Articles

The effects of a peripartum strategy to prevent and treat primary postpartum haemorrhage at health facilities in Niger: a longitudinal, 72-month study

This study evaluated the impact of an intervention that aims to halve maternal mortality caused by primary postpartum haemorrhage within 2 years, nationwide in Niger. Findings suggest that primary postpartum haemorrhage morbidity and mortality declined rapidly nationwide. Because each treatment technology that was used has shown some efficacy when used alone, a strategic combination of these treatments can reasonably attain outcomes of this magnitude. Niger's strategy warrants testing in other low-income and perhaps some middle-income settings.

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. Findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.

Postpartum Navigation Decreases Severe Maternal Morbidity Most Among Black Women

The purpose of this study was to examine if a post-partum navigation program decreased all cause 30-day postpartum hospitalizations and hospitalizations due to diagnoses of severe maternal morbidity identified by the U.S. Centers for Disease Control and Prevention. Findings suggest that high-risk medical conditions at time of delivery increase risk for post-partum hospitalization, including hospitalizations due to severe maternal morbidity. A post-partum navigation program designed to identify and resolve clinical and social needs reduced post-partum hospitalizations & racial disparity with hospitalizations. Hospitals and healthcare systems should adopt this type of care model for women at high risk for severe maternal morbidity. Cost analyses are needed to evaluate financial impact of post-partum navigation programs for women at high risk for severe maternal morbidity or mortality which could influence reimbursement for these types of services. Evidence and details of novel postpartum interventional models need to continue to be reported.

Preterm and term pre-eclampsia: relative burdens of maternal and perinatal complications

The objective of the study was to determine the relative burdens of maternal and perinatal complications, for preterm and term pre-eclampsia. Findings suggest that while adverse event risks are greater with preterm (vs term) pre-eclampsia, term disease is associated with at least equivalent total numbers of maternal, and a significant proportion of perinatal, adverse events. Increased efforts should be made to decrease the incidence of term pre-eclampsia.

Prelacteal feeding and its relationship with exclusive breastfeeding and formula consumption among infants in low- and middle-income countries

The study aimed to investigate if giving any fluids or foods other than breast milk during the first three days after birth (prelacteal feeds) affects exclusive breastfeeding and consumption of formula among children under six months of age in low and middle-income countries (LMICs). Findings suggest that feeding babies prelacteal foods shortens exclusive breastfeeding duration and increases the likelihood of formula consumption in children under six months of age in LMICs. Pro-breastfeeding interventions must be prioritized during antenatal care and throughout the stay in the maternity facility to properly protect, support, and promote exclusive breastfeeding since birth.

Receiving quality antenatal care service increases the chance of maternal use of skilled birth attendants in Ethiopia: Using a longitudinal panel survey

The aim of this study was to assess effect of quality antenatal care service on maternal use of skilled birth attendant after any antenatal care visit. Findings suggest that maternal use of skilled birth attendant can be improved by providing quality ANC service during subsequent ANC visits. Improving ANC service delivery may encourage or positively reinforce women's and partner's decision to use skilled birth attendant.

Challenges in antenatal care utilization in Kandahar, Afghanistan: A cross-sectional analytical study

The main objective of this study was to assess the barriers in the utilization of antenatal care (ANC) services in Kandahar, Afghanistan. This was a cross-sectional analytical study conducted over one year from December 2018-November 2019. Findings suggest that utilization of ANC services is inadequate in Kandahar province. Improving clinic staff professional behavior and status of women by expanding educational opportunities, and enhancing community awareness of the value of ANC are recommended.

The human right to safely give birth: data from 193 countries show that gender equality does affect maternal mortality

This study aimed to analyse the association between gender equality and maternal mortality ratio (MMR) globally. Findings suggest that gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.

Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial

The study evaluated the benefits of an Australian Nurse Home Visiting (NHV) program ("right@home") in promoting children's language and learning, general and mental health, maternal mental health and wellbeing, parenting and family relationships, at child ages 4 and 5 years. Study findings suggets that an Australian NHV program promoted longer-term family functioning and wellbeing for women experiencing adversity. NHV can offer an important component of a proportionate universal system that delivers support and intervention relative to need.

Factors associated with duration of breastfeeding in women giving birth for the first time

The objective of the study was to examine maternal, psychosocial, and pregnancy factors associated with breastfeeding for at least 6 months in those giving birth for the first time. Findings suggest that in this cohort of women giving birth for the first time, duration of breastfeeding was associated with several characteristics which highlight groups at greater risk of not breastfeeding as long as currently recommended.

Impact of gestational hypertension and pre-eclampsia on preterm birth in China: a large prospective cohort study

The objective of the study was to investigate the impact of gestational hypertension and pre-eclampsia on preterm birth. The findings suggest that pre-eclampsia was associated with a higher risk of preterm birth. The early-onset gestational hypertension and pre-eclampsia were associated with more severe risks than late-onset conditions.

Association between frequency of mass media exposure and maternal health care service utilization among women in sub-Saharan Africa: Implications for tailored health communication and education

In this study, the authors examined the association between exposure to mass media and maternal health care services utilization among women in sub-Saharan Africa. The study identified a strong positive relationship between mass media exposure and maternal health care services utilization. Specifically, exposure to radio and television were positively associated with ANC visitations. Moreover, exposure to mass media (newspaper/magazine, radio and television) were positively associated with SBA and PNC utilization. Policymakers and other non-governmental organizations should continuously invest resources in the design and implementation of maternal health service utilization educational programs through all the mass media channels to scale up women's maternal health service services utilization uptake in sub-Saharan Africa.

Association of Maternal Tobacco Use During Pregnancy With Preadolescent Brain Morphology Among Offspring

The objective of this study was to investigate the association between maternal smoking during pregnancy and offspring brain development in preadolescence as well as the mediating pathways. The findings of this cohort study suggest that continued maternal tobacco use during pregnancy was associated with lower brain volumes and suboptimal cortical traits of offspring in preadolescence, which seemed to be independent of shared family factors. Tobacco cessation before pregnancy, or as soon as pregnancy is known, should be recommended to women for optimal brain development of their offspring.

Delivery, maternal and neonatal outcomes in nulliparous women with gestational diabetes undergoing epidural labour analgesia: a propensity score-matched analysis

This study aimed to retrospectively analyse the influence of epidural labour analgesia (ELA) on delivery and maternal and neonatal outcomes in nulliparous women with gestational diabetes mellitus (GDM) using propensity score-matched analysis. Findings suggest that the use of ELA decreases the rate of caesarean section and improves maternal and neonatal outcomes in nulliparous women with GDM.

COVID-19 booster dose induces robust antibody response in pregnant, lactating, and nonpregnant women

The study sought to profile the humoral immune response to a COVID-19 mRNA booster dose in a cohort of pregnant, lactating, and age-matched nonpregnant women. These data suggest that receipt of a booster dose during pregnancy induces a robust Spike-specific humoral immune response, including against Omicron. If boosting occurs in the third trimester, higher Spike-specific cord IgG1 levels are achieved with greater time elapsed between receipt of the booster and delivery. Receipt of a booster dose has the potential to augment maternal and neonatal immunity.

Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial

The objective of this study was to determine the effect of an intensive nurse home visiting program on a composite outcome of preterm birth, low birth weight, small for gestational age, or perinatal mortality. In this South Carolina–based trial of Medicaid-eligible pregnant individuals, assignment to participate in an intensive nurse home visiting program did not significantly reduce the incidence of a composite of adverse birth outcomes. Evaluation of the overall effectiveness of this program is incomplete, pending assessment of early childhood and birth spacing outcomes.

Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019

The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes. The cesarean section rate in Georgia decreased during the 2-year post-policy period. The reduction mainly took place among primiparous women. The policy had no impact on the neonatal intensive care unit transfer rate or the perinatal mortality rate. The impact of the national cesarean section reduction policy on other outcomes is not known.

Geographical accessibility of emergency neonatal care services in Ethiopia: analysis using the 2016 Ethiopian Emergency Obstetric and Neonatal Care Survey

The objective of this study was to analyse the physical accessibility of emergency neonatal care (EmNeC) services at the national and subnational levels in Ethiopia. Findings suggest that the physical access to EmNeC services in Ethiopia is well below the universal health coverage expectations stated by the United Nations. Increasing the availability of EmNeC to health facilities where routine delivery services currently are taking place would significantly increase physical access. Our results reinforce the need to revise service allocations across administrative regions and consider improving disadvantaged areas in future health service planning.

The association between asthma and perinatal mental illness: a population-based cohort study

The authors studied the association between asthma and perinatal mental illness and explored the modifying effects of social and medical complexities. Findings suggest that women with asthma predating pregnancy are at slightly increased risk of mental illness in pregnancy and post-partum. A multidisciplinary management strategy may be required to ensure timely identification and treatment.

Mendelian randomization study of maternal coffee consumption and its influence on birthweight, stillbirth, miscarriage, gestational age and pre-term birth

The authors investigated whether there is a causal relationship between coffee consumption and miscarriage, stillbirth, birthweight, gestational age and pre-term birth using Mendelian randomization (MR). Results suggest that coffee consumption during pregnancy might not itself contribute to adverse outcomes such as stillbirth, sporadic miscarriages and pre-term birth or lower gestational age or birthweight of the offspring.