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Problem: Insights into and data of the experiences of pregnant women seeking asylum in Germany are largely lacking., Background: Due to multiple stress factors, pregnant refugees are considered a vulnerable group. Gender-specific causes of flight, traumatic experiences during flight, and numerous stressors in the respective host country have a decisive impact on the health of women and affect pregnancy and childbirth., Aim: This study aims to assess the perspectives and needs of pregnant refugee women from Nigeria, that are residing in an initial reception center in Germany., Methods: Experiences and concerns of N = 20 pregnant refugee women from Nigeria relating to pregnancy and impending childbirth were assessed in semi-structured interviews, conducted by three psychologists in English., Findings: Findings emphasize the need for continuous medical and psychotherapeutic care due to the multiple stressors and the partial lack of social support, especially for single women. The participants described their concerns particularly related to their personal and their family's health, as well as their impending birth, their optimistic attitude about the parenting experience, and confidence in medical care in Germany. Their wishes were predominantly related to items necessary for the care of their children, information about the pregnancy and birth process as well as for their integration. Utilization of resources and positive activities were indicative of adapting coping styles and resilience factors of pregnant refugee women., Conclusion: This study highlights the importance of the context-sensitive medical and psychotherapeutic care to adequately support the women during pregnancy and around childbirth. Furthermore, the study demonstrates the necessity of counteracting the negative effects of experiences on their health and that of their children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Comprehensive prenatal care incorporates recommended vaccines to help protect the mother, the pregnancy, and the infant from adverse health outcomes and severe illness from vaccine preventable diseases (VPDs). However, vaccinations during pregnancy remain underutilized, often influenced by concerns about vaccine safety and low perception of disease risk. Self-reported vaccine hesitancy among pregnant people in the United States has significantly increased in the last few years, and influenza and Tdap (tetanus, diphtheria, and pertussis) vaccination rates have declined. Furthermore, the number of vaccines routinely recommended during pregnancy has expanded. Communication strategies tailored to pregnant people may help build vaccine confidence among pregnant people and their health care providers. While characteristics and perceptions associated with hesitancy to vaccinate during pregnancy are documented in existing literature, more information is needed on promising communication practices preferred by subgroups of pregnant persons, particularly Black pregnant people who have higher rates of illness from VPDs and greater risk of pregnancy-related complications. This article summarizes literature on the current landscape of prenatal vaccination, discusses qualitative findings from focus groups with non-Hispanic Black pregnant people, and describes promising practices for communicating with this group about vaccination. Promising practices include specifying the benefits of vaccination for both the pregnant person and the infant, outlining potential risks, and emphasizing the overall importance of vaccination during pregnancy, while also acknowledging that many non-Hispanic Black pregnant people may have health concerns they perceive as superseding vaccination.

Introduction: Despite the recognized link between prenatal alcohol consumption and various congenital anomalies, the negative consequences for women's own health and family health, as well as the work done in healthcare to prevent alcohol in pregnancy, the acceptance of alcohol use during pregnancy persists in numerous communities around the world. Knowledge about women's alcohol use in pregnancy and how it relates to the social and cultural context they are part of is important to help and support women in abstaining during pregnancy. This meta-ethnography aims to offer a novel interpretation and conceptual understanding of the experiences of women who consume alcohol during pregnancy by synthesizing insights from existing qualitative studies., Methods: An interpretative meta-ethnographic design was chosen based on a systematic literature search in seven electronic databases, and manual searches were conducted in 2023. The CASP checklist was used to assess the 18 included articles., Results: In the synthesis, we use the metaphor of being trapped in a maze to illustrate the complexity of pregnant women's experiences of drinking during pregnancy. Women who drink alcohol during pregnancy are navigating the maze in a whirlwind of conflicting information and knowledge. The findings show how sociocultural norms form rigid pathways within the maze. In relation to their sociocultural context, women use several motives to justify the routes chosen within the maze. The competing information, knowledge and clashing norms within women's sociocultural contexts leave women to navigate alone in the maze., Conclusions: Alcohol in pregnancy needs to be conceptualized as an issue positioned at the intersection of social sciences and healthcare and needs to be handled accordingly, both through transdisciplinary research, by early prevention and multimodal interventions in healthcare and the broader society. Such interventions would benefit from drawing on knowledge about women's experiences with alcohol in pregnancy., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Black pregnant women who experience racial discrimination are at an increased risk of psychological distress. Studies have not adequately addressed if social support may moderate the association between experiences of racial discrimination and psychological distress among Black pregnant women., Objective: We sought to examine the moderating effect of social support on the association between experiences of racial discrimination and psychological distress among Black pregnant women., Methods: We report findings based on cross-sectional data collected from 599 Black pregnant women enrolled in a prospective cohort study prior to the COVID-19 pandemic. Women completed questionnaires about experiences of racial discrimination (Experiences of Discrimination), social support (MOS Social Support Survey), and psychological distress (Psychological General Wellbeing Index)., Results: Women had an average age of 26 ± 5 years and gestational age at data collection of 17 ± 6 weeks. Approximately 53% of women reported ever experiencing racial discrimination in at least one situation, and 54% reported psychological distress. After adjustment for covariates, racial discrimination was associated with a 2.2-fold increase in psychological distress (odds ratio [OR] = 2.24; 95% confidence interval [CI] 1.35-3.70; P  = .002). Low social support (scores below the median) was associated with a 3.8-fold higher likelihood of psychological distress (OR = 3.84, 95% CI 2.27-6.48, P  < .001). Social support did not moderate the association of lifetime experiences of racial discrimination with psychological distress., Conclusions: Findings of the study contribute to evidence that lifetime experiences of racial discrimination and low levels of social support relate to psychological distress among Black pregnant women., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The information needs of low-income pregnant women are multisectoral, encompassing both pregnancy-related and non-pregnancy-related information. Barriers to receiving information for low-income pregnant women are specific and complex. This study aimed to explore the experiences of low-income Indonesian pregnant women regarding the challenges of receiving health information., Methods: A qualitative study was conducted using content analysis according to Graneheim and Lundman's approach between January and June 2022. A total of 17 women were selected for this study using purposive sampling. In-depth interviews were done following semi-structured interview guidelines, concluding when saturation was reached. Nvivo software version March 2020 was used for organizing data and analysis., Results: Three themes emerged concerning receiving health information among low-income women, including encountering barriers to accessing information and care, access to ineffective information sources, and difficulties in applying pregnancy health information., Conclusion: This study shows that barriers to receiving information are specific to low-income pregnant women. Therefore, solution approaches must also be specific. Efforts to improve receiving health information can be achieved through developing educational materials that are easy to access and understand, improving e-health literacy, refining counseling skills among village midwives, holding culturally tailored educational programs, improving mothers' health literacy by family and husbands, integrating counseling with a focus on critical literacy, and formulating policies to alleviate the midwife's workload., Competing Interests: None declared., (Copyright: © International Journal of Community Based Nursing and Midwifery.)

Purpose: Global health researchers have a responsibility to conduct ethical research in a manner that is culturally respectful and safe. The purpose of this work is to describe our experiences with recruitment and retention in Pakistan, a low-middle-income country., Description: We draw on two studies with a combined sample of 2161 low-risk pregnant women who participated in a pilot (n = 300) and a larger (n = 1861) prospective study of psychological distress and preterm birth at one of four centers (Garden, Hyderabad, Kharadar, Karimabad) of the Aga Khan University Hospital in Karachi, Pakistan., Assessment: Challenges we encountered include economic hardship and access to healthcare; women's position in the family; safety concerns and time commitment; misconceptions and mistrust in the research process; and concerns related to blood draws. To mitigate these challenges, we developed culturally acceptable study incentives, involved family members in the decision-making process about study participation, partnered with participants' obstetrician-gynecologists, accommodated off site study visits, combined research visits with regular prenatal care visits, and modified research participation related to blood draws for some women., Conclusion: Implementation of these mitigation strategies improved recruitment and retention success, and we are confident that the solutions presented will support future scientists in addressing sociocultural challenges while embarking on collaborative research projects in Pakistan and other low-middle-income countries., (© 2024. The Author(s).)

Background: While it is recognized that social support can alleviate mental health symptoms, this relationship is not well-understood among Chinese pregnant and parenting immigrants in the United States. This study aims to bridge this gap by exploring the relationships between different types of social support and women's anxiety and depression, and examining how these associations vary with pregnancy status., Methods: Data were obtained from a cross-sectional survey conducted in Simplified Chinese or Mandarin between March-June 2021 among 526 women who were pregnant and/or parenting a child under five years. The Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, and Social Support scales were used to measure anxiety, depression, and social support levels. Descriptive statistics, t-tests, chi-square tests, and Pearson's correlations were employed for analysis. Hierarchical regression was conducted to investigate the main and interaction effects of social support types and pregnancy status on mental health outcomes., Results: Compared to non-pregnant women, pregnant women reported higher mean scores for anxiety (non-pregnant: 55, pregnant: 59, p < 0.01) and depression (non-pregnant: 54, pregnant: 56, p = 0.02). Instrumental support displayed a significant main effect in relation to anxiety (β=-0.13, p = 0.01) and depression (β=-0.16, p < 0.01); emotional support exhibited a significant main effect solely on depression (β=-0.13, p = 0.01). Notably, the interaction effects between pregnancy status and both instrumental (β=-0.28, p = 0.01) and emotional support (β=-0.42, p < 0.01) were significant for anxiety. In contrast, informational support did not exhibit a significant impact on either anxiety or depression., Conclusions: The findings indicate that tailoring support to the cultural context is crucial, especially for pregnant women in this Chinese immigrant community, with instrumental and emotional support being particularly beneficial in mitigating maternal anxiety., (© 2024. The Author(s).)

Aim: To translate the Empowerment Scale for Pregnant Women (ESPW) into Chinese and to assess its linguistic validity., Methods: The integrative method of the translation process, the Delphi technique, and cognitive interviews were used to implement cross-cultural adaptation and enhance comprehensibility and linguistic validation. This study recruited 14 experts in the expert review and cognitively reviewed 15 pregnant women., Results: The two-round Delphi method created agreement on cultural applicability. The results of content validity achieved good levels: The item-level content validity index (CVI) ranged from 0.78 to 1.00, and the scale-level content validity index, calculated using two different formulas, were 0.97 and 0.81, respectively. Kappa values ranged from 0.74 to 1.00. Pregnant women could understand most of the items and response options in the cognitive interview. The revisions to the wording were made based on suggestions from experts and pregnant women., Conclusion: The prefinal simplified Chinese ESPW was semantically and conceptually equivalent to the English version, which was well prepared for further psychometric tests in the next stage of cross-cultural adaptation., Patient or Public Contribution: This comprehensive method successfully developed a Chinese tool to measure the empowerment of pregnant women, indicating the international applicability of this tool and the methodological scientific nature. The simplified Chinese ESPW has the potential to support the identification of empowerment levels of pregnant women and the evaluation of the effectiveness of health education and promotion programmes., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Few studies have examined the associations of intimate partner violence (IPV) exposure during pregnancy and types of IPV with antenatal depression among underserved pregnant women. Methods: Data came from participants from a Healthy Start program in South Carolina between 2015 and 2019 ( n = 1,629). The first two questions in the Woman Abuse Screening Tool (WAST) were used to measure IPV exposure, that is, having a problematic relationship with their partner. Those who had IPV exposure were assessed with six additional questions of the WAST. Principal component analysis was conducted on the 8-item WAST data to identify underlying types of IPV exposure. Antenatal depression was defined as the Center for Epidemiologic Studies Depression scores ≥16. Results: Participants were racially diverse (71% black, 21% white) with 85% Medicaid recipients. Nearly 12% of participants reported IPV exposure and 30% reported antenatal depression. The odds of having IPV exposure were higher among unmarried women, those with less than a high school education, and those who lacked family support. The odds of having antenatal depression were 2.5 times higher (95% CI: 1.9-3.5) among women with IPV exposure. After controlling for covariates, a one-point increase in the scores for psychological IPV (Factor 1) or a problematic relationship (Factor 3) was associated with increased odds of antenatal depression. Conclusion: This is one of the first studies to estimate the prevalence of IPV exposure using a proxy measure (a problematic relationship) among underserved U.S. pregnant women. Its positive association with antenatal depression suggests the utility of screening for a problematic relationship using a two-item WAST and providing assistance to those with IPV exposure.

Background: Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population., Aim: Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups., Methods: Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists., Findings: Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors., Discussion: Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers., Conclusion: We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress., Purpose: To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women., Methods: Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone., Results: Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered., Conclusions: These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women., Implications: Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Extensions of objectification theory to pregnant women are few and continued research is needed to better understand the psychological consequences of significant changes to physical appearance during pregnancy. Specific interests in this area include functionality appreciation which may be particularly relevant to pregnancy. Research in this area is also lacking representation of non-Western cultural contexts. To this end, we employed an online survey to assess objectification theory and functionality appreciation in Chinese pregnant women (N = 345). Correlations showed that higher body surveillance and body shame were associated with higher disordered eating and psychological distress, and higher functionality appreciation was associated with lower body surveillance, body shame, and disordered eating. Mediation analyses suggested that higher body surveillance was associated with higher body shame which, in turn, was associated with higher disordered eating and psychological distress. Main effects suggested a negative association between functionality appreciation and body shame, but moderation analyses suggested that higher functionality appreciation strengthened the positive association between body surveillance and body shame. Findings underscore objectification theory as a useful framework to understand eating and body image disturbances and psychological distress in Chinese pregnant women and outline future directions to clarify the temporal nature of these associations and the precise role of functionality appreciation., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Pregnant women are vulnerable to Coronavirus Disease 2019 (COVID-19) complications, yet may hesitate to get vaccinated. It is important to identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy. Methods: We searched PubMed, Embase, and Web of Science for articles published through January 2023 for keywords/terms related to immunization, COVID-19, and pregnancy, and performed a systematic review and meta-analysis to examine characteristics associated with vaccine acceptance. Results: Of 1,592 articles, 23 met inclusion criteria (focused on pregnant women in the United States, and their willingness or hesitation to vaccinate). Twenty-two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. Meta-analyses demonstrated that compared with Whites, Hispanics (odds ratios [OR] 0.72; 95% confidence interval [CI] 0.58-0.91) and Blacks (OR 0.44; 95% CI 0.30-0.63) had less COVID-19 vaccine acceptance, while Asians (OR 1.78; 95% CI 1.10-2.88) had greater vaccine acceptance. College graduation or more (OR 3.25; 95% CI 2.53-4.17), receipt or intention to receive the influenza vaccine (OR 3.46; 95% CI 2.22-5.41), and at least part-time employment (OR 2.12; 95% CI 1.66-2.72) were significantly associated with vaccine acceptance. Conclusions: COVID-19 vaccine nonacceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least part-time employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination.

The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV., Methods: A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention's effect. The analyses were conducted by intention to treat., Results: Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months., Conclusion: Our intervention did not improve women's quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions., Trial Registration: NCT03397277 registered in clinicaltrials.gov on 11/01/2018., (© 2022. The Author(s).)

Background: Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights., Methods: We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting., Results: We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare., Conclusions: Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes., (© 2022. The Author(s).)

Background: Antenatal care (ANC) is a health care intervention intended to ensure the safety of pregnancy. According to the World Health Organization, at least four ANC visits are recommended for a healthy pregnancy. However, whether this recommended number of visits was followed or not in the rural areas of Southwestern Ethiopia is not known. Therefore, the study aimed to investigate the prevalence of, and the associated factors of ANC utilization by pregnant women in the rural areas of Southwestern Ethiopia., Methods: A community-based cross-sectional study design was used in three rural zones. The data were collected from n = 978 women through a structured questionnaire with face-to-face interview. The collected data were analyzed using descriptive statistics and a multiple binary logistic regression model., Results: The results showed that 56% of women made the recommended minimum number of ANC visits and the remaining 44% of them underutilized the ANC service. The multiple binary logistic regression model identified zone, marital status of the woman, educational level of the husband, occupation of the husband, knowledge of danger signs of pregnancy, birth interval, source of information, timely visits, and transportation problem to be statistically significant factors affecting the prevalence of ANC visit utilization of women. Bench Maji zone had smaller odds ratio of ANC visit prevalence as compared to Kaffa zone. Women who lived in the rural area of Sheko zone are 2.67 times less likely to utilize ANC visit than those who lived in the rural area of Kaffa zone keeping other variables constant., Conclusion: The study results highlight the need to increase the number of ANC visits, and the importance of using an appropriate model to determine the important socio-demographic factors that ANC service providers shall focus on to improve the health of the unborn baby and the mother during pregnancy., (© 2022. The Author(s).)

Background: Regular physical activity during pregnancy can prevent several adverse health outcomes during this period of a woman's life. Previous studies have shown that many women do not meet national recommendations for physical activity. This study aims to examine factors associated with sufficient leisure-time physical activity (LTPA) in a multicultural sample of pregnant women recently diagnosed with gestational diabetes mellitus (GDM)., Methods: We performed a cross-sectional study among 238 pregnant women. The women were recruited at diabetes outpatient clinics in the Oslo region of Norway from October 2015 to April 2017. The participants reported their activity levels using the Pregnancy Physical Activity Questionnaire (PPAQ). Pearson's chi-square tests were used to assess differences in socio-demographic, health and pregnancy-related characteristics in relation to sufficient and insufficient LTPA, and logistic regression modelling was employed to predict the likelihood of insufficient LTPA., Results: Less than half of the women in the sample (44.5%) had sufficient LTPA according to the minimum of ≥600 Met minutes per week. The majority of women were motivated to be physically active during pregnancy (84.9%). A low joint family income and being over 38 years of age increased the odds of not having sufficient LTPA. Women with sufficient LTPA had significantly higher scores of perceived health (p = 0.007)., Conclusions: The study indicates that pregnant women need to be better informed about the positive effects of physical activity on individually perceived health. To address the low levels of LTPA among pregnant women, communication strategies must be tailored towards women with low socio-economic backgrounds., Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02588729., (© 2021. The Author(s).)

Background: Anemia in pregnancy is a serious global public health problem in most developing countries and a major cause of maternal morbidity and mortality. Somalia which already had very high maternal mortality ratio of 829 per 100,000 live births, pregnant women in internally displaced camps (IDPs) remain at most exposed. The aim of the study was to determine the prevalence, severity and associated risk factors of anemia among pregnant women in internally displaced camps in Mogadishu, Somalia., Methods: A community based cross-sectional study was conducted among 383 households in the most IDP settled districts in Mogadishu. Every pregnant mother in these sampled households who was voluntarily consented was targeted. A sample of blood was also taken by pricking the fingertip and inserted into hemoglobin meter. Those with Hb < 11 g/dl from hemoglobin meter had been taken another sample of 3 cc blood and put into EDTA tube for CBC analysis to identify the type of anemia. Data on risk factors were collected using structured pretested questionnaire via an interview. Collected data was coded and entered in SPSS- Version 22 for analysis. Descriptive analysis, bivariate chi-square and multivariate logistic regression were done., Results: The overall prevalence of anemia among study participants was 44.4% (95%CI: 39.5-49.3%), where severe and moderate anemia were 11.8 and 47.0% respectively. In addition all anaemic cases were microcytic hypochromic anemia. Young maternal age, low Family income, fewer/zero parity, being at third or second trimesters, lack of ANC attendance during pregnancy, lack of iron supplementation during pregnancy, taking tea immediately after meal during pregnancy, lower/zero frequency of daily meat and vegetables consumption during pregnancy were associated risk factors of anemia., Conclusion: The anemia prevalence from this study was severe public health problem. Several factors were found to be associated with anemia during pregnancy. Measures has to be taken to curb the problem by including them mass iron supplementation and health education towards identified risk factors., (© 2021. The Author(s).)

Objective: Describe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER., Design: Mixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool., Settings: Aboriginal women and communities in urban and regional New South Wales, Australia., Participants: Phase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women., Results: Phase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic., Conclusions: Developing a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique's coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women's needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pregnancy constitutes a global health concern, thus the need for spousal support during this period cannot be overemphasized. This study examined the kinds of support pregnant women expected and received from their spouses as well as the effect of such supports during pregnancy, labour, and delivery., Methods: The study adopted both quantitative and qualitative methods of data collection. The respondents were selected using multistage and simple random sampling techniques., Results: Findings showed that respondents expected and received maximum support from their spouses during pregnancy, labour, and delivery. Spiritual support such as praying and fasting was top of the kinds of support pregnant women expected and received from their husbands during pregnancy and delivery. Others include helping in house chores, financial provision, taking care of other children, accompanying to labour room, and sexual support. More than three-quarters of the respondents stated that maximum support from their husbands made pregnancy, labour, and delivery easier. Cramer's V showed that the association between support and husbands' occupation was 0.233 and Pearson Chi-square showed that the association was statistically significant χ2(2) = 27.894,p < .001., Conclusion: The study concluded that spousal support during pregnancy was high among rural women in Southwestern Nigeria, and it impacted positively on their wife's period of pregnancy, labour, and delivery. A high level of spousal support should be sustained to promote family bonding and development as well as reduce maternal and child mortality., (© 2021. The Author(s).)

Background: The unregistered population remains under-researched because of its "invisible" status in statistics. Studies on perinatal health outcomes of unregistered women remains particularly limited. Our objectives were 1) to describe the sociodemographic profiles of women who are not legally residing in Belgium and 2) to analyze the associations of registration status with pregnancy outcomes according to socioeconomic status and nationality., Methods: We analysed data from birth and death certificates taken from the Belgian civil registration system, linked with the National Population Registry (NPR). The data relates to all singleton babies born between 2010 and 2016 (n = 871,283), independent of their mother's NPR registration status. We used logistic regression to estimate the odds ratios for the associations between perinatal outcomes (perinatal mortality, prematurity and low birth weight) and maternal NPR registration status according to socioeconomic status and maternal nationality., Results: Over the study period, 1.9% of births were to mothers without NPR-registration. Unregistered women from newer EU member states and non-European countries were particularly disadvantaged from a socioeconomic point of view. Apart from women with a South American nationality, all other groups of unregistered women had higher rates of prematurity, low birth weight, and perinatal mortality, compared to registered mothers (p < 0.0001). Unregistered women from Belgium and EU15 nationalities had particularly higher rates of prematurity, low birth weight, and perinatal mortality, compared to registered mothers, even after adjustment for socioeconomic status (p < 0.0001). The excess of perinatal mortality for non-European unregistered mothers could partly be explained by their precarious socioeconomic situation., Conclusions: This is the first study to include data on mothers who were not legally residing in Belgium. Unregistered women giving birth in Belgium are likely a heterogeneous socioeconomic group. Overall, unregistered women have increased risks of adverse perinatal outcomes, but it is likely that the causal mechanisms differ starkly between Belgian, European and non-European women. Further research is needed to understand the mechanisms behind these accrued rates. It is important to keep measuring the health outcomes of the populations which are "invisible" in national statistics, in order to identify the groups in most need of integration and access to services., (© 2021. The Author(s).)

In the U.S., preterm birth disproportionately impacts certain racial/ethnic groups, with Black women experiencing preterm birth at a rate 50% higher than other groups. Among the numerous factors that likely contribute to these increased rates are neighborhood characteristics, such as food environment. In this mixed-methods case study, we evaluated how pregnant women living in a predominately minority, lower income community with high preterm birth rates navigate and perceive their food environment. Qualitative interviews were performed to assess perceptions of food environment ( n = 7) along with geographic and observational assessments of their food environment. Participants traveled an average of 2.10 miles (SD = 1.16) and shopped at an average of 3 stores. They emphasized the importance of pricing and convenience when considering where to shop and asserted that they sought out healthier foods they thought would enhance their pregnancy health. Observational assessments of stores' nutrition environment showed that stores with lower nutritional scores were in neighborhoods with greater poverty and a higher percent Black population. Future policies and programmatic efforts should focus on improving nutrition during pregnancy for women living in communities with high rates of poor birth outcomes. Availability, affordability, and accessibility are key aspects of the food environment to consider when attempting to achieve birth equity.

Background: Migrant women are at increased risk for complications related to  pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services., Methods: In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers., Results: Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health., Conclusion: A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel., (© 2021. The Author(s).)

Aim: To investigate the association between placental genome-wide methylation at birth and antenatal depression and stress during pregnancy. Methods: We examined the association between placental genome-wide DNA methylation (n = 301) and maternal depression and stress assessed at six gestation periods during pregnancy. Correlation between DNA methylation at the significantly associated CpGs and expression of nearby genes in the placenta was tested. Results: Depression and stress were associated with methylation of 16 CpGs and two CpGs, respectively, at a 5% false discovery rate. Methylation levels at two of the CpGs associated with depression were significantly associated with expression of ADAM23 and CTDP1 , genes implicated in neurodevelopment and neuropsychiatric diseases. Conclusion: Placental epigenetic changes linked to antenatal depression suggest potential fetal brain programming. Clinical trial registration number: NCT00912132 (ClinicalTrials.gov).

Background: A woman's perception of risk affects her decisions about seeking obstetric care and following prescribed regimens of care. This study explored the perceptions of high-risk pregnancy among women with high-risk factors., Methods: A qualitative study was conducted in the Morang district, Nepal. A phenomenological approach was used. In-depth interviews were conducted with 14 participants. Postpartum women with one risk factor for high-risk pregnancy who non-adhere to referral hospital birth were selected purposively. Thematic analysis was done to generate themes and categories., Findings: Two main themes emerged in this study: (i) knowledge and understanding of risk and (ii) normalizing and non-acceptance of risk. The participants had inadequate knowledge of risk in pregnancy and childbirth. Their information source was their personal experiences of risk, witnessing their close relatives, and community incidents. The participants perceived pregnancy as a normal event and did not consider themselves as at risk. They tended to deny risk and perceived that everything was fine with their pregnancy., Conclusions: The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks and gave home birth. In the presence of risk factors in pregnancy, some women were not convinced that they were at risk. An antenatal check-up should be utilized as a platform to educate women, explore their intentions, and encourage safer births., (© 2021. The Author(s).)

Background: South Asian women are at a high risk of developing gestational diabetes mellitus than other women in Australia. Gestational diabetes affects up to 14-19% of all pregnancies among South Asian, South East Asian, and Arabic populations placing women at risk of adverse pregnancy outcomes. Although, gestational diabetes resolves after childbirth, women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within five to ten years of the index pregnancy. Increasingly, South Asian women are being diagnosed with gestational diabetes in Australia. Therefore, we aimed to gain a better understanding of the lived experiences of South Asian women and their experiences of self-management and their health care providers' perspectives of treatment strategies., Methods: Using an ethnographic qualitative research methodology, semi-structured one-on-one, face-to-face interviews were conducted with 21 health care providers involved in gestational diabetes management and treatment from the three largest tertiary level maternity hospitals in Melbourne, Victoria, Australia. In-depth interviews were conducted with 23 South Asian women post diagnosis between 24-28 weeks gestation in pregnancy., Results: Health care providers had challenges in providing care to South Asian women. The main challenge was to get women to self-manage their blood glucose levels with lifestyle modification. Whilst, women felt self-management information provided were inadequate and inappropriate to their needs. Women felt 'losing control over their pregnancy', because of being preoccupied with diet and exercise to control their blood glucose level., Conclusions: The gestational diabetes clinical practice at the study hospitals were unable to meet consumer expectations. Health care providers need to be familiar of diverse patient cultures, rather than applying the current 'one size fits all' approach that failed to engage and meet the needs of immigrant and ethnic women. Future enabling strategies should aim to co-design and develop low Glycaemic Index diet plans of staple South Asian foods and lifestyle modification messages., (© 2021. The Author(s).)

Background: Intestinal parasitic infections (IPIs) are public health problems widely distributed in the world and cause significant morbidity and mortality; many of which occur among women of reproductive age. IPIs caused by helminthes and protozoan parasites are common among pregnant women. Data on the national pooled prevalence of intestinal parasites and associated factors during pregnancy is not documented well in Ethiopia. This review aims at summarizing evidences on the burden of IPIs and associated factors among pregnant women in Ethiopia., Methods: Published and unpublished studies were thoroughly searched at MEDLINE/PubMed, EMBASE, Google Scholar, CINAHL, Cochrane library and Science Direct. In addition, repositories of Addis Ababa, Gondar and Jimma Universities were searched. Eligible studies were selected following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. The pooled prevalence of intestinal parasites and summary odds ratios (ORs) were determined with 95 % confidence intervals (CI). Sub-groups analyses were done based on study region, types of parasites, methods of stool examination and study setting. The statistical analyses were performed using STATA version 14.0 software., Results: Among 168 retrieved studies, 31 studies with a total population of 12,118 pregnant women were included. The estimated pooled prevalence of IPIs among pregnant women in Ethiopia was 27.32 % (95 % CI: 20.61, 33.87 %). In the subgroup analysis, Oromia and Amhara regions had the highest prevalence with a 29.78 % (95 % CI: 15.97, 43.60) and 29.63 % (95 % CI: 15.37, 43.89); respectively. In addition, studies conducted in the community showed higher prevalence than institution based studies (49.93 % Vs 24.84 %; respectively). The most prevalent type of intestinal parasite identified were Hookworm followed by Ascaris lumbricoides with a pooled prevalence of 11.2 and 10.34 %, respectively. In our analysis; residence, being bare footed, lack of hand washing habit and eating uncooked/raw vegetables were significantly associated with IPIs among pregnant women in Ethiopia., Conclusions: Prevalence of IPIs during pregnancy is relatively high in Ethiopia. Poor hygienic practices were identified as risk factors. Based on our finding, targeted preventive measures shall be considered so as to prevent morbidity and mortality due to IPIs.

Objective: This study explored stress and coping among pregnant Black women prior to and during the COVID-19 pandemic., Design: Prospective, longitudinal, cohort study., Sample: Thirty-three women enrolled in the Biosocial Impact on Black Births study prior to the COVID-19 pandemic and who were still pregnant during the pandemic., Measurements: Questionnaires included the Perceived Stress Scale, Prenatal Coping Inventory, and questions related to sociodemographic characteristics, worry about COVID-19, and coping strategies used during the pandemic., Results: Women reported very much being worried about my child getting COVID-19 (46%) and my family member getting COVID-19 (46%). Women reported specific active coping strategies very much reduced their feelings of discomfort during COVID-19: God, religion, or spirituality (24%), social media (24%), and following government advice (24%). Higher use of avoidance coping prior to the pandemic was associated with higher levels of stress both prior to (r = 0.60, p < .001) and during (r = 0.47, p < .01) the pandemic., Conclusion: Women reported worries about COVID-19 and used various strategies to cope with feelings of discomfort due to the pandemic. Nurses should assess the stress level of pregnant Black women and recommend active coping strategies during the pandemic., (© 2021 Wiley Periodicals, Inc.)

Rapid household food insecurity (HFI) tracking has been identified as a priority in the context of the COVID-19 pandemic and its aftermath. We report the validation of the Latin American and Caribbean Food Security Scale (Escala Latinoamericana y Caribena de Seguridad Alimentaria [ELCSA]) among pregnant women in Sri Lanka. The eight-item adult version of the ELCSA was translated from English to Sinhala and Tamil. Cognitive testing (on 10 pregnant women and five local experts) and psychometric validation of the self-administered HFI tool were conducted among pregnant women (n = 269) attending the special clinics of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura in February 2020. We assessed the psychometric properties and fit using a one parameter logistic model (Rasch model analysis) using STATA Version 14 and WINSTEP software Version 4.3.4. Concurrent validity was tested using psychological distress. The scale was internally consistent (Cronbach's alpha = 0.79) and had a good model fit (Rasch items infit statistic range: 0.85 to 1.07). Item 8 ('did not eat for the whole day') was removed from the model fit analysis, as it was not affirmed by respondent. Item severity scores ranged from -2.15 for 'not eating a diverse diet' to 4.43 for 'not eating during the whole day'. Concurrent validity between HFI and psychological distress was confirmed (r = 0.15, p < 0.05). The self-applied version of ELCSA-pregnancy in Sri Lanka (ELCSA-P-SL) is a valid and feasible valid tool. We recommend it to track HFI among pregnant women in lower income countries during the COVID-19 pandemic., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

COVID-19 vaccines are critical for ending the COVID-19 pandemic; however, current data about vaccination coverage and safety in pregnant women are limited. Pregnant women are at increased risk for severe illness and death from COVID-19 compared with nonpregnant women of reproductive age, and are at risk for adverse pregnancy outcomes, such as preterm birth (1-4). Pregnant women are eligible for and can receive any of the three COVID-19 vaccines available in the United States via Emergency Use Authorization.* Data from Vaccine Safety Datalink (VSD), a collaboration between CDC and multiple integrated health systems, were analyzed to assess receipt of ≥1 dose (first or second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Janssen [Johnson & Johnson] vaccine) of any COVID-19 vaccine during pregnancy, receipt of first dose of a 2-dose COVID-19 vaccine (initiation), or completion of a 1- or 2-dose COVID-19 vaccination series. During December 14, 2020-May 8, 2021, a total of 135,968 pregnant women were identified, 22,197 (16.3%) of whom had received ≥1 dose of a vaccine during pregnancy. Among these 135,968 women, 7,154 (5.3%) had initiated and 15,043 (11.1%) had completed vaccination during pregnancy. Receipt of ≥1 dose of COVID-19 vaccine during pregnancy was highest among women aged 35-49 years (22.7%) and lowest among those aged 18-24 years (5.5%), and higher among non-Hispanic Asian (Asian) (24.7%) and non-Hispanic White (White) women (19.7%) than among Hispanic (11.9%) and non-Hispanic Black (Black) women (6.0%). Vaccination coverage increased among all racial and ethnic groups over the analytic period, likely because of increased eligibility for vaccination † and increased availability of vaccine over time. These findings indicate the need for improved outreach to and engagement with pregnant women, especially those from racial and ethnic minority groups who might be at higher risk for severe health outcomes because of COVID-19 (4). In addition, providing accurate and timely information about COVID-19 vaccination to health care providers, pregnant women, and women of reproductive age can improve vaccine confidence and coverage by ensuring optimal shared clinical decision-making., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. James Donahue reports grants from Janssen Global Services, LLC; Allison Naleway and Kimberly K. Vesco report grants from Pfizer. No other potential conflicts of interest were disclosed.

Objectives: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women., Methods: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors., Results: The participants in the final analysis ( N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women ( P ≤ 0.05), those with a high school education or less ( P ≤ 0.019), single women ( P ≤ 0.028), and those who had no breastfeeding experience ( P ≤ 0.035)., Conclusions: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Black women are more likely to experience short- or long-term health consequences from their labor and delivery and die from pregnancy-related causes than White women. Similarly, infants born to Black women also have heightened health risks. Developing research suggests that a contributing factor to Black health disparities may be maternal chronic stress. A widely used biomarker for chronic stress is hair cortisol concentration (HCC). Few prior studies have explored the HCC of pregnant Black women or comprehensively examined perceived chronic stress in this population. Using a mixed-methods focus group framework, we assessed HCC and perceived chronic stress among low-income pregnant and postpartum Black women. Four focus groups were conducted (N = 24). The mean HCC for our pregnant Black participants was greater than pregnant White women in reviewed published studies. The high levels of stress evidenced at all pregnancy stages indicate that many of these women are experiencing chronic stress, which can contribute to higher Black maternal morbidity and mortality rates, and possibly infant mortality rates. From the open coding of the focus group transcripts, 4 themes emerged: chronic stress, experiences of racism, experiences of trauma, and negative thinking. Selective coding based on these themes revealed cumulative experiences of chronic stress, various traumatic experiences, and frequent encounters with racism. Negative thinking styles were observed across the 4 focus groups. More studies of HCC and perceived stress among pregnant Black women are encouraged. Findings suggest the need for tailored multi-level interventions given the layers of stressors present in this population.

Introduction: Bedouin women in Israel confront a challenging circumstance between their traditional patriarchal society and transition to modernity. In terms of reproductive health, they face grave disparities as women, pregnant women and mothers. In this article we aim to understand the challenges of Bedouin women who work as mediators in the promotion of Bedouin women's perinatal health. We explore their challenges with the dual and often conflictual role as health peer-instructors-mediators in mother-and-child clinics, and also as members of a Bedouin community, embodying a status as women, mothers, and family caretakers. Drawn upon a feminist interpretative framework, the article describes their challenges in matters of perinatal health. Our research question is: how do women who traditionally suffer from blatant gender inequality utilize health-promotion work to navigate and empower themselves and other Bedouin women., Methods: Based on an interpretive feminist framework, we performed narrative analysis on eleven in-depth interviews with health mediators who worked in a project in the Negev area of Israel. The article qualitatively analyses the ways in which Bedouin women mediators narrate their challenging situations., Results: This article shows how difficult health mediators' task may be for women with restricted education who struggle for autonomy and better social and maternal status. Through their praxis, women mediators develop a critical perspective without risking their commitments as women who are committed to their work as well as their society, communities, and families. These health mediators navigate their ways between the demands of their employer (the Israeli national mother and child health services) and their patriarchal Bedouin society. While avoiding open conflictual confrontations with both hegemonic powers, they also develop self-confidence and a critical and active approach., Conclusions: The article shows the ways by which the mediator's activity involved in perinatal health-promotion may utilize modern perinatal medical knowledge to increase women's awareness and autonomy over their pregnant bodies and their role as caregivers. We hope our results will be applicable for other women as well, especially for women who belong to other traditional and patriarchal societies.

Objective: To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates., Study Design: This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean., Results: Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p  < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31-1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06-3.61)., Conclusion: Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: To determine the population prevalence and determinants of hepatitis B (Hep B) status, and status discordance, among pregnant women and their male partners in Nigeria., Methods: Cross-sectional study assessing the seroprevalence of Hep B virus in a cohort of 16 920 pregnant women and their male partners in northcentral Nigeria. Rapid HBsAg antibody test was used for Hep B diagnosis. Demographic, socio-economic and behavioural information was collected through interviewer-administered questionnaires and evaluated as determinants of Hep B status and couple status discordance using logistic regression., Results: Of 16 920 participants who had a Hep B test result, 6750 couples and 1316 discordant couples were identified. The prevalence of Hep B among all participants was 10.9%, with lower prevalence among pregnant women (10.2%) than their male partners (11.9%), P < 0.001. The prevalence of Hep B sero-discordance among couples was 19.5% (1316/6750). Younger age, prior Hep B testing and a prior positive Hep B test increased the odds of Hep B infection while being a woman decreased the odds of Hep B among all participants, and among couples. Furthermore, polygamy (adjusted odds ratio [AOR]: 1.49, 95% confidence interval [CI]: 1.19-1.87), prior Hep B testing (AOR: 2.38, 95% CI: 1.14-4.97) and a prior positive Hep B test result were significant determinants of status discordance among the participating couples., Conclusion: The prevalence of Hep B among pregnant women and their male partners in northcentral Nigeria is high. A large-scale intervention is required to reduce Hep B prevalence in this setting., (© 2020 John Wiley & Sons Ltd.)

Objectives: Asylum seekers have been highlighted as a particularly vulnerable group of expectant mothers due to complex medical and psychosocial needs, as well as the difficulties they may face in accessing care. Our aim was to examine if there were differences in the antenatal care and perinatal outcomes for asylum seeking women when compared to age- and ethnicity-matched controls delivering at the same hospital., Methods: Two age- and ethnicity-matched non-asylum seeking controls were identified for each asylum-seeking woman. Electronic patient records were analysed to determine the amount of antenatal care received and neonatal outcomes., Results: Thirty-four asylum-seeking women were identified who had term born infants. The median number of antenatal care episodes at the delivering hospital was significantly fewer amongst asylum-seeking women compared to controls (three vs. nine, p<0.0001). The median number of antenatal ultrasound examinations at the delivering hospital amongst asylum-seeking women was one (IQR 1-2), compared to three (IQR 3-4) in the controls (p<0.0001). The postnatal length of stay was significantly longer for infants of asylum-seeking women (median three vs. two days, p=0.002). Thirty-seven percent of asylum seeking women but none of the controls required assistance from social services. There was a significant correlation between antenatal and postnatal costs for asylum seeking women (r=0.373, p=0.042), but not for controls (r=0.171, p=0.181)., Conclusions: The increased postnatal length of stay in the infants of asylum seeking mothers may reflect their mother's reduced antenatal care and hence insufficient discharge planning for mothers and infants with increased social needs., (© 2021 Sarah Sturrock et al., published by De Gruyter, Berlin/Boston.)

Purpose: To evaluate the anxiety and depression in pregnant women in China, and its influencing factors during the corona virus disease 2019 (COVID-19) pandemic., Methods: From February 22 to February 27, a questionnaire survey was conducted on 156 pregnant women, including demographic characteristics, a self-rating anxiety scale (SAS), and a self-depression rating scale (SDS)., Results: A total of 13 non-homologous end-joining (8.3%, 13/156) patients were anxious, 79 patients (50.6%, 79/156) were depressed, and 13 patients (8.3%, 13/156) suffered from both anxiety and depression. The SAS score of pregnant women was 40.55 ± 6.09, and the SDS score was 50.42 ± 11.64. For the SAS score, only 8.3% of all patients (13/156) were in a light anxiety state. For the SDS score, 46.79% (73/156) of patients was normal, 23.72% of patients (37/156) showed mild depression, 22.44% (35/156) showed moderate depression, and 4.49% (7/156) showed severe depression. No significant changes were observed in SAS and SDS scores between patients from different regions within China, health state, gestational week, educational background, and living condition (P > 0.05). Moreover, no significant differences were observed between diagnosed/suspected patients and the normal control group (P > 0.05), and between pregnant women in Wuhan compared to other regions (P > 0.05)., Conclusion: During the COVID-19 epidemic, the anxiety level of pregnant women was the same as that before the epidemic, while the level of depression was significantly higher. Pregnant women who lived in Wuhan, the epicenter of the epidemic, were not more anxious or depressed compared to pregnant women in other regions during the COVID-19 epidemic. Furthermore, the mental health status of pregnant women with COVID-19 was not more severe.

Introduction: Financial constraints are one of the biggest barriers for women of low-income countries to receive necessary reproductive health services. Educating women about the importance of saving money has been incorporated as a component of antenatal care (ANC) contacts, but little is known whether ANC contacts influence women's saving., Methods: A secondary analysis was conducted on data from a cross-sectional household survey study of 1109 women who recently gave birth in two rural districts of Zambia., Results: Receiving ANC contacts early and often and discussing saving money during ANC were associated with saving money for the mother's birth, but not with saving enough money for the most recent birth., Discussion: Continued effort is needed to encourage women to attend ANC contacts earlier and more frequently. Additionally, the importance of saving money for birth should be discussed during ANC contacts. Future studies need to explore why women's action in saving does not necessarily lead to saving enough for childbirth.

Background: Poor awareness remains a substantial limitation to harnessing the benefits of umbilical cord blood (UCB) in sub-Saharan Africa. The aim of this study was to determine the level of awareness and factors influencing intention to donate cord blood to blood bank among antenatal clinic attendees at a tertiary hospital in Nigeria., Methods: We conducted a questionnaire-based cross-sectional study of 400 women attending the antenatal clinic of a tertiary hospital in Lagos, Nigeria, between February and June 2018. The data were analyzed using Stata version 13; comparisons were conducted with Chi-square, Student's t-test, and Mann-Whitney U-test. Univariable and multivariable binary logistic regression was conducted with "willingness to donate" as the outcome variable., Results: Majority (n = 287/331 [86.2%, 95% confidence interval [CI]: 76.4-84.9]) of the participants had some knowledge of UCB, almost half intended future donation of UCB (n = 161/333, [48.3%, 95% CI: 42.9-53.6]). Based on our findings, factors such as religion (P = 0.001), education (P = 0.03), information from health-care provider (P < 0.001) appear to influence awareness, and the decision to donate UCB., Conclusion: Although the awareness of the clinical uses of UCB is very limited in Nigeria, the intent to participate in UCB donation is high. Factors such as religion, education, and prior information about UCB donation by health-care providers have been identified in this study to have an influence on the decision to donate UCB., Competing Interests: None

Introduction: Seasonal influenza vaccination is recommended for pregnant women, but half of the pregnant women in the United States remain unvaccinated. Vaccine coverage in U.S.-Mexico border states has not been examined in depth even though risk factors for low vaccine coverage exist in these states, especially in the counties bordering Mexico., Method: Using 2012-2014 New Mexico (NM) Pregnancy Risk Assessment and Monitoring System data, this study examined the weighted annual seasonal influenza vaccination rates and the relationship of various factors to vaccination among NM residents with a live birth during those years., Results: Among respondents, 53.8% were Hispanic, 15.7% were Native American, and 30.5% were non-Hispanic White. The vaccination rate in NM increased from 49.0% in 2012 to 64.8% in 2014. The adjusted odds of vaccination were higher among women whose health care provider recommended/offered vaccination during the year prior to delivery compared to women whose provider did not (AOR = 11.92, 95% confidence interval [CI: 9.86, 14.42]) and among those living in the U.S.-Mexico nonborder counties compared to those living in the border counties (AOR = 1.23, 95% CI [1.18, 1.25])., Conclusion: Efforts to increase the vaccination rate among pregnant women in border states should concentrate on health care providers and the highest risk women, such as those resident in the border region.

Background: Further efforts, informed by current data, are needed to reduce smoking during pregnancy., Aims: To describe trends in smoking during pregnancy and identify regions most likely to benefit from targeted smoking cessation interventions, in New South Wales (NSW), Australia., Materials and Methods: All women who gave birth in NSW between 1994 and 2016 were included. Smoking status was identified from the Perinatal Data Collection. For births between 2012 and 2016, women were grouped into Local Health District (LHD) of residence, and smoking rates calculated. The impacts of a hypothetical smoking cessation intervention in four LHDs with (i) high smoking rates and (ii) high numbers of smokers, were compared., Results: The overall smoking rate during pregnancy decreased from 22.1% in 1994 to 8.3% in 2016. [Correction added on 13 August 2020, after first online publication: the overall smoking rate during pregnancy in 1994 has been corrected from 14.5% to 22.1%.]. The decrease was lowest among women living in the most socioeconomically disadvantaged areas (41%) and highest among those living in the most advantaged areas (83%). Between 2012 and 2016, over half the women who smoked during pregnancy lived in one of four LHDs. Only 1% of women reporting smoking during pregnancy resided in the LHD with the highest smoking rate (34.7%). A simulated intervention targeting only four regions showed greater effect on the statewide smoking rate when targeting LHDs with high numbers of smokers rather than high smoking rates., Conclusions: Despite decreases in rates of smoking during pregnancy, there was evidence of geographic clustering of smokers. The greatest reduction in overall smoking may come from interventions targeting the four LHDs with the highest number of smokers., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objectives: Most research evaluating relationships between social network attributes and loneliness have focused on older adult and adolescent networks. The present study examines the relationships between social network size (number of relationships), social network density (whether named relationships are connected to one another) and maternal loneliness during pregnancy., Methods: Eligible women were enrolled at the time of their dating ultrasound (between 8 and 12 weeks of gestation). Interested women provided written consent and completed demographic, social network and loneliness measures. Participants completed the same surveys in their third trimester. Mixed-regression models, adjusted for age, race, ethnicity, and insurance type, were used to assess the relationship between social network size, network density, and loneliness., Results: A total of 94 pregnant women (mean age = 23.77, 70.2% Black, 87.2% public insurance) completed baseline study measures, and 60 participants completed both assessment time points. Completers and non-completers did not differ on key characteristics. Social network density, but not social network size, predicted maternal loneliness ([Formula: see text]= - 1.27, 95% CI - 2.53, - 0.01, p = 0.0489) in the first and third trimester., Conclusions: These findings indicate that pregnant women's social network density may be more intimately related to feelings of loneliness than the objective number of relationships. This knowledge can begin to inform the design of supportive approaches to improve women's health.

Importance: Racial disparities in maternal morbidity and mortality are in large part driven by poor control of chronic diseases. The association between adverse neighborhood exposures and HIV virologic control has not been well described for women with HIV during pregnancy., Objective: To evaluate the association between adverse neighborhood exposures and HIV viral load at delivery., Design, Setting, and Participants: This population-based cohort study assessed HIV surveillance data for pregnant women with HIV who had live deliveries in Philadelphia from January 1, 2005, through December 31, 2015. Data analyses were completed in August 2020., Exposures: Neighborhood exposures included extreme poverty, educational attainment, crime rates (using separate and composite measures), and social capital categorized above or below the median. Each neighborhood exposure was modeled separately to estimate its association with elevated HIV viral load., Main Outcomes and Measures: The main outcome was elevated HIV viral load of ≥200 copies/mL at delivery. We hypothesized that adverse neighborhood exposures would be associated with higher odds of having an elevated viral load at delivery. Confounders included birth year, age, race/ethnicity, previous birth while living with HIV, and prenatal HIV diagnosis. Prenatal care and substance use were considered potential mediators. We used logistic mixed effects models to estimate the association between neighborhood exposures and elevated viral load, adjusting for confounders in Model 1 and confounders and mediators in Model 2., Results: There were 905 births among 684 women with HIV, most of whom were aged 25 to 34 years (n = 463 [51.2%]) and were Black non-Hispanic (n = 743 [82.1%]). The proportion of women with elevated viral load decreased from 58.2% between 2005 and 2009 to 23.1% between 2010 and 2015. After adjusting for confounders in Model 1, higher neighborhood education was associated with lower odds of having an elevated viral load (adjusted odds ratio [AOR], 0.70; 95% CI, 0.50-0.96). More violent crime (AOR, 1.51; 95% CI, 1.10-2.07), prostitution crime (AOR, 1.46; 95% CI, 1.06-2.00), and a composite measure of crime (AOR, 1.44; 95% CI, 1.05-1.98) were positively associated with having a higher HIV viral load. These associations remained after adjusting for mediators in Model 2. In addition, the AOR for intermediate prenatal care varied between 1.93 (95% CI, 1.28-2.91) and 1.97 (95% CI, 1.31-2.96), whereas the AOR for inadequate prenatal care varied between 3.01 (95% CI, 2.05-4.43) and 3.06 (95% CI, 2.08-4.49) across regression models., Conclusions and Relevance: In this cohort study, adverse neighborhood exposures during pregnancy and poor engagement in prenatal care were associated with poor virologic control at delivery. These findings suggest that interventions targeted at improving maternal health need to take the social environment into consideration.

Purpose: The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women., Study Design and Methods: Using a cross-sectional design, a sample of 197 pregnant Black women completed a self-reported survey between 8 weeks and less than 30 weeks gestation as part of the Biosocial Impact on Black Births study. The questions asked about the initiation of prenatal care, perceived stress, depressive symptoms, and psychological wellbeing. Multiple linear regression was used to examine if timing of prenatal care initiation was related to psychological variables., Results: Sixty-three women (32%) reported they were not able to initiate their first prenatal care visit as early as they wanted due to various barriers. After adjusting for cofounders, not initiating prenatal care as early as women wanted predicted lower levels of psychological wellbeing., Clinical Implications: Perinatal nurses should assess psychological wellbeing in Black women throughout pregnancy; advocate for Black women who report high levels of stress, psychological distress, or depressive symptoms for further mental health evaluation by their health care provider; and provide resources and education (e.g., support groups, counseling) for these women.

Background: Each year thousands of pregnant women experiencing threatened premature labour are transferred considerable distances across Australia to access higher level facilities but only a small proportion of these women go on to actually give birth to a premature baby. Women from regional areas are required to move away from their home, children and support networks because of a perceived risk of birthing in a centre without neonatal intensive care facilities., Aim: This study examines the experience of women undergoing antenatal transfer for threatened premature labour in New South Wales and the Australian Capital Territory who do not give birth during their transfer admission., Methods: Thirteen semi-structured in-depth interviews were held with women across five tertiary referral sites across New South Wales and the Australian Capital Territory, and analysed until saturation for themes., Findings: Seven urban and six rural women were interviewed. Women and their families were all negatively affected by antenatal transfer. Factors that helped enable a positive experience were; enhanced sense of safety in the tertiary unit, and individual qualities of staff. Factors that contributed to negative experiences were; inadequate and conflicting information, and no involvement or choice in the clinical decision-making process to move to another facility., Conclusions: Antenatal transfer is an extremely stressful experience for women and their families. The provision of high quality written and verbal information, and the inclusion of women's perception of risk in the clinical decision making process will improve the experience for women and their families in NSW and the ACT., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy (1). ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27-36 (2,3). Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal with racial/ethnic disparities persisting (4-6). To assess influenza and Tdap vaccination coverage among women pregnant during the 2019-20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019-January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018-19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018-19 season (4). Vaccination coverage was highest among women who reported receiving a provider offer or referral for vaccination (influenza = 75.2%; Tdap = 72.7%). Compared with the 2018-19 season, increases in influenza vaccination coverage were observed during the 2019-20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018-19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019-20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Objectives: To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families., Methods: A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z -scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects., Results: Pregnant women ( n = 566) were enrolled in the third trimester; 533 randomized to intervention ( n = 266) or control ( n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance., Conclusions: Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Introduction: Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy., Methods: In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy., Results: Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy., Conclusion: Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.

Objective: This study examined whether cigarette smoking mediated the association of racial discrimination with depressive symptoms among pregnant Black women., Design: Cross-sectional., Sample: Two hundred Black women at 8-29 weeks gestation., Measurements: Women completed questionnaires including the Experiences of Discrimination and the Center for Epidemiologic Studies-Depression (CES-D) scales, as well as questions about sociodemographic characteristics and cigarette smoking., Results: The mean age of the sample was 26.9 ± 5.7 years and the mean gestational age at data collection was 15.6 ± 5.7 weeks. Approximately 17% of women reported prenatal cigarette smoking; 27% had prenatal CES-D scores ≥23, which have been correlated with depression diagnoses; and 59% reported ever (lifetime) experiencing discrimination in at least one situation (e.g., at work). Path analysis results indicated that the standardized indirect effect of experiences of racial discrimination on CES-D scores through prenatal smoking was statistically significant (standardized indirect effect = 0.03; 95% CI: 0.001, 0.094; p = .042)., Conclusion: Cigarette smoking during pregnancy partially mediated the association between lifetime experiences of racial discrimination and prenatal depressive symptoms among pregnant Black women. Smoking cessation programs should focus on identifying and treating depressive symptoms among pregnant Black women., (© 2020 Wiley Periodicals LLC.)