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Choline, folic acid, and Vitamin D are essential for fetal brain development that may be the first steps in the pathogenesis of the psychotic spectrum. Micronutrient deficiencies have been associated with changes in fetal brain development, manifest as early problems in childhood behavior, and cognition, and later as increased incidence of psychotic and autism spectrum disorders. Micronutrient supplements may not only prevent deficiency, but they may also positively affect brain development in the context of other maternal risk factors, including maternal infection, stress, inflammation, and substance abuse. Many genes associated with later psychotic illness are highly expressed in the fetal brain, where they are responsible for various neurodevelopmental mechanisms. Interaction of micronutrient vitamins with these genetically programmed mechanisms to prevent pathological brain development associated with later psychosis is under active investigation. In addition to their effects on brain development, micronutrient vitamins have effects on other aspects of gestation and fetal development, including the prevention of premature delivery and other developmental abnormalities. Supplemental micronutrient vitamins should be part of good prenatal care, as has already happened for folic acid and Vitamin D and is now advocated by the American Medical Association for choline. The benefits of these micronutrient supplements include protection of brain development and the possibility of decreased risk for future psychotic disorders in those children who are either genetically or environmentally vulnerable. The purpose of this review is to present the current evidence supporting the safety and effectiveness of micronutrients in gestation and to suggest areas for future research.

Background There is a need for evidence-based guidance on complementary medicines and therapies (CMT) use during pregnancy due to high prevalence of use and lack of guidance on the balance of benefit and harms. Aim Evaluate the extent to which current clinical practice guidelines relevant to Australian healthcare professionals make clear and unambiguous recommendations about CMT use in pregnancy, and synthesise these recommendations. Methods The search included EMBASE, PubMed, the National Health and Medical Research Council’s Clinical Practice Guidelines Portal, and websites of Australian maternity hospitals and professional/not-for-profit organisations for published guidelines on pregnancy care. Data were synthesised narratively. Guidelines were appraised by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Findings A total of 48 guidelines were found, of which 41% provided recommendations that were not limited to routine vitamin and mineral supplementation. There were wide variations in recommendations, particularly for vitamin D and calcium. There was some consensus on recommending ginger and vitamin B6 for nausea and vomiting, and additional supplementation for women with obesity. Guidelines generally scored poorly in the domains of editorial independence and rigour of development. Discussion There is a lack of guidance with regard to appropriate CMT use during pregnancy, which may result in less-than-optimal care. Inconsistency between guidelines may lead to variations in care. Conclusion Guidelines should include clear and unambiguous guidance on appropriate CMT use during pregnancy, be based on a structured search of the evidence and informed by stakeholder engagement.

During the first 1000 days of life is the basis for a child's future health established.To evaluate the impact of a prenatal educational intervention in pregnant women on the nutritional status of the child from birth to 4 months of age.Quasi-experimental intervention design in women with at least 12 weeks of gestation, who were randomly assigned to an intervention group (IG) to participate in five group and three individual sessions on feeding practices and maternal perception of the child's weight and signals of hunger-satiety; the control group (CG) received routine care that included at least three prenatal consultations.Thirty women were included in each group. After the intervention, women in the CG practiced less exclusive breastfeeding, were more likely to underestimate or overestimate the children's weight, and perceived hunger-satiety signals with less intensity (p0.05). 80 % of the infants in the IG had normal weight, whereas 63 % of those in the CG had a combination of overweight and obesity (p0.05).The prenatal education program in pregnant women showed a significant effect on postnatal nutritional status of infants four months after birth.Durante los primeros 1000 días de vida se establece la base para la salud futura de un niño.Evaluar el impacto de una intervención educativa prenatal en mujeres embarazadas sobre el estado nutricional del hijo desde el nacimiento hasta los cuatro meses de edad.Diseño cuasiexperimental de intervención con mujeres a partir de la semana 12 de gestación, asignadas aleatoriamente a un grupo de intervención (GI) para recibir cinco sesiones grupales y tres individuales sobre prácticas de alimentación y percepción materna del peso del hijo y de señales de hambre-saciedad; el grupo control (GC) recibió atención de rutina que incluía al menos tres consultas prenatales.30 mujeres conformaron cada grupo. Después de la intervención, las mujeres del GC practicaron menos lactancia materna exclusiva, fueron propensas a subestimar o sobrestimar el peso del hijo y percibieron con menor intensidad las señales de hambre-saciedad (p0.05). El 80 % de los lactantes del GI presentaron peso normal y 63 % de los niños del GC, una combinación de sobrepeso y obesidad (p0.05).El programa de educación prenatal en mujeres embarazadas mostró un efecto significativo en el estado nutricional de los lactantes después de cuatro meses del nacimiento.

Fetal development is characterized by great plasticity and the ability to respond to environmental factors, where DNA methylation is essential for proper embryonic development. One-carbon metabolism provides methyl groups for methylation and fetal DNA development and is highly dependent on maternal nutritional status. During pregnancy, the supply of methyl donors is critical and the demand for nutrients that support this process, such as folate and vitamin B12, is increased. Insufficiency or imbalance of these 2 micronutrients can alter epigenetic patterns, DNA synthesis and repair, and affect fetal growth and development, having negative long-term consequences on the offspring's health. Folate and vitamin B12 status have been associated with wide DNA methylation, as well as with specific genes related to neurological functions, embryonic development, energy metabolism, growth, and leptin. Furthermore, inadequate concentrations of both vitamins have been associated with an increased risk of perinatal outcomes such as neural tube defects, prematurity, low birth weight, pre-eclampsia, as well as maternal and infant obesity and insulin resistance, and decreased infant neurocognitive development. Supplementation, combined with a healthy diet, could be an essential strategy to prevent these results and improve maternal and fetal health.El desarrollo fetal se caracteriza por una gran plasticidad y capacidad para responder a factores ambientales, donde la metilación del ADN es indispensable para el desarrollo embrionario adecuado. El metabolismo de un carbono proporciona grupos metilo para la metilación y el desarrollo del ADN fetal, y depende en gran medida del estado nutricio materno. El embarazo es una etapa donde el suministro de donantes de metilo es crítico y la demanda de nutrimentos que apoyen este proceso, como lo son el folato y la vitamina B12, está aumentada. La insuficiencia o desequilibrio de estos dos micronutrimentos puede alterar los patrones epigenéticos, la síntesis y reparación del ADN, y afectar procesos del crecimiento y desarrollo fetal, teniendo consecuencias negativas en la salud de la descendencia a largo plazo. El estado del folato y la vitamina B12 se han asociado con la metilación global del ADN, así como con genes específicos relacionados con funciones neurológicas, con el desarrollo embrionario, el metabolismo energético, el crecimiento, y con la leptina. Además, estados alterados de ambas vitaminas se han asociado con mayor riesgo de resultados perinatales como defectos del tubo neural, prematurez, bajo peso al nacer, preeclampsia, así como obesidad y resistencia a la insulina materna e infantil, y disminución del desarrollo neurocognitivo infantil. La suplementación, aunada a una dieta adecuada, podría ser una estrategia necesaria para prevenir dichos resultados y mejorar la salud maternofetal.

espanolObjetivo: Comparar la incidencia de diabetes mellitus gestacional (DMG) en mujeres con tres o mas factores de riesgo para desarrollar DMG suplementadas con mioinositol mas probioticos versus mujeres sin suplementacion. Material y metodos: Estudio de cohorte retrospectivo, grupo 1, mujeres con suplementacion (mioinositol 2 g mas Bifidobacterium lactis y Lactobacillus rhamnosus 5x108unidades formadoras de colonias, dos veces al dia, de las 12-14 hasta las 28 semanas de gestacion); grupo 2, mujeres con control prenatal habitual sin suplementacion, pareadas por edad e indice de masa corporal (IMC). El resultado primario fue la incidencia de DMG utilizando los criterios de la Asociacion Internacional de Grupos de Estudio de Diabetes y Embarazo. Resultados: Grupo 1, n = 48, y grupo 2 n = 96. No hubo diferencias significativas en caracteristicas basales como edad, IMC, y numero de factores de riesgo entre los grupos. La incidencia de DMG en el grupo 1 fue n = 14 (29.2%) y en el grupo 2 n = 46 (47.9%); RR: 0.61 (IC 95%: 0.37-0.99; p = 0.03). Conclusiones: La suplementacion desde las 12-14 semanas de gestacion con mioinositol mas probioticos disminuye la incidencia de DMG en mujeres mexicanas. EnglishAim: To compare the incidence of gestational diabetes mellitus (GDM) in women with three or more risk factor to developing GDM supplemented with myo-inositol plus probiotics versus women care without supplementation. Methods: Retrospective cohort study, group 1, women with supplementation (myo-inositol 2g plus Bifidobacterium lactis and Lactobacillus rhamnosus 5x108 UFC, twice per day, from 12-14 to 28 weeks of gestation; group 2, women with prenatal care without supplementation, matched by age and body mass index (BMI). The primary outcome was the incidence of GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. Results: Group 1 n=48, group 2 n=96. There were no significant baseline differences between groups in age, BMI and number of risk factors. The incidence of GDM in group 1 was n=14 (29.2%), and for group 2 n=46 (47.9%); RR: 0.61 (95% CI: 0.37-0.99; p = 0.03). Conclusions: Supplementation from 12-14 weeks of gestation with myo-inositol plus probiotics decrease the incidence of GDM in Mexican women.

Objective To estimate the prevalence of perinatal cannabis use (ie, before and/or during pregnancy); document the frequency, modes, and motivations for use; and identify predictors of perinatal cannabis use. Methods Six states in the Pregnancy Risk Assessment Monitoring System, a state-specific, population-based surveillance system, administered a supplemental questionnaire on perinatal cannabis use in 2016-2018. Women with live births were surveyed 2-6 months postpartum about behaviors ≤3 months preconception and during pregnancy. Demographic, psychosocial, and behavioral characteristics were examined in relation to perinatal cannabis use using multinomial regression models. Those who: (1) never used cannabis, (2) only used in preconception period, and (3) used in both preconception and prenatal periods were compared. Results Among 6428 respondents, 379 (5.8%) used cannabis preconceptionally only and 466 (4.4%) used in both the preconception and prenatal periods. Among those using prenatally, most reported smoking as their single mode (87.1%), with the two most common reasons being stress (83.8%) and nausea/vomiting (79.2%). Marital status, race/ethnicity, socioeconomic status, parity, and cigarette and alcohol use were significantly associated with perinatal cannabis use. Single (vs partnered) women were more likely to use cannabis prenatally (odds ratio = 2.4, 95% confidence interval: 1.5, 3.9) and non-Hispanic Black (vs White) women were less likely to use prenatally (odds ratio = 0.4, 95% confidence interval: 0.2, 0.8). Conclusions Using a population-based sample of US births in six states, several demographic, psychosocial, and behavioral characteristics were identified in relation to perinatal cannabis use. These data are valuable for counseling in prenatal care and investigations of health effects.

Background The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia. Methods In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity. Results Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15. Conclusions The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.

Purpose The purpose of this report is to describe a patient who has fluorescein angiographic evidence and retinal changes suspicious for intrauterine abusive ocular trauma. Methods A case report of a premature ward of the state with no prenatal care and a presentation suspicious for intrauterine abusive ocular trauma. We performed serial ophthalmologic examinations, reviewed available prenatal history with the infant's social worker, and all relevant hospital notes, laboratory results, and imaging results. Results Following initial empiric treatment for possible viral retinitis in the setting of a positive urine CMV, repeat examinations demonstrated fluorescein angiographic evidence and clinical findings suspicious for abusive ocular trauma including neovascularization and no evidence of retinitis; therefore, the child was treated with laser photocoagulation. Conclusion At-risk newborns will benefit from an examination of the retinal periphery and wide field fluorescein angiography. Intrauterine abusive ocular trauma should be included in the differential of retinal hemorrhage and avascular retinal periphery. It is imperative for clinicians to recognize this presentation to prevent progression of associated visual morbidity.

Problem Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy. Aim The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese. Method An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010–2020 publications, and primary research on humans. Unlabeled search query of “((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken. Findings Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management. Conclusion The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.

To address gaps in coverage and quality of nutrition services, AliveThrive (AT) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the AT interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring.This study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the AT maternal nutrition intervention package.We used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed 7 PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling.Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC compared with S-ANC (90% compared with 70%), but gaps remained for training content and refresher trainings. FLWs' knowledge improvement was higher in I-ANC than S-ANC (22-36 percentage points), but knowledge of micronutrient supplement benefits and recommended foods was insufficient (50%). Most FLWs received supervision (90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30-50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52% compared with 36%) but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight-gain monitoring was low (30-40%).Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact.

The reported incidence of eclampsia is 1.6 to 10 per 10,000 deliveries in developed countries, whereas it is 50 to 151 per 10,000 deliveries in developing countries. In addition, low-resource countries have substantially higher rates of maternal and perinatal mortalities and morbidities. This disparity in incidence and pregnancy outcomes may be related to universal access to prenatal care, early detection of preeclampsia, timely delivery, and availability of healthcare resources in developed countries compared to developing countries. Because of its infrequency in developed countries, many obstetrical providers and maternity units have minimal to no experience in the acute management of eclampsia and its complications. Therefore, clear protocols for prevention of eclampsia in those with severe preeclampsia and acute treatment of eclamptic seizures at all levels of healthcare are required for better maternal and neonatal outcomes. Eclamptic seizure will occur in 2% of women with preeclampsia with severe features who are not receiving magnesium sulfate and in

Background: The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis. Materials and Methods: Data were from Alabama Medicaid delivery claims in 2017. Bivariate analyses were used to examine maternal characteristics by HDP diagnosis. Hierarchical generalized linear models, with observations nested at the county level, were used to assess multivariable relationships between maternal characteristics and HDP diagnosis. Results: Among women with HDP diagnosis, a higher proportion were older, Black, had other comorbidities, and had more perinatal hospitalizations or emergency visits compared with those without HDP diagnosis. There were increased odds of an HDP diagnosis for older women and those with comorbidities. Black women (adjusted odds ratio [aOR] = 1.24, 95% confidence interval [CI]: 1.16–1.33), women insured only during pregnancy by Sixth Omnibus Reconciliation Act Medicaid (aOR = 1.08, 95% CI: 1.02–1.15), and women entering prenatal care (PNC) in the second trimester (aOR = 1.10, 95% CI: 1.03–1.18) had elevated odds of HDP diagnosis compared with their counterparts. Conclusions: Beyond traditional demographic and clinical risk factors, not having preconception insurance coverage or first trimester PNC entry were associated with higher odds of HDP diagnosis. Improving the provision and timing of maternity coverage among Medicaid recipients, particularly in nonexpansion states, may help identify and treat women at risk of HDP and associated adverse perinatal outcomes.

Background: Antenatal care (ANC) providers are recommended to promote oral health care during pregnancy through the provision of oral health care practices, but studies have indicated that provider...

BACKGROUND: One key factor proven to increase quality of pregnancy outcome has been antenatal care (ANC) service. The perinatal triad of mother, placenta and fetus becomes functionally complete with a functional umbilical cord. The objective of the study was to establish mathematical models to predict the outcome of umbilical cord morphometric parameters using maternal first antenatal care visit biometric indices. METHOD: This analytical descriptive cross-sectional study was conducted on 240 pregnant women who attended antenatal care for the first time in their first trimester at the Victory Maternity Home and Clinic in the Kumasi Metropolis, between April 2016 and October 2019. Umbilical cord length, diameter, area, volume and weight were measured after delivery. Maternal first antenatal care visit blood pressure was taken and their non-fasting blood samples were collected and lipid profile done. RESULTS: Mean values for umbilical cord measurements were; cord length, 38.10±7.86 cm; diameter, 1.04±0.17 cm; area, 66.10±24.49 cm2 and volume was 34.02±11.16 cm3 respectively while mean cord weight was 65.01±21.35 g. The study found that a unit increase in total cholesterol led to an increase of 2.33 units in umbilical cord length, high-density lipoprotein also resulted in 0.06 units increase in cord diameter while low-density lipoprotein decreases cord length by 3.31 units. Also, a unit increase in maternal booking total cholesterol resulted in 2.33 units increase in umbilical cord length. CONCLUSION: Maternal first antenatal care visit total cholesterol, high-density lipoprotein and low-density lipoprotein could influence the outcome of umbilical cord length, diameter and area.

Pregnancy termination for fetal anomaly (TOPFA) is a possible outcome of a pregnancy complicated by a fetal anomaly detected during routine prenatal care. Limited research is available on the quality of the counselling offered to women, in terms of enabling them to make an informed decision. The goal of this descriptive cohort study was to examine the medical process offered to a cohort of 151 women who underwent TOPFA in 2018 in a single tertiary mother and child hospital to identify areas for potential quality improvement.Statistical analysis comprised basic statistical tests, Pearson's χThe counselling process was found to be minimal in 42% of cases. Counselling referrals to pediatric specialists were made in 26% of cases, with many potential explanations for this finding. Complicated bereavement was present in 39% of cases. Risk factors for complicated bereavement were explored and were found to be insufficient social support (odds ratio [OR] 6.5; 95% CI 2.0-21.0, P0.001), history of a mood disorder (OR 3.4; 95% CI 1.3-8.8, P0.01), and history of another TOPFA (OR 6.2; 95% CI 1.2-31.0, P = 0.01). Viewing the fetus after termination was not correlated with a significant reduction in complicated bereavement.The evaluation of the counselling as minimal in 42% of cases and the high prevalence of complicated bereavement call for quality improvement in the process for women who undergo TOPFA. Clinicians should be able to screen women most at risk for complicated bereavement to best orient preventive care.

Women who experience HIV seroconversion during pregnancy are missed during early routine pregnancy HIV screening and are at high risk of perinatal HIV transmission. Male partner HIV testing during routine prenatal care may be an effective primary prevention strategy by identifying women at risk of seroconversion and mitigating their risk. Our objective was to assess interest in and uptake of male partner HIV testing services offered during prenatal care. This demonstration project included all pregnant, English-speaking, HIV-negative women receiving publicly funded prenatal care in an urban hospital-based practice located in a high HIV prevalence area. Women were offered free HIV screening for their male sexual partners. From April 2017 to June 2018, enrolled women completed surveys on social demographics, medical access characteristics, and HIV testing history. Women were invited to bring their partners to a prenatal visit where HIV testing was offered to their male partners. Factors associated with women's interest in testing and completion of partner testing were assessed using bivariable and multivariable analyses. Of 392 women approached, 70% (N = 274) completed study surveys. Although the majority (76%, N = 200 of 264 respondents) of women desired their partner undergo HIV testing, testing was underutilized as only 18 (7%) male partners completed testing. While neither maternal characteristics nor male social or attitudinal factors were associated with interest in or completion of partner HIV testing, sensitivity analyses, performed with multiple imputation, demonstrated some association between interest and completion of partner testing and partner medical care access and utilization. In conclusion, although the majority of low-income women in an urban prenatal clinic expressed interest in having their partners undergo HIV testing, uptake of free partner HIV testing services was uncommon. A focused assessment of implementation and uptake barriers is needed to optimize partner testing and eliminate HIV transmission to mothers and their babies.

PURPOSE To assess and compare birth expectations of younger and older age adolescents and explore if unmet expectations predict psychological birth trauma (PBT). STUDY DESIGN AND METHODS This secondary analysis expands findings of a previous study (N = 303) which classified adolescents' perceptions of birth into four main themes. The previous study used a mixed-methods approach providing data related to birth expectations. For the current study, expectations were determined by themes as met or unmet by three reviewers. Of 116 useable written narrations, responses of younger (ages 13-17) versus older (ages 18-19) adolescents were compared and explored for impact on PBT. RESULTS Birth expectations for both age groups were more often unmet than met. Despite a smaller cohort, younger adolescents provided more remarks than older adolescents. There were no differences between groups on unmet birth expectations (p = .16). Unmet expectations most often related to pain with older adolescents more inclined to state poor pain management. Younger adolescents more often feared dying. Unmet expectations did not predict PBT. CLINICAL IMPLICATIONS Comprehensive prenatal care can allow for early, open conversations to assess labor knowledge and misconceptions, fear of birth, existing supports, and overall birth expectations, with a premier focus on expected labor pain and pain management. Multiparous adolescents should receive prenatal assessments of posttraumatic stress (PTS) symptoms (a recognized predictor of posttraumatic stress syndrome) potentially originating from a previous traumatic birth. Following birth, symptoms of acute stress and PTS should be assessed of all adolescents, especially if experienced numerous unmet labor expectations.

Background: Corona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity. Methods: The retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year. Results: A total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of 0.05). Conclusions: During the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.

Background Coverage of iron folic-acid (IFA) supplementation is a key indicator for tracking programmatic progress within and across countries. However, the validity of maternal report of this information during household surveys has yet to be determined. Objective This study aimed to examine the validity of maternal recall of receipt of IFA supplementation during antenatal care and factors associated with accuracy of maternal recall. Methods A longitudinal cohort design was employed. The direct observation of the IFA received during all antenatal care visits at the five study health posts served as the "gold standard" to the maternal report of IFA received during the postpartum interview. 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. A multivariable log-binomial model was used to assess factors associated with accurate recall. Results The majority (95.8%) of women were observed receiving IFA during pregnancy. Women overreported the number IFA tablets received compared to what was observed during ANC visits (mean difference = 45 tablets). Maternal report of any IFA receipt was moderate (AUC = 0.60, 95% CI: 0.50, 0.71) and population bias was low (IF = 1.01). However, the individual-level validity was poor across the seven IFA tablet count categories; the AUC for categories ranged from misleading to moderate. Driven by the trend of maternal overreport, the inflation factor indicated that maternal report drastically underestimated the coverage of lower tablet categories and overestimated the coverage of higher tablet counts. Accuracy of maternal report was not associated with months since last ANC observation nor any maternal characteristics. Conclusions Maternal report of the amount of IFA supplementation received during pregnancy produced extremely biased population coverage and performed poorly to moderately for individual level validity. It is imperative to improve this indicator, as it is used in global frameworks and national program planning.

Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attach...

Background Universal screening for postpartum depression (PPD) remains an unachieved national priority. A tacit screen that requires no additional resources for administration can help to achieve this priority. We examine the predictive utility of using smoking as a tacit screen for PDD. We first establish smoking is a valid proxy for more prominent psychosocial determinants of PPD and is a predictor for PPD. Methods We analyzed PRAMS data (2012-2015; N=134,435). Time of smoking was categorized as nonsmoker, during the prenatal period, the postpartum, or continuously; PPD was assessed using two PHQ-2 style questions. Results Compared to nonsmokers, women who smoked only during the prenatal period (OR: 1.41; 95% CI: 1.06 – 1.86), only during the postpartum (OR: 1.33; 95% CI: 1.18 – 1.49), and continuously throughout both periods (OR: 1.54; 95% CI: 1.41 – 1.69) were more likely to experience PPD. Smoking assessed at a prenatal visit (SN: 0.90, SP: 0.21), postpartum visit (SN: 0.86, SP: 0.25), or assessed at both visits (SN: 0.90, SP: 0.19) performed relatively well as a tacit screen for PPD, performing better among unmarried women (SN: 0.75 – 0.81; SP: 0.29 – 0.36). Limitations In this study, the criterion of positivity used was PRAMS’ adapted version of the PHQ-2. This tacit screen may perform differently relative to a clinical diagnosis. Conclusions Time of smoking predicts risk of PPD and can be used to tacitly screen for PPD with reasonable accuracy without requiring any additional time in settings with limited resources for routine screening of PPD.

Objective To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID‐19) pandemic. Methods This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early‐pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non‐coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. Results There were 22 683 consultations over the 2‐year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first‐line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. Conclusions No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID‐19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first‐line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID‐19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Background Antenatal care and skilled childbirth services are important interventions to improve maternal health and lower the risk of poor pregnancy outcomes and mortality. A growing body of literature has shown that geographic distance to clinics can be a disincentive towards seeking care during pregnancy. On the Thailand-Myanmar border antenatal clinics serving migrant populations have found high rates of loss to follow-up of 17.4%, but decades of civil conflict have made the underlying factors difficult to investigate. Here we perform a comprehensive study examining the geographic, demographic, and health-related factors contributing to loss to follow-up. Methods Using patient records we conducted a spatial and epidemiological analysis looking for predictors of loss to follow-up and pregnancy outcomes between 2007 and 2015. We used multivariable negative binomial regressions to assess for associations between distance travelled to the clinic and birth outcomes (loss to follow-up, pregnancy complications, and time of first presentation for antenatal care.) Results We found distance travelled to clinic strongly predicts loss to follow-up, miscarriage, malaria infections in pregnancy, and presentation for antenatal care after the first trimester. People lost to follow-up travelled 50% farther than people who had a normal singleton childbirth (a ratio of distances (DR) 1.5; 95% confidence interval (CI): 1.4 – 1.5). People with pregnancies complicated by miscarriage travelled 20% farther than those who did not have miscarriages (DR: 1.2; CI 1.1–1.3), and those with Plasmodium falciparum malaria in pregnancy travelled 60% farther than those without P. falciparum (DR: 1.6; CI: 1.6 – 1.8). People who delayed antenatal care until the third trimester travelled 50% farther compared to people who attended in the first trimester (DR: 1.5; CI: 1.4 – 1.5). Conclusions This analysis provides the first evidence of the complex impact of geography on access to antenatal services and pregnancy outcomes in the rural, remote, and politically complex Thailand-Myanmar border region. These findings can be used to help guide evidence-based interventions to increase uptake of maternal healthcare both in the Thailand-Myanmar region and in other rural, remote, and politically complicated environments.

Purpose Pre-surgical point-of-care (POC) pregnancy testing in women of child-bearing age has become routine practice in hospitals across the United States. Its application in the ambulatory care setting is less ubiquitous. The authors herein present its application in their outpatient oral and maxillofacial surgery clinic, as implemented prior to procedures under intravenous sedation. Methods This study was implemented as a retrospective, single-center review of clinical records. The authors examined data from Bellevue Hospital Center's oral and maxillofacial surgery clinic for women of child-bearing age undergoing outpatient procedures performed under intravenous sedation during a 22 month time period. The review focused on POC urine human gonadotropin (hCG) results. A basic statistical analysis was performed on the data. Additionally, an examination of the associated costs of this testing was performed. Results The study included women between 12 and 50 years of age, of which there were 176. Five of the subjects (2.8%) were found to have an elevated hCG suggestive of pregnancy. The average age of those found to be pregnant was 22. All patients were originally scheduled for extraction of third molars. The cost of a single POC hCG test at the authors’ institution was $2.00. The cost to identify a single pregnancy within the study period was found to be $70.40. Conclusion In the authors’ experience, POC hCG testing for women of childbearing age is easily integrated into a standardized pre-sedation workflow. Although the medications utilized for outpatient sedation procedures are generally considered safe for both mothers and developing fetuses, implementation of POC hCG testing allows for providers and patients to make more fully informed decisions regarding how to proceed with elective cases in the case of a previously undiagnosed pregnancy. Determination of pregnancy status prior to a procedure may prompt referral for appropriate prenatal care, while limiting surgeons’ exposure to medicolegal liability. This study contributes to a small body of extant reports from ambulatory surgery centers and outpatient clinics offering IV sedation, offering providers a context in which to consider their own implementation of routine hCG testing.

Purpose Previous studies have examined the relationship between age at marriage and health outcomes, but few have explored how marriage drivers are associated with health outcomes. In this study, we examine the relationship between two marriage drivers, premarital pregnancy and agency, and several health outcomes (use of maternal health care services, child health outcomes, and change in depressive symptoms) among married adolescent girls and young women (AGYW) in sub-Saharan Africa and South Asia. Methods We use three panel data sets collected by the Population Council: the Adolescent Girls Empowerment Program from Zambia (N = 660), the Malawi Schooling and Adolescent Study from Malawi (N = 1,041), and Understanding the Lives of Adolescents and Young Adults from India (N = 894 in Bihar, N = 599 in Uttar Pradesh). Our analytical models use logistic and multinomial logistic regression. Results We find mixed evidence of the association between marriage drivers and health outcomes. Results show that having agency in marital partner choice in India is associated with both an increase and decrease in reported depressive symptoms. In addition, pregnancy before marriage is associated with fewer antenatal visits and hospital-based births in Malawi than pregnancy after marriage. However, we find no evidence that it is associated with worse child health outcomes than pregnancy after marriage in Malawi and Zambia. Conclusions Overall, our study suggests that the relationship between marriage drivers and AGYW's health outcomes after marriage is not consistent across contexts. We highlight the importance of interpreting marriage drivers within prevailing norms to understand their impact on married AGYW's health.

We assessed the impact of a structured lower-limb aerobic exercise training intervention during pregnancy on brachial artery endothelial function, shear rate and patterns, and forearm blood flow and reactive hyperemia. Twenty-seven pregnant women were recruited and randomized into either a control group (n = 11; 31.0 ± 0.7 years), or an exercise intervention group (n = 16; 32.6 ± 0.9 years). The exercise group completed 40 minutes of aerobic exercise (50–70% heart rate reserve) 3–4 times per week, between the second and third trimester of pregnancy. Endothelial function was assessed using flow-mediated dilation (FMD, normalized for shear stress) at pre- (16–20 weeks) and post-intervention (34–36 weeks). The exercise training group experienced an attenuated increase in mean arterial pressure (MAP) relative to the control group (ΔMAP exercise: +2 ± 2 mm Hg vs. control: +7 ± 3 mm Hg; p = 0.044) from pre- to post-intervention. % FMD change corrected for shear stress was not different between groups (p = 0.460); however, the post-occlusion mean flow rate (exercise: 437 ± 32 mL/min vs. control: 364 ± 35 mL/min; p = 0.001) and post-occlusion anterograde flow rate (exercise: 438 ± 32 mL/min vs. control: 364 ± 46 mL/min; p = 0.001) were larger for the exercise training group compared with controls, post-intervention. Although endothelial function was not different between groups, we observed an increase in microcirculatory dilatory capacity, as suggested by the augmented reactive hyperemia in the exercise training group. Registered at ClinicalTrials.gov: NCT02948439. Novelty: Endothelial function was not altered with exercise training during pregnancy. Exercise training did contribute to improved cardiovascular outcomes, which may have been associated with augmented reactive hyperemia, indicative of increased microcirculatory dilatory capacity.

OBJECTIVE To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term. METHODS We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth. Secondary outcome was maternal morbidity, defined as: transfusion of 4 or more units of red blood cells, any transfusion of other products, postpartum infection, intensive care unit admission, hysterectomy, venous thromboembolism, or maternal death. Multivariable modified Poisson regression was used to evaluate associations between race and ethnicity, cesarean birth, and maternal morbidity. Indication for cesarean birth was assessed using multivariable multinomial logistic regression. A mediation model was used to estimate the portion of maternal morbidity attributable to cesarean birth by race and ethnicity. RESULTS Of 5,759 included participants, 1,158 (20.1%) underwent cesarean birth; 1,404 (24.3%) identified as non-Hispanic Black, 1,670 (29.0%) as Hispanic, and 2,685 (46.6%) as non-Hispanic White. Adjusted models showed increased relative risk of cesarean birth among non-Hispanic Black (adjusted relative risk [aRR] 1.21, 95% CI 1.03-1.42) and Hispanic (aRR 1.26, 95% CI 1.08-1.46) people compared with non-Hispanic White people. Maternal morbidity affected 132 (2.3%) individuals, and was increased among non-Hispanic Black (aRR 2.05, 95% CI 1.21-3.47) and Hispanic (aRR 1.92, 95% CI 1.17-3.14) people compared with non-Hispanic White people. Cesarean birth accounted for an estimated 15.8% (95% CI 2.1-48.7%) and 16.5% (95% CI 4.0-44.0%) of excess maternal morbidity among non-Hispanic Black and Hispanic people, respectively. CONCLUSION Non-Hispanic Black and Hispanic nulliparous people who are low-risk at term undergo cesarean birth more frequently than low-risk non-Hispanic White nulliparous people. This difference accounts for a modest portion of excess maternal morbidity.

BACKGROUND Opioid misuse during pregnancy has been associated with adverse infant outcomes including preterm birth, stillbirth, and neonatal opioid withdrawal syndrome. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an on-going state-based surveillance system of maternal behaviors, attitudes, and experiences prior to, during, and after pregnancy. Methods: We analyzed qualitative comments related to opioid use during pregnancy collected in 2016 from an open-ended prompt at the end of the PRAMS survey in 35 states (N = 40,408). Key word searches were conducted on the open-ended responses (n = 9,549) to identify opioid-related content with an automated function using Microsoft Excel. All responses from the initial screening (n = 1,035) were manually reviewed, and 69 responses were confirmed to relate to the respondent's personal experience with opioid use during pregnancy. Content analysis was conducted by 3 independent coders; key themes were compiled, discussed, and finalized by the coding team. Results: Five key themes related to opioid use during pregnancy were identified: (1) gratitude for treatment, recovery, and healthy infants; (2) pregnancy as motivation to seek treatment; (3) difficulty finding prenatal care providers with training in substance use disorders; (4) concern about the effects of treatment on the infant; and (5) experiences of discrimination and stigma in the hospital around the time of delivery. Conclusions: Women may be aware of the potential impact of opioid use during pregnancy on the health of their infants and motivated to seek treatment. Findings may help inform new and ongoing initiatives designed to improve care and reduce stigma for women needing or seeking treatment.

With a growing number of states legalizing recreational use, cannabis consumption during pregnancy is increasing. Population-based data and rigorous studies examining the association of cannabis use in pregnancy with perinatal outcomes are limited, but trends include preterm prelabor rupture of membranes, placenta previa, and an increased length of hospital stay. Neonates of pregnant persons who used cannabis during their pregnancy can be at increased risk of low birth weight, preterm birth, neonatal intensive care unit admission, neurocognitive deficits, and infectious and neurologic morbidity and mortality. This state of the science review examines the prevalence of cannabis use in pregnancy, its pharmacodynamics and how that is influenced by pregnancy, and associated adverse perinatal and neonatal outcomes. Implications for health care providers caring for pregnant persons using cannabis, especially in legalized states, are discussed.

Adverse childhood experiences (ACEs) are associated with poor physical and mental health outcomes in pregnancy, prompting many care agencies to ask about ACEs as part of routine care. However, limited research has been conducted in the clinical setting to demonstrate associations between ACEs and maternal health (i.e., pregnancy complications and birth outcomes) and mental health in pregnancy (i.e., depression, anxiety, and substance use). The aims of the current study were to: (1) examine the prevalence of ACEs reported by patients attending a maternity clinic for medically low-risk patients, and (2) evaluate whether these reports were associated with prenatal health and mental health. Participants included pregnant women (n = 338) receiving prenatal care at a low-risk outpatient medical clinical from June 2017 to December 2018. Total ACE scores, pregnancy complications (e.g., gestational hypertension, preeclampsia), birth outcomes (e.g., Apgar scores, preterm birth), and mental health outcomes (i.e., anxiety, depression, and substance use) were extracted from electronic medical records. The majority of women (67.8%) reported experiencing no ACEs, 16.0% reported one ACE, 10.1% reported two ACEs, and 6.2% reported three or more ACEs. ACEs were associated with increased odds of prenatal depression, anxiety, and substance use in a dose–response fashion, but not pregnancy health or birth outcomes. Prevalence rates of maternal ACEs obtained in the prenatal care setting were low compared to the general population. While ACEs were positively associated with maternal mental health and substance use in pregnancy, they were not associated with pregnancy complications.

Women in the English National Health Service facing pre-viability second trimester pregnancy loss through foetal death, premature labour or termination of pregnancy for foetal anomaly find themselves in a particular trajectory of care. This usually involves the requirement to labour and birth the foetal body and may involve undergoing feticide in cases of termination. Drawing on ethnographic research investigating women's experiences of second trimester pregnancy loss, I argue that the determining factor affecting care trajectories for the pregnant body is the biomedically diagnosed status of the foetal body. Foetal size, non-viability and the potential for live birth during terminations all structure the healthcare options for the woman facing pregnancy loss in the second trimester. As such, the diagnostic classification of the foetal body in the context of gestational time determines the medical care afforded to the pregnant body. This results in specific consequences for women, whose experiences of, and choices around, second trimester pregnancy loss are constrained by diagnostic and classificatory decisions around the status of the foetal being before legal viability.

OBJECTIVE Evaluation of relevance and feasibility of universal newborn congenital cytomegalovirus infection (cCMVI) screening in saliva. DESIGN Retrospective, population-based cohort study. SETTING Clamart, France, 2016-2020. POPULATION All neonates born consecutively in our level III maternity unit. METHODS CMV PCR in saliva for all neonates at birth, and, if positive, CMV PCR in urine to confirm or exclude cCMVI. Prospective and retrospective characterisation of maternal infections. ROC curve analysis to assess saliva PCR performances. Acceptability of screening among staff members evaluated by a survey. MAIN OUTCOME MEASURES Number of cCMVI neonates; number of expected and unexpected cCMVI. RESULTS Among 15 341 tested neonates, 63 had cCMVI (birth prevalence of 0.4%, 95% CI 0.3-0.5). In 50% of cases, maternal infection was a non-primary infection (NPI) during pregnancy. cCMVI was expected or suspected (maternal primary infection [PI], antenatal or neonatal signs) in 24/63 neonates (38%), and unexpected in 39/63 neonates (62%). The best CMV saliva threshold to predict cCMVI was 356 (2.55 log) copies/ml [95% CI 2.52 log-3.18 log], with an area under the ROC curve of 0.97. Over 90% of the 72 surveyed staff members reported that the screening was easy and quick. No parent refused the screening. CONCLUSIONS Universal screening for cCMVI with CMV PCR on saliva samples is feasible and highly acceptable to parents and healthcare providers. Over half (62%) of the cases had no prenatal/neonatal signs of cCMVI or a maternal history of CMV infection during pregnancy and would probably not have been diagnosed without universal screening. TWEETABLE ABSTRACT In 62% of congenital cytomegalovirus infection cases, only universal neonatal screening in saliva can detect infection.

Objective To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and pregnancy outcomes considering testing policy and test‐positivity‐to‐delivery interval. Design Nationwide cohort study. Setting Sweden. Population From the Pregnancy‐Register we identified 88 593 singleton births, 11 March 2020–31 January 2021, linked to data on SARS‐CoV‐2‐positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing‐policy and test‐positivity‐to‐delivery interval. Main outcome measures Five‐minute Apgar score, neonatal care admission, stillbirth and preterm birth. Results During pregnancy, SARS‐CoV‐2 test‐positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non‐universal testing. There were generally lower risks associated with SARS‐CoV‐2 under universal than non‐universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62–3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5‐minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24–1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10–5.20). Compared with term births (2.1%), test‐positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60–4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62–2.02). Conclusions Testing policy and timing of test‐positivity impact associations between SARS‐CoV‐2‐positivity and pregnancy outcomes. Under non‐universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. Tweetable abstract Testing policy and time from SARS‐CoV‐2 infection to delivery influence the association with pregnancy outcomes., Tweetable abstract Testing policy and time from SARS‐CoV‐2 infection to delivery influence the association with pregnancy outcomes.

Objetivo: Descrever os conflitos vivenciados por adolescentes grávidas. Método: Trata-se de um estudo exploratório, com abordagem qualitativa realizado com treze adolescentes que realizaram pré-natal na UBS Baixinha no município de Caxias-Ma no período de Janeiro de 2018 a Agosto de 2019. A produção dos dados foi realizada por meio de entrevista semiestruturada e analisada pela Classificação Hierárquica Descendente, após processamento no software IRaMuTeQ. Resultados: Foram apresentados em dois segmentos: o primeiro segmento subdividiu-se dando origem as classes 5, 4, 3, 2 e 7 ligadas aos conflitos vivenciados durante a gestação e a segunda ramificação originou as classes 1 e 6, relacionadas aos planos de vida. Conclusão: A gravidez é um período que as adolescentes precisam de apoio da família e de toda a sociedade, pois o processo da maternidade contribui para as adolescentes abandonarem os estudos e postergar os planos de vida.

Background. Tetanus is a bacterial disease caused by the Clostridium tetani, which is a highly fatal, noncommunicable, and toxin-mediated disease. Globally, maternal and neonatal tetanus is a public health problem due to low maternal tetanus toxoid immunization. Ethiopia has the highest neonatal mortality and morbidity related to tetanus due to low tetanus toxoid immunization and the high number of home deliveries. The main objective of this systematic review and meta-analysis was to estimate the pooled coverage of at least two doses of tetanus toxoid immunization, and the pooled effect sizes of associated factors in Ethiopia. Methods. Primary studies for this review were searched from the PubMed/MEDLINE online, ScienceDirect, Hinari, Google, and Google Scholar databases. Primary articles published from 2010 up to August 30, 2020, were included in this meta-analysis. Data were extracted in Microsoft Excel format and exported to STATA Version 14.0. A random-effects meta-analysis model was used to estimate the pooled coverage of two or more tetanus toxoid immunizations and its associated factors. Heterogeneity was evaluated by the I 2 test. Egger’s weighted regression test was used to assess publication bias. Results. We retrieved 212 records; of these, 199 articles were excluded for reasons. Finally, 14 studies were included in this meta-analysis. The pooled estimate of receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia was 52.2% (95% CI: 42.47-61.93, I 2 = 98.4 % ). Antenatal care ( OR = 7.8 (95% CI: 3.2, 19.2), I 2 = 96.3 % ), media exposure ( OR = 8.3 (95% CI: 2.1, 33.3), I 2 = 98.1 % ), distance from the health facility ( OR = 2.64 (95% CI: 1.1, 6.6), I 2 = 94.1 % ), educational status of women ( OR = 4.7 (95% CI: 2.07, 9.56), I 2 = 94.2 % ), and educational status of husbands ( OR = 2.995 (95% CI: 1.194, 7.512), I 2 = 92.5 % ) were factors significantly associated with receiving at least two doses of tetanus toxoid immunization coverage in Ethiopia. Conclusions. The coverage of tetanus toxoid immunization among childbearing women was low in Ethiopia. Strengthening maternal health service utilization (antinatal care and institutional delivery) to the nearest health facility even in health posts and empowering education for both women and their husbands is recommended to increase tetanus toxoid immunization coverage in Ethiopia.

INTRODUCTION Reproductive endocrinologists recommend selective multifetal pregnancy reduction (MFPR) to save at least one or two babies, because triplet pregnancy is known to increase the risk of miscarriage and preterm delivery. However, recently improved obstetric and neonatal care may affect pregnancy outcomes differently in triplet pregnancies, which could alter practice. We compared the maternal, perinatal, and long-term outcomes of triplet pregnancies managed expectantly with those of pregnancies reduced to twins. MATERIAL AND METHODS In this retrospective cohort study, we reviewed the clinical records of 552 trichorionic triplet pregnancies for obstetric, perinatal, and neurodevelopmental outcomes, which consisted of the expectant management (EM) group (n = 225) and MFPR group (n = 327), in Seoul National University Hospital and CHA Bundang Medical Center from January 2006 to December 2018. Neuromotor development was evaluated using the Korean-Ages and Stages Questionnaire, Bayley-III tests, and/or Gross Motor Function Measure. The two groups were compared for the following outcomes: (1) nonviable pregnancy loss before 23 weeks, (2) preterm birth before 32 weeks of gestation, (3) fetal and neonatal survival and (4) long-term neurodevelopmental outcomes. RESULTS There were no differences in maternal age, body mass index, nulliparity or previous preterm birth between the two groups. The risk of nonviable pregnancy loss was lower in the EM group than that in the MFPR group (2 [0.9%] vs 21 [6.4%], p = 0.001). The risk of preterm delivery before 34 weeks of gestation was lower in the MFPR group (adjusted odds ratios [aOR] = 0.47, 95% confidence interval [CI] 0.30-0.73, p = 0.001). The survival rate of neonates until discharge (644 [95.4%] vs 572 [87.5], p < 0.001) and the rate of pregnancies with at least one survivor (220 [97.8%] vs 301 [92.0], p = 0.002) were higher in the EM group than those in the MFPR group. In the MFPR group, the risk of developmental delay (aOR = 2.89, 95% CI 1.38-6.02, p = 0.005) was higher. CONCLUSIONS In trichorionic triplet pregnancies, the possibility of EM to improve survival and reduce the risk of developmental delay has been shown.

To report the relationship of outpatient portal (OPP) use with clinical risk, area social determinants of health (SDoH), and race/ethnicity among pregnant women. Regression models predicting overall and individual portal feature use (main effects and interactions) based on key variables were specified using log files and clinical data. Overall OPP use among non-Hispanic Black women or patients who lived in lower SDoH neighborhoods were significantly less. High-risk pregnancy patients were likely to use the OPP more than those with normal-risk pregnancy. We found similar associations with individual OPP features, like Visit (scheduling) and My Record (test results). We also found significant interactive associations between race/ethnicity, clinical risk, and SDoH. Non-Hispanic Black women and those living in lower SDoH areas used OPP less than non-Hispanic White women from similar or affluent areas. More research must be conducted to learn of OPP use implications for pregnant women with specific clinical diagnoses.

Recent studies have shown that maternal anti-CD36 antibodies represent a frequent cause of fetal/neonatal alloimmune thrombocytopenia (FNAIT) in Asian and African populations. However, little is known about the pathomechanism and antenatal treatment of anti-CD36–mediated FNAIT. Here, we established a novel animal model to examine the clinical features of pups from immunized Cd36−/− female mice after breeding with wild-type male mice. Mild thrombocytopenia was observed, but high pup mortality was also documented (40.26%). Administration of intravenous immunoglobulin (IVIG) (1 g/kg) on days 7, 12, and 17 to immunized Cd36−/− mothers after breeding reduced fetal death (12.70%). However, delaying the IVIG administration series on days 10, 15, and 20 did not reduce fetal death (40.00%). In contrast, injection of deglycosylated anti-CD36 (deg-anti-CD36) polyclonal antibodies (5 mg/kg) on days 10, 15, and 20 significantly reduced fetal death (5.26%). Subsequently, monoclonal antibodies (mAbs) against mouse CD36 were developed, and one clone producing high-affinity anti-CD36 (termed 32-106) effectively inhibited maternal antibody binding and was therefore selected. Using the same approach of deg-anti-CD36, the administration of deg-32-106 significantly reduced fetal death (2.17%). Furthermore, immunized Cd36−/− mothers exhibited placental deficiency. Accordingly, maternal anti-CD36 antibodies inhibited angiogenesis of placenta endothelial cells, which could be restored by deg-32-106. In summary, maternal anti-CD36 antibodies caused a high frequency of fetal death in our animal model, associated with placental dysfunction. This deleterious effect could be diminished by the antenatal administration of IVIG and deg-mAb 32-106. Interestingly, treatment with deg-32-106 seems more beneficial considering the lower dose, later start of treatment, and therapy success.

The exercise of sexuality may undergo changes during pregnancy, creating insecurities and impairing sexual response. This study aims to investigate the literature on sexual dysfunction during pregnancy. For that, an exploratory bibliographic research was performed at the VHL, Lilacs, and Scielo databases using the descriptors ‘pregnancy’, ‘sexuality’, and ‘prenatal care’. Full-text articles, available online, written in Portuguese, and with affiliation in Brazil were included in the study. The results indicate that pregnancy negatively influences sexual function, directly interfering with sexual satisfaction. The presence of sexual disorders interrupting or changing any one of the phases of the sexual response lead to sexual dysfunctions. In this sense, this study reinforces the importance of the role of nurses in identifying and discussing sexual dysfunction. Durante el embarazo el ejercicio de la sexualidad puede sufrir alteraciones, lo que genera inseguridad y perjudica directamente la respuesta sexual. Este estudio busca investigar la producción bibliográfica sobre la ocurrencia de disfunción sexual durante el embarazo. Esta es una investigación exploratoria y de carácter bibliográfico, realizada en las bases BVS, LILACS y SciELO. Se incluyeron los artículos disponibles en línea en su totalidad, escritos en portugués, con la afiliación en Brasil. Se utilizó como descriptores: “embarazo”, “sexualidad” y “cuidado prenatal”. El embarazo influye negativamente en la función sexual, interfiriendo directamente en la satisfacción sexual, ya que las mujeres embarazadas evitan tener relación por temor al dolor, a perjudicar el feto, malestar, incomodidad corporal y pérdida del interés en la actividad sexual. El estudio refuerza la importancia del papel del enfermero para identificar y discutir sobre la disfunción sexual durante el cuidado prenatal. Durante a gravidez, o exercício da sexualidade pode sofrer alterações, o que gera insegurança e prejudica diretamente a resposta sexual. Este estudo visa investigar a produção bibliográfica sobre a ocorrência de disfunção sexual durante a gravidez. Trata-se de uma pesquisa exploratória e de caráter bibliográfico, realizada nas bases BVS, Lilacs e Scielo. Foram incluídos artigos disponíveis on-line na íntegra, escritos no idioma português, com afiliação no Brasil. Utilizou-se como descritores: “gravidez”, “sexualidade” e “cuidado pré-natal”. A gestação interfere nas alterações da função sexual e, consequentemente, no desenvolvimento da disfunção sexual, sendo que as mulheres grávidas evitam a relação sexual principalmente por medo de sentir dor, temor de prejudicar o feto, mal-estar, desconforto corporal e perda do interesse na atividade sexual. O estudo reforça a importância do papel do enfermeiro de identificar e discutir sobre a disfunção sexual durante o cuidado pré-natal.

Introduction: Coagulopathy may be the result of hyperfibrinolysis and could exacerbate bleeding following childbirth. Timely recognition of hyperfibrinolysis during the earliest stages of postpartum hemorrhage could identify women at risk of more severe blood loss who may benefit from targeted anti-fibrinolytic therapy. Rotational thromboelastometry (ROTEM®) is a point-of-care test that could detect hyperfibrinolysis. The aim of this study was to evaluate whether early assessment of hyperfibrinolysis by ROTEM during postpartum hemorrhage could predict progression to severe postpartum hemorrhage. Material and methods: During a prospective cohort study in the Netherlands among women with postpartum hemorrhage (total blood loss at least 1000 ml within 24 h after childbirth) ROTEM measurements were performed following 800–1500 ml of blood loss. Hyperfibrinolysis was defined as an enzymatic fibrinolysis index (ROTEM EXTEM maximum clot lysis [ML] minus the ROTEM APTEM ML) above 15%. Severe postpartum hemorrhage was defined as a composite end point of total blood loss greater than 2000 ml, transfusion of four or more units of packed cells, and/or need for an invasive intervention. The predictive value of hyperfibrinolysis for progression to severe postpartum hemorrhage was assessed by area under the receiver operating curve (AUC) and positive and negative predictive values. Trial registration: ClinicalTrials.gov (NCT02149472). Results: Of 390 women included, 82 (21%) had severe postpartum hemorrhage. Four (1%) women had thromboelastometric evidence of hyperfibrinolysis, of whom two developed severe postpartum hemorrhage. The AUC for enzymatic fibrinolysis index more than 15% for progression to severe postpartum hemorrhage was 0.47 (95% CI 0.40–0.54). Positive and negative predictive values for this index were 50.0% (95% CI 6.8–93.2) and 79.3% (95% CI 74.9–83.2), respectively. Conclusions: Thromboelastometric evidence of hyperfibrinolysis was rare in women with postpartum hemorrhage when assessed between 800 and 1500 ml of blood loss. The clinical predictive value of viscoelastometric point-of-care testing for hyperfibrinolysis for progression to severe postpartum hemorrhage during early postpartum hemorrhage is limited.

Most maternal deaths are preventable with good antenatal care. The study aimed to examine factors relevant to optimal frequency of Antenatal Care (ANC) visits in Indonesia using the Indonesian Demographic and Health Survey 2017 data. Our study outcome was optimal numbers of ANC visits (≥ 8 visits). Predictors include age, had pregnancy termination, number of children, education level, employment status, awareness of pregnancy problems, wealth index, residence, region, health insurance coverage, and barriers to reach healthcare facilities. Of 3738 participants, about 60.2% had optimal number of ANC visits. There was an association between optimal ANC utilization and: experiencing pregnancy complications, distance to the healthcare facility, health insurance coverage, residence, region, awareness of pregnancy problems, and the number of children. Policymakers should improve healthcare facilities' availability, expand health insurance coverage, and educate women about the importance of ANC. This finding might be relevant in developing countries with similar health infrastructure situation.

OBJECTIVE To determine the prevalence of anemia with the associated factors in pregnant women and the effect of family medicine practice and antenatal care services provided by family physicians on the prevention of anemia during pregnancy. STUDY DESIGN Community-based cross-sectional study. PLACE AND DURATION OF STUDY Family Health Centres in the Elazig region, Turkey from January to June 2019. METHODOLOGY A total of 495 pregnant women, attending the family health centres, were included. Women were administered a questionnaire related with the anemia and related factors; and hemoglobin values were drawn. Hemoglobin concentration

Trisomy 21 is a common birth defect in humans. Screening for trisomy 21 is one of the most important tasks in routine prenatal care and robust noninvasive diagnostics are needed in clinical practice. Urinary proteomics offers a new research platform for diagnostics innovation in this context. We report here new biomarker candidates using urinary proteomics profiling. Specifically, we used liquid chromatography-tandem mass spectrometry (LC-MS/MS) to analyze the proteomes of urine samples from 19 pregnant women (aged 28-44 years) carrying fetuses with trisomy 21 and 22 healthy pregnant women (aged 27-42 years) carrying fetuses with normal karyotype. We identified more than 50 differentially expressed proteins between the trisomy 21 group and healthy group, and most of these proteins were associated with the embryonic development. Importantly, tissue inhibitor of metalloproteinases 2 (TIMP2) and lysosomal-associated membrane protein 2 (LAMP2) were further selected as potential urinary protein biomarkers. We found that the combination of TIMP2 and LAMP2 could differentiate fetuses with trisomy 21 from healthy controls with a sensitivity of 74%, a specificity of 82%, and an area under the receiver operating characteristic curves (AUC) value of 0.82 (95% confidence interval, 0.69-0.95). We conclude that TIMP2 and LAMP2 offer promise as biomarker candidates and warrant further clinical research in larger study samples. These findings further our understanding of the pathological processes involved in fetal trisomy 21 and are poised to accelerate the development of new noninvasive potential biomarkers for trisomy 21 prenatal screening.

Objective Nutritional and financial needs increase during pregnancy, making pregnant women particularly vulnerable to food insecurity. Our objective was to document the prevalence of food insecurity among pregnant women receiving prenatal care in an urban centre in Canada and to identify factors associated with food insecurity. Methods This cross-sectional study recruited pregnant women receiving prenatal care at one of two Toronto hospitals: Site 1 and Site 2 (serving a more disadvantaged population) between October 1, 2018 and October 1, 2019. Demographic information was collected, and the U.S. Household Food Security Survey Module was used to assess food security. Comparisons were made using χ2 tests, two-tailed t tests, or Mann-Whitney tests for categorical and continuous variables, as appropriate. Binary logistic regression and multivariate analyses were performed to assess associations with food insecurity and differences between hospitals sites. Results We recruited 626 participants (316 at Site 1 and 310 at Site 2). Prevalence of food insecurity was 12.8% among all participants with Site 2 having nearly 5 times the prevalence of Site 1 (66/310 [21.3%] vs. 14/316 [4.4%]; P = 0.001). Several factors were associated with food insecurity, with non-White ethnicity (OR 2.04; 95% CI 0.98–4.25, P = 0.055] and lower household income (OR 37.53; 95% CI 14.04–100, P Conclusion This Canadian study documented the prevalence of and factors associated with food insecurity in pregnancy. Targeted interventions to help low-income women and programs geared towards non-White women may be beneficial in addressing food insecurity among pregnant women.

Purpose: The objective of this study was to examine the current state of literature on group prenatal care and its impact on maternal outcomes and racial disparities in adverse maternal outcomes.Design: We conducted a scoping review of literature published between January 2010 and December 2020 using the PRISMA-ScR reporting checklist.Methods: Eligible studies were identified using key words and MeSH terms in PubMed, CINAHL, and Web of Science. Inclusion criteria were studies that were (a) conducted in the United States; (b) published between January 2010 and December 2020; (c) in English; (d) focused on the primary investigation of group prenatal care and reporting on maternal comorbidity outcomes; and (e) an observational study or clinical trial.Results: Nine studies met inclusion criteria. They reported on outcomes of preeclampsia, gestational hypertension, gestational diabetes mellitus, final A1C among patients with gestational diabetes mellitus, and postpartum hemorrhage. None reported on racial disparities for minoritized populations. Among all reported maternal outcomes, results were mixed, providing inconclusive evidence.Clinical Implications: Outcomes from group prenatal care focus more on neonatal outcomes than maternal outcomes. More studies are needed with stronger designs. Given pervasive racial disparities in U.S. maternal mortality, future studies should assess how group prenatal care participation may contribute to fewer experiences of racial discrimination and implicit bias for Black women in maternity care.

Background Childbirth preparation trainings are an important component of prenatal education, and pregnant women are increasingly interested in seeking information from online sources. The aim of this study is to compare the feasibility and the effects of in-person and virtual childbirth preparation training courses on the pregnancy experience, fear of childbirth (FOC), birth preference, and type of delivery among pregnant women. Methods In total, 165 primiparous women referring to a prenatal clinic at Milad Hospital in Tehran, will be included in this study. The subjects will be selected using the convenience sampling method and will be divided into three groups of study A, study B, and control. The study groups A and B will receive virtual and in-person childbirth training with similar content, respectively. The control group will receive only routine prenatal care. In the 18th and 20th weeks of pregnancy, the demographic information, pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed, and in the 36th and 38th weeks of pregnancy, the PES and WDEQ-A questionnaires, as well as birth preference form will be completed. The type of delivery will be recorded in the first few days of postpartum. Conclusion This quasi-experimental clinical trial will investigate the effect of virtual childbirth preparation training on primiparous women. The expected outcomes will include the difference in pregnancy experience measured by the brief version of PES, the difference in FOC measured by WDEQ-A, the birth preference, and the type of delivery. Trial registration IRCT.ir: IRCT20180427039436N2

The strategy for preserving reproductive potential in the Russian Federation is focused on the personalized women’s health care and based on preclinical identification of gynecological diseases and major obstetric syndromes at the stage of predicting adverse outcomes and subsequent preventive measures able to reduce maternal and perinatal morbidity and mortality, decrease women and neonatal disability as well as profoundly reduce extremely high costs on care of premature infants. The search for effectivepredictive methods of preeclampsia (PE) at the stage of preconception and in the first trimester of pregnancy is driven by the desire to identify women at greater risk of developing hypertensive disorders in order to take the necessary effective measures forpreventing placental pathology as early as possible, thereby preventing or reducing incidence rate of PE. At the same time, identifying a group of high-risk women would allow to rationally plan prenatal care, timely recognize emergence of multiple organdysfunction and immediately begin pathogenetic and symptomatic therapy. Taking into account the national and global experience of using predictive analytics software proving their success in reproductive medicine, it is reasonable to assume that converting prognosis into digital format by using artificial intelligence (AI) algorithms will open new opportunities for increasing accuracy of individual risk calculation for PE by meeting current paradigm of personalized preventive medicine. Our scientific review on domestic and international publications aims to inform a wide range of obstetricians-gynecologists about advances in AI technologies as well as prospects for machine learning to predict PE.

1. Margot N. Tang, MD, MPH* 2. Soukaina Adolphe, MD* 3. Stephen R. Rogers, MD† 4. Deborah A. Frank, MD* 1. *Department of Pediatrics, Boston University School of Medicine, Boston, MA 2. †Boston University School of Medicine, Boston, MA * Abbreviations: AAP: : American Academy of Pediatrics ASD: : autism spectrum disorder ASPEN: : American Society for Parenteral and Enteral Nutrition CDC: : Centers for Disease Control and Prevention FASD: : fetal alcohol spectrum disorder GI: : gastrointestinal HIV: : human immunodeficiency virus IgA: : immunoglobulinA SGA: : small for gestational age SNAP: : Supplemental Nutrition Assistance Program WHO: : World Health Organization WIC: : Special Supplemental Nutrition Program for Women, Infants, and Children Beyond recognizing the medical and nonmedical dimensions that often interact to cause childhood growth faltering and malnutrition, it is important to understand the role of pediatric feeding disorders, to screen for and address social determinants of health, and to understand the multidisciplinary model of treatment. After completing this article, readers should be able to: 1. Diagnose growth faltering and childhood malnutrition. 2. Understand the pathogenesis and differential diagnosis of growth faltering. 3. Take a complete relevant history starting with the prenatal period that includes parental heights (if appropriate), nutritional and feeding details, developmental progress, and social determinants of health. 4. Understand the role of diagnostic testing, including first-line laboratory examinations such as complete blood cell count with differential count, iron studies, lead, chemistry panel, and celiac evaluation with immunoglobulin A and tissue transglutaminase antibodies. 5. Evaluate growth faltering in special populations of children with a history of prematurity, intrauterine growth retardation, small for gestational age, autism, and prenatal substance exposures. 6. Understand the role of social determinants in child undernutrition and the screening and resources to address conditions of poverty and inequality, including but not limited to food insecurity. 7. Demonstrate cultural competence when counseling families regarding growth, nutrition, and feeding. 8. Understand multidisciplinary treatment, including medical, nutritional, and often behavioral/feeding therapy, and developmental and psychosocial support, with close follow-up, use of pharmacotherapy when needed, and collaboration among providers and programs. Failure to thrive is an archaic term—now often replaced with growth faltering, weight faltering, or poor weight gain —to describe a symptom of many forms of primary and secondary undernutrition, usually in young children. (1)(2) We use the term growth faltering herein. Worldwide, childhood malnutrition is still a major cause of morbidity and mortality, with 45% of mortality in children younger than 5 years linked to undernutrition. (3) In the United States, the epidemiology of …

A female infant is born at 35 weeks, 4 days of gestation to a 29-year-old gravida 1, para 1 mother via cesarean section because of a footling breech presentation. The mother had received adequate prenatal care and had normal ultrasonography scans except for the finding of a 2-vessel cord and an infant who was small for gestational age. Maternal infectious laboratory findings are negative. Delivery is uneventful and Apgar scores at 1 minute and 5 minutes are 7 and 9, respectively. The infant’s birthweight is 1,920 g (0.35%, Z −2.69), birth length is 44.5 cm (1.46%, Z −2.18), and head circumference is 29.8 cm. (0.02%, Z −3.6) Around 85 minutes after birth, because of jitteriness, the infant’s blood glucose (BG) is measured and found to be 21 mg/dL (1.17 mmol/L). She is offered preterm infant formula 22 kcal/oz, of which, she took around 10 mL, and repeat BG is found to be 27 mg/dL (1.5 mmol/L). A peripheral intravenous catheter is placed and a 2 mL/kg bolus of 10% dextrose (D10) given, and an infusion of D10 in water at the rate of 80 mL/kg per day is started. Repeat BG is 88 mg/dL (4.9 mmol/L). On day 2 after birth, she starts having choking episodes and nonbilious emesis with feeding. Abdominal radiography shows a nonobstructive bowel gas pattern. She is transferred to the NICU and a nasogastric (NG) tube placed for feeding. Her BG levels remain stable with NG feedings, and she continues to be in room air with no evidence of respiratory distress. A sepsis evaluation is completed, with rule-out antibiotics (ampicillin and gentamycin) for 48 hours, with negative findings noted on culture. Echocardiography and head ultrasonography findings are normal, renal ultrasonography shows normal kidneys and a questionable bicornuate uterus. Physical examination findings are otherwise normal except for …

Objective: The study aimed to examine the impact of the COVID-19 pandemic on pregnant women’s prenatal care demand.Methods: This cross-sectional study was conducted between July 2020 and November 2020. The sample included 370 pregnant women recruited using the convenience sample method. The research data were collected by face-to-face interview technique with the questionnaire form prepared by the researcher using the literature on the subject. The data were analyzed using the chi-square test, fisher’s exact test, student t-test, and one-way ANOVA test. A p, Amaç: Araştırmanın amacı COVID-19 pandemisinin gebe kadınların doğum öncesi bakım (DÖB) talepleri üzerindeki etkisini belirlemektir.Yöntem: Temmuz 2020 ve Kasım 2020 tarihleri arasında kesitsel olarak yapılan araştırmaya olasılıksız örnekleme yöntemi ile 370 gebe alındı. Araştırma verileri araştırmacı tarafından konuya ilişkin literatürden yararlanılarak hazırlanan bilgi formu ile yüz yüze görüşme tekniğiyle toplandı. Elde edilen veriler ki-kare testi, fisher’s exact testi, student t-test ve one-way ANOVA testlerleri kullanılarak analiz edildi ve p