Search

INTRODUCTION Migration is a growing phenomenon affecting many European countries,\ud with many migrants being of childbearing age. Depending on the country of origin, poorer\ud pregnancy and birth outcomes amongst migrant women have been reported. Providing\ud appropriate culturally sensitive perinatal services is of paramount importance.\ud METHODS The Operational Refugee And Migrant Mothers Approach (ORAMMA) was\ud a three-site multidisciplinary collaborative research project, designed to develop and\ud test implementation of a high-quality maternity care model including peer supporters\ud for migrant women who have recently arrived in European countries. Community-based\ud activities were undertaken to ensure ongoing local impact for maintaining supportive\ud interactions amongst peer supporters and recently arrived migrant women in the UK.\ud RESULTS The women who volunteered to become maternity peer supporters were\ud motivated by their own experiences of being newly arrived migrants in the past or a sense\ud of altruism. Forging links with multiple local community groups enabled the continuation\ud of the support provided by maternity peer supporters, including during the COVID-19\ud pandemic.\ud CONCLUSIONS Engagement of maternity peer supporters in supporting newly arrived\ud mothers has multiple advantages of addressing social isolation and marginalisation of\ud migrant communities, with potential benefits of improving access and enhancing health\ud literacy and health outcomes amongst recently arrived migrant women as well as creating\ud a self-supporting network for peer supporters themselves.

Despite its reported benefits, breastfeeding rates are low globally, and support systems such as the Baby Friendly Initiative (BFI) have been established to support healthy infant feeding practices and infant bonding. Increasingly reviews are being undertaken to assess the overall impact of BFI accreditation. A systematic synthesis of current reviews has therefore been carried out to examine the state of literature on the effects of BFI accreditation. A systematic search of CINAHL, MEDLINE, Maternal and Infant Health, Scopus, the Cochrane Library and PROSPERO was undertaken. Study selection, data extraction and critical appraisal of included reviews using the AMSTAR‐2 tool were undertaken by two authors, with disagreements resolved through discussion with the third author. Due to heterogeneity, a narrative synthesis of findings was applied. Fourteen reviews met the inclusion criteria. Overall confidence in the results of the review was rated as high for three reviews, low for two reviews and critically low for nine reviews. Most evidence suggests some increase in breastfeeding initiation, exclusivity and duration of breastfeeding, and one main trial suggests decreased gastrointestinal infection and allergic dermatitis in infants. However, overall certainty in the evidence was rated as very low across all outcomes due to concerns over risk of bias within and heterogeneity between the original studies. More contemporary, good‐quality randomised controlled trials or well‐controlled prospective comparative cohorts are required to better evaluate the impact of full BFI accreditation, with particular attention paid to the context of the research and to long‐term maternal and infant health outcomes.

Background The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project. Methods Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA project. Results A significant improvement of the median score pre to post-test was observed for midwives’ knowledge (17 to 20, p p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives’ experiences of the training revealed themes of “appropriate and applicable”, “made a difference” and “training gaps” and data from ORAMMA project experiences identified three further themes; “supportive care”, “working alongside peer supporters” and “challenges faced”. Conclusions The training improved midwives’ knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters’ roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Background Obesity is associated with increased maternal morbidity and mortality. Maternal weight management services (MWMS) are a good opportunity to influence lifestyle behaviours of mothers. To understand what constitutes the most suitable service, women's views on MWMS are paramount. Methods A purposive sample of 13 women with a BMI≥40kg/m² were interviewed at 36 weeks gestation. A semi-structured interview schedule explored their experiences of MWMS provision and advice, awareness of services and the barriers and facilitators to antenatal weight management. Interviews were recorded and transcribed verbatim. Inductive thematic analysis was undertaken. Results Four themes emerged. 'Understanding where I am at' showed women's readiness and motivation varied, from being avoidant or unaware of weight as an issue to already making changes. 'Getting information' revealed while a few women felt that they received good information during pregnancy most reported a lack of information or minimal information provided in a 'tick-box' fashion. Women particularly wanted practical advice. 'Difficulties I face' identified physical, emotional and financial barriers and the strategies some women used to overcome these. 'Encountering professionals - a mixed experience' demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals need to tread was evidenced by women thinking they had received inadequate information and yet that there was too much focus on their weight and its related risks during pregnancy. Conclusions MWMS should not be seen as a 'tick box' exercise but should be woman-centred to assist women to move forward in their weight management journey, no matter what their starting point. Women desired practical advice provided in a sensitive, respectful manner not just the continual repetition of the risks of being obese during pregnancy. Key messages Maternal weight management services require a woman-centred approach to enable women to move forward on their weight management journey. Women want practical, sensitive advice not just the continual repetition of the risks of being obese during pregnancy.

Introduction Maternal obesity is associated with increased odds of obesity in the offspring. The antenatal period is considered a good opportunity to promote lifestyle improvements. The long-term impact of maternal characteristics and attending a maternal healthy lifestyle service (MHLS) on childhood risk of overweight was evaluated. Methods Women with a body mass index (BMI) ≥35kg/m² referred to one MHLS in England from 2009 were included in a retrospective cohort study. Pseudo-anonymised data from the National Child Measurement Programme were matched to data from women referred to this service. Children were classified as 'overweight' if their weight centile was ≥95th centile at 6-8 weeks or 9-12 months or their BMI was ≥95th centile at school entry (4-5 years). Univariate logistic regression determined the odds ratios (OR) and 95% confidence intervals (CI) of childhood overweight according to uptake of the MHLS, gestational weight gain (GWG) and other characteristics. Results The proportion of infants classified as overweight increased over time [2.8% at 6-8 weeks (20/713), 13.8% at 9-12 months (89/647) and 30.4% at school entry (206/677)]. The odds of overweight increased with each unit increase in birthweight (OR 39.9 95%CI 13.4-119.1 at 6-8 weeks, OR 3.7 95%CI 2.4-5.7 at 9-12 months and OR 1.9 95%CI 1.4-2.5 at school entry). GWG above Institute of Medicine recommendations increased the odds of overweight at 6-8 weeks (OR 2.9 95%CI 1.1-7.4). Women living in the most deprived quartile (OR 1.6 95%CI 1.1-2.2) or who smoked when booking for antenatal care (OR 1.5 95%CI 1.0-2.2) had increased odds of infant with BMI ≥95th centile at school entry. Attendance at a MHLS and maternal BMI did not significantly impact on child overweight at any time; however the sample only included women with a raised BMI. Conclusions Lifestyle during pregnancy, GWG and other wider health determinants such as deprivation have long lasting effects on infant health and childhood obesity. Key messages Overweight at school entry is high (>30%) for women with a raised BMI when booking for antenatal care. Addressing maternal socioeconomic conditions, gestational weight gain and smoking during pregnancy are key priorities for the long-term health of children.

Introduction Approximately 20.1% of Indonesian pregnant women are underweight (BMI Methods This is a two armed feasibility RCT (1:1) in which 200 women with body mass index Results A total of 107 women were recruited to the trial in the first wave from Dec 2018-March 2019 (recruitment rate of ∼25/month). Of these 81 have been followed up to delivery and will be followed up to 6 months postpartum. Local Dadih production reached its full capacity in one region and recruitment had to be extended to other regions. Comparative trends on study outcomes including GWG, mode of birth, postpartum depression, postpartum haemorrhage, maternal nutritional status, anaemia, birthweight, gestational age, admission to neonatal care unit, breastfeeding, neonatal health status will be reported. Conclusions Early results show that the supplementation is acceptable to women and protocol implementation is feasible. In order for this feasibility project to be developed to a full scale RCT, improvements to the infrastructure of supply are required. Such projects may have positive economic impact and provide sustainable solutions to local maternal and neonatal health challenges. Reference 1. Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. (2017) Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Women's Health. Key messages Nutritional supplementation using a traditional Indonesian yogurt (Dadih) made from buffalo milk during pregnancy has been received positively by women. Depending on the observed comparative trends from the study outcomes, infrastructure investment is required to enable the feasibility study to be expanded to a full scale randomised controlled trial.

Background Maternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle. Methods A mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data. Results A total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas. Several themes were identified from qualitative data including “equity and variation in service provision”, “need for rigorous evaluation”, “facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, “barriers” encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and “the need for additional support”. Conclusions There is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

BACKGROUND: Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant. Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long‐term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. OBJECTIVES: To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. SEARCH METHODS: On 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi‐RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group. DATA COLLECTION AND ANALYSIS: We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster‐RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high‐income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias. Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump) Very low‐certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non‐initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum. Multiple methods of breastfeeding support versus usual care Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face‐to‐face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest. We are unclear about the effects of the intervention because we identified very low‐certainty evidence for all of the important outcomes in this review: rate of non‐initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women). The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low‐certainty evidence means that we are unclear about the effects of the intervention on those outcomes. AUTHORS' CONCLUSIONS: There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low‐certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups. Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.

Objective: To develop and refine qualitative mapping and quantitative analysis techniques to define ‘thermal territories’ of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. Method: Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5–24.9 kg/m²; overweight 25–29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. Results: We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the ‘infected’ wound thermogram. Conclusion: Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.

Background: Across Europe, there are increasing numbers of migrant women who are of childbearing age, pregnant or new mothers. Migrant women face many challenges and have particular needs during the perinatal period. In this age of super-diversity, provision of maternity care which is sensitive to the needs of all factions of our society is paramount to ensure a healthy and forward looking community. Aim: As part of a larger multicentre study “Operational Refugee and Migrant Maternal Approach” (ORAMMA)*, this review aimed to evaluate the state of current evidence on migrant women’s experiences of pregnancy, childbirth and maternity care in their destination country within Europe. Methods: A systematic search of...

Background The practice of antenatal breast expression (ABE) has been proposed as a strategy to promote successful breastfeeding. Although there has been some focus on the evaluation of the effects of ABE in promotion of breastfeeding, little or no evidence exists on women’s experiences of ABE or opinions on ABE, particularly amongst overweight or obese women. Methods This study aimed to explore women’s knowledge, practices and opinions of ABE, and any differences within the overweight and obese subgroups. A cross-sectional survey was undertaken using an online questionnaire distributed by a maternity user group representative via social media. Quantitative data were analysed using Chi-square and Fisher’s exact tests in SPSS. Simple thematic analysis was used for the qualitative data. Results A total of 688 responses were analysed; the sample represented a group of breastfeeding mothers, of whom 64.5% had heard of ABE, 8.2% had been advised to do ABE, and 14.2% had undertaken ABE. Of the women who had been advised to do ABE, 67.9% had complied. Most participants (58.6%) were unsure if ABE was a good idea; however 80.9% would consider doing ABE if it was found to be helpful to prepare for breastfeeding. Women in the overweight or obese subgroups were significantly more likely to have heard of ABE (p

Introduction. Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management.Method. All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain.Results. The most commonly used BCTs were within the categories of “feedback and monitoring,” “shaping knowledge,” “goals and planning,” “repetition and substitution,” “antecedents,” and “comparison of behaviours.” For diet and mixed interventions “feedback and monitoring,” “shaping knowledge,” and “goals and planning” appeared the most successful BCT categories.Conclusions. Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.

Out of a total of eight Millennium Development Goals (MDG) set by the United Nations, MDG5 aimed to improve maternal health worldwide. This was specifically aimed at reducing childbirth-related deaths for mothers by three quarters between 1990 and 2015. The total number of maternal deaths globally has declined by 45% from 523,000 in 1990 to 289,000 in 2013 (WHO 2014). This reduction, as an indicator of improving maternal health globally, is a remarkable achievement. There has however been wide variation in this improvement (WHO 2014) which needs thorough evaluation, individually and as a cross comparison, in order to extract\ud constructive lessons to enhance the health of mothers, families and communities subsequently. This commentary focuses on issues related to maternal mortality ratio (MMR) reduction and contributing factors in Iran; identified as one of the leading countries achieving the highest percentage MMR reduction since 1990 (WHO, 2014).

Background Indonesia has a considerably high incidence of maternal and infant mortality. The country has however been experiencing a social and economic transition, influencing its general population demographics and nutritional status including the state of health and nutrition of pregnant women. This study aimed to explore body mass index (BMI) and gestational weight gain (GWG), and their relationship with pregnancy outcomes in a sample of Indonesian pregnant women. Methods This observational cohort study included a total of 607 pregnant women who were recruited in 2010 from maternity clinics in Western Sumatra, Indonesia. Multiple logistic and regression analyses were undertaken to compare pregnancy and birth outcomes for different BMI and GWG, using normal weight women and women with a recommended weight gain as the referent groups. Results The prevalence of underweight (BMI

A Cochrane systematic review has shown midwife-led continuity models of care provide explicit benefits for mothers and babies compared with other models of maternity care, with a comparable level of safety. The Cochrane review has had much international impact. This study explored the local impact of the review, alongside other midwife-led care evidence and guidelines. Electronic surveys were undertaken exploring women's and health professionals' awareness of models of maternity care evidence, including midwife-led care and homebirth, and how they utilise evidence to guide their choices and practice. \ud A low awareness of much of the available evidence was shown among the women and the professionals. There is a need for better dissemination of information to professionals as they are women's preferred source of information about the options available for place of birth and midwife-led care.