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Objective: The study aims to examine maternal care among Hispanic birthing people by primary language and state policy environment. Data Sources and Study Setting: Pooled data from 2016 to 2020 Pregnancy Risk Assessment Monitoring System surveys from 44 states and two jurisdictions. Study Design: Using multivariable logistic regression, we calculated adjusted predicted probabilities of maternal care utilization (visit attendance, timeliness, adequacy) and quality (receipt of guideline‐recommended care components). We examined outcomes by primary language (Spanish, English) and two binary measures of state policy environment: (1) expanded Medicaid eligibility to those <133% Federal Poverty Level, (2) waived five‐year waiting period for pregnant immigrants to access Medicaid. Data Collection/Extraction Methods: Survey responses from 35,779 postpartum individuals with self‐reported Hispanic ethnicity who gave birth during 2016–2020. Principal Findings: Compared to English‐speaking Hispanic people, Spanish‐speaking individuals reported lower preconception care attendance and worse timeliness and adequacy of prenatal care. In states without Medicaid expansion and immigrant Medicaid coverage, Hispanic birthing people had, respectively, 2.3 (95% CI:0.6, 3.9) and 3.1 (95% CI:1.6, 4.6) percentage‐point lower postpartum care attendance and 4.2 (95% CI:2.1, 6.3) and 9.2 (95% CI:7.2, 11.2) percentage‐point lower prenatal care quality than people in states with these policies. In states with these policies, Spanish‐speaking Hispanic people had 3.3 (95% CI:1.3, 5.4) and 3.0 (95% CI:0.9, 5.1) percentage‐point lower prenatal care adequacy, but 1.3 (95% CI:−1.1, 3.6) and 2.7 (95% CI:0.2, 5.1) percentage‐point higher postpartum care quality than English‐speaking Hispanic people. In states without these policies, those same comparisons were 7.3 (95% CI:3.8, 10.8) and 7.9 (95% CI:4.6, 11.1) percentage‐points lower and 9.6 (95% CI:5.5, 13.7) and 5.3 (95% CI:1.8, 8.9) percentage‐points higher. Conclusions: Perinatal care utilization and quality vary among Hispanic birthing people by primary language and state policy environment. States with Medicaid expansion and immigrant Medicaid coverage had greater equity between Spanish‐speaking and English‐speaking Hispanic people in adequate prenatal care and postpartum care quality among those who gave birth. [ABSTRACT FROM AUTHOR]

Background: Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision‐making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital‐based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. Methods: Qualitative semi‐structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision‐makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. Results: Women expect to be included in decisions about their care. Health service administrators and decision‐makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision‐making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. Conclusion: This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient–clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational‐ and system‐wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations. [ABSTRACT FROM AUTHOR]

Background: Implementation of shared decision‐making in antenatal care has had limited exploration. Objective: To assess what is known about shared decision‐making in antenatal care. Search Strategy: Five databases were searched (1997–2022) limited to English language studies from OECD countries. Data Collection and Analysis: A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. Main Results: Four areas of decision‐making were identified with six themes revealing enablers and barriers to shared decision‐making in antenatal care. Conclusion: Implementation of shared decision‐making requires continuity, time and personalisation of care. [ABSTRACT FROM AUTHOR]

Objective: To describe changes in attitudes and expectations of labor over the previous six decades, comparing the Iraqi generation who labored at home without medical assistance with their descendants. Study Design: We used semi‐structured telephone interviews with 22 women across three generations of one extended family living and giving birth in Iraq between the 1950s and the 2010s. Qualitative data were analyzed thematically using open, axial, and selective coding. Results: Each generation experienced a paradigm shift in childbirth, from exclusive home births to hospital‐directed maternity care, to a trend that favors planned cesarean birth, driven by generation‐specific changes in outlook. Emerging themes included social influences, changing technology, and medical professionals' recommendations; all of these affected attitudes toward childbirth and pregnancy. There were generational disconnects in perceptions concerning the reasons childbirth has changed over the past 60 years, with the youngest generation citing wider pressures regarding body image and marital relationships as two of the factors affecting preferences in childbirth options. Conclusions: Societal changes and availability of healthcare services affect women's choices and experiences of childbirth. To be successful, efforts to improve women's experiences in labor, as well as maternal and neonatal outcomes, must consider these wider sociocultural issues. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion 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.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.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.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. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. Design: Retrospective observational study. Setting: A total of 54 referral‐level hospitals across the six geopolitical regions of Nigeria. Population: Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. Methods: Secondary analysis of routine maternity care data sets. Random‐effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. Main outcome measures: Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. Results: Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. Conclusions: Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. Methods: We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. Results: Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non‐Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non‐Korean women, highlighting the effects of the COVID‐19 pandemic. Conclusion: Antenatal care inequalities are evident in South Korea's well‐resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services. Synopsis: Despite South Korea's well‐equipped health system, significant antenatal care inequalities exist, necessitating further exploration and qualitative analysis of maternity care gaps. [ABSTRACT FROM AUTHOR]

It is estimated that over 1 billion people worldwide have a disability. In Australia, 9% of women of childbearing age have a disability, but data on disability status for women accessing maternity services are not routinely collected and data collection processes are inconsistent. Maternal disability may affect perinatal outcomes, but to understand what factors might be amenable to interventions to improve outcomes, accurate data collection on disability status is essential. This opinion piece reflects on disability identification within maternity services in Australia, identifying areas for policy and practice change. [ABSTRACT FROM AUTHOR]

Background: Recent years have brought substantial declines in geographic access to abortion facilities and maternity care across the US. The purpose of this study was to identify the reproductive health consequences of living in a county without access to comprehensive reproductive health care services. Methods: We analyzed National Center for Health Statistics data on all live births occurring in the US in 2020. We used data on locations of abortion facilities and availability of maternity care in order to classify counties by level of access to comprehensive reproductive health care services and defined comprehensive reproductive health care deserts as counties that did not have an abortion facility in the county or in any neighboring county and did not have any maternity care practitioners. We fit modified Poisson regression models with generalized estimating equations to estimate the degree to which living in a comprehensive reproductive health care desert was associated with receipt of timely and adequate prenatal care and risk of preterm birth, controlling for individual‐level and county‐level characteristics. Results: In 2020, one third of counties in the US were comprehensive reproductive health care deserts (n = 1082), and 136,272 births occurred in these counties. In adjusted models, there was no difference in prenatal health care use (timeliness or adequacy of care) between persons in comprehensive reproductive health care deserts and those with full access to care, but the risk of preterm birth was significantly elevated (aRR =1.09, 95% CI = 1.06, 1.13). Conclusions: Lack of access to comprehensive reproductive health care services may increase the incidence of preterm birth. [ABSTRACT FROM AUTHOR]

Background: The high maternal and neonatal mortality rate in sub‐Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. Methods: A quasi‐experimental design was used to test a midwife‐delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Results: Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p‐value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p‐value = 0.03). Conclusions: The results of this study indicate that it is feasible to deliver phone‐based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia (PE) is a major maternal and fetal threat. Previous risk‐scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first‐trimester PE screening model using Bayes' theorem. PE Prediction Model: FMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk. Low‐Dose Aspirin Prevention: Low‐dose aspirin is one of the potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti‐inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported. PE Prevention in Practice: Clinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications. Advancements and Prospects: Emerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction. In conclusion, integrating FMF's first‐trimester PE screening with low‐dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts. [ABSTRACT FROM AUTHOR]

This article discusses the implementation of a Plan-Do-Study-Act (PDSA) intervention to improve the practice of birth companionship at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. The study found that the introduction of the PDSA intervention significantly increased the practice of birth companionship, with the percentage of mothers utilizing the service rising from less than 2% to 94.7%. The findings suggest that a stepwise PDSA intervention can effectively improve the practice of birth companionship and contribute to the realization of effective implementation of birth companions for all mothers during labor and delivery. [Extracted from the article]

Aim: To clarify the factor structure of "expectant mothers of concern" for whom midwives anticipate difficulties in future childrearing. Methods: The participants were 2633 midwives working at hospitals and clinics in Japan. Data were collected using a 108‐item, five‐point Likert scale questionnaire about the behaviors, appearance, and family relationships of the expectant mothers of concern to the nurses. Items with a mean equal to or greater than 4.0 were selected as items considered relevant to expectant mothers of concern by midwives. Exploratory factor analysis, confirmatory factor analysis, and further secondary factor analysis were conducted. Results: The factor structure of the expectant mothers of concern as perceived by midwives comprised seven factors, including 23 items: "Suspected of being a victim of intimate partner violence," "Uneasy feeling about the expectant mother's marital relationship," "Perception that the expectant mother is conflicted about her pregnancy," "Uneasy feeling about the expectant mother's actions/behaviors concerning her medical checkups," "Engages in physically risky actions and behaviors," "Does not appear to be able to build relationships with children," and "Makes remarks that indicate possible bonding disorder" (goodness‐of‐fit index = 0.910, adjusted goodness‐of‐fit index = 0.879, comparative fit index = 0.939, and root mean square error of approximation = 0.070). Further, a secondary factor, "Expectant mothers who must urgently be connected to support," was extracted. Conclusions: The elucidation of the factor structure of the expectant mothers of concern could help midwives identify expectant mothers who may face difficulties in future childrearing. [ABSTRACT FROM AUTHOR]

A study published in the journal Paediatric & Perinatal Epidemiology reveals that one in four women enter pregnancy with a pre-existing condition. The study, conducted in British Columbia, Canada, over a 20-year period, found that the most common pre-existing conditions were depressive disorders, anxiety disorders, bipolar disorder, chronic hypertension, and diabetes mellitus. The prevalence of psychiatric disorders, particularly in women born after 1985, has been increasing. The study highlights the need for robust preconception care strategies and multidisciplinary, patient-centered care approaches to improve outcomes for pregnant women with pre-existing conditions. [Extracted from the article]

Prenatal care and infant mortality rates are crucial indicators of healthcare quality. However, millions of women in low‐income countries lack access to adequate care. Factors such as high‐risk pregnancies and unmanaged diet increase the risk of developing complications during pregnancy, highlighting the need for continuous monitoring of maternal health. The increasing burden of non‐communicable diseases represents a significant threat to fragile health systems. The lack of access to appropriate prenatal care and poor maternal and newborn health outcomes are major concerns in low‐ and middle‐income countries (LMICs). It emphasizes the need for innovative, integrative approaches to healthcare delivery, especially in pregnant women. The health services need to be reorganized holistically and effectively, focusing on factors that directly impact maternal, neonatal, and infant mortality, resulting in improved access to maternity services and survival of "at‐risk" mothers and their offspring in many LMICs. Based on the FIGO (the International Federation of Gynecology & Obstetrics) recommendations of extending preconception care to the postpartum stage, the authors of this review have developed a new model of care—PregCare—based on the triple‐intervention‐based holistic and multidisciplinary maternal and fetal medicine model for low‐risk pregnancies. This model will help transform the traditional model's high visitation frequency into a safe and reduced office visit, while increasing virtual connections, point of care and self‐care with doctors, nurses, and community‐based providers of self‐care. This shall be based on a sophisticated central PregCare call center powered by innovative technologies combined with experienced personnel in perinatal management (doctors and nurses/midwives). Digital technologies have revolutionized healthcare delivery, expanded treatment options, and improved precision in targeting specific conditions and patient types. In the realm of maternal health, there is a growing recognition of the need for a comprehensive approach encompassing prenatal care, long‐term health care, and integration with existing health programs and services. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth. Design: This was a qualitative descriptive study utilizing semi‐structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor. Setting and Participants: Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed. Twelve birth center midwives participated. Findings Six themes emerged: the birth center physical space and organization of care, dimensions of midwifery care within the birth center, continuity of care and seamless service, the empowered birthing person, physiologic birth as normative, and the hospital paradigm and US cultures of birth. Key Conclusions: We identified significant components of birth center models of prenatal care that midwives believe enhance birthing people's confidence for physiologic childbirth. These components may be considered for application to other settings and may improve perinatal care and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The authors aimed to assess the characteristics and integration of immunization services into the prenatal care provided by maternity care units (MCUs) in Italy. Methods: A cross‐sectional nationwide study using a web‐based survey was conducted from June to August 2021. The study population consisted of 342 obstetricians/gynecologists (OB/GYNs), members of the Italian Society of Gynecology and Obstetrics, and heads of MCUs. The main outcome was to assess the performance of several vaccine‐related services among the surveyed MCUs. Results: Overall, 112 of 342 MCUs completed the survey, for an overall response rate of 32.7%. Almost all MCUs (96.4%) provided vaccine information, but only 22% had an onsite vaccination clinic. Less than half (43.8%) offered vaccines during prenatal visits and 75% of those sites required women to set up an extra appointment for vaccination. Although 68% MCUs recorded vaccines administered, only 20% of them managed to record vaccines in their own medical records. The institutional‐logistic issues were the most voted vaccination barrier (40.2%). Conclusions: Institutional barriers and lack of certain vaccine‐related services offered during prenatal care in Italian MCUs might be responsible for many missed vaccination opportunities. Embedding maternal immunization programs within the current prenatal care services might optimize vaccine coverage. Synopsis: The lack of integration between maternal immunization programs and prenatal care services might represent a significant barrier that prevents maternal care providers from recommending and offering vaccines to pregnant women. [ABSTRACT FROM AUTHOR]

Little is published on cytomegalovirus (CMV) serological screening at the first antenatal visit or the contemporary CMV seroprevalence rates among the Australian pregnant population. We performed a retrospective analysis of public hospital births in a major tertiary centre (n = 840) over a two month period. We found that 13.6% (95% confidence interval (CI) 11.4–16.1%) of women had been screened for CMV at their first antenatal visit with their general practitioner. Of these, 43.0% (95% CI 34.3–52.1%) were CMV seronegative and therefore susceptible to primary infection. Seronegative women were also more likely to have been born in an economically developed country, to live in a socio‐economically advantaged postcode and to be nulliparous. The information from this study may help guide future studies of congenital CMV risk reduction strategies. [ABSTRACT FROM AUTHOR]

Background: On 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy. Aim: This multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy. Materials and methods: An online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021. Results: There were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01). Conclusions: Along with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person‐centered care during pregnancy and birth among Black birthing people in California. Methods: We used data from 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person‐Centered Prenatal Care (PCPC) and the Person‐Centered Maternity Care (PCMC‐US) scales. Bivariate and multivariate analyses were conducted to examine the associations between PCPC and PCMC‐US scores and sociodemographic, health‐related, and care‐related factors. Results: The factors associated with lower PCPC scores were having foreign‐born parents, having public or no insurance, part‐time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self‐rated health (less than very good), and lack of continuity of care with prenatal providers. Factors associated with lower PCMC‐US scores were having public insurance, late start of prenatal care, longer length of stay in facility following birth, poorer self‐rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with birth provider. Conclusions: Our analysis highlights the contributions of intersecting identities as well as health‐related and care‐related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance, in particular, were shown to improve pregnancy and birth experiences. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has dramatically affected pregnant people's prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID‐19‐related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient‐reported information sharing from the providers; and (b) Whether patient‐reported provider information sharing or disruptions to care are associated with patient satisfaction with provider. Methods: Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020. Results: Thirty‐eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled. Discussion: At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing—both generally and during public health crises—and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non‐initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor. Aims: The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population. Methods: The review was performed according to meta‐analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS‐I tool was used to assess risk of bias. Results: Twelve studies were included in the final review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association. Conclusion: Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving‐country‐born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies. [ABSTRACT FROM AUTHOR]

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid‐covered or uninsured individuals. Data Sources and Study Setting: We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. Study Design: We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non‐parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3 months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). Data Collection/Extraction Methods: The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. Principal Findings: The 55 areas in California that received their first FQHC in 2011–2016 were more populous; their residents were more likely to be covered by Medicaid, to be low‐income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: −10.4 [95% CI −38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI −7.1, 5.4]), or preterm birth (ATT: −7.0 [95% CI −15.5, 2.3]). Conclusions: Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments. [ABSTRACT FROM AUTHOR]

Background: The importance of a child's first 1000 days has now been widely accepted by the medical fraternity. Yet, we do not know much about caring practices in low‐resource settings. Aim: This study aimed to investigate the caring capabilities of mothers in a low‐resource setting. Method: In this study, in‐depth interviews were conducted with 18 mothers with children aged 30 months or younger to better understand the arrangements, means and ends that inform developmental health in a low‐resource setting in South Africa. The study was conducted in a low‐income area, the former black township of Mangaung in Bloemfontein. The mothers were recruited via pamphlets, and two interviews followed. Because of Covid‐19, interviews took place via mobile phones, in Sesotho, the local language in the area. Trained fieldworkers conducted, translated and transcribed the interviews. We used thematic analysis and the capabilities approach as the theoretical framework to analyse the responses from the mothers. Findings: We used the following organizing themes: pregnancy and ante‐natal care, nutrition, cognitive and physical development, the home environment and access to health care. Although short‐term reactions to pregnancy were often negative, the longer‐term responses showed that the respondents have agency. Most of them could change their nutrition habits, breastfeed and receive adequate nutrition support from the public health system. Most experienced joy when their children reached milestones (cognitive and others), although they became anxious if milestones were not reached. They emphasized children's play and had dreams for their children's futures. Technology was often mentioned as playing a role in their children's development. A large proportion of the respondents had disrupted homes (because of absent or abusive fathers), but some had stable homes. Most of them showed substantial capability to overcome adverse home environments. The public health system helped them deal with their health problems and their children's health problems, although it also created anxiety in many cases. Our data show how they develop their capabilities and overcome obstacles organically in the face of resource limitations. Despite pregnancies being unexpected and unplanned and fathers being absent, the respondents accepted the pregnancy, adjusted their diets and social behaviour, showed agency by attending primary healthcare facilities and ensured that their children received the required vaccinations. Their extended families played an important role in providing care. Despite the sacrifices, the respondents expressed joy and helped their children function by eating, playing, socializing, learning and using their senses. Conclusion: Our sample of mothers have the agency to adapt to the demands of parenthood and childcare and overcome adversity. Our data support the notion that mothers are held disproportionately and unfairly responsible for achieving the first 1000 days ideals. Despite considerable curtailment of their functionings and capabilities, they nevertheless showed agency to ensure their health and their children's health. A holistic approach should consider these findings in designing policy interventions for children's developmental health. Patient and Public Contribution: We used paid fieldworkers to interact with the research participants. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between continued antidepressant use in pregnancy and postpartum psychiatric visits for eating (ED) or mood/anxiety disorders in women with preexisting ED. Method: Using Danish health registry data (1998–2015), we identified 3529 pregnancies in women with ED prepregnancy: (i) 564 with continued antidepressant use before and during pregnancy; (ii) 778 with discontinued antidepressants before pregnancy; (iii) 2137 unexposed. Outpatient and inpatient postpartum visits for an ED or a mood/anxiety disorder constituted the outcome measures. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox regression with inverse probability of treatment weighting, and performed stratified analyses by antidepressant prescription filling in the first 3 months postpartum. Results: The weighted cumulative incidence for an ED visit at end of follow‐up was 4.5% (continued) and 4.8% (discontinued). We found no association between continued antidepressant and postpartum ED visit, relative to discontinued (HR: 0.89, 95% CI: 0.52–1.52). The HR for postpartum mood/anxiety disorder visit was 1.27 (95% CI: 0.68–2.36) with continued antidepressants versus discontinued but decreased if more than two antidepressant prescriptions were refilled. Continued antidepressant use was associated with a 57% reduced likelihood of a postpartum ED visit versus discontinued use in pregnancies with antidepressant prescription refills in the early postpartum. Conclusion: Among women with preexisting ED, there was no association between continued antidepressant use during pregnancy and the likelihood of postpartum psychiatric visits, relative to discontinued antidepressants before pregnancy. Continuation of treatment into the early postpartum is associated with reduced likelihood of postpartum ED visit. Public Significance: Based on data from the Danish registries, we identified 3529 pregnancies among women with preexisting eating disorders before pregnancy. Women with continued antidepressant treatment both before and during pregnancy did not have a lower probability of having postpartum psychiatric visits for an eating disorder or for mood/anxiety disorders (often coexisting with eating disorders), relative to those who discontinued antidepressants before pregnancy. Further continuation of antidepressant treatment into the early postpartum is associated with improved maternal postpartum outcomes. However, residual confounding by disease severity limits confidence in this conclusion. [ABSTRACT FROM AUTHOR]

Introduction: It is unclear whether tobacco in early pregnancy and alcohol use preceding pregnancy are associated with spontaneous abortion. The purpose was to investigate if use of tobacco and/or alcohol is associated with spontaneous abortion among women attending antenatal care, and if age and body mass index (BMI) attenuate the risk. Material and Methods: A population‐based cohort study based on data from the Swedish Pregnancy Register. All pregnant women having had the first antenatal visit from January 2014 to July 2018 were included (n = 525 604). The register had information about smoking and use of snuff before and in early pregnancy, as well as data on alcohol habits before pregnancy, measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated questionnaire. Logistic regression analysis was used to estimate the association between lifestyle factors and spontaneous abortion, and multiple imputation was used to impute missing data. Results: In total, 34 867 (6.6%) pregnancies ended in a spontaneous abortion after the first visit to maternal health care. At the first maternal healthcare visit, daily smoking was reported by 24 214 (5.1%), and 6403 (1.2%) used snuff. For 19 837 (4.2%) women, a high alcohol score was reported for the year preceding pregnancy. After adjusting for potential confounders and multiple imputation, use of tobacco was associated with spontaneous abortion; smoking 1–9 cigarettes/day (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.04–1.18), smoking 10 or more cigarettes/day (aOR 1.12, 95% CI 1.–1.26), and use of snuff (aOR 1.20, 95% CI 1.06–1.37). Higher AUDIT scores were not significantly associated with spontaneous abortion (AUDIT 6–9: aOR 1.03, 95% CI 0.97–1.10 and AUDIT 10 or more: aOR 1.07, 95% CI 0.94–1.22). Increasing maternal age showed the highest risk of spontaneous abortion from the age of 35, and BMI of 30 kg/m2 or more increased the risk. There were interactions between different lifestyle factors associated with spontaneous abortion that could either increase or decrease the risk of spontaneous abortion. Conclusions: Smoking and use of snuff were associated with an increased risk of spontaneous abortion. The AUDIT scores preceding pregnancy were not associated with an increased risk of spontaneous abortion, which contradicts the results from previous studies. [ABSTRACT FROM AUTHOR]

Pregnancy is a risk factor for the development and progression of diabetic retinopathy (DR) in women with pre‐gestational diabetes. However, a minority of pregnant women with diabetes adhere to retinal screening recommendations. The introduction of an onsite retinal camera at our tertiary maternity hospital significantly increased the proportion of women who received at least one retinal screen during pregnancy (93.0% vs 54.3%, P < 0.001) and the identification of both DR and DR progression. We conclude that the use of a retinal camera in similar clinics is a feasible option to improve DR screening and diagnosis rates in pregnancy. [ABSTRACT FROM AUTHOR]

Background and Aims: Health services during pregnancy, childbirth, and the postnatal period play a pivotal role in the survival of both the mother and the baby. We, therefore, analyzed maternal health service utilization and the related drivers among women of childbearing age in Ethiopia. Methods: We used secondary data from the 2019 Ethiopian mini Demographic and Health Survey. The survey was conducted in 11 regions, and 2 city administrations, in Ethiopia from March 21 to June 28, 2019. Maternal health service utilization was measured in terms of three dimensions including antenatal care (ANC), skilled delivery service, and postnatal care (PNC). Bi‐variable and multivariable logistic regression was used. We then fitted three separate models. Data were analyzed using SPSS version 25; all analysis was adjusted for cluster and sample weight. Results: A total of 2923, 3924, and 1899 women were included for ANC, delivery, and PNC utilization, respectively. The majority of 1802 (61.7%) women had a "good" antenatal care utilization, and it was explained by the level of maternal education, marital status, and wealth index. Nearly half, of 1899 (48.1%) of the women gave birth in a health facility, and it was associated with age, educational status, wealth index, the timing of first antenatal care, and the number of antenatal care contact. Finally, one third (33.7%) of them had adequate PNC utilization and it was associated with households having a television, the timing of first antenatal care, and the number of antenatal care contacts. Conclusion: Despite the due emphasis on maternal health services by the Ethiopian government, the uptake of services is not optimal. Women empowerment and timely and adequate ANC contacts will prepare women for better uptake of services. [ABSTRACT FROM AUTHOR]

This article describes the successful implementation of a population-based screening and assessment service for pregnant women in a remote healthcare setting in Australia. The service, called the Initial Maternity Assessment and Planning (IMAP) service, was expanded to include a remote Australian maternity healthcare setting using a co-design approach and implementation science methodology. Since its establishment in 2023, over 200 women have been seen through the service, resulting in an increase in the proportion of local women accessing first trimester ultrasound and a decrease in the number of local women not attending for antenatal care within the first trimester. This study demonstrates the feasibility of scaling up a service to improve equity of care for women in regional and remote areas. [Extracted from the article]

This article describes the establishment of the Initial Maternity Assessment and Planning Service (IMAP) in Australia, which aims to provide comprehensive and early antenatal care for women planning public maternity care. The service includes a comprehensive ultrasound assessment, screening for aneuploidy and pre-eclampsia, and a review of obstetric, medical, and personal history with a dedicated midwife. The information is collated by an obstetrician to provide early pregnancy risk stratification. This study confirms the feasibility of a redesigned approach to first trimester specialist maternity care. [Extracted from the article]

This article discusses the implementation outcomes of the Initial Maternity Assessment and Planning (IMAP) service in Australia. The IMAP service is a first trimester population-based screening and assessment service that aims to improve antenatal care. The study found that a majority of eligible women accessed the service within the recommended gestational window, and a significant proportion were allocated to low-risk community-based models of care. The findings suggest that the IMAP service has successfully improved the provision of early pregnancy care and highlights the potential benefits of a redesigned approach to first trimester specialist maternity care. [Extracted from the article]

Integrating nutrition interventions into antenatal care (ANC) requires adapting global recommendations to fit existing health systems and local contexts, but the evidence is limited on the process of tailoring nutrition interventions for health programmes. We developed and integrated maternal nutrition interventions into ANC programmes in Bangladesh, Burkina Faso, Ethiopia and India by conducting studies and assessments, developing new tools and processes and field testing integrated programme models. This paper elucidates how we used information and data to contextualize a package of globally recommended maternal nutrition interventions (micronutrient supplementation, weight gain monitoring, dietary counselling and counselling on breastfeeding) and describes four country‐specific health service delivery models. We developed a Theory of Change to illustrate common barriers and strategies for strengthening nutrition interventions during ANC. We used multiple information sources including situational assessments, formative research, piloting and pretesting results, supply assessments, stakeholder meetings, household and service provider surveys and monitoring data to design models of maternal nutrition interventions. We developed detailed protocols for implementing maternal nutrition interventions; reinforced staff capacity, nutrition counselling, monitoring systems and community engagement processes; and addressed micronutrient supplement supply bottlenecks. Community‐level activities were essential for complementing facility‐based services. Routine monitoring data, rapid assessments and information from intensified supervision were important during the early stages of implementation to improve the feasibility and scalability of models. The lessons from addressing maternal nutrition in ANC may serve as a guide for tackling missed opportunities for nutrition within health services in other contexts. Key messages: Integrating evidence‐based nutrition interventions into ANC to reach PW at scale is urgently needed for improving maternal and newborn health and nutrition.The Theory of Change and steps for strengthening nutrition interventions based on four‐country experiences provide practical guidance on addressing missed opportunities for nutrition in ANC.Strategic use of data can contextualize global maternal nutrition guidelines, protocols, capacity building and supervision approaches, and improve micronutrient supply chains and record‐keeping as part of health services strengthening.Engaging family and community members to support PW and improving the knowledge and self‐confidence of PW are important elements of all country programme models. [ABSTRACT FROM AUTHOR]

Key content: Endometriosis in pregnancy is associated with an increased risk of spontaneous miscarriage, pre‐eclampsia, postpartum haemorrhage, caesarean section, placenta praevia, fetal growth restriction, prematurity and adverse neonatal outcomes.Women with mild disease are considered as having 'low‐risk endometriosis' (LRE) and can expect a normal pregnancy and labour.The 'high‐risk endometriosis' (HRE) group may require additional antenatal and intrapartum specialist care. Learning objectives: To understand the pathophysiologic basis of adverse obstetric and perinatal outcomes in pregnant women with endometriosis.To understand the obstetric outcomes in relation to the severity and staging of endometriosis.To appreciate the risk of spontaneous haemoperitoneum in pregnancy (SHiP) associated with endometriosis in pregnancy. [ABSTRACT FROM AUTHOR]

Background: For pregnant and birthing women, maintaining a relationship with the same health care practitioner is critical to establishing a sense of safety. In postsocialist Serbia, where care is fragmented and depersonalized, this continuity is often missing. Patients are frequently handed over to new practitioners, sometimes without even knowing the name of the person overseeing their care. In response, many women turn to the private sector to keep the same practitioner across their prenatal period and their birth by establishing a personal "connection" within the hospital that they believe will shield them from mistreatment during childbirth. Methods: Data presented in this paper were collected through participant observation in one public maternity hospital and one public primary care center in Serbia; semistructured interviews with 14 physicians; and semistructured interviews with 80 women who had given birth in one public maternity hospital in Serbia. Results: Public maternity hospital physicians who supplement their income working in the private sector have the power to blur the distinctions between favors and services. They offer continuity of personalized care to their private clients/patients once they enter the public system, and they themselves obtain social and economic security unavailable to those working in only one sector. At the same time, there is evidence that personalized continuity of care does not actually shield women from mistreatment in hospitals. Conclusions: The private sector is reshaping existing informal strategies and blurring the lines between formal and informal payments. In the postsocialist context, consumer practices are not separate from, but entangled with, informality. Neoliberalism has not brought about empowerment and eliminated informality, but has instead further exacerbated existing inequalities in maternity care in Eastern Europe. [ABSTRACT FROM AUTHOR]

The National Nutrition Services of Bangladesh aims to deliver nutrition services through the primary health care system. Little is known about the feasibility of reshaping service delivery to close gaps in nutrition intervention coverage and utilization. We used a scenario‐based feasibility testing approach to assess potential implementation improvements to strengthen service delivery. We conducted in‐depth interviews with 31 service providers and 12 policymakers, and 5 focus group discussions with potential beneficiaries. We asked about the feasibility of four hypothetical scenarios for preventive and promotive nutrition service delivery: community‐based events (CBE) for pregnant women, well‐child services integrated into immunization contacts; CBE for well‐children, and well‐child visits at facilities. Opinions on service delivery platforms were mixed; some recommended new platforms, but others suggested strengthening existing delivery points. CBE for pregnant women was perceived as feasible, but workforce shortages emerged as a key barrier. Challenges such as equipment portability, upset children and a fast‐moving service environment suggested low feasibility of integrating nutrition into outreach immunization contacts. In contrast, CBE and facility‐based well‐child visits emerged as feasible options, conditional on having the necessary workforce, structural readiness and budget support. On the demand side, enabling factors include using interpersonal communication and involving community leaders to increase awareness, organizing events at a convenient time and place for both providers and beneficiaries, and incentives for beneficiaries to encourage participation. In conclusion, integrating preventive and promotive nutrition services require addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services. Key messages: This study uses a scenario‐based feasibility testing approach to explore potential interventions to strengthen preventive and promotive nutrition service delivery through the primary health care system.Our findings highlight three highly feasible potential platforms (community‐based events [CBE] for pregnant women, CBE for well‐children and well‐child visits at facilities) to expand preventive services. Scaling these community‐based services requires addressing current challenges in the health system (including human resource and logistic gaps) and investment in demand creation for these services. [ABSTRACT FROM AUTHOR]

This article describes 2 innovative models of advanced practice provider–led medication for opioid use disorder treatment programs offering comprehensive, interprofessional care for pregnant patients and provides implications for broader adaptation of practice. Increasing the number of midwives and nurse practitioners waivered to prescribe buprenorphine and able to connect pregnant patients with opioid use disorder to appropriate community‐based resources, treatment, and self‐help programs could address alarming substance use trends including overdose deaths and other sequelae associated with the opioid epidemic. [ABSTRACT FROM AUTHOR]

The Diabetes and Antenatal Milk Expressing (DAME) randomised controlled trial (RCT) was conducted in 2011–2015, at six sites in Melbourne, Australia to explore the effect of advising women with diabetes in pregnancy to express breast milk from 36 weeks gestation. Infants whose mothers were randomised to express in pregnancy were more likely to be exclusively breast milk fed during their hospital stay, and there was no evidence of harm. This paper explores women's views and experiences of antenatal expressing. In this two‐arm RCT, 635 women with diabetes in pregnancy who were otherwise of low medical risk were randomised at 36–37 weeks gestation to usual care (not expressing, n = 316), or the intervention, where women were advised to hand express for 10 min twice daily until birth (n = 319). Semistructured face‐to‐face interviews were conducted with 10 women who expressed antenatally. They were asked about their experiences of antenatal expressing, including how they felt about the overall experience, the amount of breast milk they expressed, making time to express, and their experience of breastfeeding. Thematic analysis of the in‐depth interviews identified six themes: (1) learning and adapting expressing, (2) feelings and sensations associated with expressing, (3) support, (4) dis/empowerment, (5) health, and (6) the value of breast milk. Women had both positive and negative experiences of antenatal expressing. If health professionals are advising antenatal expressing to women, it is important they understand the range of outcomes and experiences. Key messages: Women's experiences of antenatal expressing were both positive and negative; it is important to understand the range of experiences.Women should be advised that some women express little or no breast milk antenatally and therefore be reassured if they are concerned.For women with diabetes in pregnancy, their diabetes management is a significant time burden, and should be considered when discussing antenatal expressing with women.Maternity care providers need to follow‐up with pregnant women advised to express, to provide education, reassurance, and reassess expressing techniques.Maternity care providers need to manage and prioritise the use of expressed breast milk. [ABSTRACT FROM AUTHOR]

The delivery of nutrition‐related interventions and counselling during antenatal care is critical for a healthy pregnancy for both mother and child. However, the accuracy of maternal reports of many of these services during household surveys has not yet been examined. Our objectives were to assess the validity of the maternal reports of 10 antenatal nutrition interventions, including counselling, and examine associates between maternal characteristics and accuracy. Maternal report of services received collected during a post‐partum survey was compared to the gold standard, the direct observation of all women's antenatal care visits. Individual‐level validity was assessed by calculating indicator sensitivity, specificity and area under the operating curve (AUC). The inflation factor (IF) measured population‐level bias. For five indicators, the high true coverage limited our ability to assess the validity of the maternal reports. There were no indicators that had both high individual‐level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25). Indicators with greater true coverage estimates had higher sensitivity and lower specificity estimates compared to those indicators with lower true coverage. There were no maternal characteristics associated with the accuracy of the report. Maternal report of antenatal nutrition‐related interventions and counselling during household surveys was found to have variable validity across indicators. Additional research in settings with varying coverage levels should be considered to best inform antenatal care coverage measurement in household surveys. Key Messages: The coverage of nutrition‐related interventions and counselling was high (>89%) for the majority of indicators.Maternal reports resulted in higher coverage estimates than what was observed for all but one indicator.No indicator assessed had high individual level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25).The greater the indicator's true coverage estimate, the greater the sensitivity and lower the specificity values. [ABSTRACT FROM AUTHOR]

Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress. Key points: Delivering nutrition services to all pregnant women is essential for maternal and child health outcomes but remains a challenge.Nutrition gaps in antenatal care (ANC) include lack of specificity in national guidelines and protocols, bottlenecks in micronutrient supplies, low ANC provider knowledge and skills, inadequate supervision to reinforce counseling, and not engaging families to encourage key practices.National protocols for ANC should be more specific for the four nutrition interventions (micronutrient supplements, weight gain monitoring, counseling on diets and counseling on breastfeeding) and assign accountability for coverage and quality.Country models are needed for improving provision and utilisation of nutrition interventions through ANC that are based on comprehensive policy frameworks. [ABSTRACT FROM AUTHOR]

Objective: To measure satisfaction with general practitioner obstetrician‐led maternity care in Western Australia and to explore perspectives of maternity service users Design: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three‐part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi‐structured interview. Setting: Nine general practitioner obstetrician practices located in regional Western Australia. Participants: 155 women receiving general practitioner obstetrician‐led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. Main Outcome Measures: We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. Results: 116 women completed all 3 surveys. General practitioner obstetrician‐led care resulted in high rates of satisfaction across all 3 stages of care, with 78%‐100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman‐centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. Conclusion: General practitioner obstetrician‐led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction. [ABSTRACT FROM AUTHOR]

Objective: Continuum of care (CoC) in maternal health is built on evidence suggesting that the integration of effective interventions across pregnancy, childbirth, and the postnatal period leads to better perinatal health outcomes. We explored gaps along the CoC in maternal health in Benin. Methods: A mixed‐methods study triangulating results from a qualitative study in southern Benin with a quantitative analysis of Benin Demographic and Health Survey (BDHS) data on the use of services along the CoC was conducted. Results: Benin Demographic and Health Survey analysis showed that although 89% of women reported at least one antenatal care (ANC) visit, only half initiated ANC in the first trimester and completed 4 or more visits. 85% reported facility‐based childbirth and 69% a postnatal check within 48 h after childbirth. Our qualitative study confirms early initiation of ANC and the transition from facility‐based childbirth to postnatal care are important gaps along the CoC and reveals late arrival at health facility for childbirth as an additional gap. These gaps interact with spiritual and alternative care practices that aim to safeguard pregnancy and prevent complications. Structural factors related to poverty and disrespectful care in health facilities compounded to limit the utilisation of formal healthcare. Conclusions: The combined use of BDHS and qualitative data contributed to highlighting critical gaps along the maternal CoC. A lack of integration of spiritual or alternative aspects of care into biomedical services, as well as structural factors, impeded access to healthcare in Benin. [ABSTRACT FROM AUTHOR]

Background: Centers for Medicare & Medicaid Services (CMS) funded 182 US health care sites to reduce preterm birth rates by enhancing prenatal care for at‐risk women. As a funded site, the enhanced prenatal care maternity care home (MCH) model was implemented from 2013 to 2018 for 1042 Medicaid‐eligible pregnant women. Methods: This retrospective study evaluated the impact of enhanced services on preterm birth risk reduction. Certified community health workers provided enhanced services from enrollment through six weeks postpartum. Participants attending enhanced intake and third‐trimester prenatal visits comprised the Active Group (N = 632). Participants missing third‐trimester visits, but participating in enhanced intake and postpartum visits, comprised the Inactive Group (N = 128). Lost Group participants attended only intake visits (N = 282). Data were collected through CMS‐developed intake, third‐trimester, postpartum, and exit forms. Descriptive analysis, analysis of variance, and the chi‐square tests analyzed the impact of risk factors, participant characteristics, and program participation on birth outcomes. Results: Active Group compared with Inactive and Lost Group participants experienced significantly lower preterm birth rates (7.64% vs 22.48% and 15.82%, P < 0.001) and therefore a significantly lower NICU admission rate compared with Inactive and Lost Groups (2.82% vs 11.85% and 5.47%, P < 0.001). Conclusions: The MCH model of enhanced prenatal care reduced preterm birth and NICU admission rates for Active Group participants. The Black Active Group participant preterm birth rate was not significantly different than other Active Group rates, but was lower than Black Inactive and Lost Group rates. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity (SMM) occurs in 1–2% of pregnancies. Despite the knowledge that a SMM event can contribute to poor fetal/neonatal outcomes, little is known about the preventability of these adverse outcomes. Aims: To examine adverse fetal/neonatal outcomes associated with SMM to determine if these outcomes were potentially preventable. Materials and Methods: A New Zealand national retrospective cohort study examining cases of SMM with an adverse fetal/neonatal outcome. Maternity and initial neonatal care were explored by multidisciplinary panels utilising a preventability tool to assess whether the fetal/neonatal harm was potentially preventable. Adverse fetal/neonatal outcomes were defined as fetal or early neonatal death, Apgar score <7 at five minutes, admission to neonatal intensive care unit or special care baby unit and neonatal encephalopathy. Results: Of 85 cases reviewed, adverse fetal/neonatal outcome was deemed potentially preventable in 55.3% of cases (n = 47/85). Preventability was related to maternal antenatal/peripartum care (in utero) in 39% (n = 33/85), to initial neonatal care (ex utero) in 36% (n = 29/80), and to both maternal and neonatal care in 20% (16/80) of cases. Main contributors to potential preventability were factors related to healthcare providers, particularly lack of recognition of high risk, delayed or failure to diagnose, and delayed or inappropriate treatment. Conclusions: Multidisciplinary panels found that over half of adverse fetal/neonatal harm associated with SMM was potentially preventable. The novel approach of examining both maternal and neonatal care identifies opportunities to improve fetal/neonatal outcomes associated with SMM at multiple points on the perinatal continuum of care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to summarize cases of successful pregnancy and delivery in patients with transposition of the great arteries (TGA) after atrial switch operation (ASO), to provide management, clinical experience, and maternal and fetal outcomes. Methods: During a 16‐year period (2004–2019), we experienced 30 pregnancies in 15 patients after ASO at our institution. We retrospectively reviewed the medical records of the patients. Results: In 30 pregnancies, there were 21 (70%) live births, five (17%) miscarriages, and four (13%) artificial abortions. There were no maternal or neonatal deaths. Cardiac complications occurred in nine (43%) patients: deterioration of right ventricular (RV) function in one, symptomatic heart failure (HF) in three, supraventricular tachyarrhythmia requiring electrical cardioversion in two, sick sinus syndrome that required pacemaker implantation in two, and hemoptysis in one. Obstetric complications occurred in five (24%). Neonatal complications were premature births (delivery at <37 weeks of gestation) in 15 (71%), and birthweight <2500 g in 18 (86%). The mode of delivery consisted of vaginal delivery (VD) in five (24%), and cesarean section (CS) in 16 (76%). Conclusion: A high incidence of preterm CS and cardiac complications including deterioration of RV function was observed in patients who had undergone ASO for TGA. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic has resulted in rapid changes in many areas of healthcare worldwide.1 Some organisational and governance controls on innovation have been relaxed, to enable rapid adaptation to changing circumstances. A resilient maternity care system The COVID-19 pandemic exposed vulnerabilities in both countries' maternity care systems, particularly in terms of hospital and staff capacities. "Never waste a crisis": a commentary on the COVID-19 pandemic as a driver for innovation in maternity care. [Extracted from the article]

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community‐based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12‐fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level. [ABSTRACT FROM AUTHOR]

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh. [ABSTRACT FROM AUTHOR]

COVID‐19 has resulted in unprecedented changes to maternity care across Australia. This study aims to analyse trends in maternity consultations and the uptake of telehealth in Victoria and New South Wales (NSW) since the first restrictions to reduce COVID‐19 transmission were implemented. From March 2020 to April 2021, a higher proportion of antenatal care consultations was delivered via telehealth in Victoria compared to NSW (13.8% vs 7.4%, P < 0.0001). Uptake of telehealth and a shift from in‐person care has been a major contributor to maintaining pregnancy care during pandemic restrictions. However, further research is required to understand women's perspectives and health outcomes. [ABSTRACT FROM AUTHOR]