Antenatal Interventions Research Articles

Impact of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal - the VALID randomized controlled trial

IntroductionCounseling, together with iron and folic acid supplements, can improve hemoglobin levels in pregnant women, but few interventions have tested a virtual method of delivering counseling. We hypothesized that a virtual counseling intervention delivered via a mobile device (mHealth) would prevent and treat anemia, compared with routine antenatal care (ANC).MethodsVirtual antenatal intervention for improved diet and iron intake (VALID) was a non-blinded parallel group two-arm, individually randomized superiority trial (1:1 allocation). Participants were pregnant women who were married, aged 13–49 years, able to answer questions, 12–28 weeks’ gestation and living in Kapilvastu district, Nepal. Women were randomized to receive routine ANC (control arm), or ANC plus a virtual antenatal intervention of two problem-solving counseling sessions via video call. The primary outcome was iron folic acid (IFA) tablet compliance (consumption on 12 or more days of the previous 14 days). Secondary outcomes were dietary diversity, promoted food consumption, iron bioavailability enhancement, and knowledge of iron-rich foods. Primary logistic regression analysis was by intention-to-treat, adjusting for baseline values.ResultsWe enrolled 319 pregnant women (161 control, 158 intervention) from 23 January 2022 to 6 May 2022 and analyzed outcomes in 144 control and 127 intervention women. Compliance with IFA increased in both arms. In the intervention arm, compliance increased by 29.7 percentage points (pp) (49.0–78.7%) and 19.8 pp. in the control arm (53.8–73.6%). Despite the more significant increase in the intervention arm, we found no intervention effect upon IFA compliance (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI]: 0.75, 2.35; p = 0.334), dietary diversity, or ANC visits. The intervention increased knowledge of iron-rich foods (coefficient 0.96; 95% CI: 0.50, 1.41; p < 0.001), consumption of promoted foods (aOR: 1.81; 95% CI: 1.08, 3.02; p = 0.023), behavior to enhance iron bioavailability (aOR: 4.41; 95% CI: 1.23, 15.83; p = 0.023), and coronavirus disease 2019 (COVID-19) knowledge (aOR: 4.06; 95% CI: 1.56, 10.54; p = 0.004). The total intervention cost was US$35,193, and the cost per pregnant woman receiving two virtual counseling sessions was US$277.ConclusionVirtual counseling can improve antenatal health behaviors, such as the consumption of promoted foods and methods to enhance bioavailability. Improved IFA consumption and ANC attendance may require additional family/community support.Clinical trial registrationhttps://www.isrctn.com/ISRCTN17842200, identifier ISRCTN17842200.

Initiation and continued use of oral pre-exposure prophylaxis among pregnant and postpartum women in South Africa (PrEP-PP): a demonstration cohort study

When used effectively, oral pre-exposure prophylaxis (PrEP; tenofovir disoproxil fumarate and emtricitabine) prevents maternal HIV acquisition and reduces the risk of vertical transmission. Our study aimed to better understand PrEP initiation, continued use, and adherence in pregnant and postpartum women. The PrEP in Pregnancy and Postpartum (PrEP-PP) study is a demonstration cohort study that enrolled pregnant women aged 16 years and older without HIV attending their first antenatal care visit in Cape Town, South Africa, between Aug 29, 2019, and Oct 10, 2021. Eligible, consenting women were followed up quarterly up to 12 months postpartum with regular HIV testing and offer of PrEP with ongoing adherence counselling. The primary outcome was distribution of women across the PrEP cascade (ie, initiation and continuation up to 12 months postpartum) with crude and adjusted hazard ratios (HRs). We also report on HIV incidence by pregnancy and postpartum status. Overall, 1195 pregnant women were recruited and followed up (median age 26 years, IQR 23-31; median gestational age 21 weeks, IQR 15-31); 1009 (84·4%) started PrEP at enrolment. Among women who initiated PrEP at enrolment, 668 (67·5%) of 990 continued PrEP at the 1-month follow-up, 485 (49·9%) of 972 continued at 3 months, 392 (39·4%) of 994 at 6 months, and 275 (27·4%) of 1005 at 12 months. Of 186 women who did not accept PrEP at enrolment, 70 (37·6%) of 186 subsequently initiated PrEP. Overall, 200 (18·6%) of 1076 women continued PrEP at 12 months postpartum. Of 186 women who did not initiate PrEP at baseline, 70 (37·6%) subsequently initiated PrEP during the study. Factors associated with PrEP discontinuation up to 12 months postpartum included being married or cohabiting (adjusted HR 1·32, 95% CI 1·16-1·50), condomless sex since last visit (1·43, 1·23-1·65), reporting intimate partner violence (2·03, 1·59-2·59), or depression in the past 12 months (1·53, 1·14-2·05). Overall, 16 women seroconverted over 1673·8 woman-years (HIV incidence rate 0·96 per 100 woman-years, 95% CI 0·49-1·42); 14 discontinued PrEP use and two never initiated PrEP. HIV incidence was 0·28 per 100 woman-years during pregnancy (95% CI 0·22-0·33), and the incidence rate ratio was 1·77 per 100 woman-years (0·53-5·90) 0-6 months postpartum and 2·19 per 100 woman-years (0·61-7·83) 6-12 months postpartum compared with pregnant women. There is an urgent need for the integration of PrEP into antenatal and postnatal care and interventions that address barriers to continued use, including targeted counselling during pregnancy and postpartum to reduce PrEP discontinuation. National Institute of Mental Health and Fogarty International, US National Institutes of Health. For the French translation of the abstract see Supplementary Materials section.

Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis.

Health risks associated with short interpregnancy intervals, coupled with women's desires to avoid pregnancy following childbirth, underscore the need for effective postpartum family planning programs. The antenatal period provides an opportunity to intervene; however, evidence is limited on the effectiveness of interventions aimed at reaching women in the antenatal period to increase voluntary postpartum family planning in low- and middle-income countries (LMICs). This systematic review aimed to identify and describe interventions in LMICs that attempted to increase postpartum contraceptive use via contacts with pregnant women in the antenatal period. Studies published from January 2012 to July 2022 were considered if they were conducted in LMICs, evaluated an intervention delivered during the antenatal period, were designed to affect postpartum contraceptive use, were experimental or quasi-experimental, and were published in French or English. The main outcome of interest was postpartum contraceptive use within 1 year after birth, defined as the use of any method of contraception at the time of data collection. We searched EMBASE, Global Health, and Medline and manually searched the reference lists from studies included in the full-text screening. We double-screened 771 records and included 34 reports on 31 unique interventions in the review. Twenty-three studies were published from 2018 on, with 21 studies conducted in sub-Saharan Africa. Approximately half of the study designs (n=16) were randomized controlled trials, and half (n=15) were quasi-experimental. Interventions were heterogeneous. Among the 24 studies that reported on the main outcome of interest, 18 reported a positive intervention effect, with intervention recipients having greater contraceptive use in the first year postpartum. While the studies in this systematic review were heterogeneous, the findings suggest that interventions that included a multifaceted package of initiatives appeared to be most likely to have a positive effect.

Prevalence and risk factors of curable sexually transmitted and reproductive tract infections and malaria co-infection among pregnant women at antenatal care booking in Kenya, Malawi and Tanzania: a cross-sectional study of randomised controlled trial data

ObjectivesMalaria and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are associated with adverse pregnancy outcomes. This study reports the prevalence and risk factors of curable STIs/RTIs, STI/RTI co-infection and...

Effectiveness of "SAFAL MATRUTV GATS" (Stunting alleviation by facilitation of antenatal-postnatal-interventions for low birth weight reduction) - A peer-led self-empowerment group at rural villages in Eastern Maharashtra: Protocol for a pragmatic cluster randomized controlled trial.

Stunting or chronic malnutrition has been one of the major challenges to mankind for ages. The trends from the National Family Health surveys are more or less stagnant with a huge failure of the public health systems to tackle the problem of malnutrition. Innovative approaches are needed to tackle malnutrition. This pragmatic cluster randomized controlled trial (CTRI registration no. Trial REF/2023/08/071521) is planned to assess the effectiveness of a multifaceted antenatal and postnatal health educational intervention package implemented from the first trimester of pregnancy up to one year of infant age in reducing the rates of Low Birth Weight and improving the maternal-infant growth and developmental indicators in a cohort of rural pregnant women as compared to existing standards of care. Implication - The study emphasizes the importance of an ongoing continuum of care during the first 1000 days for effective birth weight, preventing malnutrition, and fostering infant growth and development as its programmatic pathway to impact. We anticipate that the intervention will complement the existing health programs and will be implemented through the grassroot-level workers along with a community peer named "Safalta Tai" enabling community ownership of the intervention. It also has a robust inbuilt monitoring and evaluation system through participatory action research for making it scalable and sustainable beyond the implementation period. The program leverages on the existing goverment programs like the poshan abhiyaan and the digital health mission. It has the potential to be incorporated in the exsiting health infrastructure without any additional resources and scaled up if found effective in reduction of low birth weight which is an important determinant of stunting in under five children.

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model.

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.

Breastfeeding behaviours in women with obesity; associations with weight retention and the serum metabolome: a secondary analysis of UPBEAT.

Maternal obesity is associated with a decreased intention and initiation of breastfeeding as well as a shortened duration of breastfeeding. This analysis was undertaken to identify breastfeeding behaviours, and relationships with maternal anthropometry and the serum metabolome at 6-months postpartum in an ethnically diverse cohort of women with obesity. A cohort analysis of 715 women from the UK Pregnancies Better Eating and Activity Trial (UPBEAT); a multi-centre randomised controlled trial of an antenatal lifestyle intervention in women with obesity. Maternal data were collected in early pregnancy and included body mass index (BMI), socio-demographic characteristics and anthropometry. At 6-months postpartum, breastfeeding behaviours, anthropometry and 158 maternal metabolic measures from blood samples were recorded. Kaplan-Meier curves of breastfeeding duration were constructed and were stratified by obesity class (I: BMI 30.0-34.9 kg/m2, II: 35.0-39.9 kg/m2, III: ≥40.0 kg/m2). Relationships between breastfeeding behaviours, socio-demographic characteristics, the metabolome, and anthropometry were determined using regression analyses. Eighty-two percent (591/715) of the cohort-initiated breastfeeding and at the 6-month follow-up 40% (283/715) were breastfeeding exclusively or partially. Duration of exclusive breastfeeding decreased with increasing BMI: Compared to BMI class I (mean 90.4 ± 64 days) the difference in mean for classes II and III were -15.8 days (95% confidence interval: -28.5, -3.1, p < 0.05) and -16.7 (95% CI: -32.0 to -1.35, p < 0.05), respectively. Compared to no breastfeeding, any breastfeeding at 6-months postpartum was associated with improvements in metabolites towards a healthier profile, reduced weight retention by -1.81 kg (95% CI -0.75, -2.88, p < 0.05 ) and reduced anthropometric measures, including mid-upper arm and hip circumferences. The breastfeeding related changes in anthropometry were not evident in women of Black ethnicity. Greater emphasis on enabling breastfeeding for women with obesity could improve duration, women's weight management and metabolic health. The lack of breastfeeding related anthropometric effects in Black women requires further investigation. ISRCTN reference 89971375.

Routine antenatal molecular testing for α-thalassemia at a tertiary referral hospital in China: ten years of experience.

This study aimed to evaluate the efficacy of α-thalassemia gene testing as a part of an antenatal intervention program over a 10-year period. All patients underwent α-thalassemia gene testing, which included the analysis of three types of deletions and mutations. Rare α-thalassemia gene testing was performed using Sanger sequencing, multiplex ligation-dependent probe amplification, and sequencing techniques. Prenatal diagnosis was performed in high-risk couples using chorionic villus sampling or amniocentesis. From 2010 to 2019, among the 91,852 patients examined, α-thalassemia mutations were identified in 41.78% of patients. The most frequent α0 gene mutation was--SEA, followed by--THAI. Two rare α0-thalassemia gene mutations at --32.8 and --230, were also observed. A total of 2,235 high-risk couples were identified, of which 562 were affected, including three with the--SEA/--THAI genotype and one with the--SEA/--230 genotype. Additionally, prenatal diagnosis revealed four cases of fetal anemia and/or mild edema, along with two cases of severe fetal edema. Chromosome and gene chip results were normal. Thalassemia gene testing showed an αCSα/αCSα genotype in four patients with anemia and/or mild edema, while two patients with severe fetal edema had one--SEA/αCSα genotype and one--SEA/--GX genotype. Using the cut-off points of 74.6fL and 24.4pg as criteria for identifying α0-thalassemia carriers and HbH disease, the detection rate of missed diagnoses in high-risk couples is consistent with national guidelines for standards, potentially saving 10,217,700 ¥. Routine molecular testing for α-thalassemia in high-risk prenatal populations effectively prevented severe α-thalassemia births. Despite the high cost, the cutoff points proposed by this study suggest that implementing screening using a new parameter has the potential to reduce current expenses.

Antenatal Determinants of Postnatal Renal Function in Fetal Megacystis: A Systematic Review.

Introduction: To evaluate the clinical usefulness of demographic data, fetal imaging findings and urinary analytes were used for predicting poor postnatal renal function in children with congenital megacystis. Materials and methods: A systematic review was conducted in MEDLINE's electronic database from inception to December 2023 using various combinations of keywords such as "luto" [All Fields] OR "lower urinary tract obstruction" [All Fields] OR "urethral valves" [All Fields] OR "megacystis" [All Fields] OR "urethral atresia" [All Fields] OR "megalourethra" [All Fields] AND "prenatal ultrasound" [All Fields] OR "maternal ultrasound" [All Fields] OR "ob-stetric ultrasound" [All Fields] OR "anhydramnios" [All Fields] OR "oligohydramnios" [All Fields] OR "renal echogenicity" [All Fields] OR "biomarkers" [All Fields] OR "fetal urine" [All Fields] OR "amniotic fluid" [All Fields] OR "beta2 microglobulin" [All Fields] OR "osmolarity" [All Fields] OR "proteome" [All Fields] AND "outcomes" [All Fields] OR "prognosis" [All Fields] OR "staging" [All Fields] OR "prognostic factors" [All Fields] OR "predictors" [All Fields] OR "renal function" [All Fields] OR "kidney function" [All Fields] OR "renal failure" [All Fields]. Two reviewers independently selected the articles in which the accuracy of prenatal imaging findings and fetal urinary analytes were evaluated to predict postnatal renal function. Results: Out of the 727 articles analyzed, 20 met the selection criteria, including 1049 fetuses. Regarding fetal imaging findings, the predictive value of the amniotic fluid was investigated by 15 articles, the renal appearance by 11, bladder findings by 4, and ureteral dilatation by 2. The postnatal renal function showed a statistically significant relationship with the occurrence of oligo- or anhydramnion in four studies, with an abnormal echogenic/cystic renal cortical appearance in three studies. Single articles proved the statistical prognostic value of the amniotic fluid index, the renal parenchymal area, the apparent diffusion coefficient (ADC) measured on fetal diffusion-weighted MRI, and the lower urinary tract obstruction (LUTO) stage (based on bladder volume at referral and gestational age at the appearance of oligo- or anhydramnios). Regarding the predictive value of fetal urinary analytes, sodium and β2-microglobulin were the two most common urinary analytes investigated (n = 10 articles), followed by calcium (n = 6), chloride (n = 5), urinary osmolarity (n = 4), and total protein (n = 3). Phosphorus, glucose, creatinine, and urea were analyzed by two articles, and ammonium, potassium, N-Acetyl-l3-D-glucosaminidase, and microalbumin were investigated by one article. The majority of the studies (n = 8) failed to prove the prognostic value of fetal urinary analytes. However, two studies showed that a favorable urinary biochemistry profile (made up of sodium < 100 mg/dL; calcium < 8 mg/dL; osmolality < 200 mOsm/L; β2-microglobulin < 4 mg/L; total protein < 20 mg/dL) could predict good postnatal renal outcomes with statistical significance and urinary levels of β2-microglobulin were significantly higher in fetuses that developed an impaired renal function in childhood (10.9 ± 5.0 mg/L vs. 1.3 ± 0.2 mg/L, p-value < 0.05). Conclusions: Several demographic data, fetal imaging parameters, and urinary analytes have been shown to play a role in reliably triaging fetuses with megacystis for the risk of adverse postnatal renal outcomes. We believe that this systematic review can help clinicians for counseling parents on the prognoses of their infants and identifying the selected cases eligible for antenatal intervention.

Duration of biophysical profile in periviable and very preterm low-risk pregnancies

BackgroundIn recent years, perinatal viability has shifted from 24 to 22 weeks of gestation at many institutions after improvements in survival in neonates delivered at the limit of viability. Monitoring these fetuses is essential since antenatal interventions with resuscitation efforts are available for patients at risk of delivery at the limit of viability. However, fetal monitoring as biophysical profile has not been extensively studied in very preterm pregnancies, particularly in the periviable period (20 weeks 0 days – 23 weeks 6 days). Objectives (i)To investigate whether the completion of biophysical profiles within 30 min is feasible in very preterm pregnancies. (ii) To determine the average observation time required to achieve a score of 8/8 in very preterm pregnancies from 20 weeks 0 days to 31 weeks 6 days. Study DesignThis study prospectively evaluated biophysical scores in singleton pregnancies undergoing routine ultrasonography at or near viability from 20 weeks 0 days to 23 weeks 6 days (periviable or group I), 24 weeks 0 days to 27 weeks 6 days (group II), and 28 weeks 0 days to 31 weeks 6 days (group III). The results and duration of biophysical profiles were compared to those of a control group (32 weeks 0 days to 35 weeks 6 days) undergoing indicated fetal surveillance. Biophysical profiles were performed on all studied pregnancies until a score of 8/8 was obtained. When more than one biophysical profile was obtained during pregnancy, each was analyzed individually. Pregnancies with fetal anomalies or obstetric/medical indications for fetal well-being surveillance were excluded. Analysis of variance and post-hoc Tukey’s test were used for comparisons. ResultsData was completed for 123 participants, yielding 79, 75, and 72 studies for groups I, II, and III, respectively. The control group included 42 patients, yielding 140 studies. At 30 min, 80% (63/79) of the studies in the periviable group had a score of 8/8, compared to 100% (140/140) in the control group (P<0.001). The mean + standard deviation time in minutes to achieve a biophysical score of 8/8 was 23.3 + 10.1 in the periviable group compared to 9.4 + 6.5 in controls (P<0.001). Extending the study to +2 standard deviations (43.6 min) in the periviable group resulted in 97% (77/79) of the scans scoring 8/8 in the absence of adverse outcomes. In the other groups, a biophysical score of 8/8 within 30 min was obtained in 97% (73/75) and 100% (72/72) in groups II and III, respectively; the mean + standard deviation times were 17.1 + 8.4 min (group II) and 13.1 + 7.3 min (group III). No adverse outcomes developed during the study participation in groups I–III. ConclusionsBiophysical scores of 8/8 can be successfully obtained in low-risk periviable pregnancies (20 weeks 0 days – 23 weeks 6 days) within an observation time longer than the standard 30 min. The time required to reach a score of 8/8 decreases as gestation progresses. We suggest adjusting the observation time for biophysical profile completion according to the gestational age.

Promoting informed decision making about maternal pertussis vaccination: the systematic development of an online tailored decision aid and a centering-based group antenatal care intervention.

Maintaining and enhancing vaccine confidence continues to be a challenge. Making an informed decision not only helps to avoid potential future regret but also reduces susceptibility to misinformation. There is an urgent need for interventions that facilitate informed decision-making about vaccines. This paper describes the systematic development of two interventions designed to promote informed decision making and indirectly, acceptance of maternal pertussis vaccination (MPV) in the Netherlands. The 6-step Intervention Mapping (IM) protocol was used for the development of an online tailored decision aid and Centering Pregnancy-based Group Antenatal Care (CP) intervention. A needs assessment was done using empirical literature and conducting a survey and focus groups (1), intervention objectives were formulated at the behavior and determinants levels (2), theoretical methods of behavior change were selected and translated into practical applications (3), which were further developed into the two interventions using user-centered design (4). Finally, plans were developed for implementation (5), and evaluation (6) of the interventions. The needs assessment showed that pregnant women often based their decision about MPV on information sourced online and conversations with their partners, obstetric care providers, and peers. Responding to these findings, we systematically developed two interactive, theory-based interventions. We created an online tailored decision aid, subjecting it to four iterations of testing among pregnant women, including those with low literacy levels. Participants evaluated prototypes of the intervention positively on relevance and usability. In addition, a CP intervention was developed with midwives. Using IM resulted in the creation of an online decision aid and CP intervention to promote informed decision making regarding MPV. This description of the systematic development of the interventions not only serves to illustrate design rationales, it will also aid the interpretation of the evaluation of the interventions, the development of future interventions promoting informed decision and acceptance of vaccines, and comparisons with other interventions.

Management, Outcome, Risk, and Expectation Classification for Structural Fetal Anomalies to Aid Antenatal Counseling: A Systematic Review.

The aim of this study was to propose Management, Outcome, Risk, and Expectation (MORE) as a risk based stratification to aid in antenatal parental counseling and decision making through a systematic review of published literature. A Preferred Reporting Items for Systematic Reviews and Meta Analyses compliant systematic review was conducted to include articles that covered antenatal counseling of pediatric surgical conditions. The following information was solicited for each anomaly: primary organ syste*-m of involvement, single or multi system anomaly, natural history of the disease, standard management of the anomaly, need for antenatal intervention, and whether the anomaly requires any alteration in the obstetric management. Twenty two studies were identified fulfilling the inclusion criteria, between 1993 and 2023. Only two studies were found to have GRADE A recommendation and Level I evidence. Most of the studies were review articles/ survey, and 6 studies were found to be retrospective observational studies. Based on the analysis of the solicited information, the anomalies were stratified into a group subsequently maturing them into a simplified MORE classification scheme which stressed the importance of Management (10, 45.45%), Outcome (9, 40.90%), Risk (9, 40.90%), and Expectation (10, 45.45%) categories during antenatal counseling. MORE classification of fetal structural anomalies is a simple but comprehensive framework to assist the physicians and other medical personnel antenatal parental counseling and decision making.

Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation.

The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic. This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used. When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033). Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.

Preterm Birth: A Review of Its Early Diagnosis and Prevention

Preterm birth, a major global healthcare concern, is characterized by infants being born before completing 37 weeks of gestation. Accurate diagnosis and effective interventions are critical to managing this complex issue. This abstract provides an overview of the diagnosis and prevention of preterm birth, focusing on risk assessment, diagnostic techniques, and various interventions for mothers and newborns. The diagnostic process involves evaluating risk factors, clinical history, and the assessment of potential membrane rupture. Techniques such as speculum examination, the Nitrazine test, the Fern test, ultrasonography, and the Placental Alpha Microglobulin-1 test play vital roles in identifying membrane rupture and infection. Additional diagnostic markers include cervical ultrasonography and fetal fibronectin testing. Prevention strategies include lifestyle changes, maternal therapies, and antenatal interventions. Smoking cessation programs, low-dose aspirin, antenatal corticosteroid therapy, progesterone supplementation, magnesium sulfate, and antibiotic treatment are employed to reduce the risk of preterm birth. Cervical cerclage, another surgical intervention, is recommended in specific cases.&#x0D; For preterm newborns, immediate and effective care is vital. This includes thermal care, early breastfeeding, infection prevention, and respiratory distress syndrome management. These interventions are crucial in reducing infant mortality and morbidity associated with preterm birth. Efforts to diagnose and prevent preterm birth are essential in improving the well-being of both mothers and their newborns. A comprehensive approach, combining accurate diagnosis and effective interventions, can make a significant impact in reducing the burden of preterm birth on healthcare systems and families.&#x0D; Keywords: Preterm birth, infants, gestation, potential membrane rupture

Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 8–10 years of age: LIMIT randomised trial follow-up

BackgroundThe LIMIT randomised controlled trial looked at the effect of a dietary and lifestyle intervention compared with routine antenatal care for pregnant women with overweight and obesity on pregnancy outcomes. While women in the intervention group improved diet and physical activity with a reduction of high birth weight, other outcomes were similar. We have followed the children born to women in this study at birth, 6 and 18 months and 3–5 years of age and now report follow-up of children at 8–10 years of age.MethodsChildren at 8–10 years of age who were born to women who participated in the LIMIT randomised trial, and whose mother provided consent to ongoing follow-up were eligible for inclusion. The primary study endpoint was the incidence of child BMI z-score > 85th centile for child sex and age. Secondary study outcomes included a range of anthropometric measures, neurodevelopment, child dietary intake, and physical activity. Analyses used intention to treat principles according to the treatment group allocated in pregnancy. Outcome assessors were blinded to the allocated treatment group.ResultsWe assessed 1,015 (Lifestyle Advice n = 510; Standard Care n = 505) (48%) of the 2,121 eligible children. BMI z-score > 85th percentile was similar for children of women in the dietary Lifestyle Advice Group compared with children of women in the Standard Care Group (Lifestyle Advice 479 (45%) versus Standard Care 507 (48%); adjusted RR (aRR) 0.93; 95% CI 0.82 to 1.06; p = 0.302) as were secondary outcomes. We observed that more than 45% of all the children had a BMI z-score > 85th percentile, consistent with findings from follow-up at earlier time-points, indicating an ongoing risk of overweight and obesity.ConclusionsDietary and lifestyle advice for women with overweight and obesity in pregnancy has not reduced the risk of childhood obesity, with children remaining at risk of adolescent and adult obesity. Other strategies are needed to address the risk of overweight and obesity in children including investigation of preconception interventions to assess whether this can modify the effects of maternal pre-pregnancy BMI. The LIMIT randomised controlled trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

Trustworthiness assessment as an inclusion criterion for systematic reviews—What is the impact on results?

AbstractBackgroundThere is increasing concern that a significant proportion of randomized controlled trials (RCTs) included in Cochrane reviews may not be trustworthy. Applying the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool (CPC‐TST) has already had a clinically important effect on several reviews published by the Cochrane Pregnancy and Childbirth Group.ObjectivesWe wanted to assess the impact of removing untrustworthy RCTs from already‐published Cochrane reviews on a defined clinical area (antenatal and postnatal nutritional interventions).MethodsWe applied the tool to 18 Cochrane reviews (374 RCTs). The tool had four domains: (i) is the research governance trustworthy; (ii) are the baseline characteristics trustworthy; (iii) is the study feasible; (iv) are the results plausible? When additional information was needed, authors were contacted using a standard template. At least two attempts were made to contact the authors. At the end of the evaluation process each study was classified as: (i) included (YES to all questions); (ii) excluded (retracted study); or (iii) awaiting classification (any NO to the questions).ResultsNinety‐three out of 374 included studies (25%) were reclassified as “excluded” or “awaiting classification.” The number of included RCTs was reduced in 14 out of 18 reviews. Six reviews (33%) were judged to require updating because of important differences in the Summary of Findings tables (direction and size of effects and/or GRADE ratings), conclusions, implication for practice, and/or implication for research.ConclusionsFormal assessment of trustworthiness, and inclusion only of studies that satisfy prespecified criteria for trustworthiness, affect conclusions in a relatively large number of Cochrane reviews, with potentially important clinical implications for practice and research.

Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study.

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.

The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review.

Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs). This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs. Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions. The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024. Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=366354. PRR1-10.2196/48234.

"With group antenatal care, pregnant women know they are not alone": The process evaluation of a group antenatal care intervention in Ghana.

An essential component to improving maternal and newborn outcomes is antenatal care. A trial of group antenatal care was implemented in Ghana where 7 health care facilities were randomized to be intervention sites and 7 control sites continued traditional antenatal care. Group antenatal care, where 10-14 women with similar due dates meet together for visits, includes traditional components such as risk assessment with increased opportunity for education and peer support. The study aim was to assess and report the process evaluation of the implementation of a group antenatal care intervention. Process evaluation data were collected alongside intervention data and included both quantitative and qualitative data sources. Midwives at the health facilities which were randomized as intervention sites completed tracking logs to measure feasibility of the intervention. Research team members traveled to intervention sites where they conducted structured observations and completed fidelity and learning methods checklists to determine adherence to the model of group antenatal care delivery. In addition, midwives facilitating group antenatal care meetings were interviewed and focus groups were conducted with women participating in group antenatal care. In the majority of cases, midwives facilitating group antenatal care completed all components of the meetings with fidelity, following best practices such as sitting with the group rather than standing. Across 7 intervention sites, 7 groups (622 pregnant women) were documented in the tracking logs and of these participants, the majority (74%) attended more than half of the meetings, with 32% attending all 8 group meetings. Three themes were identified in both the midwife interviews and focus groups with pregnant women: 1) information sharing, 2) sense of community, and 3) time management challenges. An additional theme emerged from the focus groups with the women: women who had already given birth noticed a disconnect between what they learned and treatment received during labor and birth. This process evaluation determined that group antenatal care can be implemented with fidelity in low and middle-income countries. Time management was the biggest challenge, however both midwives and pregnant women found the model of care not only acceptable, but preferable to traditional care. The knowledge shared and sense of community built during the meetings was a valuable addition to the individual model of antenatal care.

PERINATAL OUTCOME OF EARLY PRETERM STAGE II IUGR AT TWO HOSPITALS IN ADDIS ABABA: A RETROSPECTIVE CROSS SECTIONAL STUDY

Abstract Background: Intrauterine growth restriction is a common obstetric complication. Based on the severity it is classified into stage 0-IV. Stage II IUGR is defined as ultrasound estimated fetal weight less than 10th percentile for gestational age with absent end diastolic velocity on umbilical artery Doppler ultrasound. Studies focusing on perinatal outcome of specific class of IUGR are limited. Objective: The aim of this study is to show the magnitude of stage II IUGR and see the perinatal outcome of early preterm stage II IUGR at two public hospitals in Addis Ababa, Ethiopia. Method: A retrospective cross sectional study conducted from January 2019 to August 2022. Data was collected from medical records using a structured pre-tested questionnaire. Data was coded, entered and analyzed using SPSS version 25. Result: There were 49,338 deliveries at the two study hospitals. Of these 192 pregnancies were complicated by stage II IUGR; 151 of which were diagnosed at the early preterm gestational age. The prevalence of stage II IUGR was 0.39% where as the prevalence of early preterm stage II IUGR was 0.3% out of the total deliveries. Preeclampsia was the leading obstetric complication diagnosed in 107 (70.9%) of the cases. Mode of delivery for all of the neonates was by cesarean section and all required NICU admission. The single most common perinatal morbidity was RDS, which accounted for 42 (27.8%) of the cases. Half of the 151 pregnancies diagnosed with early preterm stage II IUGR, 75 (50 %), ended up in perinatal death. Majority of the perinatal losses were during early neaonalal period, 56 % (42/75). Compared to those with birth weight of &lt;1000gm those with birth weight of 1500-2499gm had more than 37 times chance of survival in the perinatal period (AOR=37.67 (7.05, 201.36), p&lt;0.000). Conclusion and recommendations: The prevalence of stage II IUGR was 0.39% where as the prevalence of early preterm stage II IUGR was 0.3%. Early preterm stage II IUGR was associated with significant perinatal morbidity and mortality. Birth weight was a determinant factor significantly associated with perinatal survival. Antenatal interventions that can help delay the onset of disease may help improve perinatal outcome. Key terms: IUGR, Stage II IUGR, perinatal death, perinatal outcome.