Modeling Water Insecurity as an Existential Threat to Neonatal Health in the San Joaquin Valley of California.

Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post-partum. The search encompassed January 2000 to June 2022 and only peer-reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. We used standard methodological procedures expected by The Campbell Collaboration. In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants.

Current evidence has shown that transitional care benefits the health outcomes of moderately compromised infants and mothers in terms of de-medicalisation of care, improving mother and infant attachments, parenting skills for dependant infants and the potential for shorter length of hospitalisation. Transitional care units exist in a variety of forms in neonatal services, ranging from nurse-led to midwife-led units. This review establishes whether transitional care units improve maternal and neonatal health outcomes. Objective: To review and synthesise published research on ‘Does transitional care improve neonatal and maternal health outcomes?’ Methods: Systematic reviews of published literature from nine electronic databases were undertaken and a total of ten studies were reviewed that met the reviews inclusion criteria. Findings: Five studies were rated as moderate strength, four studies were rated as very high quality and one study was rated as poor quality. Three overarching primary outcomes were identified. Within each outcome, a series of seven secondary outcome measures were reported. These included very positive benefits on one end of the scale and no benefits at the other end. The outcome measures report inconsistently across studies of the values of transitional care units for infants, ‘shorter length of stay’, ‘transitional model of care’ and the ‘reduced risks of infection’. Family centred care, mother as main carer, and increased bonding and attachments featured strongly across studies and thus supported the benefits of transitional care units in improving neonatal and maternal health outcomes. Conclusion: This review highlighted the values of transitional care in increasing the ‘mother–infant’ model of care. More studies are required for the evidence base for strategies to reduce the length of hospitalisation for moderately vulnerable infants. It was discovered that there are substantial variables in transitional care unit practices in the UK, as well as a need for well-conducted studies.

Background/Aims Neonatal mortality remains a global challenge. In Ghana, neonatal mortality accounts for up to 50% of child mortality. A better understanding of the neonatal outcomes of obstetrics complications could contribute to context-specific evidence-based care to prevent neonatal deaths. This study aimed to describe the relationship between poor neonatal outcomes and obstetric complications in a tertiary health facility in the north of Ghana. Methods This was a cross-sectional quantitative study conducted at a tertiary health facility in northern Ghana. Purposive convenience sampling was used to select 384 mothers who experienced obstetric complications. A structured questionnaire was used to collect data on the participants' neonatal health outcomes. The chi-square test was performed to determine the relationship between neonatal health outcomes and obstetric complications, with significance set at P<0.05. Results A total of 20 obstetric complications were recorded. Overall, 327 participants had a single complication. The three most common obstetric complications resulting in adverse neonatal outcomes were obstructed labour (56.0%), pregnancy-induced hypertension (14.6%) and postpartum haemorrhage (11.6%). The majority (66.7%) of the neonates were healthy at birth, with 21.9% and 11.5% being sick or stillborn respectively. Obstetric complications were significantly associated with both neonatal morbidities and mortalities at P<0.000. Conclusions Preventable maternal obstetric complications continue to cause adverse neonatal outcomes in health facilities in Ghana. Appraisal of maternal and newborn care practices may be necessary to understand context-specific factors.

Purpose: This study aims to explore the role of midwifery practices in promoting maternal and neonatal health, emphasizing the impact of midwifery-led care models, cultural competence, and the integration of midwifery into national health systems. Research Design and Methodology: The research employs a qualitative design, utilizing semi-structured interviews and focus group discussions with midwives, healthcare providers, policymakers, and community health workers in low-resource settings. Thematic analysis was used to identify key themes and patterns within the data. Findings and Discussion: The findings indicate that midwifery-led care models significantly improve maternal and neonatal outcomes by providing continuous, personalized support, which reduces unnecessary medical interventions and enhances maternal satisfaction and emotional well-being. The study also underscores the importance of cultural competence in midwifery, as culturally sensitive care builds trust and improves health outcomes. Integrating midwifery into national health systems, supported by appropriate policies and resources, is crucial for achieving better maternal and neonatal health outcomes. The research highlights the need to address socio-economic barriers that hinder effective midwifery care in low-resource settings. Implications: The study provides valuable insights for policymakers and healthcare providers, emphasizing the need for supportive policies, adequate resources, and continuous professional development for midwives. Countries can enhance maternal and neonatal health outcomes by integrating midwifery services into national health systems and fostering cultural competence. The findings also suggest areas for future research, including the need for more diverse settings and mixed method approaches to provide a comprehensive understanding of midwifery practices.

Backgroud and objectiveMaternal obesity and gestational weight gain (GWG) are important determinants of maternal and neonatal health outcomes. This study aimed to investigate the effects of prepregnancy body mass index (PPBMI) and GWG on maternal and neonatal outcomes in Türkiye.MethodsThis prospective cross-sectional study was conducted in a public hospital in Turkey between December 2021 and December 2022. A total of 1137 women between the ages of 19 and 45 who had singleton and live births and had complete medical records were included in the study using simple random sampling. Data were collected using medical records and a structured interview form. PPBMI and GWG were calculated from self-reported weight and height data. Kruskal-Wallis, Mann-Whitney U, and binary logistic regression tests were used to analyze the data.ResultsAmong the participants, 4.7% were underweight, 61% had a normal weight, 27.6% were overweight, and 9.9% were obese on the basis of PPBMI. According to the Institute of Medicine (IOM) GWG guidelines, 17.2% had insufficient GWG, 55.1% had adequate GWG, and 27.8% had excessive GWG. Overweight women had significantly increased odds of gestational diabetes mellitus (OR = 0.479, p = 0.024), genital tract infections (OR = 2.15, p = 0.000), urinary tract infections (OR = 2.42; p = 0.011), elective cesarean delivery (OR = 8.62, p = 0.035), macrosomia (OR = 9.15, p = 0.031), and low APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores (< 7 at 5 min) (OR = 0.20, p = 0.000). Obese women also showed higher odds of elective cesarean (OR = 9.56; p = 0.030) and macrosomia (OR = 8.27, p = 0.044). Underweight women had higher odds of neonatal hospital stay > 5 days. Insufficient GWG was associated with increased risks of low birth weight (OR = 0.46, p = 0.013), third-trimester bleeding (OR = 0.45, p = 0.016), and neonatal hospitalization > 5 days (OR = 0.44, p = 0.003), while macrosomia risk was lower (OR = 2.06, p = 0.001).ConclusionPPBMI and GWG are significant predictors of maternal and neonatal health outcomes. Elevated PPBMI and inappropriate GWG are associated with increased risks of gestational diabetes, macrosomia, cesarean delivery, low APGAR scores, low birth weight, and prolonged neonatal hospitalization. These findings highlight the critical role of routine assessment and management of maternal weight status and weight gain during prenatal care in reducing preventable complications for both mothers and their newborns.

IntroductionGestational diabetes mellitus (GDM) is often associated with adverse pregnancy outcomes. However, the association of risk factors with GDM diagnosis, maternal and neonatal health outcomes is less established when compared...

SummaryBackgroundPregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes.MethodsIn this multicentre, open-label, randomised controlled trial, we recruited women aged 18–40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527.FindingsBetween March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference −0·19%; 95% CI −0·34 to −0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy).InterpretationUse of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use.FundingJuvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

BACKGROUNDPreimplantation genetic testing (PGT) of embryos developed in vitro requires a biopsy for obtaining cellular samples for the analysis. Signs of cell injury have been described in association with this procedure. Thus, the consequences of the biopsy on obstetric and neonatal outcomes have been the subject of some quantitative analyses, although the reliability of data pooling may be limited by important issues in the various reports.OBJECTIVE AND RATIONALEThe present review identifies evidence for whether pregnancies conceived after embryo biopsy are associated with a higher risk of adverse obstetric, neonatal, and long-term outcomes. Available evidence has been summarized considering manipulation at various stages of embryo development.SEARCH METHODSWe used the scoping review methodology. Searches of article databases were performed with keywords pertaining to the embryo biopsy technique and obstetric, neonatal, and postnatal outcomes. Studies in which embryos were biopsied at different stages (i.e. both at the cleavage and blastocyst stages) were excluded. We included data on fresh and frozen embryo transfers. The final sample of 31 documents was subjected to qualitative thematic analysis.OUTCOMESSound evidence is lacking to fully address the issues on the potential obstetric, neonatal or long-term consequences of embryo biopsy. For polar body biopsy, the literature is too scant to draw any conclusion. Some data, although limited and controversial, suggest a possible association of embryo biopsy at the cleavage stage with an increased risk of low birthweight and small for gestational age neonates compared to babies derived from non-biopsied embryos. An increase in preterm deliveries and birth defects in cases of trophectoderm biopsy was suggested. For both biopsy methods (at the cleavage and blastocyst stages), an increased risk for hypertensive disorders of pregnancy was found. However, these findings may be explained by confounders such as other embryo manipulation procedures or by intrinsic patient or population characteristics.WIDER IMPLICATIONSSince there is inadequate evidence to assess obstetric, neonatal, and long-term health outcomes following embryo biopsy, an invasive PGT strategy should be developed with a cautious approach. A non-invasive approach, based on the analysis of embryo cell-free DNA, needs to be pursued to overcome the potential limitations of embryo biopsy.

Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.

To evaluate the risks and benefits of routine labour induction at 41(+0) weeks' gestation for mother and newborn. Population-based retrospective cohort study of inter-institutional variation in labour induction practices for women at or beyond 41(+0) weeks' gestation. Women in British Columbia, Canada, who remained pregnant ≥41(+0) weeks and delivered at one of the province's 42 hospitals with >50 annual deliveries, 2008-2012 (n = 14,627). The proportion of women remaining pregnant a week or more past the expected delivery date who were induced at 41(+0) or 41(+1) weeks' gestation for an indication of 'post-dates' was calculated for each institution. We used instrumental variable analysis (using the institutional rate of labour induction at 41(+0) weeks as the instrument) to estimate the effect of labour induction on maternal and neonatal health outcomes. Caesarean delivery, instrumental delivery, post-partum haemorrhage, 3rd or 4th degree lacerations, macrosomia, neonatal intensive care unit admission, and 5-minute Apgar score <7. Institutional rates of labour induction at 41(+0) weeks ranged from 14.3 to 46%. Institutions with higher (≥30%) and average (20-29.9%) induction rates did not have significantly different rates of caesarean delivery, instrumental delivery, or other maternal or neonatal outcomes than institutions with lower induction rates (<20%). Instrumental variable analyses also demonstrated no significantly increased (or decreased) risk of caesarean delivery (0.69 excess cases per 100 pregnancies [95% CI -10.1, 11.5]), instrumental delivery (8.9 per 100 [95% CI -2.3, 20.2]), or other maternal or neonatal outcomes in women who were induced (versus not induced). Within the current range of clinical practice, there was no evidence that differential use of routine induction at 41(+0) weeks affected maternal or neonatal health outcomes.

Background: Antenatal care (ANC) is a cornerstone of maternal health services that significantly reduces maternal and perinatal morbidity and mortality. However, disparities in the quality and coverage of ANC services continue to affect outcomes, particularly in public tertiary healthcare settings. Aim: To evaluate the quality of antenatal care received by pregnant women and analyze its association with maternal and neonatal outcomes at a tertiary care hospital in Bihar. Methods: This prospective observational study was conducted at Anugrah Narayan Magadh Medical College &amp; Hospital, Gaya, Bihar, India. A total of 130 pregnant women attending ANC clinics and delivering at the facility were included using purposive sampling. Data were collected using structured interviews, review of antenatal cards, and follow-up during delivery and the postpartum period. Quality of ANC was assessed based on WHOrecommended parameters: timing and frequency of visits, provision of supplements, essential investigations, risk identification, and counseling. Maternal (e.g., anemia, hypertension, mode of delivery) and neonatal (e.g., birth weight, gestational age, NICU admission) outcomes were recorded and statistically analyzed in relation to ANC quality. Results: Among the 130 women studied, 76% completed four or more ANC visits, while only 52% registered in the first trimester. Full ANC coverage—including supplementation, investigations, and counseling—was observed in 62% of participants. Women who received quality ANC were significantly less likely to experience anemia (18% vs. 46%, p&lt;0.01) and hypertensive disorders (6% vs. 21%, p&lt;0.05). Better neonatal outcomes, such as higher birth weights and fewer NICU admissions, were also associated with complete ANC coverage (p&lt;0.05). Conclusion: This study reinforces the critical role of comprehensive antenatal care in improving both maternal and neonatal health outcomes. Addressing gaps in early registration, education, and follow-through on essential services is essential. Policies must prioritize strengthening primary outreach, timely referral, and awareness among expectant mothers to optimize the full benefits of ANC in resource-limited settings.

AimTo investigate maternal and neonatal outcomes following implementation of a nurse practitioner‐led model of care for diabetes in pregnancy.BackgroundDiabetes in pregnancy increases the risk of adverse health outcomes in mothers and infants. The management of diabetes in pregnancy is crucial to reduce poor outcomes.DesignUncontrolled before‐after intervention study.MethodsInternational Classification of Diseases codes were used to identify pregnancies suspected of being complicated by diabetes. Demographic, health, diabetes and maternity data were extracted from hospital records. Adverse maternal and neonatal outcomes were compared pre‐ (2003–2006) and postintervention (2010–2011). Adjusted relative risks (aRR) were calculated using the glm command in Stata.ResultsA total of 261 pregnancies were included: 112 pre‐intervention and 149 managed under the nurse practitioner‐led model. There were 37 women with pre‐existing diabetes (26 T1DM, 11 T2DM) and 195 with gestational diabetes. Referrals to dieticians and diabetes educators increased, while referrals to physicians decreased. There was no decrease in the risk of adverse maternal outcomes for all women with DIP or women with GDM. However, there was a 24% decrease in adverse neonatal outcomes overall and a 40% decrease among infants of women with gestational diabetes.ConclusionThe study demonstrated that nurse practitioner‐led models of care for diabetes in pregnancy are feasible. The findings suggest that the model reduced adverse neonatal outcomes. By improving information provision, support and care coordination, the model is particularly valuable in rural areas, where access to medical specialists is often restricted.

Background:Maternal and neonatal health outcomes are heavily influenced by equitable access to specialized healthcare providers. Globally, unequal distribution of obstetricians and gynecologists (OB/GYN) has been linked to higher maternal mortality rates and worse neonatal outcomes. In Saudi Arabia, ongoing regional disparities in healthcare infrastructure and workforce distribution continue to affect maternal and neonatal health despite reforms.Objective:This study aims to evaluate the regional distribution of obstetricians and gynecologists (OB/GYN) across Saudi Arabia and its impact on maternal and neonatal health outcomes.Methods:We conducted a cross-sectional secondary data analysis using the 2022 Saudi Ministry of Health Statistical Yearbook, covering all 20 health regions. We calculated the number of OB/GYN specialists per 100 000 females by region. Pearson’s correlation examined associations between specialist density, population size, infrastructure, and health outcomes. Multiple regression identified predictors of specialist distribution.Results:Specialist distribution varied widely. Rural regions, such as Qurayyat, had the highest specialist-to-female ratio (92 per 100 000), while urban regions, like Riyadh, had the lowest (53 per 100 000). A strong negative correlation existed between population size and specialist density (r = −.748, P < .001). OB/GYN bed availability was the strongest predictor of specialist distribution (β = .908, P < .001).Conclusions:This nationwide analysis highlights significant disparities in the distribution of OB/GYN specialists across Saudi Arabia. Urban regions are underserved relative to their population size, while rural regions often lack adequate infrastructure to support existing specialists. Addressing these imbalances through equitable workforce planning and infrastructure investment is crucial for enhancing maternal and neonatal outcomes in alignment with Vision 2030 goals.

BackgroundMobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, particularly in sub-Saharan African countries. Poor-quality clinical decision-making is known to be associated with poor pregnancy and birth outcomes. This study aims to assess the effect of a clinical decision-making support system (CDMSS) directed at frontline health care providers on neonatal and maternal health outcomes.Methods/designA cluster randomized controlled trial will be conducted in 16 eligible districts (clusters) in the Eastern Region of Ghana to assess the effect of an mHealth CDMSS for maternal and neonatal health care services on maternal and neonatal outcomes. The CDMSS intervention consists of an Unstructured Supplementary Service Data (USSD)-based text messaging of standard emergency obstetric and neonatal protocols to providers on their request. The primary outcome of the intervention is the incidence of institutional neonatal mortality. Outcomes will be assessed through an analysis of data on maternal and neonatal morbidity and mortality extracted from the District Health Information Management System-2 (DHIMS-2) and health facility-based records. The quality of maternal and neonatal health care will be assessed in two purposively selected clusters from each study arm.DiscussionIn this trial the effect of a mobile CDMSS on institutional maternal and neonatal health outcomes will be evaluated to generate evidence-based recommendations for the use of mobile CDMSS in Ghana and other West African countries.Trial registrationClinicalTrials.gov, identifier: NCT02468310. Registered on 7 September 2015; Pan African Clinical Trials Registry, identifier: PACTR20151200109073. Registered on 9 December 2015 retrospectively from trial start date.

Maternal and newborn care has been a primary focus of performance-based financing (PBF) projects, which have been piloted or implemented in 21 countries in sub-Saharan Africa since 2007. Several evaluations of PBF have demonstrated improvements to facility delivery or quality of care. However, no studies have measured the impact of PBF programmes directly on neonatal health outcomes in Africa, nor compared PBF programmes against another. We assess the impact of PBF on early neonatal health outcomes and associated health care utilization and quality in Burundi, Lesotho, Senegal, Zambia and Zimbabwe. We pooled Demographic and Health Surveys and Multiple Indicator Cluster Surveys and apply difference-in-differences analysis to estimate the effect of PBF projects supported by the World Bank on early neonatal mortality and low birthweight. We also assessed the effect of PBF on intermediate outputs that are frequently explicitly incentivized in PBF projects, including facility delivery and antenatal care utilization and quality, and caesarean section. Finally, we examined the impact among births to poor or high-risk women. We found no statistically significant impact of PBF on neonatal health outcomes, health care utilization or quality in a pooled sample. PBF was also not associated with better health outcomes in each country individually, though in some countries and among poor women PBF improved facility delivery, antenatal care utilization or antenatal care quality. There was no improvement on the health outcomes among poor or high-risk women in the five countries. PBF had no impact on early neonatal health outcomes in the five African countries studied and had limited and variable effects on the utilization and quality of neonatal health care. These findings suggest that there is a need for both a deeper assessment of PBF and for other strategies to make meaningful improvements to neonatal health outcomes.