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BACKGROUND: The prevalence of alcohol use among pregnant women aged 18-44 years old increased in recent years. The influence of mental health issues on an individuals likelihood to use alcohol during pregnancy has not been thoroughly investigated. This study will examine the association between experiencing a major depressive episode (MDE) in the past year and past-month alcohol use among pregnant women using the 2011-2020 National Survey on Drug Use and Health (NSDUH). METHODS: Pregnant women between the ages of 18 and 44 years old were included in the study for analysis. Multivariable logistic regression analysis was used to examine the association between past-year MDE and past-month alcohol use adjusting for age, race/ethnicity, marital status, and employment status. Additional logistic regression analysis was performed to investigate whether this relationship differed by trimester of pregnancy. RESULTS: A total of 6745 participants were included in the analytic sample. The prevalence of past-year MDE and past-month alcohol use was 7.67% and 9.15% respectively. Logistic regression analysis showed past-year MDE was significantly associated with past-month alcohol use in pregnant women adjusting for age, race/ethnicity, marital status, and employment status (aOR = 1.96; 95% CI, 1.34-2.87). This relationship became stronger in second and third trimesters of pregnancy. CONCLUSIONS: This study showed a positive association between MDE and past-month alcohol use among pregnant women, with strongest effect estimates in the third trimester. These findings may inform approaches for improved screening guidelines and health education for individuals who may be at higher risk of prenatal alcohol use.

BACKGROUND: Mother-to-child transmission is the primary cause of HIV cases among children. Antiretroviral therapy (ART) plays a critical role in preventing mother-to-child transmission and reducing HIV progression, morbidity, and mortality among mothers. However, after more than two decades of ART during pregnancy, the comparative effectiveness and safety of ART medications during pregnancy are unclear, and existing evidence is contradictory. This study aimed to assess the effectiveness and safety of different ART regimens among pregnant women living with HIV at preconception or during pregnancy. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized trials that enrolled pregnant women living with HIV and randomized them to receive ART for at least four weeks. Pairs of reviewers independently completed screening for eligible studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Our outcomes of interest included low birth weight, stillbirth, preterm birth, mother-to-child transmission of HIV, neonatal death, and congenital anomalies. Network meta-analysis was performed using a random-effects frequentist model, and the certainty of evidence was evaluated using the GRADE approach. RESULTS: We found 14 eligible randomized trials enrolling 9,561 pregnant women. The median duration of ART uptake ranged from 6.0 to 17.4 weeks. No treatment was statistically better than a placebo in reducing the rate of neonatal mortality, stillbirth, congenital defects, preterm birth, or low birth weight deliveries. Compared to placebo, zidovudine (ZDV)/lamivudine (3TC) and ZDV monotherapy likely reduce mother-to-child transmission (odds ratio (OR): 0.13; 95% CI: 0.05 to 0.31, high-certainty; and OR: 0.50; 95% CI: 0.33 to 0.74, moderate-certainty). Moderate-certainty evidence suggested that ZDV/3TC was associated with decreased odds of stillbirth (OR: 0.47; 95% CI: 0.09 to 2.60). CONCLUSIONS: Our analysis provides high- to moderate-certainty evidence that ZDV/3TC and ZDV are more effective in reducing the odds of mother-to-child transmission, with ZDV/3TC also demonstrating decreased odds of stillbirth. Notably, our findings suggest an elevated odds of stillbirth and preterm birth associated with all other ART regimens.

IntroductionIn South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined.Methods and analysisA two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models.Ethics and disseminationStudy protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to stakeholders including local government and non-governmental organisations, and directly to the communities and individuals that participated in the intervention.Trial registration numberNCT06024616.

Gait asymmetry is a predictor of fall risk and may contribute to increased falls during pregnancy. Previous work indicates that pregnant women experience asymmetric joint laxity and pelvic tilt during standing and asymmetric joint moments and angles during walking. How these changes translate to other measures of gait asymmetry remains unclear. Thus, the purpose of this case study was to determine the relationships between pregnancy progression, subsequent pregnancies, and gait asymmetry. Walking data were collected from an individual during 2 consecutive pregnancies during the second and third trimesters and 6 months postpartum of her first pregnancy and the first, second, and third trimesters and 6 months postpartum of her second pregnancy. Existing asymmetries in step length, anterior–posterior (AP) impulses, AP peak ground reaction forces, lateral impulses, and joint work systematically increased as her pregnancy progressed. These changes in asymmetry may be attributed to pelvic asymmetry, leading to asymmetric hip flexor and extensor length, or due to asymmetric plantar flexor strength, as suggested by her ankle work asymmetry. Relative to her first pregnancy, she had greater asymmetry in step length, step width, braking AP impulse, propulsive AP impulse, and peak braking AP ground reaction force during her second pregnancy, which may have resulted from increased joint laxity. [ABSTRACT FROM AUTHOR]

ObjectivePregnant and postpartum women (PPW) in Southern Africa are at increased risk of acquiring HIV and curable sexually transmitted infections (STIs). Oral pre-exposure prophylaxis (PrEP) is safe and effective to use during pregnancy to reduce HIV acquisition and vertical transmission. Point-of-care (POC) STI testing can identify PPW at risk of HIV and facilitate risk-differentiated and person-centred counselling to improve PrEP initiation, persistence and adherence. We evaluated the impact of POC STI testing compared with STI syndromic management on PrEP outcomes among PPW in Cape Town, South Africa.MethodsThe STI and PrEP in Pregnancy Study enrolled PPW without HIV and ≤34 weeks pregnant at their regular antenatal care visit with follow-up after 1 month. PPW were randomised to receive POC STI testing or STI syndromic management. PPW randomised to POC STI testing self-collected vaginal swabs for Chlamydia trachomatis, Neisseria gonorhoeae and Trichomonas vaginalis (Cepheid GeneXpert) testing and were offered same-day treatment if diagnosed. We compared PrEP initiation at baseline, PrEP prescription refill at 1 month (persistence) and adherence through tenofovir-diphosphate detection in dried blood spots by randomisation arm. In a secondary analysis, we evaluated the association between an STI diagnosis (positive STI test or reporting STI symptoms) with PrEP outcomes.ResultsWe enrolled and randomised 268 pregnant women. Twenty-eight per cent of women were diagnosed with ≥1 STI. Overall, 65% of women initiated and 79% persisted on PrEP with no significant differences by randomisation arm. Secondary analysis demonstrated that an STI diagnosis (positive STI test or reporting STI symptoms) was associated with higher PrEP initiation (adjusted relative risk=1.28; 95% CI 1.08 to 1.52), controlling for arm, maternal and gestational age.ConclusionsPOC STI testing was not associated with PrEP initiation or persistence relative to syndromic management. However, improving STI diagnosis by supplementing syndromic management with POC STI testing could improve PrEP initiation among PPW.Trial registration numberNCT03902418; Clinical Trials.gov; 1 April 2019.

The Microbicide Trials Network 042 study (MTN-042/DELIVER) is a two-arm, randomized, open-label Phase 3b trial that is evaluating the safety, adherence, and acceptability of the monthly ring and daily oral PrEP among HIV-uninfected pregnant people in four African countries. This analysis focuses on acceptability data captured qualitatively from a subset (n = 48) of the 150 people in the first cohort of the trial who were enrolled in late-stage pregnancy at 36 to 38 weeks gestational age and followed until after delivery. Single IDIs were conducted by trained interviewers at each clinic site using a semi-structured guide. Data excerpts of key codes pertaining to acceptability, pregnancy, and maternal health were summarized, reviewed and interpreted by multinational analyst teams. Although the product use period was relatively short, the data suggested several acceptability findings that may directly translate to longer durations of product use in pregnancy. The first was the overarching maternal sentiment that being able to protect both oneself and their baby was highly valued. The second was the importance of counseling support from providers not only because participants used methods that might generate side effects, but because pregnancy itself is a period with its own set of side effects. The third was that, similar to non-pregnant participants in other trials, here study products were generally liked and described as easy to use. Concerns about ring and oral PrEP use could be addressed with provider counseling and support and should form an essential component rollout among pregnant people.

Objective: the aim of this study was to identify plasma metabolomic markers of Dietary Approaches to Stop Hypertension (DASH) dietary patterns in pregnant women. Methods: This study included 186 women who had both dietary intake and metabolome measured from a nested case-control study within the NICHD Fetal Growth Studies-Singletons cohort (FGS). Dietary intakes were ascertained at 8-13 gestational weeks (GW) using the Food Frequency Questionnaire (FFQ) and DASH scores were calculated based on eight food and nutrient components. Fasting plasma samples were collected at 15-26 GW and untargeted metabolomic profiling was performed. Multivariable linear regression models were used to examine the association of individual metabolites with the DASH score. Least absolute shrinkage and selection operator (LASSO) regression was used to select a panel of metabolites jointly associated with the DASH score. Results: Of the total 460 known metabolites, 92 were individually associated with DASH score in linear regressions, 25 were selected as a panel by LASSO regressions, and 18 were identified by both methods. Among the top 18 metabolites, there were 11 lipids and lipid-like molecules (i.e., TG (49:1), TG (52:2), PC (31:0), PC (35:3), PC (36:4) C, PC (36:5) B, PC (38:4) B, PC (42:6), SM (d32:0), gamma-tocopherol, and dodecanoic acid), 5 organic acids and derivatives (i.e., asparagine, beta-alanine, glycine, taurine, and hydroxycarbamate), 1 organic oxygen compound (i.e., xylitol), and 1 organoheterocyclic compound (i.e., maleimide). Conclusions: our study identified plasma metabolomic markers for DASH dietary patterns in pregnant women, with most of being lipids and lipid-like molecules.

We studied T-cell responses to SARS-CoV-2 in 19 pregnant subjects at different gestational weeks who received three doses of mRNA-based vaccination to prevent COVID-19. SARS-CoV-2 peptide pools were used for T-cell recognition studies: peptides were 15 amino acids long and had previously been defined in COVID-19-convalescent subjects. T-cell activation was evaluated with the AIM assay. Most subjects showed coordinated, spike-specific CD4+ and CD8+ T-cell responses and the development of T cell memory. Non-spike-specific T cells in subjects who were not aware of previous COVID-19 infection suggested a prior undetected, asymptomatic infection. CD4- CD8- double negative (DN) T cells were numerous, of which a percentage was specific for SARS-CoV-2 spike peptides. Regulatory T cells (Treg), both spike- and non-spike-specific, were also greatly expanded. Two Treg populations were defined: a population differentiated from naïve T cells, and pTreg, reverting from pro-inflammatory T cells. The Treg cells expressed CCR6, suggesting homing to the endometrium and vaginal epithelial cells. The pregnant women responded to SARS-CoV-2 vaccination. Asymptomatic COVID-19 was revealed by the T cell response to the non-spike peptides. The numerous DN T cells and Treg pointed our attention to new aspects of the adaptive immune response in vaccine recipients.

Intimate partner violence (IPV) occurs at alarmingly high rates towards pregnant women in South Africa. Experiences of emotional, physical, and sexual IPV in pregnancy can adversely impact the health and safety of mother and fetus. Furthermore, IPV is associated with increased risk of HIV, exacerbating the public health impact of violence among pregnant women in this HIV endemic setting. In-depth understanding of cultural and contextual drivers of experiences of IPV is a critical precursor to development of interventions effectively addressing this issue among pregnant women in South Africa. The present study examines factors contributing to IPV among pregnant women to identify potential points of intervention. We conducted twenty in-depth interviews with postpartum women who used oral pre-exposure prophylaxis (PrEP) in pregnancy and reported recent experiences of IPV and/or ongoing alcohol use in a township near Cape Town, South Africa that experiences a heavy burden of both HIV and IPV. Interpretive thematic analysis was used. Several patterns of IPV during pregnancy were identified and violence was frequently described as co-occurring with male partner alcohol use. A majority of women referenced oral PrEP as their preferred method for HIV prevention, highlighting the agency and discretion it provided as beneficial attributes for women experiencing IPV. Fear of judgement from peers for remaining with an abusive partner and a lack of clear community messaging around IPV were identified as barriers to disclosure and support-seeking. Addressing the lack of social support received by women experiencing IPV during pregnancy in South Africa is essential to comprehensive IPV programming.

Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden borne by others than the alcohol user. Alcohol's harm to others includes a multitude of conditions, such as trauma from traffic crashes, fetal disorders due to prenatal exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol's causal role in these conditions is well-established, alcohol's harm to others' contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol's detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol's harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others' alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them. Chaque annee, un peu moins de 2,5 millions de deces sont lies a la consommation d'alcool. Cette estimation globale ne tient cependant pas compte de l'impact sur la sante de l'entourage des consommateurs d'alcool. Les mefaits de l'alcool sur les autres ont une multitude de consequences, parmi lesquelles des traumatismes dus aux accidents de la circulation, des anomalies fatales liees a une exposition prenatale a l'alcool, ainsi que des actes de violence interpersonnelle et entre partenaires. Bien que le role causal de l'alcool dans ces problematiques soit bien etabli, les repercussions de tels mefaits sur la sante dans son ensemble restent a determiner. Des lacunes qui aboutissent souvent a une situation dans laquelle les politiques et strategies de prevention se concentrent principalement sur la diminution des effets nefastes de l'alcool sur la sante des consommateurs eux-memes, negligeant les personnes qui les entourent et les categories de population les plus vulnerables, en particulier les femmes et les enfants. Dans cet article, nous tentons d'expliquer pourquoi il n'existe aucune estimation concernant les mefaits de l'alcool sur les autres et prodiguons des conseils pour de futures recherches. Nous plaidons aussi pour une analyse complete de la charge sanitaire imputable a l'alcool incluant les mefaits de l'alcool sur les autres, afin d'ameliorer la visibility et de mieux sensibiliser l'opinion publique a ces problematiques, mais aussi de faire progresser l'evaluation des interventions politiques entreprises pour y remedier. Cerca de 2,5 millones de personas mueren cada ano por el consumo de alcohol. Sin embargo, esta estimacion global excluye la mayor parte de la carga sanitaria que soportan personas que no son consumidores de alcohol. Los danos del alcohol a terceros incluyen multitud de afecciones, como los traumatismos por accidentes de trafico, los trastornos fetales debidos a la exposicion prenatal al alcohol, y la violencia interpersonal y de pareja. Aunque se sabe que el alcohol influye en estas afecciones, se desconoce la contribucion de los danos del alcohol a terceros a la carga sanitaria global que supone el alcohol. Esta falta de conocimiento conduce a una situacion en la que las estrategias de politica y de prevencion del alcohol se centran en gran medida en la reduccion de los danos perjudiciales del alcohol para la salud de los consumidores de alcohol, dejando de lado a los demas afectados y a los grupos de poblacion mas vulnerables a estos danos, incluidas las mujeres y los ninos. En este articulo, tratamos de dilucidar por que faltan estimaciones sobre los danos del alcohol en otras personas y ofrecemos orientaciones para futuras investigaciones. Tambien argumentamos que una evaluacion completa de la carga sanitaria del alcohol que incluya los danos causados por el consumo de alcohol de otras personas mejoraria la visibilidad y la concienciacion publica de esos danos, y haria avanzar la evaluacion de las intervenciones politicas para mitigarlos. [phrase omitted], Introduction Just under 2.5 million people die annually due to alcohol use. (1) This global estimate, however, excludes most of the health burden borne by others than the alcohol user. [...]

Purpose: Investigate whether obesity risk and current weight status are independently associated with physical activity (PA) and whether PA is associated with adiposity and insulin resistance (homeostatic model assessment of insulin resistance) among children with high versus low obesity risk based on in utero exposure to maternal overweight/obesity with gestational diabetes mellitus (GDM; high risk) or without GDM (overweight/obesity; high risk) or maternal normal weight without GDM (low risk). Method: Secondary analysis of data from children born to women with overweight/obesity and GDM, overweight/obesity without GDM, or normal weight without GDM. PA was assessed with accelerometry, percentage of body fat derived from anthropometrics, and homeostatic model assessment of insulin resistance calculated from glucose and insulin. Results: Among 4- to 10-year-old children (N = 163), analyses of covariance showed that children with a current BMI ≥85th percentile had less vigorous PA than those with BMI <85th percentile, but in utero exposure was not an independent predictor of PA. In linear regression modeling, moderate to vigorous PA was inversely associated with percentage of body fat and homeostatic model assessment of insulin resistance independent of age, Tanner stage, and accelerometer wear time, with stronger associations in high-risk groups. Conclusions: Children's PA is related to current weight status but not underlying risk for obesity but may be especially important to reduce obesity and insulin resistance in high-risk children. [ABSTRACT FROM AUTHOR]

Pregnancy can be experienced as a significant transition for many women with associated body dissatisfaction, depression, pregnancy-related anxiety, and disordered eating attitudes. Problematic Social Media Use (PSMU) creates abundant opportunities for women to compare themselves with others and expose themselves to sociocultural influences which may increase body dissatisfaction and psychological distress. This study examined whether the relationship between PSMU and psychological distress (defined as depression, pregnancy-related anxiety and disordered eating attitudes) was mediated by negative social comparisons and body dissatisfaction. A sample of 225 pregnant Australian women (M age = 31.91 years, SD age = 4.39) recruited online, completed self-report measures related to the variables of interest. Results: PSMU was associated with higher levels of depression, pregnancy-related anxiety, and disordered eating attitudes. Negative social comparisons and body dissatisfaction partially mediated the relationship between PSMU and pregnancy-related anxiety and depression, and fully mediated the relationship between PSMU and disordered eating attitudes. Cross-sectional nature of the study limited our ability to determine the direction of the relationships. Moreover, the recruitment method via social media led to high rates of non-completion. The findings of this study suggest that problematic social media usage during pregnancy may increase depression, pregnancy-related anxiety and disordered eating attitudes. This study identified potential pathways that may explain this relationship, (via social comparisons and body dissatisfaction). This study highlights the potentially negative impact of social media use amongst expectant mothers and the importance of screening for body dissatisfaction in routine antenatal care. • Problematic social media use linked to negative psychological outcomes in pregnancy. • Social comparisons a potential mechanism linking social media to negative outcomes. • Body dissatisfaction a potential mechanism linking social media to negative outcomes. [ABSTRACT FROM AUTHOR]

Background: Coronavirus Disease 2019 (COVID–19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics. Methods: A cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client's volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson's chi-squire and Fisher's test were used to analyze the independent determinants of COVID-19 vaccine uptake. Results: The proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents' vaccine uptake with primary education and < 5 work experience to vaccine uptake P = 0.015 (AOR = 6.58; 95% CI; 1.45–29.85), and P = 0.046 (AOR = 2.45; 95% CI; 1.02–5.89) respectively. The association of attitude influence to COVID-19 vaccine uptake was statistically significant (acceptance of vaccine due to its availability, vaccine acceptance for protection against COVID-19 pandemic to respondent and her baby, experience from other vaccines) was statistically significant at P = 0.011 (AOR = 4.43; 95% CI; 1.41–13.93), P = 0.001 (AOR = 45.83; 95% CI; 18.6-112.89) respectively. The level of trust in the COVID-19 vaccine influenced respondents' association with vaccine uptake in the 2nd and 3rd trimesters of pregnancy (P = 0.633 (AOR = 1.23; 95% CI; 0.53–2.48), respectively. Conclusion: Pregnant women's positive attitude and trust in the COVID-19 vaccine influenced them to uptake it; our conclusion supports the WHO guidelines that the COVID-19 vaccine should be administered to pregnant women since it is a safer means to curb COVID-19 pregnancy-related complications. [ABSTRACT FROM AUTHOR]

Background: Pregnant women face significant physiological and psychological stressors, which can lead to mental health issues such as anxiety and depression. Despite the importance of professional psychological assistance, many pregnant women in China do not seek help due to various barriers. This study aims to explore the experiences and challenges of pregnant women in seeking psychological help in China through qualitative methods. Methods: Purposive sampling was employed to select 20 pregnant women from a Class III Type A hospital in Hainan. Semi-structured in-depth interviews were conducted from July to August 2023, focusing on psychological states, help-seeking experiences, encountered challenges, and suggestions for improving psychological support. Colaizzi’s 7-step method was used to synthesize the themes. Results: We distilled five themes: (1) Psychological conditions during pregnancy, which includes stress and emotional fluctuations and anticipations of postpartum challenges; (2) Barriers to seeking help, underscored by societal misconceptions, limited professional access, and varied familial support; (3) Sources of psychological stress, highlighting physical changes, familial and work pressures, and societal expectations; (4) Expectations for psychological assistance, emphasizing the need for professional understanding and societal awareness; (5) Impact of psychological issues on daily life, such as decreased work efficiency and affected social activities. Conclusion: Pregnant women in China confront significant psychological stress and face multiple barriers in accessing help. There is an urgent need for personalized and professional psychological services for pregnant women. Addressing barriers such as societal stigma and poor accessibility, along with increasing public awareness and improving mental health services, is crucial. These findings provide a foundation for developing effective psychological support strategies aimed at enhancing the mental health of pregnant women in China. [ABSTRACT FROM AUTHOR]

Objective: Medical interventions used in pregnancy can affect the length and quality of life of both the pregnant person and fetus. The aim of this systematic review was to identify and describe the theoretical frameworks that underpin outcome measurement in cost-utility analyses of pregnancy interventions. Methods: Searches were conducted in the Paediatric Economic Database Evaluation (PEDE) database (up to 2017), as well as Medline, Embase and EconLit (2017–2019). We included all cost-utility analyses of any intervention given during pregnancy, published in English. We conducted a narrative synthesis of: study design; outcome construction (life expectancy, quality adjustment, discount rate); and whether the Incremental Cost-Effectiveness Ratio (ICER) was constructed using maternal or fetal outcomes. Where both outcomes were included, methods for combining them were extracted. Results: We identified 127 cost-utility analyses in pregnancy, of which 89 reported QALYs and 38 DALYs. Outcomes were considered solely for the fetus in 59 studies (47%), solely for the pregnant person in 13 studies (10%), and for both in 49 studies (39%). The choice to include or exclude one or both sets of outcomes was not consistent within particular clinical areas. Where outcomes for both mother and baby were included, methods for combining these outcomes varied. Twenty-nine studies summed QALYs/DALYs for maternal and fetal outcomes, with no adjustment. The remaining 20 took a variety of approaches designed to weigh maternal and fetal outcomes differently. These include (1) treating fetal outcomes as a component of maternal quality of life, rather than (or in addition to) an independent individual health outcome; (2) treating the maternal-fetal dyad as a single entity and applying a single utility value to each combination of outcomes; and (3) assigning a shorter time horizon to fetal outcomes to reduce the weight of lifetime fetal outcomes. Each approach made different assumptions about the relative value of maternal and fetal health outcomes, demonstrating a lack of consistency and the need for guidance. Conclusion: Methods for capturing QALY/DALY outcomes in cost-utility analysis in pregnancy vary widely. This lack of consistency indicates a need for new methods to support the valuation of maternal and fetal health outcomes. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions While 10% of pregnant individuals report a penicillin allergy, there is no established best practice for penicillin allergy delabeling in pregnancy. To better understand options for penicillin delabeling, we aimed to evaluate two penicillin allergy delabeling protocols in pregnancy regarding efficacy, adverse events, and patient satisfaction.From July 2019 to December 2022, we completed a two‐center prospective cohort study, where each site recruited pregnant patients over 24 weeks gestational age with a reported penicillin allergy. One center offered antepartum amoxicillin oral challenges, either directly or after negative skin testing (i.e., antepartum oral challenge site). Our other centers completed a two‐step approach with antepartum penicillin skin testing only and deferred oral challenges to the postpartum period (i.e., postpartum oral challenge site). Our primary outcome was the rate of penicillin allergy delabeling, defined as tolerating an antibiotic challenge with penicillin or amoxicillin. Univariate analyses were completed using chi‐squared, Fisher's exact, and Wilcoxon rank tests.During the study period, 276 pregnant patients were assessed, with 207 in the antepartum oral challenge site and 69 in the postpartum oral challenge site. Among the 204 patients who completed antepartum oral challenges, 201 (98%) passed without reactions. Deferring oral challenges to the postpartum period led to a loss of follow‐up for 37/53 (70%) of eligible individuals. Overall, 97% (201/207) of patients at the antepartum oral challenge site were delabeled from their penicillin allergy—compared to 38% (26/69) of patients referred to the postpartum oral challenge site (p < 0.0001). Three antepartum oral challenge reactions were noted, including two mild cutaneous reactions and a case of transient abdominal discomfort.Antepartum amoxicillin oral challenge is a more effective method to delabel pregnant patients from their penicillin allergy. Deferral of oral challenges to the postpartum period introduces a significant barrier for penicillin allergy delabeling. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long‐term renal outcome of pregnant IgAN patients remained unclear.We performed a retrospective observational study covering 2003–2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO.In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome.Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES. Presentation case: A pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient's consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae. Conclusion: In summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity. [ABSTRACT FROM AUTHOR]

Background: Cannabis is the most common illicit substance used in pregnancy. As use continues to increase, understanding peoples' behaviors surrounding cannabis use during pregnancy is needed to improve maternal and child health outcomes. The aim of this study was to better understand pregnant individuals' perceptions and knowledge of cannabis use and use patterns as well as the social and environmental factors that may influence their use. Methods: We conducted interviews with 19 participants between December 2022 and March 2023. Individuals self-identified as BIPOC (Black, Indigenous, People of Color), were over 21 years of age, spoke English or Spanish, resided in California, and had used cannabis during pregnancy in the last 0–2 years. Using qualitative, constructivist grounded theory methods, we analyzed the contexts that contributed to participants' lived experiences surrounding cannabis use behaviors during pregnancy. Results: Participants reported making conscious decisions to responsibly manage their cannabis use during pregnancy to minimize potential harm to the fetus. Participants prioritized making what they perceived to be safer adjustments to their use of cannabis: (1) changing the amount of cannabis used, (2) changing the types of cannabis products used, and (3) changing sources of cannabis procurement. Discussion: Our findings show that pregnant individuals are seeking information about safe cannabis use beyond medical supervision and are open to altering their cannabis consumption patterns. However, they are unable to find trustworthy and evidence-based harm reduction practices which can be implemented to mitigate harm to their unborn children. A harm reduction approach is needed in the field of maternal cannabis use to promote positive maternal and fetal health outcomes. Conclusions: More data is needed on comprehensive harm reduction approaches to cannabis use during pregnancy. This requires implementation of education on these topics in healthcare settings presented by prenatal care clinicians. [ABSTRACT FROM AUTHOR]

Background: Prehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes. Aims: The study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital. Methods and materials: Between September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment. Results: Composite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118). Conclusion and recommendations: Prehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women. [ABSTRACT FROM AUTHOR]

Background: Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion. Methods: A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified. Results: Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05). Conclusion: In this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is a critical time for women, making them more susceptible to infectious diseases like COVID-19. This study aims to determine the immunogenicity of COVID-19 in pregnant women who have been infected compared to those who have received the inactive COVID-19 vaccine. Materials and methods: In this retrospective cohort study, pregnant women who received the inactivated COVID-19 vaccine (Sinopharm) and those with a history of COVID-19 infection during pregnancy were studied. Participants who had experienced stillbirth, received different COVID-19 vaccines, or had intrauterine fetal death were excluded from the study. Overall, the study included 140 participants. The participants were divided into two groups of 70 participants - pregnant women who received the Sinopharm vaccine and pregnant women who had COVID-19 infection during pregnancy. Before delivery, blood samples were collected from all mothers to evaluate the maternal immunoglobulin G (IgG) level. Blood samples were also taken from the baby's umbilical cord during delivery to measure the newborn's IgG level. Additionally, blood samples were collected from babies whose mothers showed signs of acute infection to measure their IgM levels and evaluate vertical transmission. Findings: The study found a significant relationship between the mean level of maternal IgG and umbilical cord IgG within the groups (P < 0.001). The highest levels of maternal IgG (2.50 ± 2.17) and umbilical cord IgG (2.43 ± 2.09) were observed in pregnant women with a previous COVID-19 infection and no history of vaccination (P < 0.001). Only one baby was born with a positive IgM, and this baby was born to a mother who showed signs of COVID-19 infection in the last five days of pregnancy. The mother was 28 years old, with a BMI of 33; it was her first pregnancy, and she gave birth to a male newborn at term. Conclusion: Administering an inactivated vaccine during pregnancy can generate immunity in both the mother and the child. However, the vaccine's immunity level may not be as potent as that conferred by COVID-19 infection during pregnancy. Nonetheless, the risk of vertical transmission of COVID-19 is considered minimal and can be classified as negligible. [ABSTRACT FROM AUTHOR]

Susceptibility to diseases and fear of infections might vary intra-individually, depending on life circumstances. The main aims of the current research were to examine whether perceived vulnerability to disease (PVD) is higher in expectant women and their partners as compared to their non-pregnant peers (Study 1), and to test whether a mother's disease aversion during pregnancy relates to health of her newborn (Study 2). In Study 1 we collected cross-sectional data from 412 men and women varying in parenthood status. Pregnant female participants were more likely to exhibit higher levels of PVD as compared with childless peers, although mothers also reported relatively high PVD scores. PVD in men, generally lower than that of women, seemed to be rather independent of their parenthood status. In Study 2, a sample of 200 pregnant women completed the PVD scale during the second pregnancy trimester and a follow-up survey after their child was born. We found that PVD in pregnant women was not related to further health outcomes in their newborns. Birth weight, average Apgar score, and general health of a newborn were not associated with the pregnancy-period mother's PVD score. However, the probability of giving birth to a child with 10 Apgar points was higher in younger mothers and tended to decrease with the increasing number of health issues before pregnancy. Overall, this research contributes to understanding of the health-oriented beliefs of expectant parents and parents of infants, but it also shows that the possible, PVD-related disease avoidance has a relatively little effect on basic markers of a newborn's health. [ABSTRACT FROM AUTHOR]

The rise of mHealth has transformed maternal healthcare in low- and middle-income countries, enhancing care and women’s access to quality services. The “Kapasia Model,” launched in 2017 in Bangladesh, aims to connect beneficiaries with healthcare providers, improve antenatal care (ANC) and reduce maternal mortality. This study aimed to explore healthcare providers’ perspective on digitalized ANC services within the Kapasia model. Conducted from January to July 2022, it involved 30 in-depth interviews with community-level healthcare providers across 17 facilities in Kapasia Upazila, Gazipur. A thematic analysis was performed to analyze data. The findings revealed that healthcare providers emphasized the Kapasia Model’s role in raising awareness and knowledge of pregnancy care and increasing antenatal care attendance. They viewed digitalized service as means of improving connectivity and access to healthcare for pregnant women. However, providers also discussed challenges such as women’s limited access to mobile phones and the time-consuming nature of completing information forms. Overall, healthcare providers supported integration of digital tools and endorsed digitalization in their workflow. Addressing these challenges is essential for optimizing ANC delivery and improving quality of services. Insights from this study will inform evidence-based decisions for future scaling-up and replication by policymakers and stakeholders in similar settings. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody‐mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well‐characterized, the clinical and laboratory monitoring practices are inconsistent.We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell‐free fetal DNA testing, and result reporting and documentation practices.The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube‐based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell‐free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers.There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal‐fetal medicine service are needed. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Excessive weight gain, obesity, or insufficient weight gain during pregnancy can adversely affect both the mother and her offspring. This study aims to investigate the relationship between pregnant women's self‐perception and beliefs and their body weight management during pregnancy.A cross‐sectional survey involving 350 pregnant women in Changsha City was conducted from July to September 2023. Instruments included a sociodemographic data sheet, protective motivation questionnaire for pregnancy body quality management, and scales measuring body image, anxiety, self‐efficacy, and social support. Univariate analysis and multiple linear regression were employed to identify factors influencing protective motivation for body quality management during pregnancy.The average score of the protective motivation questionnaire was 124 (SD = 13.07), suggesting a need for enhanced weight management. Key factors influencing protective motivation included household income, cooperation with healthcare workers, sources of pregnancy information, midnight snacking habits, prepregnancy exercise, body image, and self‐efficacy (P < 0.05).The study highlights significant factors influencing pregnant women's motivation for body quality management. These include economic status, healthcare collaboration, information accessibility, lifestyle habits, and psychological factors. The findings underscore the need for healthcare professionals to integrate these factors into pregnancy care programs to improve body quality management. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To assess variations in the presentation and clinical implications of pre‐eclampsia between Iranian and Afghan mothers at a maternity center in Tehran.We conducted a cross‐sectional study of Iranian and Afghan mothers diagnosed with pre‐eclampsia. Data were collected from March 2021 to February 2023 at a maternity center in Tehran, Iran. Demographic information, clinical characteristics, and laboratory findings were extracted from medical records. Statistical analyses were employed to compare differences between Iranian and Afghan mothers, including Mann–Whitney U, Pearson χ2 tests, and logistic regression models.We included 822 pregnant women with pre‐eclampsia, predominantly Iranian (75.5%) and Afghan (24.5%). Regarding the multivariate logistic regression model, Iranian mothers were older, with a higher proportion over 35 years. Although Afghan mothers showed higher gravidity counts and greater gestational ages at delivery, they had lower rates of hypothyroidism. Iranian women were more often categorized as obese than Afghan women, and the difference was statistically significant. Serum levels of alkaline phosphatase were significantly greater in Afghan women.Pre‐eclampsia poses significant maternal health risks, especially among Afghan refugees in Iran. Variances in age, gravidity, and hypothyroidism prevalence highlight the need for tailored healthcare strategies. Addressing cultural barriers and implementing targeted interventions can improve maternal and fetal outcomes in these populations. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals' preferences towards the use of daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals' preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy. Methods: Design: Convergent mixed-methods. Participants: Pregnant women or those planning a pregnancy with VTE recurrence risk. Intervention: A SDM intervention about thromboprophylaxis with LMWH in pregnancy. Analysis: Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke's pentad of motives framework: act (what needs to be done), scene (patient's context), agent (perspectives and influence of people involved in the decision), agency (aspects of the medication), and purpose (patient's goals). We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance. Results: We comprehensively determined preferences for using LMWH by pregnant individuals at risk of VTE: through value elicitation exercises we found that the least valued health state was to experience a pulmonary embolism (PE), followed by major obstetrical bleeding (MOB), deep vein thrombosis (DVT), and using daily injections of LMWH (valued as closest to a 'healthy pregnancy'); through interviews we found that: previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks were described (agency). For participants, the main goal of using LMWH was avoiding any risks in pregnancy (purpose). Side-by-side comparisons revealed concordance and discordance between health states and motives. Conclusions: Mixed-methods provide a nuanced understanding of LMWH preferences, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care around preference-sensitive decisions in thromboprophylaxis during pregnancy. [ABSTRACT FROM AUTHOR]

Background: To reduce neonatal mortality, it is necessary to identify neonates with fetal malnutrition at birth using the clinical assessment score (CAN score). Furthermore, comprehensive summary data that shows burden of fetal malnutrition in Africa is scarce. As a result, this systematic review and meta-analysis aimed to assess fetal malnutrition among newborns in Africa. Method: The PRISMA guidelines were used for this study. Articles were obtained from databases and websites. The outcome of the study was fetal malnutrition, as determined using the CAN score. The meta-analysis of the primary and secondary outcomes was performed using Stata version 18 statistical software. The pooled prevalence with a 95% CI was estimated using the random effect method with the Der Simonian Liard model. Results: This meta-analysis and systematic review included 5356 newborns from 13 studies. The pooled prevalence of fetal malnutrition (FM) among newborns diagnosed using the CAN score in Africa was 19% [95% CI: 17, 22]. Based on subgroup analysis by publication year, the lowest prevalence of fetal malnutrition 17% (95% CI: 9–27) was observed in the studies published in the years 2020–2023. Maternal and fetal factors were significantly associated with fetal malnutrition. Conclusion: Nearly one-fifth of neonates delivered in Africa were found to have fetal malnutrition based on the clinical evaluation of nutritional status. It has also been established that maternal malnutrition, a lack of proper treatment during pregnancy, maternal malnutrition, and newborn morbidities were associated with fetal malnutrition. To prevent fetal malnutrition, integrated efforts should be made for early maternal infection screening. Furthermore, maternal nutritional therapy should be explored for malnourished pregnant women. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregnancy-related anxiety in LMICs have utilized scales developed in high-income countries, despite significant variations in pregnancy-related anxiety due to socioeconomic and cultural contexts. This review surveyed existing literature in order to identify which scales have been used to measure pregnancy-related anxiety in SSA. Methods: A systematic search was conducted in PubMed, Health and Psychosocial Instruments, and APA PsycNet for relevant studies published in the English language up to March 22, 2023. Eligible studies focused on anxiety in pregnant populations within SSA, using validated scales or tools. Screening followed PRIMSA guidelines, with blinded review at the abstract/title level and subsequent full-text review. Data was extracted and analyzed to identify trends and characteristics of the screening tools used. Results: From 271 articles, 37 met inclusion criteria, identifying 24 different tools used to measure anxiety in pregnant women in SSA. The most common tools were the Generalized Anxiety Disorder 7-item scale (seven uses), State-Trait Anxiety Inventory (five uses), and the Self-Reporting Questionnaire 20 (five uses). Seven tools were pregnancy-specific, with only two designed specifically for SSA: the Risk Factor Assessment (RFA), and the 4-Item Screening Tool. Studies were most frequently conducted in South Africa, followed by Tanzania, Ethiopia, Nigeria, and Ghana. Conclusions: This scoping review illustrates that only two tools (the RFA and 4-item Screening Tool) were created to assess pregnancy-related anxiety specifically in SSA. This highlights the need for more culturally sensitive tools tailored to the specific contexts of pregnant populations in SSA. [ABSTRACT FROM AUTHOR]

Background: Body image dissatisfaction, leading to a variety of negative emotions and adverse pregnancy or birth outcomes. Studies on body image interventions for pregnant and postpartum women have been reported, yielding mixed results. Existing evidence lacks a comprehensive review of the effectiveness of body image interventions for pregnant and postpartum women. Objective: The aim of this study was to systematically review interventions which aimed at improving body image during pregnancy and postpartum in women of childbearing age, and further to explore their effectiveness. Methods: A comprehensive literature search was conducted using electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, SinoMed, CNKI, and Wanfang Database, to retrieve relevant studies. Body image was reported employing descriptive analysis, whereas the Cochrane Handbook tool was used to evaluate the quality and potential bias of each included study. Results: Following established inclusion and exclusion criteria, 11 studies were identified from an initial 1,422 records for further analysis, involving 1290 participants. This systematic review grouped body image interventions into lifestyle interventions and psychological interventions based on their content. These interventions yielded more pronounced positive effects on improving body image in pregnant and postpartum women when compared to control groups. And, the statistical difference on psychological interventions is more significant on the whole. Conclusions: Our work offers a comprehensive overview of the effectiveness of body image interventions for pregnant and postpartum women. Psychological interventions are considered to be a suitable measure to improve body image for pregnant or postpartum women. Additional research and practical applications are recommended to enhance the mental health and well-being of perinatal women. Trial registration: PROSPERO registry: CRD42024531531. [ABSTRACT FROM AUTHOR]

Background: Multiple marker screening is offered to pregnant individuals in many jurisdictions to screen for trisomies 21 and 18. On occasion, the result is 'double-positive'—a screening result that is unexpectedly positive for both aneuploidies. Although this occurs rarely, the paucity of available evidence about the outcomes of these pregnancies hinders patient counselling. This study aimed to investigate the association of double-positive results with preterm birth and other adverse perinatal outcomes. Methods: We conducted a population-based retrospective cohort study of pregnancies with an estimated date of delivery from September 1, 2016, to March 31, 2021, using province-wide perinatal registry data in Ontario, Canada. Pregnancies with double-positive screening results where trisomies 21 and 18 were ruled-out were compared to pregnancies with screen negative results for both aneuploidies. We used modified Poisson regression models with robust variance estimation to examine the association of double positive results with preterm birth and secondary outcomes. Results: From 429 540 pregnancies with multiple marker screening, 863 (0.2%) had a double-positive result; trisomies 21 and 18 were ruled out in 374 pregnancies, 203 of which resulted in a live birth. Among the pregnancies in the double-positive group resulting in a live birth, the risk of preterm birth was increased compared to pregnancies with a screen negative result: adjusted risk ratio (aRR) 2.6 (95%CI 2.0-3.6), adjusted risk difference (aRD) 10.5% (95%CI 5.4–15.7). In a sensitivity analysis excluding all diagnosed chromosomal abnormalities, the risk of preterm birth remained elevated to a similar degree: aRR 2.6 (95%CI 1.9–3.7), aRD 10.0% (95%CI 4.8–15.3). The risk of other adverse perinatal outcomes was also higher, including the risk of chromosomal abnormalities other than trisomies 21 and 18: aRR 81.1 (95%CI 69.4–94.8), aRD 34.0% (95%CI 29.2–38.8). Pregnancies with double-positive results were also less likely to result in a live birth, even when excluding all diagnosed chromosomal abnormalities; and at increased risk of adverse perinatal outcomes for those resulting in a live birth. Conclusion: Although rare, double-positive multiple marker screening results are associated with an increased risk of preterm birth and other adverse perinatal outcomes, even when excluding all identified chromosomal abnormalities. [ABSTRACT FROM AUTHOR]

Background: Pregnant women, fetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their fetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the fetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low- and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in LMICs. Methods: A Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy, and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2024. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy, and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute's (JBI) critical appraisal tools. Discussion: This protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs. [ABSTRACT FROM AUTHOR]

Background: The increase in the rate of multiple pregnancies in clinical practice is associated with assisted reproductive technology (ART). Given the high risk of dichorionic triamniotic (DCTA) triplet pregnancies, reducing DCTA triplet pregnancies to twin or singleton pregnancies is often beneficial. Case presentation: This article reports on two cases of DCTA triplet pregnancies resulting from two blastocyst transfers. Given the high risk of complications such as twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies, patients have a strong desire to preserve the dichorionic diamniotic (DCDA) twins. Multifetal pregnancy reduction (MFPR) was performed in both cases to continue the pregnancy with DCDA twins by reducing one of the MCDA twins. Both of the pregnant women in this report eventually gave birth to healthy twins at 37 weeks. Conclusions: For infertile couples with multiple pregnancies but with a strong desire to remain the DCDA twins, our report suggests that reducing DCTA triplets to DCDA twin pregnancies may be an option based on clinical operability and assessment of surgical difficulty. [ABSTRACT FROM AUTHOR]