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Abstract Objectives Maternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum. Methods In 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions. Results Participants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p

Objective Methods Results Conclusion The study presents the risk of the maternal‐fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity.This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal‐fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal‐fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression.A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted‐odds‐ratio [AOR] 13.7, 95% CI: 4.5–42.7), anemia (AOR 6.8, 95% CI: 4.5–10.2), severe anemia (AOR 4.3, 95% CI: 3.3–5.6), preterm delivery (AOR 4.5, 95% CI: 3.6–5.7), cesarean section (AOR 5.5, 95% CI: 4.7–7.0), stillbirth (AOR 3.4, 95% CI: 2.3–5.3), and low birth weight (AOR 3.1, 95% CI: 2.4–39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities.We concluded that SCD might be an independent risk‐factor for developing maternal‐fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy care aims to prevent complications during pregnancy, is a step to prepare for a healthy delivery for the mother and her fetus, and prevent death during pregnancy and childbirth. Pregnancy care will maintain the growth and health of the fetus well until before delivery, during, and after delivery. Inadequate pregnancy care will increase the risk of perinatal death. This study aims to explore the meaningfulness of village shamans in the care of adolescent pregnancy in Dayak Communities. Materials and methods: This research uses a qualitative approach in the Dayak communities South of Barito. The study subjects were ten pregnant teenage women, ten husbands, ten mothers or mothers-in-law, and four village shamans. Data analysis is carried out manually based on themes and sub-themes. Results: There are two phenomena found. First, adolescent pregnant women do not carry out pregnancy checks according to standards (frequency, quantity, helper, and place). The second is using village shamans, which are helpful in pregnancy check-ups. Some other origins presented are mobility restrictions and the closure of health service facilities (independent practices of midwives and doctors, public health centers, and auxiliary health centers) over a long period. Conclusion: Pregnancy care carried out by adolescent pregnant women is not up to standard, and Increased involvement of village shamans can help in the early detection of health problems in adolescent pregnant women. The government should regulate the role of village shamans in dealing with teenage pregnancy. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Evidence‐based indicators are needed to increase the frequency of practicing care for hiesho, which can be a risk factor during childbirth. Such practice will lead to hiesho prevention. This study aimed to develop a Hiesho Care Practice Scale (HCPS) for pregnant women and examine its reliability and validity.To develop a HCPS and examine its reliability and validity, we conducted a questionnaire‐based survey among nurses who provide hiesho care for pregnant women in Japan.The analysis included 100 participants (recovery rate: 96%). Exploratory factor analysis produced four factors and 20 items. The model's fit indices obtained from the confirmatory factor analysis include goodness of fit of .80, adjusted goodness of fit of .75, comparative fit index of .88, and root mean squared error of approximation of .08. The correlation coefficients for the patient coaching skill evaluation scale for criterion‐related validity test ranged from .23 to .51 (p < .01).Cronbach's α was .88, and intraclass correlation coefficient (ICC) was .81.The HCPS developed in this study consisted of four factors and 20 items, and its reliability and validity were verified. This scale enables the subjective and objective evaluation of hiesho care practice in the nursing profession. It may contribute to standardizing and developing improvement measures for hiesho care among pregnant women by nurses and midwives. [ABSTRACT FROM AUTHOR]

Issue Addressed: Health literacy development can help to reduce the growing noncommunicable disease burden globally. However, less is known about the health literacy needs of pregnant women and mothers necessary to guide health literacy development in this priority population group. To enhance the understanding of the health literacy needs of pregnant women and mothers, this study aimed to develop data‐informed health literacy profiles of pregnant women and mothers with children (0–8 years) in Tasmania, as well as data‐informed vignettes describing the health literacy needs of women in the different health literacy profiles. Methods: An online cross‐sectional survey was undertaken. The survey included demographic questions and the health literacy questionnaire (HLQ). The data were analysed using a cluster analysis to identify subgroups with varying health literacy needs. The clusters, in conjunction with demographic characteristics, were used to generate data‐informed vignettes representing various health literacy profiles. Results: The cluster analysis generated seven health literacy profiles and five vignettes representing diverse health literacy needs of pregnant women and mothers in Tasmania. Each vignette tells a data‐informed story of women in Tasmania experiencing diverse health literacy strengths and challenges influencing their access and use of health information and health services. This allowed deeper exploration of the health literacy needs of the subgroups within the target population. Conclusion: A better understanding of the health literacy needs of pregnant women and mothers can provide policymakers and health care providers with the key insights needed to guide the planning and development of fit‐for‐purpose solutions. This understanding can also guide the tailoring of existing health and community services, to create a health literacy‐responsive environment that is more likely to meet the diverse health needs of pregnant women and mothers. So What: We must shift away from a 'one size fits all' approach and promote the development of a health literacy‐responsive environment to improve health and equity outcomes for pregnant women and mothers in Tasmania. [ABSTRACT FROM AUTHOR]

Objectives: Maternal mortality in the U.S. continues to increase, and the State of Georgia has one of the highest maternal mortality rates among the 50 states at 33.9 deaths per 100,000 live births, disproportionately affecting Black and rural populations. This study sought to ascertain knowledge of adults living in Georgia about proper pregnancy care behaviors and their ability to identify warning signs and symptoms (WSS) of life-threatening complications during pregnancy and up to 1-year postpartum. Methods: In 2022, using a cross-sectional study design, a questionnaire including items from validated instruments was distributed to adults residing in Georgia through social media and email. Questions were grouped into categories: total pregnancy knowledge, general pregnancy care behaviors, and pregnancy and postpartum WSS. Based on correct answer choices, scores were created for each of the four categories and compared by gender, age, education, race, and ethnicity using multiple linear regressions. Results: Participants (n = 588) ranged from 18 to 76 years old and were primarily female (80%). The vast majority (83.3%) failed to identify important pregnancy care behaviors. More than half of all participants were unable to recognize pregnancy and postpartum WSS of complications, 52% and 56% respectively. Male, Black, and Hispanic self-identified adults exhibited lower recognition of pregnancy care behaviors and WSS of pregnancy and postpartum complications, relative to other genders, races, and ethnic groups, respectively (p < 0.001). Conclusions: This research identified important gaps in maternal health knowledge among adults living in the State of Georgia, highlighting specific opportunities for intervention and offering evidence-based information that can help improve health literacy for better maternal outcomes. [ABSTRACT FROM AUTHOR]

Background: Maternal and infant health is still one of the issues that receive special attention related to improving the quality of human life in the world. Every hour, one woman dies during childbirth or due to causes related to pregnancy. There are still many pregnant women who are less aware of the importance of examination as an effort to detect pregnancy risk factors. Lack of knowledge and attitude, makes pregnant women less aware of the emergence of symptoms of certain dangerous diseases, either indirectly causing maternal death. Objective: The purpose of the study was to determine the knowledge and attitudes of pregnant women after being given education through the Ebumil android application. Methods: The study used a quasi-experimental approach. The sample was 120 pregnant women who were divided into two groups, namely the intervention group (which was given education through the ebumil application and the control group (which was not given education through the ebumil application) using a simple random sampling technique. The research variables were knowledge and attitudes of pregnant women. The research instrument data was a knowledge and attitude questionnaire. The analysis test used was the paired t test. Results: The results of the study showed an increase in knowledge in the intervention group of 80.03 (post 1) and 90.50 (post 2) while the control group did not experience an increase in knowledge of 40.98 (post 1) and 40.50 (post 2). There was an increase in attitudes in the intervention group of 78.16 (post 1) and 90.25 (post 2) while the control group did not experience an increase in attitudes of 42.84 (post 1) and 42.35 (post 2). The results of the paired t test statistical test obtained a p-value of 0.000

Abstract Background Maternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups. Objective To measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy. Methods Data from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives. Results Study finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1–1.4), community motivators (aOR = 1.9, CI: 1.7–2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women. Conclusion Despite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions.

Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background. [ABSTRACT FROM AUTHOR]

Background: Maternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups. Objective: To measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy. Methods: Data from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives. Results: Study finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1–1.4), community motivators (aOR = 1.9, CI: 1.7–2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women. Conclusion: Despite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions. [ABSTRACT FROM AUTHOR]

ObjectiveThis analysis describes the use patterns of web-based virtual triage (VT) by pregnant patients before and during the first two years of the COVID-19 pandemic, and how the pandemic influenced frequency of VT use, nature of symptoms reported, and the associated implications for maternal healthcare delivery.MethodsAn online survey of 36,910 patients who reported pregnancy was completed between January 1, 2019 and June 30, 2022. The data were segmented into six month periods to allow comparative analyses of usage frequency and changes in initial complaints over the study period, with particular emphasis on the early months of the COVID-19 pandemic. Descriptive statistics and trend analyses were used to identify significant shifts in symptom reporting and user demographics.ResultsA marked increase in the utilization of VT by pregnant women during the pandemic occurred. The percentage of pregnant users grew from 0.32% in the first half of 2019 to 0.85% in late 2021, with the greatest rise (213%) in the first six months of 2020. The most common symptoms reported were abdominal pain, headache, nausea, back pain, fatigue and cough. Pre-pandemic, VT use focused on prospective mothers learning about the potential causes of typical symptoms occurring during pregnancy, but during the pandemic there was a substantial increase in reporting symptoms associated with acute respiratory infections such as cough, nasal congestion, and dyspnea.ConclusionsThe COVID-19 pandemic significantly influenced the use of VT by pregnant women, with a shift towards addressing concerns related to respiratory symptoms and potential COVID-19 exposure. These findings underline the significant role of digital health tools in maintaining access to health information during times of crisis and highlight the evolving needs of pregnant patients in such settings.

Background: Obesity is an increasing problem, even in young women of reproductive age. Obesity has a negative impact on conception, the course of pregnancy, and neonatal outcomes. Caring for obese pregnant women has becoming an important aspect of standard prenatal care. The Guideline "Obesity and Pregnancy" of the German Society of Gynecology and Obstetrics aims to create evidence-based recommendations which can be used to improve the care of obese pregnant women. As obesity is a worldwide problem, many societies for obstetrics and gynecology have created national guidelines. Methods: We reviewed the following guidelines for obesity and pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2021, Royal College of Obstetrics and Gynecology (RCOG) 2018; AND Society of Obstetricians and Gynecologists of Canada (SOGC) 2019. These guidelines were compared to the German guideline. Results: There are some variations between the guidelines, though no major contradictions exist. Disparities were found regarding the recommendations for substitution of high folic acid and Vitamin D. Furthermore, the recommended time for screening for gestational diabetes and the methods to control fetal growth differ between the guidelines. Regarding place of birth, RCOG allows delivery in midwifery-led units in the absence of other high-risk circumstances, while others request facility of care by neonatologists and medical staff trained in care of obese women. Induction of labor at term due to increased risk of intrauterine demise is mostly limited to women with a body mass index of 40 kg/m2. Only one guideline considers induction of all obese women. For intrapartum management, the majority allows tolerating of longer labor times to delivery if fetal monitoring is sufficient and fetal stress is excluded. Special encouragement of breastfeeding and healthy lifestyle is commonly recommended; only in the Canadian guideline, postpartum depression evaluation is requested due to the overall high prevalence of depression and anxiety in obese women. Conclusion: All guidelines consider pregnancies in obese women as high-risk pregnancies and emphasize the need for preconception counseling. There are special needs in pregnancy care and in the intrapartum and postpartum management to be observed. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, social networks have attracted the attention of various segments of society, including women, as a source of health information. Therefore, the purpose of this study was to investigate the impact of using social networks on women’s awareness of thier physical health. Method: In terms of purpose, this research was practical research and in terms of nature, it was descriptive-explanatory research, which was conducted as an online survey on the Instagram social network. The statistical population for this study included the Iranian female Instagram users aged 20 to 60 who were the members of the selected Instagram pages in the field of women’s physical health, approximately 22,800 people. A sample size of 384 people was included in the research by the available sampling method. Data were collected through a researcher-made questionnaire, the validity and reliability of which had already been confirmed. Findings were analyzed using descriptive and inferential statistical methods by SPSS software version 21. Finding: Making use of health social networks has a significant positive impact on women’s consciousness of their physical health and all its dimensions, including puberty health, malnutrition and obesity, care during pregnancy and post-pregnancy care,and women’s diseases and cancers. Discussion: The effective use of social networks in the field of women’s physical health should become a health discourse in the society because one of its important consequences for women is increasing the potential ability to make informed decisions during illness, reducing healththreatening risks, increasing disease prevention, increasing the quality of life, and increasing the quality of self-care. [ABSTRACT FROM AUTHOR]

The Health Equity Leadership & Exchange Network states that “health equity exists when all people, regardless of race, sex, sexual orientation, disability, socioeconomic status, geographic location, or other societal constructs, have fair and just access, opportunity, and resources to achieve their highest potential for health.” It is clear from the wide discrepancies in maternal and infant mortalities, by race, ethnicity, location, and social and economic status, that health equity has not been achieved in pregnancy care. Although the most obvious evidence of inequities is in low-resource settings, inequities also exist in high-resource settings. In this presentation, based on the Global Pregnancy Collaboration Workshop, which addressed this issue, the bases for the differences in outcomes were explored. Several different settings in which inequities exist in high- and low-resource settings were reviewed. Apparent causes include social drivers of health, such as low income, inadequate housing, suboptimal access to clean water, structural racism, and growing maternal healthcare deserts globally. In addition, a question is asked whether maternal health inequities will extend to and be partially due to current research practices. Our overview of inequities provides approaches to resolve these inequities, which are relevant to low- and high-resource settings. Based on the evidence, recommendations have been provided to increase health equity in pregnancy care. Unfortunately, some of these inequities are more amenable to resolution than others. Therefore, continued attention to these inequities and innovative thinking and research to seek solutions to these inequities are encouraged.

Background: Antenatal care (ANC) is crucial to reducing maternal and neonatal deaths, but few studies examined adolescent girls’ and young women’s ANC utilisation and knowledge in Ghana. Aim: To assess adolescents’ and young mothers’ knowledge of ANC, utilisation and factors influencing its use in Ghana. Setting: Tano North Municipality, Ahafo Region. Methods: This community-based, cross-sectional study involved 440 adolescent and young mothers (between 10 and 24 years). A structured questionnaire was employed to collect data face-to-face. Descriptive and statistical analyses were performed, and p 0.05 was considered statistically significant. Results: Of the 440 respondents, most were aged 20–24 years (61.2%), married (30.0%), Christians (78.2%), completed junior high school (JHS) (47.8%) and traders (38.9%). Postnatal mothers were 71.6% (315), and all had utilised ANC services. Antenatal care knowledge was good among 75% (330) respondents, with no significant variation by age. Religion influenced knowledge, with Muslims having lower knowledge. Antenatal care utilisation was high ( 50%) among those aged 15–19 years, married, Christians, JHS graduates and traders. Age, marital status and employment type significantly influenced ANC utilisation. Individuals in the age group 15–19 years and married women demonstrated higher odds of utilising ANC services. Casual workers and unemployed respondents were found to have lower odds of utilising ANC services compared to traders. Conclusion: Age, marital status, and employment type influenced ANC utilisation in the Ahafo Region. Adolescent mothers under 15 years had lower rates, requiring targeted interventions to improve pregnancy outcomes. Contribution: This study highlights the knowledge and factors influencing ANC use in Ahafo Region and adds to the existing research evidence on ANC.

Maternal mortality is a major public health concern worldwide. It is the number of preventable deaths that occur each year due to pregnancy and childbirth. The research investigates how machine learning may be used to minimize maternal mortality. Historical data on maternal health is used to develop predictive models, early detection systems, and resource allocation techniques. Machine learning helps to identify risk factors, monitor vital signs, and improve access to care. This allows for targeted interventions and better healthcare delivery. The challenges of data accessibility and model interpretation are addressed, highlighting the ethical and equitable applications of machine learning in maternal healthcare. This study emphasizes the potential of machine learning to reduce maternal mortality rates and the pressing need for its incorporation into healthcare systems worldwide.

Amal A Alyami,1 Manal M Alem,2 Shereen R Dorgham,3 Sahar A Alshamandy4 1Obstetrics & Gynecology Hospital, King Saud Medical City, Riyadh, Saudi Arabia; 2Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Obstetrics and Women’s Health Nursing Department, College of Nursing, Minia University, Minya, EgyptCorrespondence: Manal M Alem, Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia, Email malem@iau.edu.saBackground: Globally, unjustified medication use during pregnancy, a critical phase in human life, is a threat that compromises the safety of both, the mother and the child. We aim to investigate the prevalence of over-the-counter (OTC) or non-prescription and prescription medication use during pregnancy in women from the city of Riyadh, Saudi Arabia, the level of prior knowledge, and the sources of their information about medication hazard/safety.Methods: A cross-sectional study was performed using a self-administered questionnaire for 287 pregnant women visiting King Saud Medical City (KSMC) – outpatient departments for routine antenatal care during 3 months (1st Mar– 31st May 2021). The questionnaire was developed by Navaro et al with 4 sections: socio-demographic data, medication use during pregnancy, level of knowledge, and relevant sources of information.Results: The participants had a mean age of 32.21 years ± 6.41 (SD), and gestational age of 23.67 weeks ± 8.47. About 76.66% of them reported using medication during their current pregnancy: predominantly prescribed (86.36%). Women who used medication during pregnancy were slightly older; the mean difference was 1.97 years (95% CI 0.23– 3.71) (P=0.027). Women living in an urban environment as compared with rural had a higher prevalence of medication use (79.01% vs 52%) (P=0.002). Overall, 58.19% reported using non-prescribed medications during pregnancy, with analgesics as the most frequently used class (70.30%). The mild nature of the illnesses and availability of an old prescription and information from pharmacists were the main reasons for self-medication. About 40.77% denied receiving any information about medication use during pregnancy.Conclusion: The prevalence of the medication use during pregnancy in our population is alarmingly high. Analgesics were the most frequently used. Lack of adequate information from treating physicians appears to be contributory to self-medication during this critical time.Keywords: nursing, antenatal care, pregnancy care, prescription medication, non-prescription medications, over-the-counter, fetal health and development, self-medication

Background: Although studies from high-income countries have examined social support during pregnancy, it remains unclear what type of support is received by expectant mothers from low- and middle-income country settings. Aim: To explore young women’s social support networks during pregnancy in Soweto, South Africa. Setting: This study was undertaken in an academic hospital based in the Southwestern Townships (Soweto), Johannesburg, in Gauteng province, South Africa. Methods: An exploratory descriptive qualitative approach was employed. Eighteen (18) young pregnant women were recruited using a purposive sampling approach. In-depth interviews were conducted, and data were analysed using inductive thematic analysis. Results: Analysis of the data resulted in the development of two superordinate themes namely; (1) relationships during pregnancy and (2) network involvement. Involvement of the various social networks contributed greatly to the young women having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. Conclusion: Focusing on less-examined characteristics that could enhance pregnant women’s health could help in the reduction of deaths that arise because of pregnancy complications and contribute in globally accelerating increased accessibility to adequate reproductive health. Contribution: This study’s findings emphasise the necessity for policymakers and healthcare providers to educate the broader community about the importance of partner, family and peer support to minimise risks that may affect pregnancy care and wellbeing of mothers.

Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus in the future. Understanding the prevalence, evaluating risk factors contributing to pathogenesis, and identifying treatment challenges related to diabetic retinopathy in expectant mothers are all of utmost importance. Pregnancy-related physiological changes, including those in metabolism, blood flow, immunity, and hormones, can contribute to the development or worsening of diabetic retinopathy. If left untreated, this condition may eventually result in irreversible vision loss. Treatment options such as laser therapy, intravitreal anti-vascular endothelial growth factor drugs, and intravitreal steroids pose challenges in managing these patients without endangering the developing baby and mother. This narrative review describes the management of diabetic retinopathy during pregnancy, highlights its risk factors, pathophysiology, and diagnostic methods, and offers recommendations based on findings from previous literature. [ABSTRACT FROM AUTHOR]

Background: Despite the emerging application of clinical decision support systems (CDSS) in pregnancy care and the proliferation of artificial intelligence (AI) over the last decade, it remains understudied regarding the role of AI in CDSS specialized for pregnancy care. Objective: To identify and synthesize AI-augmented CDSS in pregnancy care, CDSS functionality, AI methodologies, and clinical implementation, we reported a systematic review based on empirical studies that examined AI-augmented CDSS in pregnancy care. Methods: We retrieved studies that examined AI-augmented CDSS in pregnancy care using database queries involved with titles, abstracts, keywords, and MeSH (Medical Subject Headings) terms. Bibliographic records from their inception to 2022 were retrieved from PubMed/MEDLINE (n=206), Embase (n=101), and ACM Digital Library (n=377), followed by eligibility screening and literature review. The eligibility criteria include empirical studies that (1) developed or tested AI methods, (2) developed or tested CDSS or CDSS components, and (3) focused on pregnancy care. Data of studies used for review and appraisal include title, abstract, keywords, MeSH terms, full text, and supplements. Publications with ancillary information or overlapping outcomes were synthesized as one single study. Reviewers independently reviewed and assessed the quality of selected studies. Results: We identified 30 distinct studies of 684 studies from their inception to 2022. Topics of clinical applications covered AI-augmented CDSS from prenatal, early pregnancy, obstetric care, and postpartum care. Topics of CDSS functions include diagnostic support, clinical prediction, therapeutics recommendation, and knowledge base. Conclusions: Our review acknowledged recent advances in CDSS studies including early diagnosis of prenatal abnormalities, cost-effective surveillance, prenatal ultrasound support, and ontology development. To recommend future directions, we also noted key gaps from existing studies, including (1) decision support in current childbirth deliveries without using observational data from consequential fetal or maternal outcomes in future pregnancies; (2) scarcity of studies in identifying several high-profile biases from CDSS, including social determinants of health highlighted by the American College of Obstetricians and Gynecologists; and (3) chasm between internally validated CDSS models, external validity, and clinical implementation. [ABSTRACT FROM AUTHOR]

Objective: To determine and predict the maternal and neonatal outcomes of pregnancies occurring in patients with cardiac disease. Method: This retrospective review included 147 pregnancies identified from antenatal, delivery, and nursery records. Information concerning the nature and severity of the pre‐existing cardiac disease, comorbidities, risk scores, obstetric or cardiac complications, and pregnancy outcomes were collected. The data were analyzed using SPSS Windows version 22. Results: In all, 111 (73.5%) of the cohort had acquired heart disease and 4 (2.7%) of patients belonged to WHO class IV, in which pregnancy is not recommended. Additionally, 12 (8.1%) were categorized as being at significant risk of having a cardiac complication. The proportion of patients that had maternal and perinatal mortality was 6 (4.0%) and 7 (4.8%), respectively. The WHO and CARPREG scoring systems were reliably able to predict cardiac events (P < 0.01). Mothers who received preconception counseling had significantly fewer occurrences of cardiac and obstetric events than those who did not. Conclusion: Cardiac disease in pregnancy in women managed at our center was most often an acquired disease. The baseline risk assessment scores accurately predicted the likelihood of adverse cardiac outcomes. Synopsis: There is potential benefit of risk assessment of pregnancies with cardiac disease by a multidisciplinary team in an expert center, especially in middle‐income settings. [ABSTRACT FROM AUTHOR]

Background/Aims: In Indonesia, cultural beliefs affect holistic healthcare practices. The aim of this study was to identify the effects of cultural beliefs on maternity care and fetal wellbeing. Methods: This study used an ethnographic-qualitative design and was conducted in a community setting in West Java, Indonesia. A total of 16 participants of Sundanese culture were recruited based on information from local health workers and community leaders. Questionnaires, semi-structured interviews and observation sheets were used to collect data on cultural beliefs that impacted pregnant women. Data were analysed using an editing analysis style. Results: The seven themes were: dietary practices and restrictions during pregnancy, hygiene practices, managing sleep and drowsiness, sexual intimacy and interactions, cultural beliefs and religious devotion, family participation and challenges monitoring fetal wellbeing. Conclusions: To ensure quality pregnancy and fetal care, and facilitate provision of basic needs and parental empowerment, healthcare workers must consider women's cultural beliefs. [ABSTRACT FROM AUTHOR]

People who speak languages other than English face structural barriers in accessing the US healthcare system. With a growing number of people living in countries other than their countries of birth, the impact of language and cultural differences between patients and care teams on quality care is global. Cultural brokering presents a unique opportunity to enhance communication and trust between patients and clinicians from different cultural backgrounds during pregnancy care—a critical window for engaging families in the healthcare system. This critical review aims to synthesize literature describing cultural brokering in pregnancy care. We searched keywords relating to cultural brokering, pregnancy, and language in PubMed, Embase, and CINAHL and traced references of screened articles. Our search identified 33 articles. We found that cultural brokering is not clearly defined in the current literature. Few of the articles provided information about language concordance between cultural brokers and patients or clinicians. No article described the impact of cultural brokering on health outcomes. Facilitators of cultural brokering included: interprofessional collaboration within the care team, feeling a family connection between the cultural broker and patients, and cultivating trust between the cultural broker and clinicians. Barriers to cultural brokering included: misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. We propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system. Clinicians, researchers, and policymakers should develop consistent language around cultural brokering in pregnancy care and examine the impact of cultural brokers on health outcomes. Synopsis: Cultural brokering, understudied and ill‐defined in pregnancy care, may present an opportunity to enhance communication and trust between patients and clinicians from different cultural backgrounds. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a subtype of diabetes that develops during pregnancy. Managing blood glucose (BG) within the healthy physiological range can reduce clinical complications for women with gestational diabetes. The objectives of this study are to (1) develop benchmark glucose prediction models with long short-term memory (LSTM) recurrent neural network models using time-series data collected from the GDm-Health platform, (2) compare the prediction accuracy with published results, and (3) suggest an optimized clinical review schedule with the potential to reduce the overall number of blood tests for mothers with stable and within-range glucose measurements. A total of 190,396 BG readings from 1110 patients were used for model development, validation and testing under three different prediction schemes: 7 days of BG readings to predict the next 7 or 14 days and 14 days to predict 14 days. Our results show that the optimized BG schedule based on a 7-day observational window to predict the BG of the next 14 days achieved the accuracies of the root mean square error (RMSE) = 0.958 ± 0.007, 0.876 ± 0.003, 0.898 ± 0.003, 0.622 ± 0.003, 0.814 ± 0.009 and 0.845 ± 0.005 for the after-breakfast, after-lunch, after-dinner, before-breakfast, before-lunch and before-dinner predictions, respectively. This is the first machine learning study that suggested an optimized blood glucose monitoring frequency, which is 7 days to monitor the next 14 days based on the accuracy of blood glucose prediction. Moreover, the accuracy of our proposed model based on the fingerstick blood glucose test is on par with the prediction accuracies compared with the benchmark performance of one-hour prediction models using continuous glucose monitoring (CGM) readings. In conclusion, the stacked LSTM model is a promising approach for capturing the patterns in time-series data, resulting in accurate predictions of BG levels. Using a deep learning model with routine fingerstick glucose collection is a promising, predictable and low-cost solution for BG monitoring for women with gestational diabetes. [ABSTRACT FROM AUTHOR]

Abstract Background The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. Case presentation We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new onset hypertension associated with headaches, dry heaves, diaphoresis, and palpitations. She was initially diagnosed with preeclampsia and treated with labetalol and an urgent cesarean section, delivering a healthy baby girl. The diagnosis of preeclampsia came into question when, 6 weeks postpartum, she continued to have hypertension with atypical features. Testing revealed metastatic paraganglioma associated with a succinate dehydrogenase B gene mutation. The patient was then started on alpha-adrenergic blockade and has had close blood pressure monitoring while discussion of advances therapies is ongoing. Conclusion This case demonstrates how paraganglioma/pheochromocytoma can be misdiagnosed as preeclampsia due to the overlapping features of new-onset hypertension late in pregnancy accompanied by headache and proteinuria. It is impractical to routinely screen for paraganglioma/pheochromocytoma in all pregnant patients diagnosed with preeclampsia due to the rarity of these tumors and the harm from high false-positive rates. Therefore, it is incumbent on the provider to have a high degree of suspicion for paraganglioma/pheochromocytoma when clinical features are unusual for preeclampsia, such as intermittent palpitations, diaphoresis, orthostatic hypotension, or hyperglycemia. Early detection of paraganglioma/pheochromocytoma with interventions to mitigate the risk of hypertensive crisis greatly reduce maternal and fetal mortality. Fortunately, our patient delivered a healthy baby and did not have any additional pregnancy complications despite the delay in her diagnosis.

Ayu Khoirotul Umaroh,1 Belinda Meliana Elisabet,2 Dewi Ayu Puspitasari,2 Feniati Rahayu Aisyah,2 Sylviasari Risgiantini,2 Hadi Pratomo2 1Department of Public Health, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia; 2Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, IndonesiaCorrespondence: Ayu Khoirotul Umaroh, Department of Public Health, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Surakarta, Central Java, 57169, Indonesia, Tel +62 83842454023, Email Aku669@ums.ac.idPurpose: This study was to analyze the responses of informants about Instagram infographics on Covid-19 prevention for pregnant women.Methods: This was a qualitative study that used Rapid Assessment Procedure (RAP) and used pretesting communication theory. The informant selection technique was purposive sampling that consist of three pregnant women as main informants, a midwifery lecturer and a visual graphic designer as key informants. One-to-one pretesting communication procedure was selected because the research was conducted at the beginning of the Covid-19 pandemic, so it had a difficulty in recruiting informants. The interview guideline was conducted by the research team and was examined in a field trial. Data collection was by semi-structured interview using voice call WhatsApp application. Data were analysed using thematic analysis.Results: In attraction aspect, this was considered quite interesting by the informants. In comprehension aspect, the messages were easily understood because of using brief, concise, and simple sentences. Furthermore, the messages were supported by images and comprehensive. In acceptance aspect, all the informants’ opinions were identified that the messages of this infographic did not have a conflict with the existing norms. In self-involvement aspect, this infographic was in accordance with the current condition of the informants. In persuasion aspect, it had a good persuasive value as the informants were willing to share the infographic with others.Conclusion: The infographic still needed improvements from the attraction aspect such as consider using contrasting colour between the background and text, equalize the font size and change icons to become related to the text. As from the comprehension aspect consider using terms that are more popular in the community. There were no need improvements from acceptance, self-involvement, and persuasion aspects. However, evidence-based research is still needed on how this infographic is developed and implemented to optimize transfer of knowledge.Keywords: disease emergence, health education, social media, pregnancy care

Abstract Background The COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic. Methods In-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied. Results Eigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality. Conclusion In this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond.

Introduction: This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. Methods: Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. Results: The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. Discussion: Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women. Significance: Migration is an important social determinant of health that can greatly affect health outcomes. Despite the advances in maternal and child health in the United States, women who migrate from Africa to the United States from low or middle-income countries often face maternal healthcare challenges. The maternal healthcare utilization of African immigrant women is important as pregnancy often constitutes a period of increased vulnerability for adverse health outcomes. African immigrant women experience adverse maternal health outcomes following their migration which is not explained by maternal risk factors alone. Therefore, there is a critical need to understand the maternal health experiences and healthcare utilization for African immigrant women. This systematic review summarized research on the maternal health experiences of African immigrant women and how these experiences facilitate or hinder the use of maternal health services. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy? SUMMARY ANSWER Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy. WHAT IS KNOWN ALREADY Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time. STUDY DESIGN, SIZE, DURATION This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min). PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated. MAIN RESULTS AND THE ROLE OF CHANCE Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme ' The first 20 weeks: a 'scary' gap in care ' there were two themes: Positive pregnancy test: 'Tell them it's not the same pregnancy' and First trimester: 'We craved that someone was taking care of us'. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme ' The second 20 weeks: Safety in the care system ' there were two themes: Second trimester: 'I think we are in good hands' and Third trimester: 'It's more of a 'nice to know' everything is OK than a 'need to know'. C ouples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions. LIMITATIONS, REASONS FOR CAUTION Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans. WIDER IMPLICATIONS OF THE FINDINGS The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit. STUDY FUNDING/COMPETING INTEREST(S) This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests. [ABSTRACT FROM AUTHOR]

Automated insulin delivery (AID) systems have established benefits in terms of glycemic control, health outcomes, and quality of life and are strongly recommended for people with type 1 diabetes outside of pregnancy. While evidence for use of investigational AID systems during pregnancy is promising, data and guidance are still needed regarding use of commercially available systems during pregnancy. Unfortunately, none of the hybrid closed-loop (HCL) systems that are currently available in the United States have glucose targets that are as aggressive as pregnancy glycemic targets, none have a pregnancy-specific algorithm, and none are approved for use during pregnancy. As such, any use of these systems during pregnancy is considered off-label in the United States and would be "assisted" by provider/user techniques. Despite these limitations, many women conceive while using clinically available HCL systems and may be hesitant to cease use during pregnancy. Achievement of strict pregnancy glycemic targets can be difficult, and it is conceivable that selective off-label use of clinically available HCL systems in some women could lead to improved glycemia. We herein offer expert guidance based on clinical experience and available case reports on how to identify appropriate candidates for HCL therapy in pregnancy, how to counsel pregnant women with diabetes on the potential risks and benefits of HCL therapy during pregnancy, and how to manage commercially available systems off-label throughout gestation in an assisted HCL approach. [ABSTRACT FROM AUTHOR]

The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman's experience – with likely adverse effects on mental health and wellbeing. To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support. [ABSTRACT FROM AUTHOR]

Background: The new presentation of pheochromocytoma or paraganglioma in pregnancy is very rare and can be life-threatening for mother and child. Case presentation: We present the case of a 26-year-old gravida 3 para 2 otherwise healthy Caucasian woman at 34 weeks gestation who presented with new onset hypertension associated with headaches, dry heaves, diaphoresis, and palpitations. She was initially diagnosed with preeclampsia and treated with labetalol and an urgent cesarean section, delivering a healthy baby girl. The diagnosis of preeclampsia came into question when, 6 weeks postpartum, she continued to have hypertension with atypical features. Testing revealed metastatic paraganglioma associated with a succinate dehydrogenase B gene mutation. The patient was then started on alpha-adrenergic blockade and has had close blood pressure monitoring while discussion of advances therapies is ongoing. Conclusion: This case demonstrates how paraganglioma/pheochromocytoma can be misdiagnosed as preeclampsia due to the overlapping features of new-onset hypertension late in pregnancy accompanied by headache and proteinuria. It is impractical to routinely screen for paraganglioma/pheochromocytoma in all pregnant patients diagnosed with preeclampsia due to the rarity of these tumors and the harm from high false-positive rates. Therefore, it is incumbent on the provider to have a high degree of suspicion for paraganglioma/pheochromocytoma when clinical features are unusual for preeclampsia, such as intermittent palpitations, diaphoresis, orthostatic hypotension, or hyperglycemia. Early detection of paraganglioma/pheochromocytoma with interventions to mitigate the risk of hypertensive crisis greatly reduce maternal and fetal mortality. Fortunately, our patient delivered a healthy baby and did not have any additional pregnancy complications despite the delay in her diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to improve the understanding of the interrelationships between sociodemographic factors, pregnancy intention, and antenatal care by: (1) identifying sociodemographic predictors of unintended pregnancy; (2) examining associations between unintended pregnancy types and antenatal care (ANC) inadequacy; (3) examining how the association between unintended pregnancy and ANC inadequacy is modified by maternal characteristics; and (4) identifying sociodemographic predictors of ANC inadequacy by pregnancy intention status. Methods: We analyzed women 15–49 years of age who participated in the nationwide cross-sectional Vietnam Multiple Indicator Cluster Survey. Pregnancy intention and ANC adequacy were assessed for the most recent live birth within two years preceding survey completion. Weighted Poisson regression was used to estimate risk ratios. Results: Of the 1,474 study participants, 17.8% had unintended pregnancy and 29.0% had inadequate ANC. There was no significant confounding-adjusted association between unintended pregnancy and ANC inadequacy, except in those currently not working. Women with intended pregnancy or unintended pregnancy had significantly higher ANC inadequacy risk if they lived in rural areas, were less educated, and had no media exposure, lower wealth status, or more than two children. Younger age, ever given birth, having child loss, and positive attitude towards partner violence were significant predictors of ANC inadequacy only in women with intended pregnancy. Conclusions for Practice: ANC inadequacy was more strongly predicted by sociodemographic characteristics rather than pregnancy intention, and the sociodemographic variables' prediction of ANC inadequacy was stronger in women with intended pregnancy than unintended pregnancy. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic. Methods: In-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied. Results: Eigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality. Conclusion: In this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond. [ABSTRACT FROM AUTHOR]

Pregnancy is a long and critical period for most women and a period that has significant impacts for newborns. Many pregnancies have an increased risk for complications for a variety of reasons. Fortunately, early prenatal care and regular examination can help women have healthy pregnancies and deliver with fewer complications. However, current research shows that many expectant mothers do not have a clear understanding of the pregnancy process due to the complexity of medical information and inadequate attention from caregivers. Therefore, in this work, we collected data on expectant mothers’ requirements and investigated the various medical treatments during pregnancy and the correlations between possible symptoms and newborn diseases. Based on the above knowledge, we then developed a visual analytic system named PregnancyLine, which presents a pregnancy care plan and information on the medical examinations at each pregnancy stage using a series of vivid visual metaphors. This system is designed to improve communication between pregnant women and doctors and help doctors identify patients with abnormalities and abnormal events. The results of the evaluation and case studies indicate that our system is effective in helping pregnant women understand pregnancy risk and the importance of examinations and that it is very useful in the detection and understanding of abnormalities.

Abstract Backgrounds Risk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting. Methods In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients’ residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study. Results We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality. Conclusions In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy.

BACKGROUND: Use of timely antenatal care has been identified as key to facilitating healthy pregnancies worldwide. Although considerable investment has been made to enhance maternal health services in Nepal, approximately one-third of women do not attend antenatal care until after the first trimester (late). These women miss out on the benefits of screening and interventions that are most effective in the first trimester. OBJECTIVE: This study aimed to identify the missed opportunities of women who do not attend antenatal care in the first trimester, and to explore some of the factors underlying late attendance and consider potential solutions for minimizing these missed opportunities in the future. STUDY DESIGN: This study was conducted in 3 hospitals in Nepal. Focus groups (n=18) with a total of 48 postnatal women and 49 staff members, and 10 individual interviews with stakeholders were conducted. Purposive sampling facilitated the obtainment of a full range of maternity experiences, staff categories, and stakeholder positions. Data were qualitative and analyzed using a thematic approach. RESULTS: Limited awareness among women of the importance of early antenatal care was reported as a key factor behind attendance only after the first trimester. The family and community were described as significant influencers in women's decision-making regarding the timing of antenatal care. The benefits of early ultrasound scanning and effective supplementation in pregnancy were the major missed opportunities. Increasing awareness, reducing cost, and enhancing interprofessional collaboration were suggested as potential methods for improving timely initiation of antenatal care. CONCLUSION: Limited awareness continues to drive late attendance to antenatal care after the first trimester. Investment in services in the first trimester and community health education campaigns are needed to improve this issue and enhance maternal and neonatal outcomes.

Background: Men’s influences are gradually being recognised in pregnancy and delivery care. The study aims to determine the knowledge and attitude of male commercial motorcyclists on pregnancy care and delivery of women. Materials and Methods: This cross-sectional study was conducted among married male commercial motorcyclists, operating in Ibadan North Local Government Area selected using a cluster sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS version 16. Each section was evaluated using rating of a three-point Likert scale with each item scored based on responses ranging from disagree to agree. Results were presented in tables and charts. Results: Four hundred and fifty three male commercial motorcyclists were interviewed. The mean age was 34.2±7.3years, 301 (66.4%) had secondary education, while 390 (86.1%) were in a monogamous marriage. Thirty 30(6.6%) respondents did not know when their wives registered for ANC while majority, 444(98.1%) did not know the duration of their wives’ labour. Few respondents 46 (10.2%) recognized vaginal bleeding as a common danger signs in pregnancy while 277 (61.1%) agree that women should have at least four ANC visits before delivery. Many of the respondents 315 (69.6%) had good knowledge, and 304 (67.1%) had positive attitude towards antenatal and delivery care. Conclusion: Educational efforts on maternal health care should also focus on the men to improve their knowledge, attitude and involvement in antenatal and pregnancy.

Abstract Background Health insurance ownership is one indicator of the readiness of pregnant women for the delivery process. The study aimed to analyze the determinants of health insurance ownership among pregnant women in Indonesia. Methods The study population was pregnant women in Indonesia. The study involved 2542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. In the final step, the study employed binary logistic regression to explain the relationship between health insurance ownership and predictor variables. Results The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don’t see the danger signs of pregnancy to have health insurance. Conclusions The study concluded that four variables, including education level, wealth status, parity, and knowledge of the danger signs of pregnancy, were significant determinants of health insurance ownership in Indonesia.

Introduction: Gestational diabetes increases maternal and neonatal complications. Therefore, this study was performed with aim to examine the effect of the number of pregnancy cares on the reduction of maternal and neonatal complications in women with gestational diabetes. Methods: This cohort study was performed in 2018-2020 on 119 mothers with gestational diabetes in Omolbanin hospital. The subjects in the two groups of pregnancy visits < 10 times and ≥10 times were compared in terms of neonatal complications such as overweight 90%, dystocia and maternal complications like preeclampsia. Data were analyzed using SPSS statistical software (version 23) and independent t-test and Mann-Whitney, Chi-square and Fisher tests. P< 0.05 was considered statistically significant. Results: In this study, among 119 pregnant women with gestational diabetes, 37 (31.09%) were in the group of pregnancy visits ≥ 10 times and 82 (68.90%) in the group of pregnancy visits < 10 times. The number of infants weighing more than 90 percent was 4 (10.8%) in the group of pregnancy visits ≥ 10 times and was 4 (4.9%) in the group of pregnancy visits < 10 times, which had no statistically significant difference (P=0.2). Mean fasting blood sugar of mothers in third trimester was 91.22 ± 75.14 mg/dl in the group of pregnancy visits ≥ 10 times and was 93.65 ± 30.23 mg/dl in the group of pregnancy visits < 10 times, which was similar in both groups (P=0.2). Also, the incidence of preeclampsia was 3 (6.2%) in the group of pregnancy visits ≥ 10 times and 5 (8.1%) in the group of pregnancy visits < 10 times, which was similar in the two groups (P=0.8). There was no significant difference between the two groups in terms of other maternal and neonatal consequences. Conclusion: Increasing the number of pregnancy visits in women with gestational diabetes does not improve the maternal and neonatal outcomes.

Objectives: To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period.Design: Critical 'umbrella' reviews of the scientific evidence, combined with adaptation of recently published guidelines.Methods: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines.Results: Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy.Conclusions: All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided. [ABSTRACT FROM AUTHOR]

IntroductionAustralian antenatal care includes specific screening and service provision for domestic and family violence (DFV) and mental health. However, the COVID-19 pandemic resulted in major care changes, including greatly expanded telehealth. Given difficulties in a safe assessment and management of disclosures via telehealth, DFV and mental health service provision might be substantially impacted. This study therefore aimed to assess COVID-19 effects on DFV and mental health screening, as well as broader service provision from the perspective of local maternity service providers.MethodsMixed-methods study of staff surveys and interviews of staff directly involved in pregnancy care (doctors, midwives, and allied health) in three Sydney (Australia) maternity units, from October 2020 to March 2021. Surveys and interviews interrogated perceived effects of the COVID-19 pandemic on delivery (ensuring required services occurred), timeliness, and quality of (a) overall maternity care and (b) DFV and mental health screening and care; and also advantages and disadvantages of telehealth. Surveys were descriptively analyzed. Interviews were conducted online, recorded, and transcribed verbatim prior to thematic analysis.ResultsIn total, 17 interviews were conducted and 109 survey responses were received. Breakdown of survey respondents was 67% of midwives, 21% of doctors, and 10% of allied health. Over half of survey respondents felt the pandemic had a negative effect on delivery, timeliness, and quality of overall pregnancy care, and DFV and mental health screening and management. Perceived telehealth positives included convenience for women (73%) and reducing women's travel times (69%). Negative features included no physical examination (90%), difficulty regarding non-verbal cues (84%), difficulty if interpreter required (71%), and unsure if safe to ask some questions (62%). About 50% felt telehealth should continue post-pandemic, but for

Midwifery education has an important role in producing competent and professional midwives. Competent and professional midwife staff starts from a quality learning process. This study aimed to develop a valid and reliable 3D Pageflip Professional pregnancy care e-module. The type of research was Research and Development (R&D) research. The data collection techniques use primary data from the validation of experts (media expert and content expert). The results of this study indicated that media expert review got an average score of 3.77 (good criterion), content expert got an average score of 4.15 (good criterion) and the pregnancy care lecturer evaluation got an average score of 4.14 (good criterion). In addition, it stated that 3D Pageflip Professional pregnancy care e-module was good and deserved to be tested in the learning process. 3D Pageflip Professional pregnancy care e-module developed as an alternative to assist midwifery students in overcoming learning difficulties. Implications this article are giving the curriculum knowledge focused on learning innovations. The application of e-pregnancy care modules was easy to learn and practically accessible anywhere. To be development and innovative teaching content of education midwife and source study midwifery student so as to increase motivation and learning outcome.

Background and Aim: Pregnancy due to physiological and psychological changes can affect the mental health of mothers. This study aims to investigate the Approach of acceptance and commitment based on the fear of delivery pain. Materials and Methods: This study was a randomized educational trial with a commitment-based treatment approach that was performed on pregnant women in Arak in 2016-2017. After obtaining written consent forms, 42 subjects were selected through the available sampling method. Subjects were grouped in the intervention group (ACT) and in the control group. Eight 90-minute sessions were held for 8 consecutive weeks of counseling Fear of delivery pain at 10 and one month after the intervention was measured in 2 groups by the Likert scale of pain (1-7) score. Data analysis was performed through repeated measure ANOVA by using SPSS (Version 18). Results: Results showed that the mean pain immediately after the intervention was 2.52±2.20 in the intervention group and 4.66±1.80 in the control group. Which is a month later in the intervention group compared to the control group had a significant decrease (3.52±1.81 vs. 4.52±2.30) (P=0.001). Conclusion: In this study, counseling with the approach of acceptance and commitment reduction the fear of delivery pain, which is the most important reason for choosing cesarean section in women, Therefore, it seems that empowering midwives to counseling approaches can be useful to improve maternal care during pregnancy, especially in the administration of delivery preparation classes.

Abstract Background This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications. Methods Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh (N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications. Results Around one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57–2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01–2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47–3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage (p

COVID-19 and its associated lockdowns and restrictions on movement may be impacting women and men's access to and use of health care services including contraceptive, prenatal, and postnatal care.Yet we know little of its impact to date, especially in low- and middle-income countries, including India. Understanding how COVID-19 impacts the use of these services now, and as it persists, is essential for improving access and use today. Additionally, these data are necessary to understand fertility and other health-related outcomes we may see in the future. The objectives of this study are to understand a Facebook sample of respondent's perceived barriers to contraceptive, prenatal, and postnatal care in India and how these changed over 4 months of the COVID-19 pandemic. To meet this need, we conducted four rounds of monthly online surveys with men and women ( N = 9,140) recruited using Facebook ads in India between April and July 2020, a period when the national lockdown was tapered from the strictest to restricted. While about 75% of respondents reported no barriers to contraception due to COVID-19, about half of those pregnant or postpartum reported barriers to pre- and postnatal care. Barriers to care for contraception, prenatal, and postnatal care increased significantly over time. Most respondents reported some change on fertility preferences, with more respondents reporting desire to delay, rather than to have a child sooner, due to COVID-19. Overall, as the early COVID-19 pandemic persisted, barriers to reproductive and maternal health care increased in India, suggesting that as the pandemic continued there have likely been additional challenges for people seeking these services. It is essential that health care providers begin to address these barriers to ensure access to care throughout these important time periods. [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) technologies, such as wearable sensors, smart health devices, and mobile apps, that are capable of supporting pregnancy care are emerging. Although mHealth could be used to facilitate the tracking of health changes during pregnancy, challenges remain in data collection compliance and technology engagement among pregnant women. Understanding the interests, preferences, and requirements of pregnant women and those of clinicians is needed when designing and introducing mHealth solutions for supporting pregnant women's monitoring of health and risk factors throughout their pregnancy journey. Objective: This study aims to understand clinicians' and pregnant women's perceptions on the potential use of mHealth, including factors that may influence their engagement with mHealth technologies and the implications for technology design and implementation. Methods: A qualitative study using semistructured interviews was conducted with 4 pregnant women, 4 postnatal women, and 13 clinicians working in perinatal care. Results: Clinicians perceived the potential benefit of mHealth in supporting different levels of health and well-being monitoring, risk assessment, and care provision in pregnancy care. Most pregnant and postnatal female participants were open to the use of wearables and health monitoring devices and were more likely to use these technologies if they knew that clinicians were monitoring their data. Although it was acknowledged that some pregnancy-related medical conditions are suitable for an mHealth model of remote monitoring, the clinical and technical challenges in the introduction of mHealth for pregnancy care were also identified. Incorporating appropriate health and well-being measures, intelligently detecting any abnormalities, and providing tailored information for pregnant women were the critical aspects, whereas usability and data privacy were among the main concerns of the participants. Moreover, this study highlighted the challenges of engaging pregnant women in longitudinal mHealth monitoring, the additional work required for clinicians to monitor the data, and the need for an evidence-based technical solution. Conclusions: Clinical, technical, and practical factors associated with the use of mHealth to monitor health and well-being in pregnant women need to be considered during the design and feasibility evaluation stages. Technical solutions and appropriate strategies for motivating pregnant women are critical to supporting their long-term data collection compliance and engagement with mHealth technology during pregnancy. [ABSTRACT FROM AUTHOR]