Articles

Induction of labor versus expectant management among low-risk patients with one prior cesarean delivery

The objective of the study was to determine the association between clinical outcomes and induction of labor at 39 weeks in a national sample of low-risk patients with one prior cesarean delivery. Findings suggest that when compared to expectant management, elective induction of labor at 39 weeks in low-risk patients with one prior cesarean delivery was associated with a significantly higher likelihood of vaginal delivery with no difference in composite maternal and neonatal morbidity outcomes. Prospective studies are needed to better elucidate the risks and benefits of induction of labor in this patient population.

Effects of perineal massage at different stages on perineal and postpartum pelvic floor function in primiparous women: a systematic review and meta-analysis

Meta-analysis was used to evaluate the effect of implementing perineal massage in antenatal versus the second stage of labor on the prevention of perineal injuries during labor and early postpartum pelvic floor function in primiparous women. Findings suggest that Reducing perineal injuries in primiparous women can be achieved by providing perineal massage both antenatally and during the second stage of labor. Pelvic floor function is improved in the postnatal phase by perineal massage during the antenatal stage.

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.

Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability

The objective of this stusy was to examine the associations of acetaminophen use during pregnancy with children's risk of autism, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability. Findings suggest that acetaminophen use during pregnancy was not associated with children's risk of autism, ADHD, or intellectual disability in sibling control analysis. This suggests that associations observed in other models may have been attributable to familial confounding.

Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids: The ALPS Follow-Up Study

The Antenatal Late Preterm Steroids (ALPS) trial changed clinical practice in the United States by finding that antenatal betamethasone at 34 to 36 weeks decreased short-term neonatal respiratory morbidity. However, the trial also found increased risk of neonatal hypoglycemia after betamethasone. This follow-up study focused on long-term neurodevelopmental outcomes after late preterm steroids. In this follow-up study of a randomized clinical trial, administration of antenatal corticosteroids to persons at risk of late preterm delivery, originally shown to improve short-term neonatal respiratory outcomes but with an increased rate of hypoglycemia, was not associated with adverse childhood neurodevelopmental outcomes at age 6 years or older.

Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy

The authors conducted two independent randomized trials of calcium supplementation, in India and Tanzania, to assess the noninferiority of a 500-mg daily dose to a 1500-mg daily dose of calcium supplementation. In each trial, the two primary outcomes were preeclampsia and preterm birth, and the noninferiority margins for the relative risks were 1.54 and 1.16, respectively.  In these two trials, low-dose calcium supplementation was noninferior to high-dose calcium supplementation with respect to the risk of preeclampsia. It was noninferior with respect to the risk of preterm live birth in the trial in India but not in the trial in Tanzania.

Reducing Severe Maternal Morbidity for Birthing Persons with Severe Hypertension through a Statewide Quality Improvement Initiative

The study aimed to assess the improvement in hospital care processes and patient outcomes associated with hypertensive disorders of pregnancy after introduction of a statewide Severe Maternal Hypertension quality improvement initiative. Findings suggest that introduction of a statewide quality improvement effort was associated with improved time-to-treatment of severe hypertension, as well as increased frequency of provider/nurse debriefs, appropriate patient education, and early postpartum follow up scheduled at discharge, and reduced severe maternal morbidity.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review

This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries (LMICs), residing in high-income countries. Findings suggest that there is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period.

When addressing resources is not enough: lessons learned from a respectful maternal and neonatal care provider training intervention evaluation in Kenya and Tanzania

MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards Respectful Maternal and Neonatal Care (RMNC). It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches. The results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training.

Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus

This study aimed to develop an international expert’s consensus on evidence-based approaches for early detection and obstetric first response management of postpartum haemorrhage (PPH) intraoperatively and postoperatively in caesarean birth. Findings present the proposed agreed on approaches that could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.

School-age Children and Adolescents Nutritional Survey (SCANS), Pakistan

SCANS was conducted in the province of Sindh and Punjab in Pakistan in the year 2020. The survey findings are crucial as it presents nutritional and health indicators from a large-scale survey to lay the foundation of future research aimed towards improving the health and lifestyle of children in the 5 – 10 years’ age group.

Sexual orientation disparities in adverse pregnancy outcomes

Sexual minority (SM) individuals experience poorer health outcomes than their heterosexual counterparts in various health domains and have health profiles—for example, health behaviors, experiences of healthcare discrimination, and limited resources owing to structural, interpersonal, and individual stigma—that may place them at higher risk for adverse pregnancy outcomes (APOs). However, little research has examined disparities in these outcomes with multidimensional measures of sexual orientation. 

Pregnancies complicated by bulimia nervosa are at increased risk of chorioamnionitis, anemia, and preterm birth

In this study, the authors aimed to investigate the risk for a wide array of adverse pregnancy outcomes among people with bulimia nervosa using an adjustment analysis to account for maternal confounding factors. Findings suggest that pregnant people with bulimia nervosa were at increased risk for a number of clinically important adverse live born pregnancy outcomes. Like others, however, we found no association with preterm birth overall, low birth weight, or small for gestational age.

RSV Prefusion F Protein-Based Maternal Vaccine - Preterm Birth and Other Outcomes

The authors conducted a phase 3 trial involving pregnant women 18 to 49 years of age to assess the efficacy and safety of RSVPreF3-Mat. The results of this trial, in which enrollment was stopped early because of safety concerns, suggest that the risks of any and severe medically assessed RSV-associated lower respiratory tract disease among infants were lower with the candidate maternal RSV vaccine than with placebo but that the risk of preterm birth was higher with the candidate vaccine.

Barriers to care and treatment experiences among individuals with postpartum psychosis

Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population. This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.

Racial Disparity in Severe Maternal Morbidity Associated with Hypertensive Disorders in Washington State: A Retrospective Cohort Study

The objective of the study was to evaluate the relationship between hypertensive (HTN) disorders and severe maternal morbidity (SMM). To understand whether there is differential prevalence of HTN disorders by race and whether the relationship between HTN disorders and SMM is modified by race and ethnicity. Findings suggest that in Washington, HTN disorders are associated with SMM in a dose-dependent fashion with the greatest impact among Black individuals.

Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis

The objective of the study was to assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.

Factors influencing gestational diabetes self-care among pregnant women in a Syrian Refugee Camp in Jordan

The main objective of this study is to identify the level of self-care practices and the determinants of Gestational Diabetes Mellitus (GDM) among pregnant women residing in one of the refugee camps in Jordan. The findings of this study highlight that pregnant women with GDM who have higher levels of self-efficacy and diabetes knowledge are more likely to achieve higher levels of GDM self-care. Beside developing health promotion programs to enhance women's self-efficacy in adhering to GDM care, adequate support and relevant resources to facilitate GDM management among refugee women are recommended. Future research for identifying other potential factors affecting GDM self-care among refugees is highly recommended.

Association between tuberculosis and pregnancy outcomes: a retrospective cohort study of women in Cape Town, South Africa

This study aimed to determine risk factors for an adverse pregnancy outcome among pregnant women diagnosed with TB. Findings suggest that pregnancy outcomes among women with TB were poor, irrespective of HIV status. Pregnant women with TB are a complex population who need additional support prior to, during and after TB treatment to improve TB treatment and pregnancy outcomes. Pregnancy status should be considered for inclusion in TB registries.

The contribution of suicide to maternal mortality: A nationwide population-based cohort study

The objective of this study was to identify the incidence and characteristics of maternal suicide. Findings suggest that although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve.