Antenatal Counseling Research Articles

Maternal Cannabis Use Disorder and Neonatal Health Outcomes: A Data Linkage Study.

We tested for the potential associations between maternal antenatal cannabis use disorders (CUD) and neonatal health outcomes using large linked administrative data. Population-based retrospective cohort study. The study was conducted in New South Wales, Australia. A total of 215 879 singleton live births. Generalised linear models (GLMs) fitted using log-binomial regression to estimate risk ratios (RRs) with the corresponding 95% confidence intervals (95% CI). Additionally, we conducted a propensity score matching (PSM) analysis. The outcomes include preterm births (PTB), low birth weight (LBW), small for gestational age (SGA), 5-min lower Apgar scores and admission to the neonatal intensive care unit (NICU). In unmatched analyses, antenatal CUD was associated with increased risks for all adverse neonatal outcomes (adjusted risk ratio [RR] ranging from 1.47 [95% CI: 1.01, 2.14] for 5-min lower APGAR scores to 2.58 [95% CI 2.28, 2.91] for PTB). In PSM analyses, we observed slightly attenuated risks of PTB (RR = 1.98 [1.70, 2.31]), LBW (RR = 2.46 [2.13, 2.84]), SGA (RR = 1.84 [1.44, 2.35]) and admission to NICU (RR = 1.91 [1.49, 2.45]) after matching by covariates. However, we found no significant association between antenatal CUD and 5-min low APGAR scores (RR = 1.47 [0.94, 2.30]). We found that maternal antenatal exposure to CUD is associated with a range of adverse neonatal outcomes. This study highlights that targeted interventions focusing on antenatal counselling are recommended to mitigate risks associated with maternal cannabis use.

Antenatal counselling at the cusp of viability and parental decision-making in the zone of parental discretion: A cohort study.

Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision-making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion. Single centre retrospective cohort study. Sixteen thousand three hundred fifty-four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty-seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty-six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29). Thirty-six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty-eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling. Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population.

Stillbirth prevention with counseling during antenatal care visits in pregnant women: A systematic review

At important stages in women's lives, antenatal care (ANC) serves as a means of communication for women, their families and communities. This study aimed to determine the effectiveness of counseling during ANC as an intervention to prevent stillbirths. Narrative studies with scientific journal database sources published in PubMed, EBSCO and Science Direct were used. This study was conducted during September–November 2023. The keywords used were stillbirth, counseling, ANC, and pregnancy, and the search included research published within five years of the study. A total of 185 articles were found, and 12 articles were selected for review. The findings indicate that an effective intervention to prevent stillbirth can be carried out through counseling during ANC visits. Antenatal counseling is the intervention of choice to change the behavior of pregnant women and health workers and improve the quality of ANC as a strategy for preventing stillbirths. ANC counseling topics that are effective in preventing stillbirth include weight control, breastfeeding, nutrition, physical activity, alcohol, smoking, HIV, drugs, and safe medication during pregnancy. By enhancing the quality of ANC and focusing on education and support, healthcare providers can play a crucial role in preventing stillbirths and promoting maternal and infant health.

Analyzing women’s knowledge of pregnancy complications in Ethiopia through a multilevel approach

Pregnancy complications can’t always be predicted. However, pregnant women must be aware of these pregnancy complications to avoid serious complications and begin treatment as soon as possible. Maternal mortality can be decreased by offering high-quality maternity services and educating women about the early warning signs of pregnancy. Therefore, the current study aimed to assess individual and community-level factors associated with women’s knowledge about pregnancy complications in Ethiopia based on the 2019 Ethiopian mini-demographic health survey data (EMDHS). The study analyzed data from the 2019 EMDHS, including a weighted sample of 1,655 reproductive-age women. Multilevel binary logistic regression analysis was used to fit the associated variables. Using the interclass correlation (ICC), deviance, proportional change variance (PVC), and median odds ratio (MOR), the comparison and fit of the models were evaluated. The significant variables associated with knowledge about complications during pregnancy were identified using an adjusted odds ratio (AOR) and a 95% confidence interval (CI). The proportion of mothers with good knowledge of pregnancy complications was 44.8% (CI 42.4%–47.2%). The multi-level analysis revealed that secondary education (AOR = 1.54, 95% CI = 1.04–2.29), a higher education level (AOR = 1.74, 95% CI = 1.11–2.72), four and above ANC Visits (AOR = 0.74, 95% CI = 0.49–0.98), women who lived in Amhara (AOR = 2.10, 95% CI = 1.24–3.55), and SNNPR (AOR = 3.92, 95% CI = 2.10–7.31) were positively associated with knowledge about pregnancy complications while, women residing in Harari (AOR = 0.20, 95% CI = 0.98–0.44) and Dire-Dawa (AOR = 0.48, 95% CI = 0.24–0.95) were negatively associated with knowledge about pregnancy complications. This study found that nearly half (44.8%) of the study participants demonstrated knowledge about pregnancy complications. This suggests a significant gap in awareness that could potentially impact access to obstetric care for women experiencing complications during pregnancy. Therefore, prioritizing enhancements in antenatal counseling services and community health education regarding pregnancy complications is crucial.

Positioning comfort measures in antenatal counselling for periviable infants.

Caring for the extremely premature infant born in the grey zone of viability is the most difficult area of neonatal medicine. Little research has been done on antenatal communication between neonatologists and parents anticipating the birth of a periviable infant. This article analyses 25 antenatal consultations between neonatologists and parents in one Midwestern hospital in the United States of America. It explores how neonatologists position comfort care as one of two predominant care trajectories for extremely premature infants born into the grey zone of viability. We found comfort care featured minimally in and was often marginalised by neonatologists' language. The two dominant discourses contributing to this were acute medicine's life-saving capacity and a limited temporal window marked by gestational age where comfort measures were deemed appropriate. Antenatal consultations framed by shared decision-making could be approached as a form of care characterised by a relational openness and responsiveness to parents' views on care. This asks neonatologists to enter antenatal consultations for periviability without knowing ahead of time which care trajectory will necessarily call one's attention or the particular response one should take, thus highlighting the skills of reflexivity in addition to an attentiveness and openness towards those receiving care.

The Contribution of Hypertensive Disorders of Pregnancy to Neonatal Unit Admissions and Iatrogenic Preterm Delivery at < 34+0 Weeks' Gestation in the UK: A Population-Based Study Using the National Neonatal Research Database.

The objectives of this study were to (i) quantify the contribution of maternal hypertensive disorders of pregnancy (HDP) to iatrogenic preterm birth (PTB) and neonatal unit (NNU) admissions < 34+0 weeks and (ii) describe short-term population-level outcomes for HDP infants, exploring ethnic disparities and comparing outcomes by HDP exposure. Retrospective population-based study using the National Neonatal Research Database. England and Wales. Infants born < 34+0 weeks and admitted to NNU 2012-2020. Descriptive statistics, linear and logistic regression models to compare outcomes between groups. Survival to discharge with/without comorbidity. 122 228 infants met inclusion criteria. Where collected, 49 839/114 164 (43.7%, 95% CI 43.4%-43.9%) of infants had an iatrogenic PTB. HDP was recorded in 16 510/122 228 (13.5%) of all infants and 13 560/49 839 (27.2%) of iatrogenic PTBs. HDP and/or foetal growth restriction (FGR) were recorded in 24 124/49 839 (48.4%) of iatrogenic PTBs. Singleton HDP infants < 10th BWC had ≥ 90% survival to discharge from 28 weeks' gestation, versus from 26 weeks' gestation for those born ≥ 10th BWC. In extreme preterm HDP infants (< 27 weeks), 27.3% of infants < 10th BWC died compared to 15.2% of those ≥ 10th BWC. Survival without comorbidity was ≥ 90% from 32 weeks' gestation in HDP infants across BWC. These contemporaneous population-level data show that almost one in two PTB < 34+0 weeks' gestation are iatrogenic, with HDP and/or FGR being the major contributors to iatrogenic prematurity. This has substantial implications for strategies to reduce preterm birth in the UK and internationally. The data further inform antenatal and at-birth counselling of HDP-exposed infants.

Investigating Vitamin D Status: A Key Factor in Gestational Diabetes among Pregnant Women

Background: Vitamin D deficiency within the general population suggests the emergence of glucose intolerance. The relationship between insufficient vitamin D levels and gestational diabetes mellitus remains a subject of ongoing discussion. Objectives: The investigation looked into the connection between vitamin D levels and the chances of developing gestational diabetes mellitus. Methodology: This cross-sectional analytic study includes 262 pregnant women who attended the Gestational Diabetes Center and Antenatal Counseling Center at the Maternity Teaching Hospital in Sulaimani City. The study used convenience sampling, and the data was collected from November 1st, 2021, to October 1st, 2022. The study used a specific questionnaire divided into four sections: demographics, medical, and obstetric. Simultaneously, the Roche Elecsys vitamin D3 assay determined serum vitamin D status. Results: Women with gestational diabetes mellitus had a significantly higher prevalence of vitamin D inadequate levels (p =0.000), Significant variance in residency (p =0.000), education (p =0.000), body mass index (p =0.038), age at marriage (p =0.023), history of using the contraceptive pill (p-value =0.000), parity (p =0.001), and gravidity (p =0.014) were additionally identified between the two groups of gestational diabetes mellitus and non-gestational diabetes mellitus. Conclusion: Women with gestational diabetes mellitus had higher rates of vitamin D deficiency than those without, but the differences were not statistically significant.

Considerations for Antenatal Milk Expression Education and Counseling in Clinical Settings.

Considerations for Antenatal Milk Expression Education and Counseling in Clinical Settings.

What Is Culture Made of? An Exploratory Study of Ethical Cultures and Provider Perspectives on the Care of Periviable Neonates

Objective Studies examining intercenter variation in neonatal intensive care unit practices at the limits of fetal viability have hypothesized that institutional “culture” can be one of many factors that impact patient care. This study aimed to describe institutional culture at a single, large academic center with regard to the antenatal consultation, resuscitation, and postnatal management of periviable neonates. Study Design Members of six clinical groups—attending and fellow maternal–fetal medicine physicians, attending and fellow neonatal–perinatal medicine physicians, neonatal nurses, advanced practiced neonatal nurses, pediatric hospitalist physicians, and neonatal respiratory therapists—were invited to complete qualitative, semi-structured interviews. All audio recordings were transcribed. Dedoose software was used to complete team-based coding and thematic analysis. Results Twenty-two interviews were completed. Thematic analysis revealed three central themes described by participants as contributory to institutional culture: Perception, referring to factors based on individual attitudes and insights, Statements of Information, referring to factors anchored in more objective concepts such as outcomes data and institutional policy, and Dynamic Factors, referring to the relatively fluid factors of institutional culture that interact with both Perception and Statements of Information. Participants were more likely to mention factors in the Perception category (n = 430) compared with factors in the Information category (n = 225), and although the latter were described as critical components of antenatal counseling and perinatal management, the philosophy of our unit appeared to be more heavily rooted in institutional memory and individual belief systems. Conclusion Our data demonstrate a personal undertone to institutional culture at the limits of viability, with an emphasis on individual attitudes and subjective interpretations of fact rather than empirical data. As the landscape of neonatology continues to change, understanding those factors that contribute to culture remains a necessary step toward deconstructing institutional belief systems and optimizing clinical care. Key Points

Epidemiology of intrapartum stillbirth and associated factors among women who gave childbirth in Ethiopia: systematic review and meta-analysis

BackgroundStillbirth always resulted in a multi-dimensional impact from the individual level to the country level at large. It causes psychological depression, social stigmatization, and decreased quality of life for women. Despite several studies conducted in Ethiopia, no national pooled estimates were done. Therefore, this systematic review and meta-analysis sought to assess intrapartum stillbirth and associated factors among women who had childbirth in Ethiopia using the available published evidence.MethodsThe current review included studies conducted in Ethiopia. The databases used primarily were Medline/PubMed, Google Scholar, Scopus, Web of Science, Ethiopian University Repository Online, CINAHL, African Journals Online and Cochrane Library. All cross-sectional studies conducted in English and met eligibility criteria were included in the final review. A random-effects meta-analysis was performed. Data extraction and analysis were also performed using Microsoft Excel and STATA version 14 software respectively.ResultsIn the current review, eleven studies were included, and their quality was assessed before being chosen for the final review. The pooled prevalence of intrapartum stillbirth among women who had childbirth in Ethiopia was 9.21% [95% CI (7.03%, 11.39%); I2 = 90.2, P = 0.000]. Women with a previous history of stillbirth [OR = 5.14, 95% CI (3.53–6.75), I2 = 60.0%, p = 0.04] and had no use of antenatal care {[OR = 0.43, 95% CI (0.18–0.68) I2 = 85.3%, p = 0.001]} were significantly associated with intrapartum stillbirth among women who gave childbirth. ConclusionsNearly one-tenth of women who had childbirth in Ethiopia had an intrapartum SB. Revitalizing the existing health extension package particularly family health services with emphasis on focused antenatal care and counselling as well as with prompt referral system would reduce intrapartum SB. This review calls for the need to assess the quality of ANC provision and tailor targeted interventions to best improve the service quality.

Qualitative evaluation of a package of implementation strategies codesigned to support the introduction of multiple micronutrient supplementation (MMS) for pregnant women in Bamako, Mali.

Mali national policy recommends that women take iron and folic acid supplements (IFA) from the time of the first antenatal care (ANC) visit, throughout pregnancyand during the first 3 months after delivery. In 2020, the World Health Organization (WHO) updated their ANC guidelines to recommend the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) formulation of multiple micronutrient supplements (MMS) in the context of rigorous research, including implementation research. In Bamako, Mali, a codesign process was used to tailor antenatal care MMS packaging and counselling materials aimed at optimizing delivery and uptake of and adherence to MMS. This paper presents the codesign process along with the results of a post-intervention qualitative assessment to evaluate the behaviour change intervention. At the conclusion of the intervention, we conducted semistructured qualitative interviews with 24 women who had received the intervention and six pharmacy managers from the six health centres participating in the study. We conducted two focus groups with midwives who had delivered the intervention and two group discussions with family members of women who had received the intervention. Respondent perspectives reveal an easy experience transitioning from previously used IFA. Women and providers concur that the intervention counselling materials and visual aids were instrumental in influencing the perceived benefit and uptake of MMS. Family members play an influential role in pregnant women's decision-making regarding MMS uptake. MMSand the associated implementation strategies developed through the codesign process were found to be a highly acceptable intervention.

Postpartum contraception provision across Europe: preliminary findings from a multi country survey

Introduction Looking after a baby and recovering from birth pose barriers to accessing and initiating effective contraception in the postpartum period. Another pregnancy at this time can end in abortion or a short interbirth interval. These are preventable if contraception is provided immediately from maternity settings. Our aim was to survey contraceptive experts across Europe about provision of postpartum contraception (PPC) in their country to develop a greater understanding of availability of and delivery of PPC services within the region. Materials and Methods Contraceptive experts across Europe were invited to participate in an anonymous mixed-methods online survey consisting of free text and fixed-response questions focusing on: (1) national guidelines/policy (2) antenatal contraceptive discussion and (3) immediate postpartum provision of methods. Respondents were asked to rate PPC provision in their region and detail perceived facilitators or barriers. Results Experts from 28 countries completed the survey. Fifteen (40%) reported their country had national guidelines for PPC provision, 40% reported that some antenatal contraceptive counselling was offered and 51% reported that contraceptive methods were provided in some (43%) or all (8%) maternity settings. Country-level PPC provision was reported as ‘poor’ or ‘very poor’ by 54% of respondents. Reported barriers to PPC provision included: cost, lack of policy/government support, awareness and training of maternity staff. Conclusions There is significant variation in PPC provision across Europe. Few countries offer antenatal contraceptive counselling or provide contraception from maternity settings. Introduction of supportive PPC policies, funding and training for staff could improve outcomes for mothers and babies.

Acceptance of contraception in couples receiving contraceptive counselling in antenatal period.

Objective: To conduct research in order to determine the effect that antenatal counseling has on the use of contraception during the immediate postpartum period in the conservative society that exists in the rural areas surrounding Lahore, Pakistan. Study Design: Randomized Clinical Trial. Setting: Central Park Teaching Hospital in Lahore, Pakistan. Period: Jan, 2022 to April, 2022. Methods: A random selection was used to divide 400 antenatal patients who were at least 28 weeks along in their pregnancies into two groups. Patients who did not receive antenatal counseling regarding birth control options were included in Group X while patients who received antenatal counseling regarding the use of birth control were included in Group Y. A pre-designed proforma was completed following a written informed consent. Data was analyzed using SPSS 26. Results: Data was collected from 400 females (200 in each group) who visited CPTH. The mean age of the female participants was 27.26 + 4.78 years. Most of the participants lived in extended family systems. Nearly one third of the females was illiterate or has primary level of education. Approximately one-fourth of the females were graduated or above. After first pregnancy, 68% in group I and 86% in group II mentioned that they used contraceptive method, (p = 0.005, statistically significant). After second and fifth pregnancy, effect of counseling was affective and difference was statistically significant. The most common contraceptive method was barrier method followed by injection after first and second pregnancy. Conclusion: Antenatal contraceptive counseling proves to be a highly effective intervention in enhancing the acceptance and utilization of contraceptives within the conservative societies of Pakistan. Health care providers ought to undergo comprehensive training and exhibit unwavering motivation in order to effectively engage in antenatal contraceptive counseling.

Association of antenatal counselling with breastfeeding outcomes: a comparative analysis

Background: Breastfeeding is an art and a skill which needs to be learnt and mastered. Breastfeeding practice gets affected by many factors like Social, cultural, biophysical, demographic and psychological. One of the important factors for ineffective breastfeeding is the lack of adequate knowledge of women regarding breastfeeding, such as the time of initiation of feeding, feeding of colostrum and mother’s position while feeding the baby. Objective of the study was to find out association of antenatal counselling with the preference for breastfeeding positions, early initiation of breastfeeding and feeding of colostrum. Methods: This was a prospective cohort study where 120 primigravida who had taken structured counseling on breastfeeding during their antenatal period and ended up with vaginal delivery at labour room of SSG Hospital, Baroda were recruited. With every such mother, the next woman who delivers vaginally and has not taken structured counselling during ANC was taken as the control. After delivery, all the mothers were observed for early initiation of breastfeeding, feeding of colostrum and adoption of cross-cradle breastfeeding position in comparison with other positions. Results: The rate of early initiation of breastfeeding (EIBF) and number of mothers who fed colostrum to their babies was significantly higher in case group compared to the control group. The number of mothers preferring the cross cradle position was also higher in case group. Conclusions: Antenatal counseling on breastfeeding helps mothers to raise the rate of early initiation of breastfeeding and feeding of colostrum to babies. It also helped mothers to choose cross cradle position as their preferred method of breast feeding.

Clinical characteristics and outcome of omphalocele and gastroschisis: a 20-year multicenter regional experience.

Omphalocele and gastroschisis are the most common types of abdominal wall defects. Comprehensive local experience helps parents to make decisions on the pregnancy and foresee the disease journey. A retrospective review of abdominal wall defect patients in all three pediatric surgical centers in Hong Kong between January 2003 and February 2023 was conducted. All patients consecutively diagnosed with omphalocele and gastroschisis were included, excluding other forms. Data of demographics and short- and long-term outcome parameters were collected. A total of 99 cases were reviewed and 85 patients met the inclusion criteria. Diagnoses include omphalocele major (n = 49, 57.6%), omphalocele minor (n = 22, 25.9%) and gastroschisis (n = 14, 16.5%), with mean gestational age 37weeks (SD 2.2) and birth weight 2.7kg (SD 0.6). Omphalocele is most commonly associated with cardiovascular (n = 28, 39.4%) and chromosomal defects (n = 11, 15.5%). Surgical procedures including primary repair (n = 38, 53.5%), staged closure (n = 30, 42.3%) with average 8.6days (SD 4.7) of silo reduction, and conservative management (n = 3, 4.2%) were performed. The mortality rate was 14.1% (n = 10) and the complication rate was 36.6% (n = 26). The majority of patients had normal intellectual development (92.5%) and growth (79.2%) on the latest follow-up. For gastroschisis, one patient (7.1%) had intestinal atresia. Surgical procedures included primary repair (n = 9, 64.3%) and staged closure (n = 5, 35.7%) with average 8days (SD 3.5) of silo reduction. Complication rate was 21.4% (n = 3), with one mortality (7.1%). All patients had normal intellectual development and growth. The mean follow-up time of this series is 76.9months (SD 62.9). Most abdominal wall defects in our series were managed surgically with a good overall survival rate and long-term outcome. This information is essential during antenatal and postnatal counseling for parents.

Evaluation of change in knowledge, attitude, and practice of medical students towards early childhood oral health following educational intervention

Medical health professionals have the opportunity to influence the oral health of children, as they are the first health professionals to come in contact with expectant mothers and parents of infants and toddlers. Aim: To evaluate and compare undergraduate medical students’ knowledge, attitude, and practice about early childhood oral health care before and after educational intervention. Methods: A cohort study was conducted among undergraduate medical students during their course. The baseline knowledge and attitude of 80 medical students were evaluated using a validated questionnaire (Phase I). Following, they completed 8 hours of educational intervention and their change in the knowledge and attitude was reassessed (Phase II). The intervention continued through web-based learning till they reached their residency. The students’ knowledge, attitude, and practice were again reassessed at the end of their residency (Phase III). Results: Knowledge: There was a significant increase in the knowledge about the term gum pads, from 70% in Phase I to 90% in Phase III. Only 30% of medical students knew that the oral cavity of a newborn was devoid of microorganisms during Phase I, but this knowledge improved to 86% in Phase III. Almost 58 to 90% of the medical students had a basic knowledge of the influence of high caries on mothers, the importance and benefit of antenatal counselling, and the effect of poor maternal health. In Phase I, although 92% were aware of the multifactorial pattern of dental caries, only 42% and 53% knew the causative organism and transmissibility of it from mother to child, respectively. Around 77% and 62% agreed that antenatal counselling and counselling on feeding and weaning, respectively, will prevent ECC. Attitude: The attitude towards treating primary teeth was less (66%) in Phase I, subsequently increasing to 100% at the end of Phase III. Practice: Following Phase III, most of them (88%) examined the child’s oral cavity during routine medical checkups in the Knee-to-Knee position (93%) and counted the number of teeth present (91%), and they were able to identify the dental carious teeth (88%). Conclusion: The medical curriculum should include a module on early childhood oral health.

Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review.

Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling. An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition. Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines. Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

The Impact Of Exclusive Breastfeeding Promotion On Increasing The Interest Of Pregnant Women In Exclusive Breastfeeding

Introduction: Promotion of exclusive breastfeeding is one of the important efforts to increase breastfeeding practices. However, the extent to which the promotion of exclusive breastfeeding affects the interest of pregnant women in providing exclusive breastfeeding still needs to be further examined. This study aims to conduct a systematic review of studies examining the impact of exclusive breastfeeding promotion on increasing the interest of pregnant women in providing exclusive breastfeeding. Materials &amp; Methods: Literature searches were conducted on electronic databases such as PubMed, Embase, and the Cochrane Library. Articles that meet the inclusion criteria will be analyzed narratively. Results: The results of the systematic review show that comprehensive promotion of exclusive breastfeeding, including antenatal education, counseling, and postpartum support, significantly increases the interest and practice of pregnant women in providing exclusive breastfeeding. Factors such as the involvement of health workers, families, and the social environment also contribute to increasing maternal interest. Conclusions: Promotion of exclusive breastfeeding that is carried out comprehensively and integrated into the health care system has been proven effective in increasing the interest of pregnant women to provide exclusive breastfeeding. These interventions need to consider the local cultural, economic, and health system contexts.

Dilatative fetal cardiomyopathy followed by amirror syndrome.

Mirror syndrome (Ballantyne syndrome) is arare condition characterized by maternal edema, which often affects the lungs. It mirrors the image of fetal and placental edema; therefore, it is also called triple edema. We present the case of a37-year-old secundigravida, referred to our clinic at 26weeks of apregnancy complicated by fetal dilatative restrictive cardiomyopathy and hydrops, placentomegaly, new-onset dyspnea, and maternal calf edema. Due to worsening mirror syndrome, preterm labor was induced. Labor was complicated, with soft tissue dystocia, stillbirth, and postpartum hemorrhage. The first pregnancy was also complicated by fetal right ventricular noncompaction dilatative cardiomyopathy. Aeutrophic male child was born vaginally at term and died due to deterioration of the cardiac disease in the third year of life. Next-generation sequencing panel for pediatric cardiology was performed in the deceased child and parents. Two gene variants were recorded: MYOM1: c.770_771delCA (p.Thr257fs) and TPM1: c.814G>A (p.Glu272Lys). Both variants were classified as variants of uncertain significance. This case emphasizes the importance of antenatal counseling, the timing of labor induction, appropriate management of possible complications such as postpartum hemorrhage and soft tissue dystocia, and the interpretation of placental biomarkers in the context of mirror syndrome. Finally, it contributes to understanding the clinical significance of the MYOM1 and TPM1 gene variants.

A rare case of polysplenia syndrome associated with atrioventricular canal defect and type four ileal atresia in a preterm neonate: A case report and literature review

Antenatal diagnosis of heterotaxy syndrome is only the tip of the iceberg. These neonates can have a myriad of multi-system anomalies, each of which requires anticipation and an individualized management plan. The spectrum of heterotaxy syndrome ranges from incidentally detected innocuous anomalies to major life-threatening congenital malformations such as atrioventricular canal defects and bowel atresia. Neonatal sepsis tends to be more fulminant and catastrophic in these neonates with complex anomalies and poor outcomes that necessitates better-informed antenatal counseling regarding the termination of such pregnancies.