paired comparisons between ultrasound at 32 and 36 weeks’ gestation were done to predict SGA at delivery. Percentages of SGA fetuses were compared by chi-squared test. ANOVA test was used for comparing centiles among groups. Receiver operating characteristic (ROC) curve was used to find the best cutoff ultrasound centile to predict SGA at delivery. Statistical significance was previously set at 95% level (p < .05). Results: Ultrasound-based EFW at 32 weeks showed 23 cases of SGA (2.5%) while at 36 weeks this rate increased up to 4% (37/915) (p < .000001). When comparing both outcomes, 2.8% of those catalogued as adequate-for-gestational age (AGA) at 32 weeks were cases of SGA at 36 weeks. In addition, 47.8% of those diagnosed as SGA were not confirmed at 36 weeks. Only 12.3% of SGA neonates were identified at 32 weeks’ gestation ultrasound, while using the 36 weeks’ gestation approach this rate increased up to 30.9%. So, only a low proportion of SGA neonates were SGA fetuses at any of these two gestational ages. However, the area under the curve (AUC) at 36 weeks was as high as 0.86. Being a matter of cutoff rather than a matter of choosing the correct variable, ROC analysis showed that the best cutoff for prediction having the best sensitivity (0.80) with the best specificity (0.77) was 28th centile of EFW. This represents 24.9% of the studied women (228/915). Conclusions: In general, ultrasound at 36 weeks has better performance detecting SGA fetuses than ultrasound at 32 weeks and we suggest to definitively change from 32 to 36 weeks in order to increase the detection rate of SGA fetuses. Moreover, in order to detect those fetuses who will grow below the lower level of the normal range in the last month of pregnancy, we suggest that those with EFW below the 28th centile at 36 weeks should be rescanned later in pregnancy to identify prenatally as many cases as we can of SGA newborns. [ABSTRACT FROM AUTHOR]

Introduction: Issues of disposal of fetal remains and related parental distress do not concern only the present. This contribution aims at offering a glimpse of what grieving management concerning perinatal death must have been in ancient times. The discussion of the topic of death and treatment of perinatal remains is based on historical, anthropological, and bioethical reasoning, in a dialogue that contributes to the current debate on fetal personhood. Methods: We have considered written and archaeological sources to investigate the response of past societies to perinatal death, in parallel with today’s bioethical and legislative issues on fetal identity. Results: From historical evidence and archaeological findings, it emerges that lay community compassion and mercy often far exceeded the Church’s norms, which for centuries have denied the burial of fetuses and stillborn infants in consecrated cemeteries. Over the centuries, the practices implemented by people have led to a theoretical reflection on the dignity to be recognized to infants. Conclusions: This contribution highlighted how issues about the treatment and burial of infants have interrogated women and men over the centuries. In the past, the development of rituals, even far from ecclesiastical norms, allowed people to endure mourning for the death of their children. Recent legislative initiatives by some States on the burial of embryos and fetuses within cemeteries have reopened the long-standing debate on the value to be attributed to the life of the fetus. The challenge of reaching an agreement on ethically controversial questions gives vigor to the research for strategies capable of settling different needs: the respect for the choice of women, the need to identify forms of protection of human life after death, the development by the community of rites capable of welcoming and accompanying parental mourning. [ABSTRACT FROM AUTHOR]

Objective To determine the principal prognostic factors and neonatal outcomes associated with perinatal death in cases of early-onset intrauterine growth restriction (IUGR) due to placental insufficiency and to define the cutoff point for the risk of perinatal death. Methods A retrospective cohort study conducted with 198 pregnant women with a diagnosis of early-onset IUGR (as detected before the 32nd week of gestational age). The association between the dependent variable (perinatal death) and the independent variables was investigated using a multivariate logistic regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine the sensitivity and specificity of the adjusted model. A significance level of 5% was established for the entire statistical analysis. Results Perinatal deaths occurred in 89 (44.9%) of the 198 fetuses with early-onset IUGR. Birthweight <800 grams (OR: 14.73; 95%CI: 4.13–52.54; p < .001), postnatal need for mechanical ventilation (OR: 24.56; 95%CI: 5.58–108.08; p < .001) and postnatal use of an oxygen hood (OR: 0.09; 95%CI: 0.02–0.39; p = .001) remained significantly associated with neonatal death in the multivariate model. The sensitivity, specificity, positive and negative predictive values for birthweight <800 grams and need for mechanical ventilation as predictors of death were, respectively, 84%, 91%, 88%, 88% and 93%, 71%, 60% and 96%, while the values for use of an oxygen hood were, respectively, 15%, 62%, 15% and 62%. Conclusion The principal determinants of perinatal death in fetuses with early-onset IUGR were birthweight <800 grams, gestational age at delivery <30 weeks and postnatal need for mechanical ventilation as risk factors while postnatal use of an oxygen hood was found to constitute a protective factor. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence and perinatal outcomes of COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts of Russian Federation over 10 months of a pandemic. Materials and methods: This was secondary analysis of Public Data basis on 25 Dec 2020. Statistics included descriptive statistics, analysis of contingency tables, which assessed the value of x², the achieved significance level (p). Results: During the first year of the SARS-CoV-2 pandemic, 8485 cases of COVID-19 were registered in pregnant women in the Far Eastern Federal District and the Siberian Federal District, accounting for 5.9% of registered pregnant women and 1.71% of the total affected population. The morbidity rate in pregnant women was 3.02 times higher than in the general population: 5933.2 vs 1960.8 per 100 thousand population. 27.4% of mothers had asymptomatic disease; 52.7% – mild; 16.6% – moderate, 2.5% – severe, 0.5% – critical disease. The incidence of hospitalization in ICU of pregnant women was higher relative to the general population (3.57% vs 2.24%, p < .001), but the frequency of mechanical ventilation was lower (0.48% vs 1.05%, p < .001). Preterm delivery had 18.3% (p < .001 CS - 42.0%. The mortality rate in pregnant women was 0.14% vs 1.95% – in the general population (p < .001). Perinatal mortality was 37 cases (1.56%), of which there were 31 stillbirths (1.26%), and 6 (0.25%) cases of early neonatal mortality. 148 (6.2%) COVID-19(þ) newborns were identified, despite anti-epidemic measures. Conclusion: The incidence of COVID-19 in pregnant women in Siberia and the Far East is higher than in the general population, but the disease is characterized by a milder. Women with COVID-19 have a high rate of preterm birth and CS. 148 (6.2%) newborns isolated COVID-19. [ABSTRACT FROM AUTHOR]

Objective and methods: We conducted a prospective observational cohort study in 458 pregnant and puerperal women, with confirmed COVID-19 at Hospital San Jose, Santiago, Chile, to determine the impact of COVID-19 on pregnancy and confirm safety and feasibility of a management protocol based on clinical presentation of the disease. Results: 25.5% (117/458) of women were severe and 74.4% (341/458) mild presentation. Three percent (9/341) of mild presentations required a subsequent hospitalization. Overall, 26/458 women (5.6%) were admitted to ICU, and 13/458 (2.8%) required mechanical ventilation. One maternal death occurred at 49-days postpartum. Severe presentation, infection above 24 weeks, and comorbidities were associated with an adverse maternal outcome. Of total deliveries, 16.5% (36/217) were <37 weeks. Perinatal mortality was 6/226 (2.7%), mostly due to the fetal component. Conclusions: A quarter of the women had severe COVID-19 that, combined with occurrence of disease in the second half of pregnancy, resulted in substantial maternal compromise. Perinatal morbidity and mortality in women with severe disease were high and warrant consideration. Outpatient management was safe for mild cases. [ABSTRACT FROM AUTHOR]

Objective To compare Doppler alterations and perinatal outcomes in pregnant women who evolved with early- and late-onset fetal growth restriction (FGR). Methods A retrospective, observational cohort study with pregnant women who evolved with FGR treated between January 2018 and April 2019, in which all live births from singleton pregnancies, over 24 weeks, with FGR ultrasound diagnosis and under 2700 g weight were included in the study. Results Pregnancies with early-onset FGR were more associated with hypertensive disorders (p = .00) and placental vascular insufficiency, resulting in a high degree of umbilical artery Doppler involvement (p = .00) in a short period of pregnancy and higher rates of adverse perinatal outcomes (p = .00). The time of prenatal follow-up of early- and late-onset FGR cases was similar, but the degree of prematurity of the former made the evolution more unfavorable. Conclusion Early-onset FGR had a lower prevalence but was associated with higher maternal and fetal morbidity and mortality than late-onset FGR. [ABSTRACT FROM AUTHOR]

Objective Existing guidelines and studies on the benefits of cerclage in twin pregnancies with a dilated cervix have low reliability and inconsistent conclusions. New randomized control trials and cohort studies focusing on twin pregnancies with cervical insufficiency were published recently. Therefore, this meta-analysis aimed to compare outcomes of cerclage placement and expectant treatment in twin pregnancies with a dilated cervix using recent data. Methods We screened the PubMed, Web of Science, ClinicalTrials.gov, and Cochrane Library databases to identify randomized controlled trials and cohort studies comparing maternal and perinatal outcomes of twin pregnancies with cervical dilation, with and without cerclage placement, published until December 2020. Estimates were pooled using random-effects or fixed-effect models depending on the heterogeneity. Mean difference, 95% confidence interval, and relative risk were used to compare the outcomes. The risk of bias was assessed using the Cochrane Handbook and the Newcastle-Ottawa Scale. The meta-analyses followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews of observational studies. Results Five studies, comprising 275 twin pregnancies, met the inclusion criteria; of those, 167 underwent cerclage and 108 were expectantly managed. Cerclage placement significantly prolonged the interval from the time of diagnosis to delivery and reduced the incidence of preterm delivery, perinatal death, and complications. The fetal outcomes improved significantly in cases managed with cerclage. Conclusion Therefore, emergent cerclage is a potential option for managing twin pregnancies with cervical dilation of at least 1 cm. [ABSTRACT FROM AUTHOR]

Objective The objective of this article was to evaluate the outcome of transabdominal amnioinfusion in pregnant patients with oligohydramnios. Method This is a prospective observational study involving 80 cases of oligohydramnios treated with transabdominal amnioinfusion guided by ultrasound, in the period between 2011 and 2016. The patients were treated in two centers; however, all the procedures were performed by the same operator. Results The mean gestational age at the first treatment was 24 weeks. Some patients received more than one amnioinfusion. The mean interval between the first infusion and delivery was 31 d. Perinatal and neonatal mortalities were 45% and 35%, respectively. There were five cases of chorioamnioitis and in majority of the cases; the final diagnosis was made after amnioinfusion. Conclusion The procedure has been proven to be very safe. The result showed a high perinatal mortality which was not surprising, as these pregnancies were complicated by a major fetal malformation. Significantly, this study showed that the diagnosis accuracy of the concomitant congenital fetal malformation was significantly improved. The diagnosis accuracy had a major impact on the management of patients, especially the mode of delivery. [ABSTRACT FROM AUTHOR]

Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women's experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.Results: All women expressed a heightened "awareness of risk". Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a "quiet, unspoken subject" causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them "expecting the worst and hoping for the best" in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.Conclusion: Women's experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether a diagnosis of a perinatal mood and anxiety disorder (PMAD) is associated with adverse perinatal outcomes.Methods: Mental health symptom screening and diagnostic data from 82 women with single gestation in the Healthy Babies Before Birth study conducted from 2013 to 2018 were obtained by clinic interview. If a woman scored over 10 on the Patient Health Questionnaire (PHQ-9) or endorsed the suicidality item; or scored over 7 on the Overall Anxiety Severity and Impairment Scale (OASIS), a Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders was administered. An adverse perinatal outcome was operationalized as a diagnosis of gestational diabetes mellitus, intrauterine growth restriction, preeclampsia, chorioamnionitis, hemorrhage, fetal death, preterm birth, or a low birthweight baby, and abstracted from the medical records.Results: Women were between 22.0 and 45.0 years old (Mean age = 33.1 ± 4.3). Mean BMI was 24.7 ± 5.6 (Range 16.8 to 47.1). Nineteen percent (16) of the 82 women had a SCID diagnosis of a PMAD. Thirty-seven percent (30) had a diagnosed adverse perinatal outcome. Multiple logistic regression was conducted with these predictors: SCID diagnosis of a PMAD, maternal age, BMI. All predictors were significant with respective odds ratios as follows: OR = 3.58, 95% CI 1.03-12.44, p = .045; OR = 2.30, 95% CI 1.21-4.38, p = .011; OR = 1.69, 95% CI 1.06-2.69, p = .027.Conclusions: A PMAD diagnosis was associated with 3.5 times higher odds of having an adverse perinatal outcome. For every 5 years a woman aged or every five units her BMI increased her odds of having an adverse perinatal outcome increased. Older age and increased BMI are well established adverse perinatal outcome risk factors. These results suggest that mental illness risk should also be consistently assessed in obstetric settings. [ABSTRACT FROM AUTHOR]

Asthma during pregnancy and extremes of body mass index (BMI) are independently associated with adverse pregnancy outcomes but the impact of the two conditions combined are currently unknown. The aim of this study was to determine the contribution of maternal BMI to adverse birth outcomes in pregnancies complicated by asthma. The study utilized the routinely collected perinatal data on births at the Mater Mother's Hospital Brisbane, Australia, from January 2008 to December 2019. BMI was grouped as underweight (<18.5), normal weight (18.5-<24.99), overweight (25-29.99), and obese (≥30) and the population split by the presence and absence of maternal asthma. The comparison group was normal BMI, non-asthmatic pregnant women. A modified Poisson regression with robust variance was used to estimate the relative risk. In a retrospective cohort study of 110,057 pregnant women, 17.08% of women had asthma. Asthma and BMI were associated with an increased risk of poor fetal and neonatal outcomes. Asthma significantly increased the risk of stillbirth in underweight [adjusted RR: 2.22 (95% CI: 1.25-3.94] and obese [1.74 (1.11-2.71)]; neonatal death in underweight [3.41 (1.89-6.16)] and obese [2.22 (1.37-3.59)] and perinatal death in underweight [2.34 (1.50-3.66)] and obese [1.92 (1.38-2.67)] women. Admission to the neonatal intensive care unit was increased in neonates of underweight [1.65 (1.44-1.89)] and obese [1.26 (1.14-1.40)] asthmatic women. Extremes of BMI, specifically underweight and obesity, increased the risk of adverse perinatal outcomes among asthmatic women highlighting the importance of accounting for BMI during pre-conception and pregnancy related management of asthmatic women. [ABSTRACT FROM AUTHOR]

Growing evidence indicates that a suboptimal intrauterine environment confers risk for schizophrenia. The developmental model of schizophrenia posits that aberrant brain growth during early brain development and adolescence may interact to contribute to this psychiatric disease in adulthood. Although a variety of factors may perturb the environment of the developing fetus and predispose for schizophrenia later, a common mechanism has yet to be elucidated. Micronutrient deficiencies during the perinatal period are known to induce potent effects on brain development by altering neurodevelopmental processes. Iron is an important candidate nutrient to consider because of its role in energy metabolism, monoamine synthesis, synaptogenesis, myelination, and the high prevalence of iron deficiency (ID) in the mother-infant dyad. Understanding the current state of science regarding perinatal ID as an early risk factor for schizophrenia is imperative to inform empirical work investigating the etiology of schizophrenia and develop prevention and intervention programs. In this narrative review, we focus on perinatal ID as a common mechanism underlying the fetal programming of schizophrenia. First, we review the neural aberrations associated with perinatal ID that indicate risk for schizophrenia in adulthood, including disruptions in dopaminergic neurotransmission, hippocampal-dependent learning and memory, and sensorimotor gating. Second, we review the pathophysiology of perinatal ID as a function of maternal ID during pregnancy and use epidemiological and cohort studies to link perinatal ID with risk of schizophrenia. Finally, we review potential confounding phenotypes, including nonanemic causes of perinatal brain ID and future risk of schizophrenia. [ABSTRACT FROM AUTHOR]