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Background: The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. Methods: A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. Results: A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. Conclusions: Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment. [ABSTRACT FROM AUTHOR]

Background: Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. Methods: A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. Results: Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). Conclusions: Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to characterize the use of higher doses of folic acid (≥1 mg daily) in relation to pregnancy in Denmark, Norway, and Sweden in women with epilepsy treated with antiseizure medication (ASM). Methods: In this observational study, we used data from national medical birth, patient, and prescription registers in Denmark, Norway, and Sweden to retrospectively identify pregnancies in women with epilepsy treated with ASM from 2006 to 2017. The proportion of higher dose folic acid supplementation in pregnancies among women receiving ASM for epilepsy was calculated according to country of origin, time period, and type of ASM. Logistic regression with restricted cubic splines was used to model country‐specific time trends. Results: Among a total of 2 748 882 pregnancies, we identified 8695 (.3%) pregnancies after restricting the population to women with ASM‐treated epilepsy. A prescription for higher dose folic acid was filled in 4719 (54.3%) of these pregnancies. The proportion supplemented with higher dose folic acid was highest in Sweden (74.3%) and lower in Norway (41.4%) and Denmark (34.3%). Furthermore, we observed a decreasing trend of higher dose folic acid use in Denmark and Norway from year 2012 to 2017. Among those who used higher dose folic acid, 42% did not start preconception supplementation with higher dose folic acid. Significance: Supplementation with higher dose folic acid occurred in approximately half of pregnancies in women with ASM‐treated epilepsy, with many not starting supplementation until after becoming pregnant. Considerable variability was observed in the use of higher dose folic acid across the countries, despite similar population characteristics and health care systems. Future guidelines should be simplified with clear recommendations developed in a collaborative manner by relevant specialists including neurologists, obstetricians, pediatricians, and public health specialists to enhance real‐world applicability. [ABSTRACT FROM AUTHOR]

Introduction Congenital syphilis (CS) is preventable through timely antenatal care (ANC), syphilis screening and treatment among pregnant women. Robust CS surveillance can identify gaps in this prevention cascade. We reviewed CS cases reported to the South African notifiable medical conditions surveillance system (NMCSS) from January 2020 to June 2022. Methods CS cases are reported using a case notification form (CNF) containing limited infant demographic and clinical characteristics. During January 2020–June 2022, healthcare workers supplemented CNFs with a case investigation form (CIF) containing maternal and infant testing and treatment information. We describe CS cases with/without a matching CIF and gaps in the CS prevention cascade among those with clinical information. Findings During January 2020–June 2022, 938 CS cases were reported to the NMCSS with a median age of 1 day (interquartile range: 0–5). Nine percent were diagnosed based on clinical signs and symptoms only. During January 2020–June 2022, 667 CIFs were reported with 51% (343) successfully matched to a CNF. Only 57% of mothers of infants with a matching CIF had an ANC booking visit (entry into ANC). Overall, 87% of mothers were tested for syphilis increasing to 98% among mothers with an ANC booking visit. Median time between first syphilis test and delivery was 16 days overall increasing to 82 days among mothers with an ANC booking visit. Discussion Only 37% of CS cases had accompanying clinical information to support evaluation of the prevention cascade. Mothers with an ANC booking visit had increased syphilis screening and time before delivery to allow for adequate treatment. [ABSTRACT FROM AUTHOR]

Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the association between select determinants and HCV screening guideline adherence among physicians who provide prenatal care. Research question: What factors may act as determinants of guideline adherence to HCV screening among physicians who provide prenatal care? Methods: We surveyed a national sample of physicians who provided prenatal care in 2021. The survey included questions from the Clinician Guideline Determinant (CGD) questionnaire, demographic characteristics, and medical practice characteristics. We estimated odds ratios and 95% confidence intervals (CIs) using semi-Bayesian logistic regression for the association between determinants and guideline adherence. Results: Participants included 224 physicians in the United States who reported providing prenatal care. Most physicians practiced in private practice (65%) and the majority were members of the American College of Obstetricians and Gynecologists (ACOG; 91%). Less than half (43%; 95% CI: 36%–49%) of physicians reported regular use of the HCV screening guideline. Physicians who reported general knowledge about HCV (OR = 9.0, 95% CI 3.1–30) or endorsed agreement with ease of implementation (OR = 8.0, 95% CI 2.7–25) had higher odds of adherence to the HCV screening guideline. Conclusion: Our study suggests that less than half of practicing prenatal care physicians adhere to HCV screening guidelines for pregnant patients. Our results may be useful as a preliminary screening of select determinants of guideline use for further investigation. [ABSTRACT FROM AUTHOR]

Introduction:Methods:Results:Discussion:Telehealth has emerged as a promising supplementary modality in prenatal care. However, its impact on patient-provider communication (PPC), especially among pregnant women from underserved settings, requires comprehensive evaluation. This study examined the factors associated with the quality of patient-provider communication during the COVID-19 pandemic among pregnant telehealth users and non-users.Using a cross-sectional study design, 242 women were surveyed (response rate = 23%) regarding their experience with telehealth, quality of PPC, and experiences of discrimination during prenatal care. Multiple regression models were used to identify the factors associated with the quality of PPC during the COVID-19 pandemic. A sub-group analysis explored the factors associated with the quality of PPC separately among telehealth users and non-users.The majority of the participants were on Medicaid (95%) and self-identified as Black/African American (57.3%). Regression analyses revealed a negative relationship between telehealth use during pregnancy and the quality of PPC (β = −1.13, P = 0.002). Irrespective of the telehealth use, the experience of discrimination was associated with poor quality of PPC among users (β = −3.47, P = .02) and non-users (β = −.78, P = .03), while adjusting for sociodemographic factors and social support during pregnancy.While telehealth offers advantages like convenience, increased accessibility, and continuity of care, challenges in establishing effective PPC in virtual settings have emerged that emphasize the necessity for comprehensive provider training extending beyond technical competencies. The persistent issue of perceived discrimination, impacting PPC across both groups, underscores the necessity to rethink existing strategies of mandatory training to increase providers’ knowledge. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, involving male partners in the prevention of mother-to-child transmission of HIV improves maternal and infant outcomes. Male involvement is typically conceptualised as male partners attending antenatal care, which is difficult for many men. Little is known about how men view their involvement in family health within the context of HIV, particularly outside of clinic attendance. Through interviews with 35 male partners of pregnant or postpartum women living with HIV in Kenya and Zambia, this study elicited perceptions of male involvement in maternal and infant health in families affected by HIV. Men supported the importance of clinic attendance but reported conflicts with the need to work and fulfil their role as the family's financial provider. Providing money for necessities was deemed more critical for their family's health than clinic attendance. Men's involvement was conveyed through various other supportive actions, including helping with household chores and providing emotional support (showing love and reducing women's stress). Future strategies to promote male partner involvement in the prevention of mother-to-child transmission of HIV and maternal and child health should build upon the actions men view as most meaningful to promote their family's health within their real-world life circumstances and cultural context, particularly their role as financial providers. [ABSTRACT FROM AUTHOR]

Prenatal cannabis use and maternal stress have been proposed as risk factors for autism spectrum disorder (ASD). Black mothers and mothers of lower socioeconomic status (SES) may be especially likely to experience high levels of stress. This study examined the impact of prenatal cannabis use and maternal stress (i.e., prenatal distress, racial discrimination, and lower SES) on child ASD-related behaviors in a sample of 172 Black mother-child pairs. We found that prenatal stress was significantly associated with ASD-related behaviors. Prenatal cannabis use did not predict ASD-related behaviors and did not interact with maternal stress to predict ASD-related behaviors. These findings replicate previous work on prenatal stress-ASD associations and add to the limited literature on prenatal cannabis-ASD associations in Black samples. [ABSTRACT FROM AUTHOR]

Infants with anterior abdominal wall defects (AWD) can suffer from pulmonary complications. Our aims were to determine if the chest radiographic thoracic areas (CRTAs) on day one differed between infants with exomphalos or gastroschisis, whether this related to differing severity of outcomes and if they were lower than those of controls indicating abnormal antenatal lung growth. A review of infants with exomphalos or gastroschisis born between January 2004 and January 2023 was conducted. The control group was term, newborn infants ventilated for poor respiratory drive at birth. Chest radiographs on day one were analysed and the highest CRTA in the first 24 h after birth for each infant included in the analysis. The 127 infants with gastroschisis had a lower gestational age and birthweight than the 62 exomphalos infants and 130 controls (all p<0.001) The CRTAs of the controls were greater than the CRTAs of the exomphalos and the gastroschisis infants (p = 0.001). The median CRTA corrected for birthweight was lower in the exomphalos infants [688, IQR 568-875 mm2/kg] than the gastroschisis infants [813, IQE 695-915 mm2/kg] No gastroschisis infant developed bronchopulmonary dysplasia (BPD). A CRTA of 1759 mm2 had a sensitivity of 81 % and specificity of 71 % in predicting BPD in infants with exomphalos. Infants with gastroschisis or exomphalos had lower CRTAs than controls suggesting both groups had abnormal antenatal lung development. The CRTA was lower in the exomphalos infants who also had worse respiratory outcomes, hence CRTA assessment may a useful prognostic aid. [ABSTRACT FROM AUTHOR]

Universal opt-out antenatal screening for Hepatitis C virus (HCV) is not currently recommened and it is recommended that maternity services offer risk-based testing. We aimed to investigate antenatal HCV testing and adherence to testing guidance. A cross-sectional survey was circulated to maternity service providers between November–December 2020 which included testing policy, training for healthcare staff, and management of women found to be HCV positive. Descriptive data are presented. A total of 75 questionnaires were returned, representing 48 % of English maternity service providers. 87 % of providers reported offering antenatal HCV risk-based testing. Risk factors used to identify pregnant women for testing varied. Less than 15 % of respondents considered women that were ever homeless or with history of incarceraton or from higher HCV prevalence areas as high risk. Current antenatal HCV testing practices are inadequate and HCV infection likely goes undiagnosed in pregnancy, especially among vulnerable population groups. In the absence of universal antenatal screening, re-framing antenatal HCV risk-based testing and management as a quality improvement initiative and developing HCV specific pathway guidance for maternity units is required. [ABSTRACT FROM AUTHOR]

We aimed to analyze trends in the rate of effective antenatal corticosteroid prophylaxis (ACS) administrations across a spectrum of typical diagnoses associated with preterm birth. In this retrospective study we utilized delivery data after ACS from 2014 to 2020 at Charité Berlin, Germany. We evaluated the rate of effective ACS administrations defined as ≤10 days between last dose of ACS and delivery as well as the rate of post-ACS births on/after 37 + 0 weeks. We explored conditions associated with high rates of ineffective ACS administrations (>10 days before delivery). We analyzed the trend of ACS-effectiveness during the study period in the overall cohort and in placental dysfunction and cervical insufficiency diagnoses. The overall rate of effective ACS administrations was 42 % (709/1,672). The overall percentage of deliveries after/at 37 + 0 weeks following ACS administration was 19 % (343). Placenta previa, twin pregnancy and isthmocervical insufficiency were associated with ineffective ACS (19–34 % effective i.e. ≤10 days before delivery). The overall ratio of effective ACS applications rose over time (p=0.002). Over the course of this study ACS effectiveness increased in placental dysfunction and isthmocervical insufficiency diagnoses (p=0.028; p=0.001). Compared to a previous publication we found a decrease of post-ACS deliveries after/at 37 + 0 weeks (19 vs. 27 %). Ineffective ACS administrations are still frequent in patients with placenta previa, twin pregnancy and isthmocervical insufficiency. It remains to be investigated in future trials if the introduction of new diagnostic tools such as soluble Fms-like tyrosinkinase-1/placental growth factor (sFlt-1/PlGF) testing and placental alpha-microglobulin-1 (PAMG-1) testing directly led to an increased ACS effectiveness. [ABSTRACT FROM AUTHOR]

Background: Cesarean birth has been associated with increased risks of short‐term mental health problems. Little is known about whether these associations persist in the long term. This study aimed to estimate the associations between mode of birth and maternal mental health in midlife while considering mental health before and during pregnancy. Methods: Cohort study among mothers in the Danish National Birth Cohort. Birth mode for each woman's entire reproductive history was obtained from Danish national registries. Symptoms of depression and stress in midlife were self‐reported using validated scales. Log binomial regression was used to calculate risk ratios (RR) with 95% confidence intervals (CI) for the association between birth mode and depressive symptoms. Linear regression was used to calculate mean difference in stress score by birth mode. Results: Among 42,872 women, 15.5% reported depressive symptoms at follow‐up, where they were, on average, 43.9 years and 11.2 years after their last birth. Compared with women who only ever had spontaneous vaginal births, women who only had cesarean births, or had both cesarean and vaginal births with the last birth by cesarean, reported slightly more symptoms of depression (RR 1.10, 95% CI 1.01;1.20) and stress (mean difference 0.68 on a 100‐point scale, 95% CI 0.10;1.26). Conclusion: Whether due to the birth experience or underlying factors, depression and stress in midlife were more frequent in women with only cesarean births or whose last birth was by cesarean compared with women with vaginal births. [ABSTRACT FROM AUTHOR]

Background: Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID‐19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID‐19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. Methods: We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. Results: During the COVID‐19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre‐pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. Conclusions: According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID‐19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid‐pandemic (January 2021) and to explore socioeconomic and COVID‐19‐related economic factors associated with experiencing barriers to care. Methods: We recruited two cross sections of women and birthing people in the US in July 2020 (N = 4645) and January 2021 (N = 3343) using Facebook and Instagram Ads. Results: Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67–7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71–4.35), and not being offered visits (OR = 4.26, 95% CI 2.32–7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14–3.45). Women who experienced more economic impacts from COVID‐19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments. Conclusions: Certain subgroups are more at risk during COVID‐19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic. [ABSTRACT FROM AUTHOR]

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

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

Background: Drawing on the family stress model (Conger and Donnellan in Ann Rev Psychol 58:175–199, 2007. https://doi.org/10.1146/annurev.psych.58.110405.085551), parenting programs typically support caregivers' nurturing and cognitively stimulating practices to mitigate the effects of poverty on child development, with small-to-moderate intervention effect sizes. Objective: This study evaluated a nonrandomized parenting program in Turkiye for low-income pregnant women and mothers of infants. The program utilized home visiting (HV) implemented by local municipalities for the first time. It was hypothesized that program mothers would engage in cognitively-stimulating practices more often at child age 9 months, and thereby expand their child's vocabulary at 18 months of age. Subgroup analyses based on maternal depression were also conducted. Methods: Using a quasi-experimental design, 526 mothers were allocated to one of two groups: HV intervention (n = 282, 77% pregnant) vs. control (n = 244, 69% pregnant). Mothers completed questionnaires on family and environmental risk at enrollment (T1), on depression and stimulating parenting at infant age 9 months (T2), and child vocabulary at 18 months (T3). Results: HV mothers reported stimulating parenting more frequently than controls at T2. Enrollment in HV predicted larger child vocabulary at T3 through stimulating parenting at T2. Subgroup differences were not detected. Conclusions: Results suggested that HV is a promising strategy to offer parent coaching to economically disadvantaged Turkish families. Though the present study made statistical adjustments to minimize group nonequivalence in baseline, selection bias might pose a threat to internal validity. A randomized controlled trial is warranted to examine its impact more rigorously prior to wider scale implementation. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB). Methods: Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989–1991) and their mothers (born 1956–1976). Results: In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively. Conclusions for Practice: Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas. Significance: What is Already Known on this Subject?: Robust literature supports a life-course conceptual model of birth outcome. Prior studies have demonstrated associations between upward economic mobility from poverty and decreased rates of preterm birth in non-Latina Black and White women. What this Study Adds?: Upward economic mobility is associated with decreased rates of preterm birth in US-born Latina women. This finding adds context to the life-course conceptual model of birth outcomes and may be salient to understanding the increased risk of adverse birth outcome among US-born (versus foreign-born) Latina women. [ABSTRACT FROM AUTHOR]

To determine the effect of self-evaluation of foetal movement and position tracking on prenatal attachment and distress. The study was a randomised controlled study. The study included women who came to the Kahramanmaraş Maternity and Children's Hospital for prenatal examination. The data were collected using a questionnaire form, the prenatal attachment inventory (PAI), and the Tilburg pregnancy distress scale (TPDS). The pregnant women in the intervention group were trained to count the foetal movements and track the position of the foetus. Data were evaluated using paired samples t-test, independent samples t-test, chi-square test, Pearson correlation analysis, and linear regression analysis. This trial was registered at ClinicalTrials.gov under the process NCT05313113. Although the mean PAI pre-test scores were similar in the intervention and control groups (t = −0.811; p = 0.420), a significant difference was observed in the mean post-test scores between the two groups (t = 6.404; p < 0.001). The mean TPDS pre-test scores were similar in both groups (t = 0.933; p = 0.453), but a significant difference was observed in the mean post-test scores (t = −3.345; p < 0.001). Thus, self-evaluation of foetal movement and foetal position tracking increased the prenatal attachment. [ABSTRACT FROM AUTHOR]

The article presents the discussion on case study of 5-week-old former 38-week female born via cesarean section due to twin breech positioning presented to a pediatric emergency department secondary to abdominal distention. Topics include twins were both average weight for gestational age, received vitamin K and erythromycin, and received routine newborn care prior to discharge on day 2 of life; and patient was exclusively breastfeeding with appropriate weight gain since birth.

Aim: To consolidate healthcare professionals' insights about waterbirths and water immersion during labour. Design: Mixed studies review. Data Sources: Seven electronic databases were searched from their inception dates till June 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations and Theses Global. Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines and Pluye and Hong's mixed studies review framework guided this review. The quality of included studies was evaluated using the Mixed Methods Appraisal Tool. Findings were synthesized using the convergent qualitative synthesis method, and results were thematically analysed using Braun and Clarke's framework. Results: Three main themes were identified from the 22 included studies: (1) believing in waterbirths, (2) opposing forces and (3) plotting the course ahead. Conclusion: Healthcare professionals reported different views about waterbirths and water immersion practices; midwives were most likely to support these practices, followed by nurses and lastly, few physicians supported them. Reasons for opposing waterbirths include insufficient training and support from colleagues as well as concerns about work efficiency, waterbirth safety and litigation issues. Impact: The available evidence suggests the need to provide waterbirth training for healthcare professionals, equip healthcare facilities with necessary waterbirth‐related infrastructure and develop appropriate waterbirth policies/guidelines. Healthcare professionals could also consider providing antenatal waterbirth education to women and obtain women's feedback to improve current policies/guidelines. Future research should explore the views of different types of healthcare professionals from more diverse cultures. Reporting Method: The PRISMA guidelines. No Patient or Public Contribution: Systematic review. [ABSTRACT FROM AUTHOR]

Repeated visits to clinical trial sites inflict hardships on study participants, especially pregnant women. A newer trend is community-based follow-up for measurements, dosage, or monitoring, through technology or physical visits. We conducted a methodological experiment of performing "community-based physical follow-up" of participants of a trial, receiving facility-based diagnosis and pathogen-specific antibiotics for asymptomatic bacteriuria, guided by an optical-sensor-based rapid point-of-care test. We were able to retain 95.8% participants in the study. Here we describe challenges faced and socio-economic and gender issues encountered in this approach in a low-resource Indian scenario, to guide researchers world-wide for designing mother-friendly clinical trials. [ABSTRACT FROM AUTHOR]

Kidney transplant recipients are at risk of complications in late pregnancy, with increased rates of pre-eclampsia, intrauterine growth restriction and preterm birth. It is recommended that these women receive more intensive monitoring after 20 weeks' gestation, ideally provided by a multidisciplinary team in a tertiary centre. This review focuses on the management of late pregnancy in kidney transplant recipients, from the perspective of different members of the multidisciplinary team. This includes evidence and guidance to inform the nephrologist, obstetrician, obstetric anaesthetist, transplant surgeon, midwife, and a summary of the woman's perspective. The review outlines a late pregnancy and early postnatal care pathway as a common algorithm to be used by the whole multidisciplinary team. [ABSTRACT FROM AUTHOR]

Objective: To describe utilization of prenatal care and outcomes of low birth weight and preterm birth among adolescent births in Mexico. Methods: We used birth certificate data and included live births to individuals 10–24 years, 2008–2019. Our outcomes were binary measures of adequate prenatal care, low birth weight, and preterm birth. We compared adolescents (10–14 years, 15–16, and 17–19) to those 20–24 years. We included individual‐, clinical‐, and municipality‐level variables, used multivariable logistic regression, and calculated adjusted predicted probabilities. We also tested whether receipt of prenatal care moderated the relationship of age with preterm birth and low birth weight. Results: We included a total of 12 106 710 births to women 10–24 years. The adjusted predicted probability of adequate prenatal care increased with age: 56.07% (95% CI 55.82–56.31%) adjusted probability among adolescents 10–14 years compared with 65.51% (95% CI 65.48%–65.55%) among individuals 20–24 years. Receipt of adequate prenatal care in part mitigated disparities in preterm birth and low birthweight across all age groups: 7.30% (95% CI 7.17%–7.43%) adjusted probability of delivering a preterm infant among those 10–14 years who received adequate prenatal care compared with 9.37% (95% CI 9.20%–9.53%) among those 10–14 years without adequate prenatal care. Conclusion: In Mexico, adolescent pregnancies are associated with inadequate prenatal care as well as higher odds of preterm delivery and low birth weight. Youngest adolescents (10–14 years) have the highest probability of adverse outcomes. Adequate prenatal care may help partially mitigate disparities in poor perinatal outcomes. Synopsis: In Mexico, adolescent pregnancies have higher odds of prematurity and low birthweight. Adequate prenatal care may partially mitigate these disparities. [ABSTRACT FROM AUTHOR]

The aim of the study is to examine the relationship between spiritual well-being, prenatal stress and attachment level of Turkish women conceiving spontaneously or with assisted reproductive techniques (ART). The comparative descriptive study type was conducted between November 2021 and June 2022 with 202 pregnant women, including 87 women conceiving with ART and 115 women conceiving spontaneously, who applied for routine prenatal care checkup in a state hospital in the west of Turkey. Both groups have a high level of spiritual well-being. Pregnant women in the ART group experience higher prenatal distress (9.6% for spontaneous, 12.6% for ART, p = 0.487) and low level of attachment (69.72 ± 7.98 for spontaneous, 66.24 ± 8.88 for ART, p = 0.006) compared to the other group. Additionally, as insufficient partner involvement in the prenatal process increases in pregnant women in both groups, prenatal attachment decreases. It is extremely important that midwives and nurses evaluate the spiritual well-being of pregnant women and provide holistic care in line with their spiritual needs. [ABSTRACT FROM AUTHOR]

Background: Pregnancy provides a privileged and opportune moment to implement interventions promoting healthy lifestyle behaviors and significantly improving perinatal outcomes. The Healthy Lifestyle Behaviors Scale (HLBES) can be used to assess health promoting behaviors, such as diet, physical activity, and mental health. Purpose: This study aimed to examine the psychometric properties of the HLBES in Portuguese pregnant women. Methods: A methodological study was conducted on a convenience sample of 192 pregnant women receiving prenatal care. After cross-cultural adaptation, an exploratory factor analysis and internal consistency assessment were carried out to evaluate the psychometric properties of the scale. Data collected included the Healthy Lifestyle Beliefs Scale to assess the HLBES' criterion validity. Results: Exploratory factor analysis with Varimax rotation yielded 2 subscales that explained 45.23% of the total variance. The scale revealed an overall internal consistency of 0.78 and a good criterion validity with the Healthy Lifestyle Beliefs Scale (r = 0.65, P <.01). Conclusion: Our results suggest that the HLBES is an instrument for reporting healthy lifestyle behaviors in Portuguese pregnant women; however, further studies are recommended. This scale can be used to not only describe healthy lifestyle behaviors in pregnant women but also to determine the effects of health promoting interventions. [ABSTRACT FROM AUTHOR]

Background: With the right support, people with learning disabilities can be 'good enough' parents (Coren et al., 2011; Murphy & Feldman, 2002). Parenting programmes exist to support parents and are made accessible for people with learning disabilities who are expecting a baby, but evaluation of the benefit of these interventions is poor due to a lack of accessible outcome measures (May & Harris, 2020; Wade et al., 2008). The Tool to Measure Parenting Self‐Efficacy in the antenatal period (TOPSE‐ ante‐natal) measures the impact of parenting interventions on an individual's self‐efficacy during the antenatal period. This study aimed to modify the TOPSE ante‐natal tool through a process of inclusive research, to support a consistent approach to evaluating parenting interventions from the perspective of parents‐to‐be with learning disabilities. Methods: A two‐phase study using interviews and discussion groups was conducted in a process of inclusive research to modify the TOPSE ante‐natal tool. Phase one involved conducting eight cognitive interviews (interviews to understand how individuals process and recall information) with parents with learning disabilities. These were conducted remotely via Microsoft Teams, transcribed verbatim and analysed using content analysis (Krippendorff, 2013). Participants were recruited using snowballing techniques through the advisory groups' networks. Phase two included three discussion groups with study collaborators and advisors (n = 14) to assess the accessibility and acceptability of adaptations of the tool, each making further refinements for consideration. Findings: Interviews and discussion groups highlighted how parents‐to‐be with learning disabilities experienced some of the original TOPSE‐ante‐natal negative statements, including negative points on a Likert scale, difficult to comprehend. Figurative statements and unfamiliar words also caused confusion, and statements focussed on the pressures of parenting were experienced as confrontational by people with learning disabilities. Statements were removed or replaced and agreed upon in discussion groups to ensure that the tool was accessible and meaningful to people with learning disabilities. Conclusions: We have used a process of inclusive research to modify a self‐efficacy tool for parents‐to‐be with learning disabilities that is freely available on the TOPSE website (https://www.topse.org.uk/site/). The next steps are for this tool to be used and validated in future studies evaluating parenting interventions for people with learning disabilities. This will inform a knowledge base of what interventions should be used by practitioners who are supporting people with learning disabilities to prepare for parenthood. Accessible summary: People with learning disabilities may need support to be good parents.There are parenting programmes to support people with learning disabilities who are expecting a baby, but it is difficult to find out how helpful they are, as questionnaires to measure this are not accessible for people with learning disabilities.This article describes how we worked with parents with learning disabilities and advisors (advocates, researchers and health professionals) to make an accessible and meaningful version of a questionnaire.This questionnaire can be used to find out if and how parenting programmes help people with learning disabilities feel more confident in how they will parent their babies. [ABSTRACT FROM AUTHOR]

Background/Aims: Anaemia is a multifactorial condition and understanding its prevalence and associated factors is crucial for effective healthcare planning and interventions. The aim of this study was to explore the prevalence of anaemia during pregnancy and its potential risk factors in Oman. Methods: A retrospective approach was used to identify anaemia cases by examining medical records taken from 9321 women who gave birth at the hospital over 3 years. Chi-squared tests were used to establish differences in risk factors using a case-control design, with a 1:2 ratio. Results: The crude prevalence of anaemia was 31.2%, dropping to 4.9% after excluding women with chronic and/or acute diseases. Significant differences were found in nationality (χ2=4.738, P=0.030), body mass index (χ2=6.392, P=0.041) and gestational age (χ2=4.329, P=0.037) for women with anaemia compared to those without. Conclusions: These findings underscore the significance of assessing and managing anaemia in pregnancy, while considering the interaction of demographic and clinical variables in formulating anaemia prevention strategies. [ABSTRACT FROM AUTHOR]

Congenital heart disease is now the most common reason for women to attend a high-risk joint cardiac–obstetric clinic. With advances in medical care and surgical techniques, most children born with congenital heart disease reach childbearing age and have a good prognosis for long-term survival with a good quality of life. Pregnancy remains a major life event for these women, posing additional risks with the potential for severe morbidity and mortality. The hemodynamic changes induced by pregnancy can unmask undiagnosed congenital heart disease or exacerbate pre-existing conditions. Therefore, specialist care is essential for a successful pregnancy outcome. Women with complex congenital heart disease embarking on pregnancy need the support of a multidisciplinary team, including cardiologists, obstetricians, anaesthetists, midwives and adult congenital heart disease clinical nurse specialists. Clinical nurse specialists in particular play a crucial role in coordinating, supporting, educating and advocating for the mother and fetus through preconception, pregnancy, the puerperium and beyond. [ABSTRACT FROM AUTHOR]

Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms. Pregnant people (N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum. The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p ≤0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time. The study relied on self-reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability. Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period. • Depression during pregnancy and postpartum is common. • Discrimination is positively associated with perinatal depressive symptoms. • There is a lack of research on modifiable social and psychological factors that may moderate this association. • This research suggests that social support and resilience may protect against perinatal depressive symptoms, and social support may buffer the adverse effects of discrimination on these symptoms [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe syphilis treatment status and prenatal care among people with syphilis during pregnancy to identify missed opportunities for preventing congenital syphilis. METHODS: Six jurisdictions that participated in SET-NET (Surveillance for Emerging Threats to Pregnant People and Infants Network) conducted enhanced surveillance among people with syphilis during pregnancy based on case investigations, medical records, and linkage of laboratory data with vital records. Unadjusted risk ratios (RRs) were used to compare demographic and clinical characteristics by syphilis stage (primary, secondary, or early latent vs late latent or unknown) and treatment status during pregnancy (adequate per the Centers for Disease Control and Prevention’s “Sexually Transmitted Infections Treatment Guidelines, 2021” vs inadequate or not treated) and by prenatal care (timely: at least 30 days before pregnancy outcome; nontimely: less than 30 days before pregnancy outcome; and no prenatal care). RESULTS: As of September 15, 2023, of 1,476 people with syphilis during pregnancy, 855 (57.9%) were adequately treated and 621 (42.1%) were inadequately treated or not treated. Eighty-two percent of the cohort received timely prenatal care. Although those with nontimely or no prenatal care were more likely to receive inadequate or no treatment (RR 2.50, 95% CI, 2.17–2.88 and RR 2.73, 95% CI, 2.47–3.02, respectively), 32.1% of those with timely prenatal care were inadequately or not treated. Those with reported substance use or a history of homelessness were nearly twice as likely to receive inadequate or no treatment (RR 2.04, 95% CI, 1.82–2.28 and RR 1.83, 95% CI, 1.58–2.13, respectively). CONCLUSION: In this surveillance cohort, people without timely prenatal care had the highest risk for syphilis treatment inadequacy; however, almost a third of people who received timely prenatal care were not adequately treated. These findings underscore gaps in syphilis screening and treatment for pregnant people, especially those experiencing substance use and homelessness, and the need for systems-based interventions, such as treatment outside of traditional prenatal care settings. [ABSTRACT FROM AUTHOR]

Introduction: Polio eradication is a current and common strategy throughout the globe. The study of the newly introduced inactivated poliovirus vaccine provides a grasp on the current status of immunization and identifies any disparities in the implementation of the vaccine throughout Ethiopia. Thus, this study aimed to demonstrate the spatial distribution, coverage, and determinants of inactivated poliovirus vaccine immunization in Ethiopia. Method: Spatial distribution and determinants of inactivated poliovirus vaccine immunization in Ethiopia were conducted using Ethiopian mini-demographic and health survey 2019 data. A total of 2,056 weighted children aged 12 to 35 months were included in the analysis. The association between the outcome and explanatory variables was determined by commuting the adjusted odds ratio at a 95% confidence interval. The p-value of less than 0.05 was used to declare factors as significantly associated with the inactivated poliovirus vaccine immunization. Result: The weighted national coverage of inactivated poliovirus vaccine immunization in Ethiopia was 51.58% at a 95% confidence interval (49.42, 53.74). While the rates of inactivated poliovirus vaccine immunization were observed to be greater in Addis Ababa, Tigiray, Amahara, and Benishangul Gumuz provinces and lower in the Somali, Afar, and SNNPR provinces of Ethiopia, Antenatal care follow-up, place of delivery, place of residence, and region were significantly associated with inactivated poliovirus immunization in Ethiopia. Conclusion: The distribution of inactivated poliovirus immunization was spatially variable across Ethiopia. Only about half of the children aged twelve to thirty-five months received the inactivated poliovirus vaccine in the country. The factors, both at the individual and community level, were significantly associated with inactivated poliovirus immunization. Therefore, policies and strategies could benefit from considering antenatal care follow-up, place of delivery, place of residence, and region while implementing inactivated poliovirus vaccine immunization. [ABSTRACT FROM AUTHOR]

Background: Perinatal mortality remains a global challenge. This challenge may be worsened by the negative effects of the COVID-19 pandemic on maternal and child health. Objectives: Examine the impact of the COVID-19 pandemic on perinatal care and outcomes in the Tamale Teaching Hospital in northern Ghana. Methods: A hospital-based retrospective study was conducted in the Tamale Teaching Hospital. We compared antenatal care attendance, total deliveries, cesarean sections, and perinatal mortality before the COVID-19 pandemic (March 1, 2019 to February 28, 2020) and during the COVID-19 pandemic (March 1, 2020 to February 28, 2021). Interrupted time series analyses was performed to evaluate the impact of the COVID-19 pandemic on perinatal care and outcomes at TTH. Results: A total number of 35,350 antenatal visits and 16,786 deliveries were registered at TTH from March 2019 to February 2021. Antenatal care, early neonatal death, and emergency cesarean section showed a rapid decline after the onset of the pandemic, with a progressive recovery over the following months. The total number of deliveries and fresh stillbirths showed a step change with a marked decrease during the pandemic, while the macerated stillbirths showed a pulse change, a temporary marked decrease with a quick recovery over time. Conclusion: The COVID-19 pandemic had a negative impact on perinatal care and outcomes in our facility. Pregnancy monitoring through antenatal care should be encouraged and continued even as countries tackle the pandemic. [ABSTRACT FROM AUTHOR]

Background: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. Methods: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. Results: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. Conclusion: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed. [ABSTRACT FROM AUTHOR]

Introduction: Maternal and neonatal health are among the top prioritised agendas of global health care with due emphasis given to developing countries, where the burden is profound. Antenatal care accompanied by its recommended components is highly beneficial for both maternal health and birth outcome. Objective: The objective of this study was to identify the proportion of pregnant women who received adequate Antenatal care components and associated factors among Ethiopian women. Methods and materials: We used a nation-wide data from Mini Ethiopian Demographic and Health Survey (MEDHS) of 2019. All women of age 15–49 and who had at least one ANC visit, who were either permanent residents of the selected households or visitors who slept in the household the night before the survey, were eligible to be interviewed. Since we utilised multilevel logistic regression model, the STATA output had two components, the fixed effect and the random effect. In our model, the fixed effect part was displayed by odds ratio while the random effect was addressed by variance and intra-cluster correlation (ICC). Results: From the total women with at least one antenatal care (ANC) visit 55.41% (95% CI 53.60%, 57.20%) of them received adequate components of the care. In the final model after adjusting for the cluster and individual level variables, attending primary (AOR = 1.45; 95% CI: 1.15 to 1.84), secondary (AOR = 2.21; 95% CI: 1.51 to 3.24) and higher education (AOR = 2.42; 95% CI: 1.38 to 4.26) were significantly associated with higher odds of receiving adequate components of ANC. Similarly, wealth index of middle (AOR = 1.51; 95% CI: 1.06, 2.14), richer (AOR = 1.92; 95% CI: 1.32, 2.80), and richest (AOR = 3.86; 95% CI: 2.35, 6.33) compared to poorest index and having two or more ANC visits were significantly associated with receiving adequate components of ANC. On the other hand, being from Oromia region, from female headed household and protestant religion were negatively associated with receiving adequate components of ANC. Conclusion: The proportion of women who received adequate ANC component was much lower compared to the universal recommendation for every woman on ANC visit. Educational status, wealth index, number of ANC visit, region of residence and type of health facility were significantly associated with the odds of receiving adequate components of ANC. The government should pay attention to those without any formal education, encouraging pregnant women to receive the optimum number of ANC visits, and devising techniques to address those in poorest wealth index so that the proportion of adequate components of ANC will be increased. [ABSTRACT FROM AUTHOR]

Background: Using claims data to identify a predominant prenatal care (PNC) provider is not always straightforward, but it is essential for assessing access, cost, and outcomes. Previous algorithms applied plurality (providing the most visits) and majority (providing majority of visits) to identify the predominant provider in primary care setting, but they lacked visit sequence information. This study proposes an algorithm that includes both PNC frequency and sequence information to identify the predominant provider and estimates the percentage of identified predominant providers. Additionally, differences in travel distances to the predominant and nearest provider are compared. Methods: The dataset used for this study consisted of 108,441 live births and 2,155,076 associated South Carolina Medicaid claims from 2015–2018. Analysis focused on patients who were continuously enrolled throughout their pregnancy and had any PNC visit, resulting in 32,609 pregnancies. PNC visits were identified with diagnosis and procedure codes and specialty within the estimated gestational age. To classify PNC providers, seven subgroups were created based on PNC frequency and sequence information. The algorithm was developed by considering both the frequency and sequence information. Percentage of identified predominant providers was reported. Chi-square tests were conducted to assess whether the probability of being identified as a predominant provider for a specific subgroup differed from that of the reference group (who provided majority of all PNC). Paired t-tests were used to examine differences in travel distance. Results: Pregnancies in the sample had an average of 7.86 PNC visits. Fewer than 30% of the sample had an exclusive provider. By applying PNC frequency information, a predominant provider can be identified for 81% of pregnancies. After adding sequential information, a predominant provider can be identified for 92% of pregnancies. Distance was significantly longer for pregnant individuals traveling to the identified predominant provider (an average of 5 miles) than to the nearest provider. Conclusions: Inclusion of PNC sequential information in the algorithm has increased the proportion of identifiable predominant providers by 11%. Applying this algorithm reveals a longer distance for pregnant individuals travelling to their predominant provider than to the nearest provider. [ABSTRACT FROM AUTHOR]

Introduction: Existing research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan. Methods: We analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012–2013 and 2017–2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women's last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples. Results: Exposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups. Conclusions: Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusions Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history‐based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population‐based screening has failed to be translated into broad clinical practice.This study aimed to redesign antenatal care within an Australian public healthcare centre to align with evidence‐based maternity care, including population‐based first‐trimester screening with early initiation of preventative strategies in high‐risk pregnancies.A five‐phase action‐process model, sharing key elements with implementation science theory, was used to explore barriers to change in antenatal care, co‐design a novel service with consumers and establish a population‐based antenatal pathway commencing with a multidisciplinary first‐trimester screening, assessment and planning visit.The case for change and associated barriers were defined from the perspective of antenatal care stakeholders. Key needs of each group were established, and solutions were created using co‐design methodology, allowing the team to create a novel approach to antenatal care which directly addressed identified barriers. Implementation of the service was associated with a fall in the median gestation at first specialist maternity care provider visit from 20 to 13 weeks.This study confirms the feasibility of establishing a comprehensive first‐trimester screening program within a public Australian healthcare setting and highlights a co‐design process which places individualised assessment at the forefront of antenatal care. This framework may be applicable to most public maternity settings in Australia, with expansion aimed at providing equity of care, including in rural and remote settings. [ABSTRACT FROM AUTHOR]

Objective: We sought to investigate the impact of individualized exercise guidance during pregnancy on the incidence of macrosomia and the mediating effect of gestational weight gain (GWG). Design: A prospective randomized clinical trial. Setting: A Hospital in Xingtai District, Hebei Province. Population: Older than 20 years of age, mid-pregnancy, and singleton pregnant women without contraindications to exercise during pregnancy. Methods: A randomized clinical trial was conducted from December 2021 to September 2022 to compare the effects of standard prenatal care with individualized exercise guidance on the incidence of macrosomia. Main outcome measure: Incidence of macrosomia. Results: In all, 312 singleton women were randomized into an intervention group (N = 162) or a control group (N = 150). Participants who received individualized exercise guidance had a significantly lower incidence of macrosomia (3.73% vs. 13.61%, P = 0.002) and infants large for gestational age (9.94% vs. 19.73%, P = 0.015). However, no differences were observed in the rate of preterm birth (1.86% vs. 3.40%, P = 0.397) or the average gestational age at birth (39.14 ± 1.51 vs. 38.69 ± 1.85, P = 0.258). Mediation analysis revealed that GWG mediated the effect of exercise on reducing the incidence of macrosomia. Conclusion: Individualized exercise guidance may be a preventive tool for macrosomia, and GWG mediates the effect of exercise on reducing the incidence of macrosomia. However, evidence does not show that exercise increases the rate of preterm birth or affects the average gestational age at birth. Trial registration: The trial is registered at www.clinicaltrails.gov [registration number: NCT05760768; registration date: 08/03/2023 (retrospectively registered)]. [ABSTRACT FROM AUTHOR]

Background: In group-based pregnancy models, antenatal care and childbirth/parenting education are provided in groups of eight to 10 women, usually with two midwives, and six to eight sessions. Current evidence is inconclusive regarding potential benefit or harm. We aimed to explore the feasibility of implementing an adequately powered randomised controlled trial (RCT). Methods: A two-arm pilot RCT was conducted in a tertiary maternity hospital in Melbourne, Australia. Women were randomly allocated to either the intervention to receive group-based antenatal care and education (group care) or to usual care, which included hospital-based midwife, caseload midwifery, team midwifery, or GP shared care. Participants were English-speaking, primiparous, low risk, and < 24 weeks gestation at booking. Data collection: feasibility measures throughout pilot, baseline questionnaire at recruitment, clinical outcome data from the medical record, and a telephone-administered questionnaire 6 weeks postpartum. A focus group explored midwives' views. Results: Seventy-four women were recruited from May to June 2017 (group care = 40, usual care = 34). Study uptake was 35%. Women allocated to group care rated their overall pregnancy care more highly (88% good/very good vs 77% in usual care). There was no evidence of harm related to group care. Overarching themes from the midwives were that group care helped 'build connections' and 'empower women'. All midwives would work in the model again and believed it should be expanded. Conclusion: Group care was acceptable to both women and midwives with no evidence of harm. The pilot demonstrated the feasibility of undertaking a large adequately powered RCT, important given the inconclusive evidence on clinical outcomes regarding the model, and its current relatively widespread implementation. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000858695. [ABSTRACT FROM AUTHOR]

Background: Malaria during pregnancy is associated with poor maternal, foetal, and neonatal outcomes. To prevent malaria infection during pregnancy, the World Health Organization recommended the use of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) in addition to vector control strategies. Although Ghana's target is to ensure that all pregnant women receive at least three (optimal) doses of SP, the uptake of SP has remained low; between 2020 and 2022, only 60% of pregnant women received optimal SP during their most recent pregnancy. This study sought to map the geospatial distribution and identify factors associated with SP uptake during pregnancy in Ghana. Methods: Secondary data analysis was conducted using the 2019 Ghana Malaria Indicator Survey dataset. The data analysed were restricted to women aged 15–49 years who reported having a live birth within the two years preceding the survey. A modified Poisson regression model was used to determine factors associated with SP uptake during pregnancy. Geospatial analysis was employed to map the spatial distribution of optimal SP uptake across the ten regions of Ghana using R software. Results: The likelihood that pregnant women received optimal SP correlated with early initiation of first antenatal care (ANC), number of ANC contacts, woman's age, region of residence, and family size. Overall, the greater the number of ANC contacts, the more likely for pregnant women to receive optimal SP. Women with four or more ANC contacts were 2 times (aPR: 2.16; 95% CI: [1.34–3.25]) more likely to receive optimal SP than pregnant women with fewer than four ANC contacts. In addition, early initiation and a high number of ANC contacts were associated with a high number of times a pregnant woman received SP. Regarding spatial distribution, a high uptake of optimal SP was significantly observed in the Upper East and Upper West Regions, whereas the lowest was observed in the Eastern Region of Ghana. Conclusions: In Ghana, there were regional disparities in the uptake of SP during pregnancy, with the uptake mainly correlated with the provision of ANC services. To achieve the country's target for malaria control during pregnancy, there is a need to strengthen intermittent preventive treatment for malaria during pregnancy by prioritizing comprehensive ANC services. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Evidence suggests that transgender and gender‐expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender‐expansive people from a critical midwifery perspective.We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender‐expansive identities.Three themes emerged from our analysis: “Navigating identity during pregnancy,” “Experiences with mental health and wellbeing,” and “Encounters in the maternal and newborn care system.” Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender‐affirmative (midwifery) care and daily social realities were often shaped by trans‐negativity and transphobia.To improve care outcomes of transgender and gender‐expansive people, it is necessary to counter anti‐trans ideologies by “fixing the knowledge” of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among “sex,” “gender,” and “pregnancy” is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy. Methods: The 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models. Results: Among the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care. Conclusion: About half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is essential health care and medical support provided to pregnant women, with the aim of promoting optimal health for both the mother and the developing baby. Pregnant women should initiate ANC within the first trimester of pregnancy to access a wide range of crucial services. Early initiation of ANC significantly reduces adverse pregnancy outcomes, yet many women in Sub-Saharan Africa delay its initiation. The aim of this study was to assess prevalence and determinants of delayed ANC initiation in Ethiopia. Methods: We conducted a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The study involved women of reproductive age who had given birth within the five years prior to the survey and had attended ANC for their most recent child. A total weighted sample of 2,895 pregnant women were included in the analysis. Due to the hierarchical nature of the data, we employed a multi-level logistic regression model to examine both individual and community level factors associated with delayed ANC initiation. The findings of the regressions were presented with odds ratios (OR), 95% confidence intervals (CI), and p-values. All the statistical analysis were performed using STATA—14 software. Results: This study showed that 62.3% (95% CI: 60.5, 64.1) of pregnant women in Ethiopia delayed ANC initiation. Participants, on average, began their ANC at 4 months gestational age. Women with no education (AOR = 2.1; 95% CI: 1.4, 3.0), poorest wealth status (AOR = 1.9; 95% CI: 1.3, 2.8), from the Southern Nations, Nationalities, and Peoples (SNNP) region (AOR = 2.1; 95% CI: 1.3, 3.3), and those who gave birth at home (AOR = 1.4; 95% CI: 1.1, 1.7) were more likely to delay ANC initiation. Conclusions: The prevalence of delayed ANC initiation in Ethiopia was high. Enhancing mothers' education, empowering them through economic initiatives, improving their health-seeking behavior towards facility delivery, and universally reinforcing standardized ANC, along with collaborating with the existing local community structure to disseminate health information, are recommended measures to reduce delayed ANC initiation. [ABSTRACT FROM AUTHOR]

Background: Even if there is currently no research on food integration practices, there is an unreliable hole in the data for the first motives, especially 6 to 24 months, research at ages varies in different ways, always, but the child's development affects an important part of both the child and the parents. This gap limits our comprehensive knowledge of strategic choices and—their potential impact on children's overall health and well-being. Therefore, the aim of this study was factors shaping complementary feeding for 6 to 24-Month-Olds in Northeast Ethiopia. Methods: A community-based survey was conducted in northeastern Ethiopia from June to July 2022. A sample of 409 mothers with infants aged 6 to 24 months was selected using a simple random sampling method. A structured questionnaire was adopted and data were collected by an interviewer. Collected data were entered into Epi Data version 4.6 and subsequently converted to SPSS version 21 for further analysis. Variables with a P-value < = 0.25 in the bivariate analysis were included in the multivariable logistic regression model. Multivariable logistic regression analyses aimed at identifying independent associations between early initiation of supplement feeding and determinants-adjusted odds ratios with corresponding 95% confidence intervals were calculated to determine the strength of associations. P-values less than or equal to 0.05 were considered statistically significant. Results: A total of 409 mothers with their children were included in the analysis, revealing a prevalence of 38.1% for early initiation of complementary feeding among children aged 6–24 months. Factors associated with -early initiation included place of residence (Adjusted Odds Ratio (AOR) 3.63, 95% Confidence Interval (CI) 1.1–11.95), husband's educational status (AOR 16.83, 95% CI 1.98–24.8), maternal occupation (AOR 21.2, 95% CI 1.11–46.9), number of antenatal care (ANC) visits (AOR 25.94, 95% CI 22.7–85.67), initial breastfeeding time (AOR 4.98, 95% CI 1.22–14.9), and medical illness (AOR 2.81, 95% CI 1.12–3.6. Conclusion: Significant associations with Complementary Feeding were identified with the number of antenatal care (ANC) visits, postnatal care (PNC) check-ups, current residency, breastfeeding initiation time, maternal medical illness, and occupational status. To mitigate the early initiation of complementary feeding, it is recommended to enhance ANC/PNC services and educate mothers about the precise timing for introducing complementary foods to their infants. [ABSTRACT FROM AUTHOR]

Background: Stillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016. Methods: All restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs). Results: A total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41–4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16–2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50–2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12–2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19–2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20–1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98–7.23), birthing age 35–40 years (aOR, 1.92; 95% CI, 1.02–3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12–3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17–6.16) and unemployment (aOR, 4.06; 95% CI, 1.41–11.73). Conclusion: Factors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority. [ABSTRACT FROM AUTHOR]

Background: Non-invasive prenatal testing (NIPT) has been clinically available in Australia on a user-pays basis since 2012. There are numerous providers, with available tests ranging from targeted NIPT (only trisomies 21, 18, and 13 +/- sex chromosome aneuploidy) to genome-wide NIPT. While NIPT is being implemented in the public health care systems of other countries, in Australia, the implementation of NIPT has proceeded without public funding. The aim of this study was to investigate how NIPT has been integrated into antenatal care across Australia and reveal the successes and challenges in its implementation in this context. Methods: An anonymous online survey was conducted from September to October 2022. Invitations to participate were sent to healthcare professionals (HCPs) involved in the provision of NIPT in Australia through professional society mailing lists and networks. Participants were asked questions on their knowledge of NIPT, delivery of NIPT, and post-test management of results. Results: A total of 475 HCPs responded, comprising 232 (48.8%) obstetricians, 167 (35.2%) general practitioners, 32 (6.7%) midwives, and 44 (9.3%) genetic specialists. NIPT was most commonly offered as a first-tier test, with most HCPs (n = 279; 60.3%) offering it to patients as a choice between NIPT and combined first-trimester screening. Fifty-three percent (n = 245) of respondents always offered patients a choice between NIPT for the common autosomal trisomies and expanded (including genome-wide) NIPT. This choice was understood as supporting patient autonomy and informed consent. Cost was seen as a major barrier to access to NIPT, for both targeted and expanded tests. Equitable access, increasing time demands on HCPs, and staying up to date with advances were frequently reported as major challenges in delivering NIPT. Conclusions: Our findings demonstrate substantial variation in the clinical implementation of NIPT in Australia, including in the offers of expanded screening options. After a decade of clinical use, Australian clinicians still report ongoing challenges in the clinical and equitable provision of NIPT. [ABSTRACT FROM AUTHOR]

Background: Mexico has one of the world's highest rates of cesarean section (C-section). Little is known about Mexico's frequency of and risk factors for non-consented C-sections, a form of obstetric violence. We examined the prevalence of sociodemographic and obstetric-specific characteristics of Mexican women who delivered via C-section, as well as the association between the location of prenatal care services and experiencing a non-consented C-section. Methods: We conducted a secondary analysis of data collected from Mexico's 2016 National Survey on the Dynamics of Household Relationships (ENDIREH 2016) of women who reported a C-section during their latest delivery. Adjusted logistic regressions were calculated to explore the associations between the location of prenatal care services and experiencing a non-consented cesarean delivery, stratifying by Indigenous belonging. Results: The sample size for this analysis was 10,256 ENDIREH respondents, with 9.1% not consenting to a C-section. ENDIREH respondents between the ages of 26 and 35 years old, living in urban settings, living in Central or Southern Mexico, and married or living with a partner experienced a higher prevalence of non-consented C-sections. For both women who identified as Indigenous and those who did not, the odds of experiencing a non-consented C-section were higher when receiving prenatal services in private settings. Receiving more than one type of prenatal service was also associated with increased odds of non-consented C-sections, while ENDIREH 2016 respondents who did not identify as Indigenous and received prenatal care at the State Institute for Social Security and Services for State Workers facility had lower odds of experiencing a non-consented C-section. Conclusions: This analysis indicates that receiving prenatal care at a private facility or a combination of public and private services increases the risk of experiencing a non-consented C-section in Mexico. Additional research is required to further understand the factors associated with non-consented C-sections in Mexico. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Noninvasive prenatal testing (NIPT) has increased the number of conditions that can be screened. However, the prevalence of conditions assessed by NIPT has remained stable. The “prevalence threshold,” a novel epidemiological concept, uses a test's sensitivity and specificity to determine the prevalence below which a test's positive predictive value declines most sharply relative to disease prevalence. In this article, we calculated the prevalence threshold for common conditions assessed through NIPT and compared the value with the actual prevalence of each condition to best ascertain the reliability of NIPT results.Six databases and PubMed were searched from January 2010 to March 2023 for sensitivity and specificity parameters of common conditions tested through NIPT. Using an equation previously derived by the authors of the current paper, the prevalence threshold for each condition was calculated. The theoretical number of test iterations required to reach the prevalence threshold was also reported.None of the conditions tested through the NIPT had a prevalence rate that met or exceeded the calculated prevalence threshold. Trisomy 21 had the greatest concordance between the prevalence rate and the prevalence threshold. In contrast, Angelman, Cri‐du‐chat, and Prader‐Willi syndromes had the most significant discordance. Apart from trisomy 21 and XXY, all remaining conditions required more than one test iteration to reach their respective prevalence threshold.We conclude that at the current prevalence levels, the positive predictive value of NIPT remains low, with the prevalence of disease levels significantly lower than the prevalence threshold for each condition tested. [ABSTRACT FROM AUTHOR]