Maternal metabolism adapts during pregnancy to support fetal growth, yet how variability in maternal substrate oxidation influences neonatal adiposity is not well understood. Metabolic flexibility-the ability to adapt to substrate availability-may be a critical determinant of fetal nutrient supply. Therefore, the objective of this study was to examine associations between maternal metabolic flexibility and infant adiposity. Forty-seven pregnant women (28 ± 5 yr) with obesity (35.8 ± 5.8 kg/m2) were assessed in early (14.8 ± 0.7 wk) and late (35.9 ± 0.6 wk) gestation. Maternal substrate oxidation was measured overnight in a whole room indirect calorimeter. Metabolic flexibility was calculated as the difference in respiratory exchange ratio (RER) between peak postprandial RER following a standardized dinner and RER during sleep. Maternal body mass and composition were recorded at the same time points, and infant adiposity was measured within 10 days of birth by air displacement plethysmography. Maternal metabolic flexibility in late gestation was positively associated with infant birth weight [β = 169; 95% confidence interval (CI): 18-320; P = 0.03] and adiposity (β = 2.4; 95% CI: 0.4-4.3; P = 0.02), independent of gestational weight gain. Lower fasting RER was inversely associated with infant adiposity (β = -2.4; 95% CI: -4.3 to -0.4; P = 0.02). Postprandial RER was not predictive. Associations with infant adiposity were attenuated when birth weight was included, suggesting maternal substrate oxidation primarily influences adiposity via fetal growth. Maternal metabolic flexibility and fasting reliance on lipid oxidation in late pregnancy are key determinants of fetal growth and adiposity, highlighting the importance of maternal metabolism on developmental programming with implications for long-term offspring health.NEW & NOTEWORTHY This study revealed that maternal metabolic flexibility-the ability to switch between fuel sources depending on availability-and greater reliance on lipid oxidation during fasting in late pregnancy were linked to higher infant birth weight and adiposity, independent of gestational weight gain. These findings suggest that maternal substrate oxidation influences fetal nutrient supply and, consequently, growth, thereby playing a key role in shaping neonatal body composition and long-term health outcomes.

The insulin/insulin-like growth factor (IGF) system is a key regulator of fetal growth and placental nutrient regulation. The objective of this study was to investigate associated gene and protein expressions of the insulin/IGF, adiponectin, and peroxisome proliferator-activated receptor (PPAR) pathways in placenta and cord blood from small-, appropriate-, or large-for-gestational-age (SGA, AGA, LGA) infants and corresponding first-trimester maternal blood. A total of 60 SGA, 109 AGA, and 55 LGA term infants (birth weight z scores <-2, -2 to +2, and >2, respectively) were included. Placental mRNA expression of 22 genes was analyzed using RT-qPCR. Immunohistochemistry (IHC) was used to determine the protein localization and abundance of 5 differentially expressed genes in 78 representative placental samples. Cord blood and maternal blood concentrations of related proteins were analyzed by ELISA. Placental gene expression of IGF1, IGF2, IGBP2, IGF2R, and PPARA was significantly lower in the SGA group. A moderate correlation in expression levels was observed among differentially expressed genes, except for IGF2R. In the SGA group, IHC staining for IGF1, IGF2, IGF2R, and PPARα was weaker, while IGFBP2 staining was stronger. In the cord blood, the IGF1 and IGF2 concentrations increased successively from the SGA group to the LGA group, whereas the IGFBP2 concentration decreased successively. No differences in maternal blood were observed between the groups. Placental IGF1, IGF2, and PPARα signaling are positively associated with birth weight, whereas that of IGFBP2 is negatively associated, possibly reflecting a shared upstream regulation by nutrition. Conversely, placental IGF2R signaling may aid in normalizing abnormal fetal growth.

Early brainstem volume and the need for respiratory and vasoactive support in very preterm infants.

To compare perinatal outcomes in pregnancies with prepregnancy body mass index (BMI) ≥ 50 kg/m2 across prespecified gestational weight-gain categories, and to describe maternal characteristics more frequently observed among individuals with preterm delivery. Retrospective cohort study of singleton pregnancies (June 2002-April 2020) at a tertiary academic institution comparing maternal and neonatal outcomes across four prespecified gestational weight-gain categories using unadjusted group-based analyses: weight loss/no gain, 0.45 to 4.5 kg (1-10 lb.), 5.0-9.1 kg (11-20 lb.), and >9.1 kg (>20 lb.). Statistical comparisons used Kruskal-Wallis H, Mann-Whitney U, Welch ANOVA, and chi-square tests (α = 0.05), with Holm's correction applied for multiple comparisons. Of 525 identified pregnancies, 483 met inclusion criteria. Groups 1 to 4 included 89, 113, 93, and 188 pregnancies, respectively. The cohort was predominantly parous (73.7%) and non-Hispanic Black (65.1%), with high rates of chronic hypertension (43.5%) and preexisting diabetes (10.1%). Preterm delivery occurred in 14.9% of individuals. Compared with term deliveries, those delivering preterm were older (30 years vs. 28 years; p = 0.01), had higher prepregnancy BMI (55.4 vs. 54.1 kg/m2; p = 0.026), and were more likely to have chronic hypertension and preeclampsia (both p < 0.01). Fetal growth restriction (FGR) was more frequent in the weight loss/no-gain group (p = 0.02), and infant birth weight increased linearly with greater gestational weight gain (p < 0.01). No consistent trend in perinatal complications was observed across weight-change categories. In pregnancies with BMI ≥ 50 kg/m2, perinatal outcomes did not differ consistently across weight-gain categories. Birth weight increased linearly with greater weight gain, while FGR occurred more frequently with weight loss/no gain. Preterm birth was more frequent among older individuals with chronic hypertension, preeclampsia, and higher prepregnancy BMI; however, independent contributions remain undetermined from unadjusted comparisons. The relationship between gestational weight loss and FGR warrants prospective confirmation. · In pregnancies with BMI ≥ 50 kg/m2, outcomes did not differ consistently by weight gain categories.. · Birth weight increased linearly with greater weight gain.. · FGR occurred more frequently with weight loss/no gain.. · Prematurity was more frequent with older age, hypertension, preeclampsia and higher prepregnancy BMI..

To describe Kangaroo Mother Care (KMC) practice in the community (cKMC) two months after discharge from the Neonatal Intensive Care Unit (NICU). in South Indian mother-LBW infants. A prospective study enrolling 420 dyads at discharge from the NICU with follow-up on cKMC practice two months after discharge. Factors associated with cKMC were explored using logistic regression. Among the 420 enrolled, 2 (0.5%) infants died, and 12 (2.9%) were lost to follow-up. Of the remaining families, 25% (101) never practiced cKMC, effective practice was done by 19% (77). Infant birth weight ≥ 1.5kg (OR: 3.1, 95% CI 1.8, 5.3) was associated with higher odds of practicing cKMC, while being born at term (OR: 0.5, 95% CI 0.3, 0.8) and mothers' weight > 45kg (OR: 0.3, 95% CI 0.1-0.7) was associated with lower odds of practicing cKMC. Continued KMC practice 48h before discharge was associated with higher odds (OR: 3.4, 95% CI 1.8-6.2), while absence of father's support was associated with lower odds (OR: 0.6, 95% CI 0.3, 1.0) of effective cKMC. The continuum of cKMC after discharge from the NICU was inadequate. Factors associated with cKMC practice should be considered when planning interventions to improve cKMC practices.

PurposeSmall-for-gestational-age (SGA) infants (birth weight <10th percentile) routinely undergo blood glucose monitoring (BGM) to detect hypoglycaemia. However, application of the INTERGROWTH-21st 10th percentile cut-off may increase SGA classification in certain populations, potentially leading to unnecessary monitoring. This study aimed to compare the safety and effectiveness of a 3rd centile-based BGM strategy with the conventional 10th centile approach in stable SGA infants.MethodsIn this quasi-randomized controlled trial conducted at a tertiary-care centre in India (July 2024-April 2025), inborn, hemodynamically stable infants of 35+0 to 42+0 weeks' gestation classified as SGA by INTERGROWTH-21st charts were enrolled within 1hour of birth. Eligible infants were allocated to either a restricted monitoring strategy (<3rd percentile) or a conventional monitoring strategy (3rd-10th percentile) using a predefined quasi-randomization method. Blood glucose was measured at predefined intervals during the first 72h. The primary outcome was incidence of hypoglycaemia (<47mg/dL) within 72h. Secondary outcomes included time to full feeds, intravenous fluid requirement, sepsis, length of stay, and mortality.ResultsAmong 324 enrolled infants (162 per group), hypoglycaemia occurred in 10.5% in the 3rd centile group and 13% in the 10th centile group (p = 0.49). The absolute risk difference was 2.5% (95% CI 8.8% to 3.8%), confirming non-inferiority. No significant differences were observed in secondary outcomes.ConclusionA 3rd centile-based BGM strategy was non-inferior to the conventional 10th centile approach in stable SGA infants. Targeted monitoring based on severity of growth restriction may reduce unnecessary interventions without compromising short-term safety.

Background: Increasing evidence suggests that breast milk and its bioactive components, including short-chain fatty acids and the milk microbiome, are influenced by maternal nutrition and body mass index (BMI). Bioactive components transferred to the infant through breast milk play a pivotal role in infant growth and development and have indications in the child's future short- and long-term health outcomes. This study aimed to assess the impact of maternal pre-pregnancy BMI (PP-BMI) on human breast milk macronutrient composition, short- and long-chain fatty acid profiles, and breast milk microbiome profiles. Approach: This was an exploratory cohort study of forty-four lactating Caucasian women, two to fourteen weeks postpartum, divided into groups based on pre-pregnancy body mass index (BMI). Study participants signed informed consent, completed health and nutritional surveys, and provided a breast milk sample. Breast milk samples were subjected to proximate analysis, microbiome identification and short- and long-chain fatty acid extraction and analysis. Results: Maternal age, maternal physical activity, infant birth weight, and time of lactation at sample collection were not significantly different between the maternal PP-BMI groups. PP-BMI was significantly different between the two maternal groups. No significant differences were found between the maternal BMI groups concerning nutritional intake. No differences in breast milk microbiomes were observed in alpha diversity and beta diversity between the maternal PP-BMI groups. For long-chain fatty analysis in breast milk samples, myristic acid was significantly higher in the PP-BMI overweight/obese group while stearic acid was significantly higher in the PP-BMI normal-weight group. Butyric, valeric, and isocaproic acid concentrations in HBM were significantly higher in the PP-BMI normal-weight group and lower or undetectable in the PP-BMI overweight/obese group. Conclusions: Data from this exploratory cohort study indicate that maternal diet and pre-pregnancy BMI may be associated with differences in selected HBM fatty acids. There were no significant differences in microbiomes for alpha and beta diversity in breast milk between maternal PP-BMI groups; however, lower relative abundance was observed in the breast milk of the PP-BMI overweight/obese group. These findings should be interpreted in the context of the study's limitations, including convenience recruitment from a Facebook group, the modest sample size, and restriction to Caucasian women from a single geographic region.

This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.

The admission of a preterm infant to the neonatal intensive care unit (NICU) represents a stressful event for parents and families, often precipitating negative emotions such as anxiety and sadness, and in some cases, depressive symptoms. The impact of preterm infants' admission to the NICU within 2-3 days after birth on maternal EPDS-defined depressive symptoms has been extensively studied, but research on EPDS-defined depressive symptoms arising from this context remains scarce. This study aimed to investigate the prevalence and associated factors of EPDS-defined depressive symptoms among fathers of preterm infants shortly after the infants' admission to the NICU. A cross-sectional study was conducted between November 2024 and October 2025 using a convenience sampling method in a tertiary maternal and child health hospital's neonatal intensive care unit (NICU) in Gansu Province, China. A total of 379 fathers of preterm infants were recruited as study participants. The survey was conducted at 2-3 days after NICU admission. Data were collected using baseline demographic questionnaires, the Edinburgh Postnatal Depression Scale (EPDS), the Eysenck Personality Questionnaire-Revised Short Form (EPQ-RSC), and the Family Assessment Device (FAD). In this study, we used the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of ≥ 10 to define screen-positive depressive symptoms. The prevalence of screen-positive depressive symptoms among fathers of preterm infants at 2-3 days after NICU admission was 29.55%. The associated factors included monthly income 5,000-10,000 CNY (OR = 0.557, 95%CI:0.312-0.995), paternity leave availability (OR = 0.532, 95%CI:0.291-0.974), infant birth weight 1,500-2,499g (OR = 0.327, 95%CI:0.117-0.916), Psychoticism (OR = 1.913, 95%CI:1.592-2.299), Extraversion(OR = 0.846, 95%CI:0.739-0.968), Neuroticism (OR = 1.507, 95%CI:1.331-1.706), moderate family functioning (OR = 2.634, 95%CI: 1.356-5.117), poor family functioning (OR = 8.939, 95%CI:4.351-18.365). Among fathers of preterm infants shortly after the infants' admission to the NICU, EPDS-defined depressive symptoms were relatively common and were associated with several paternal, infant, and family-related variables. These findings warrant further exploration in multicenter longitudinal studies.

Relationship between micro- and nanosized plastics in cord blood and birth weight and gestational age of newborns.

To assess the agreement between the Fenton and INTERGROWTH charts in classifying birth weight for gestational age in preterm infants, considering prematurity degree and small/adequate/large-for-gestational-age (SGA/AGA/LGA) status individually and simultaneously. Retrospective cohort study including 2529 preterm infants admitted between 2018 and 2021. Gestational age was estimated from obstetric data or by the Capurro/Ballard methods. Birth weight-for-gestational-age Z-scores were calculated according to both charts. Agreement was analyzed overall and by subgroups defined by prematurity degree and SGA/AGA/LGA status using the Bland-Altman method, complemented by boxplots. Overall agreement was reasonable (mean bias: -0.08; limits of agreement: -0.67 to 0.50), with slight overestimation of Z-scores by INTERGROWTH. Relevant variability was observed across subgroups. Disagreement extended across all prematurity strata with distinct patterns: greater dispersion in extremely and very preterm infants and more consistent but systematically biased differences in moderate-to-late preterm infants (bias: -0.12). The largest discrepancies occurred among SGA, especially in extremely preterm infants, among whom 50% had Z-scores beyond the limits of agreement. In this subgroup, Fenton tended to assign higher Z-scores, especially between 26 and 32 weeks of gestation, attenuating birth weight deficit severity. Agreement was considerable among AGA and LGA infants, especially in more mature preterm groups. Although overall agreement between the charts was acceptable, clinically relevant differences were observed across all prematurity strata, particularly among more immature SGA infants. The charts are not interchangeable at the individual level, and their use may influence nutritional diagnosis and clinical management, reinforcing the importance of consistent and context-appropriate selection of growth reference.

We and others have shown that maternal hyperglycemia during pregnancy in women with insulin-dependent diabetes mellitus (IDDM) influences fetal growth. Less is understood regarding how trimester-specific glycemic patterns, particularly glucose variability, shape offspring obesity risk across the life course and whether this is mediated by birthweight. Leveraging data from the Diabetes in Pregnancy Program Grant (PPG; 1978-1995) and the Transgenerational Effects on Adult Morbidity (TEAM Study; 2017-2023) cohort, we aimed to evaluate whether the association between maternal glycemic control and adult offspring obesity status was mediated in part through infant birthweight. Maternal glycohemoglobinA1 levels were collected monthly during pregnancy and harmonized across laboratories using standard deviation units (HbA1SD). Functional principal component analysis characterized patterns in blood glucose level and variability. TEAM Study participants, adult offspring of PPG women, completed in-person or online assessments (via Zoom) of body anthropometrics. Linear mixed-effects models and generalized estimating equations estimated associations between maternal glycemia and adult offspring outcomes. Classical mediation methods tested whether birthweight mediated observed relationships. Consistent with prior findings, third-trimester HbA1SD demonstrated the most consistent positive associations with adult offspring body mass index (BMI) outcomes, after adjustment for maternal BMI at last menstrual period, maternal education, gestational weight gain, and sex of offspring (for offspring weight only). There was no evidence that birthweight mediated the relationship between maternal glycemic patterns and adult offspring overweight and obesity; however, birthweight exhibited an independent direct effect on adult offspring BMI in fully adjusted models. Infant birthweight was not shown to be a mediator in the association of maternal gestational glycemic control and overweight/obesity in adult offspring of women with IDDM. Although birthweight does not appear to mediate these long-term associations, the findings underscore the importance of trimester-specific evaluation of blood glucose level and variability, motivating further investigation into transgenerational metabolic risk pathways. · It is unlikely that birthweight mediates the association between gestational blood glucose levels and offspring adult obesity.. · Higher birthweight is an important risk factor for overweight and obesity in the adult offspring.. · Early gestation hyperglycemia may program obesity in adult offspring of IDDM women..

Infants who are HIV-Exposed Uninfected (HEU) may experience adverse growth outcomes compared to those HIV Unexposed Uninfected (HUU). However, there are limited data from the context of universal antiretroviral therapy (ART) and promotion of extended breastfeeding (BF) for infants HEU. We compared the growth of infants HEU and HUU enrolled January 2017-July 2018 from the same community in Cape Town, South Africa. Data were collected during pregnancy and at seven days, 10 weeks, six and 12 months postpartum. Infant birth weight and length were converted to weight-for-age and length-for-age z-scores (WAZ, LAZ) using Intergrowth-21st software. We determined WAZ, LAZ and weight-for-length z-scores (WLZ) at postpartum visits using World Health Organization Anthro survey analyzer tool. Linear mixed effects models were fit to compare WAZ, LAZ and WLZ between infants HEU and HUU and assess associations with infant feeding practices, social support and food security, adjusting for infant HIV exposure status, time (study visit), maternal age, employment and marital/cohabiting status, household food security status and duration of BF. Among 796 mother-infant pairs, infants HEU (50%) had shorter median BF duration [73 days; interquartile range (IQR) 12-222 vs 209 (IQR 72-365) for infants HUU (p < 0.001)]. Complementary feeding was introduced early with a high proportion having sweet beverages and no differences between infants HEU and HUU. Among all infants WAZ increased at 12 months vs 7 days [β = 0.621; 95% CI 0.523 to 0.720] but LAZ decreased [β = -1.260; 95% CI -1.406 to -1.114], with higher WLZ [β = 0.171; 95% CI 0.026 to 0.316] at 12 months vs 10 weeks and no impact of HIV exposure or BF. Infants of mothers married/cohabiting (proxy for social support) had higher WAZ and LAZ. Food security was associated with higher WLZ [β = 0.341; 95% CI: 0.029 to 0.653]. In our study, overall infants experienced suboptimal length growth but gained weight with no difference by HIV status or BF. Being married/cohabiting improved all growth parameters and food security improved growth in weight. Public health interventions should enhance social support and food security to promote optimal growth.

ABSTRACTMalnourished infants under 6 months experience poor growth and development. A pilot study applied the WHO guideline for treatment of acute malnutrition and found that it was possible to re‐establish exclusive breastfeeding during inpatient treatment. However, weight gain could not be sustained 6 weeks after discharge suggesting that follow‐up breastfeeding support may be required. Our study aimed to pilot the feasibility and acceptability of a follow‐up intervention among infants discharged from malnutrition treatment. A home‐based post‐discharge breastfeeding support intervention was developed to be delivered by breastfeeding peer supporters in a series of three home visits and three intervention phone calls over a period of 7 weeks after discharge from the hospital. The intervention was piloted among 20 mother‐infant pairs providing quantitative and qualitative data from a standardized questionnaire and in‐depth interviews. Data was analyzed descriptively and using thematic analysis. The median infant birth weight was 2.07 kg and > 50% of the mothers had primary education or less. The intervention was feasible with 100% reach of the target participants with a geographic spread of 25% urban and 75% rural areas. All intervention components were applied consistently, resulting in 100% adherence over a 6‐month period. The intervention was accepted by mothers, perceived to be beneficial, and reported to increase breastfeeding confidence. It was adaptable, adjusting to emerging challenges, and was successfully integrated into existing health services. The pilot demonstrated high feasibility and widespread acceptance of the intervention. Its effectiveness to improve weight gain among recovering infants is being determined in a trial.

Prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) has been linked to lower birth weight (BW) and shorter gestational age (GA) at delivery. Most research has focused on populations in high-income countries, leaving low- and middle-income countries (LMICs) understudied. We examined associations between pregnancy urinary PAH metabolites and birth outcomes in a prospective cohort in Nairobi, Kenya. The study population was drawn from women and their newborn babies enrolled in a pregnancy cohort. Third-trimester urinary mono-hydroxylated PAH metabolites (OH-PAH) were measured and infant BW and GA were ascertained using medical record abstraction and self-report; BW-for-GA z-scores were computed. Linear and modified Poisson regression models were used to estimate the effects of five OH-PAHs on birth outcomes; Weighted Quantile Sum regression was used to explore OH-PAH mixture effects. Among 353 mother-infant pairs, the median infant BW was 3.2 kg and 7.6% were born preterm. All OH-PAH metabolites were present in urine of >99% of mothers. Individual OH-PAH concentrations were not associated with BW or BW-for-GA z-scores. One metabolite, 2-hydroxyphenanthrene, was associated with shortened gestation (RR = −1.6 day per doubling in concentration, 95% confidence interval: −3.1, −0.1). This association was attenuated after adjusting for self-reported exposure to household fuel and outdoor combustion and was strengthened among female infants, but not male infants, in sex-stratified analyses. Other metabolites and the OH-PAH mixture were not associated with birth outcomes. Our findings suggest that exposure to 2-hydroxyphenanthrene may have a modest adverse effect on pregnancy duration, with potential sex-specific differences in association. No associations were observed for markers of fetal growth. These results highlight need for further studies on sex-specific vulnerabilities and the role of environmental co-exposures in impacting birth outcomes in LMICs.

Background: Low birth weight (LBW), defined as a birth weight of less than 2,500 grams, remains a significant public health concern due to its considerable impact on infant mortality and long-term growth dan development outcomes. This study aims to examine the relationship between maternal dietary patterns (non-vegetarian and vegetarian) and other maternal factors on the incidence of LBW in selected areas in Indonesia. Methods: This research uses a cross-sectional design involving 122 respondents, data were collected through structured questionnaires and a Food Frequency Questionnaire (FFQ). The study was conducted from March to May 2025 using purposive sampling. Results: A LBW prevalence of 5.7% in Indonesia, with prevalence rates of 8.3% among vegetarian mothers and 5.1% among non-vegetarian mothers. Bivariate analysis revealed no statistically significant associations between LBW incidence and dietary type (p = 0.623), frequency of staple food consumption (p = 0.272), frequency of animal protein consumption (p = 0.751), frequency of plant protein consumption (p = 0.113), pre-pregnancy nutritional status (p = 0.941), gestational weight gain (p = 0.707), interpregnancy interval (p = 1), parity (p = 0.709), ANC visit frequency (p = 1), maternal education level (p = 0.650), and supplement consumption (p = 0.555). Conclusions: There is no significant relationship between all independent variables with the incidence of low birth weight

Adverse childhood experiences (ACEs) are strongly associated with poor physical and mental health across the life course. Maternal ACEs have been linked to prenatal stress, hypertensive disorders, gestational diabetes, shorter gestation, lower infant birth weight, and increased risk of prenatal and postpartum depression. Benevolent childhood experiences (BCEs) and social support may buffer these effects; however, ACE-informed perinatal care remains uncommon in low- and middle-income settings. This study aimed to estimate the prevalence of ACEs and BCEs among pregnant women in Mexico and to examine their associations with perceived stress and depressive symptoms during pregnancy. We conducted a cross-sectional observational study at a large public maternity hospital (Hospital Materno Infantil y de Especialidades de Nuevo León) in Monterrey, Mexico, between September 2023 and March 2024. Pregnant women receiving prenatal care were invited to participate; of 400 eligible women, 368 consented, and 330 provided complete data for analysis. Participants completed the WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Benevolent Childhood Experiences (BCE) Scale, the Perceived Stress Scale (PSS-10), the Edinburgh Postnatal Depression Scale (EPDS), and the Social Support Questionnaire (SSQ-6). Sociodemographic and pregnancy-related variables were self-reported. Descriptive statistics summarized sample characteristics. Bivariate associations were assessed using chi-square tests and Spearman correlations. Structural equation modeling (SEM) was used to evaluate hypothesized pathways linking ACEs, BCEs, social support, perceived stress, and depressive symptoms. Model fit was evaluated using the comparative fit index (CFI), root mean square error of approximation (RMSEA), and χ²/df. Overall, 90% of participants reported at least one ACE, and 45.2% reported four or more ACEs. The most prevalent ACE domains were violence- and neglect-related adversities. Social support levels were moderate to high, and BCE scores were high (mean = 8.55). Perceived stress levels were moderate (mean = 17.87), and 13% of participants screened positive for depressive symptoms. SEM analyses indicated that higher ACE exposure was associated with lower benevolence and social support and with increased perceived stress. Both benevolence and social support were associated with lower stress and fewer depressive symptoms, with perceived stress acting as a central mediator. Overall model fit was acceptable (CFI = 0.93; RMSEA = 0.06). Pregnant women in this public maternity hospital sample experienced high levels of childhood adversity alongside substantial protective factors. ACE exposure was associated with increased perceived stress and depressive symptoms during pregnancy, while benevolent childhood experiences and social support appeared to mitigate these associations. These findings underscore the importance of integrating trauma- and resilience-informed approaches into prenatal care in low- and middle-income settings.

Longitudinal association between human milk macronutrient intake and infant growth throughout the first 8.5 months of life: a multicenter cohort study.

BackgroundUgandan women and their children suffer from high maternal and perinatal mortality, often due to low antenatal care (ANC) and skilled birth usage. We partnered with community members, women and the Ugandan Ministry of Health to formatively develop an intervention (Support-Moms app) to improve health education, engage social support networks, and augment access to ANC and delivery by a formal health care provider (HCP) for pregnant women in rural Uganda.MethodsWe conducted a type 1 hybrid effectiveness-implementation trial to test the effectiveness of the Support-Moms intervention. We enrolled 824 pregnant women (<20 weeks gestation) living in Southwestern Uganda and randomized them (1:1) to standard of care or Support-Moms intervention. The primary effectiveness outcome was completion of a HCP-led skilled birth (discharge card) and was analyzed as intention-to-treat. Secondary outcomes included number of ANC visits, institution-based delivery, social support, quality-of-life, mode of infant delivery, pre-term birth, birth weight, obstetric complications and deaths (maternal, fetal, newborn).ResultsA total of 1,216 women were screened, and 824 pregnant women enrolled (mean age ~28 years; gestation at enrolment ~13 weeks). Complete outcomes were available for 818 (99%). The Support-Moms intervention increased HCP-led skilled births compared to standard of care (93% vs 84%; OR 2.51, 95% CI 1.57–4.03, p<0.001). Women in the intervention group were more likely to achieve ≥4 ANC visits (84.1% vs 75.1%; OR 1.76, 95% CI 1.24–2.50, p=0.001) and less likely experience postpartum hemorrhage (9.1% vs 22.7%, OR 0.34, 95% CI 0.22–0.52, p<0.001) or for their neonates to require resuscitation (9.8% vs 13.7%, OR 0.69, 95% CI 0.45–0.99, p=0.001). Initiation of breastfeeding within an hour was higher (97.1% vs 71.7%, OR 1.76, 95% CI 1.15–3.44, p=0.001) and postnatal depression decreased (20.1% vs 27.1%, OR 0.68, 95% CI 0.49–0.94, p=0.019). More intervention participants reported adequate support, were birth-prepared and had a birth companion. There were no maternal deaths or differences in term births, birthweight, mode of delivery, perinatal mortality or other obstetric complications.ConclusionsIn rural Uganda, the Support-Moms mHealth-based, social-support intervention significantly increased HCP-led skilled births compared with routine care, while also improving ANC attendance, early breastfeeding initiation, birth preparedness, perceived social support and higher presence of companion at birth. Less women experienced PPH, neonatal resuscitation, and postnatal depression. Further evaluation should focus on the cost effectiveness and sustainability of this program.Trial registration:Clinicaltrials.govNCT05940831

Breastfeeding is a key determinant of infant health and survival; however, exclusive breastfeeding (EBF) rates remain low worldwide. Various maternal, infant, and socioeconomic factors influence the feeding practices. The main objective of this study was to identify maternal, infant, and socioeconomic determinants of infant feeding practices during the first six months of life among mothers in northern Jordan. A prospective cross-sectional study was conducted at Princess Rahma and Prince Rashid Hospitals in Irbid City, northern Jordan, from December 2023 to February 2024. Mothers of healthy infants aged 6-24 months participated in a survey that gathered information on their demographics, feeding practices, and other infant-related details. Statistical analyses were performed to identify the associations and key predictors of feeding type. Among the 508 mothers who participated in this study, 29.9% were exclusively breastfeeding, 46.5% used mixed feeding, and 23.6% opted for formula feeding. The key factors influencing these choices include maternal health issues, work hours, and infant birth weight. Maternal illness was identified as the strongest predictor of exclusive artificial feeding (AOR = 12.72; 95% CI: 4.10-39.45; P < 0.001). Low birth weight (<2.5 kg) was also associated with higher odds of artificial feeding (AOR = 4.75; 95% CI: 2.08-10.88; p < 0.001). Maternal employment significantly increased the likelihood of mixed feeding compared with EBF (AOR = 3.54; 95% CI: 1.65-7.60; p = 0.001). Surprisingly, no significant correlation was found between maternal education, family income, cultural factors, and feeding methods. This study highlighted the low exclusive breastfeeding rate, emphasizing the need for improved support systems to encourage breastfeeding in the form of workplace accommodations and healthcare counseling to address barriers to its practice.