BMC Pregnancy Research Articles

Interview with Professor Edwin van Teijlingen

Edwin van Teijlingen is Dutch by birth and a Professor of Reproductive Health at Bournemouth University in the south of England. He has achieved a PhD in Medical Sociology at the University of Aberdeen, UK. Prof. Edwin van Teijlingen connected with Nepal while supervising Nepali PhD scholars in UK, and he has been a frequent visitor to Nepal since 2006. He has supervised more than 35 PhDs, among which 13 are Nepali. He has examined more than 50 PhDs. He has published around 300 academic papers and book chapters in health promotion, midwifery, and health services research. He serves as a peer reviewer for worldwide famous health journals such as PLOS One and BMC Pregnancy and Childbirth. He delivered a speech to the Members of Parliamentarians in Kathmandu in 2016 as part of a workshop to promote evidence-based policymaking. He is a committee member on various grant-awarding bodies in the UK, Belgium, the Netherlands, Norway, Switzerland, and the USA. He is a visiting Professor at the Centre for Disability Studies, Mahatma Gandhi University, Kerala in India (2020-present); the School of Health Sciences at the University of Nottingham in England (2017-2026); Nobel College, affiliated with Pokhara University, Nepal (2012-present); and Manmohan Memorial Institute of Health Sciences affiliated with Tribhuvan University (2009-present). We would like to express our gratitude for his acceptance to share personal and academic lives, which can inspire young and energetic scholars in Nepal and elsewhere.

THE MANAGEMENT OF DELIVERY PAIN: A BIBLIOMETRIC ANALYSIS

<p><strong>Introduction</strong>: Management of delivery pain was part of the most important tasks that health workers need to focus on. Non-pharmacological and pharmacological approaches have been shown to provide significant benefits in managing delivery pain and ensuring the well-being of the mother and her baby. This study analyses research trends on management of delivery pain.</p><p><strong>Methods: </strong>The documents from 2013 to 2022 (December 31, 2022) were searched, in English, Article and Review. The implementation date of the strategy is April 11, 2023 and search terms and strategies are as follows “delivery” OR “pain management” AND “Articles and Reviews” AND “English”. Visualization and analysis of research trends from downloaded article data in CSV format using VOSviewer 1.6.18.</p><p><strong>Results</strong>: To achieve this goal, a bibliometric analysis was conducted on 469 articles obtained from the Scopus database, which identified the most productive countries/regions, journals, authors, and potential future topics of this research field. According to this study, 2017 saw the most significant growth; the United States was the most productive country in this field; BMC Pregnancy and Childbirth was the most prestigious journal in this field; Khildea, S., contributed the most significant research in this field. The use of complementary therapies, drug administration and maternal care requires further study in the future.<strong></strong></p><p><strong>Conclusion</strong>: The conclusion of this study was that pain management continues to grow in research across different countries, fields and expertise. The future needs to focus on the use of complementary therapies, drug delivery pathways and maternal care for further research.</p><p> </p>

Interprofessional collaboration in maternity care

African Journal of Midwifery and Women's HealthVol. 17, No. 2 EditorialInterprofessional collaboration in maternity careUnice GoshomiUnice GoshomiCorrespondence to:E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:16 Jun 2023https://doi.org/10.12968/ajmw.2023.0019AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Behruzi R, Klam S, Dehertog M et al.. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy Childbirth. 2017;17(1):1–4. https://doi.org/10.1186/s12884-017-1381-x Crossref, Google ScholarCharalambous C, Rampton B. Language learning, identity, and intercultural communication in contexts of conflict and insecurity. In: Jackson J (ed). The Routledge handbook of language and intercultural communication. Abingdon, Oxfordshire: Routledge; 2020 Crossref, Google ScholarKruk ME, Gage AD, Arsenault C et al.. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 17Issue 2ISSN (online): 2052-4293 Metrics History Published online 16 June 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

Women's experiences with unexpected induction of labor: A qualitative study.

Induction of labor is the most common intervention in modern obstetrics and is a growing phenomenon worldwide. Research on women's experiences with the induction of labor is scarce, especially on being unexpectedly induced. The purpose of this study is to explore women's experiences with unexpected induction of labor. We conducted a qualitative study including 11 women who had undergone an unexpected induction of labor within the last three years. Semi-structured interviews were conducted in the period February-March 2022. Data were analyzed using systematic text condensation (STC). The analysis led to four result categories. The decision to induce labor came as a surprise to the women, both for better and for worse. Information was not automatically provided and was often obtained through the women's own efforts. Consent to the induction mainly took the form of a decision by healthcare personnel, and the birth was a positive experience during which the woman felt looked after and reassured. The women were very surprised when told they had to be induced and were unprepared for the situation. They received insufficient information, and several experienced stress from the time of induction up until they gave birth. Despite this, the women were satisfied with the positive birth experience, and they emphasized the importance of being looked after by empathetic midwives during childbirth.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Photo by Alexander Grey on Unsplash ABSTRACT Current studies show that about half of transgender and gender-diverse (TGD) people wish to have children in the future. TGD patients who pursue gender-affirmation interventions must be aware of the impact that various treatments can have on fertility, as gender-affirming care through medical or surgical treatment can limit or alter reproductive potential. Many medical professional societies encourage providers to educate and counsel patients about the consequences of treatment and viable options for fertility preservation (FP) as early as possible, though patients may not be aware of all the family formation methods available. There is a significant need for a tool that thoroughly details not only the various opportunities for parenthood but the perceived cost, rates of success, and risks associated with each option. A fertility decision-aid would allow for a more robust informed consent process and shared decision-making for all individuals pursuing gender-affirming care. INTRODUCTION Over 1.6 million adults and youth in the United States, or about 0.6 percent of those age 13 and over, identify as transgender, according to a report released by The Williams Institute in June 2022.[1] Current studies show that approximately half of transgender and gender-diverse (TGD) people wish to have children in the future, which aligns with the rate of cisgender individuals who desire parenthood in some form.[2] Studies on parenthood show improved quality of life and mental health in TGD adults and decreased incidence of suicide in TGD women.[3] In one study, almost half of the TGD individuals who indicated an interest in parenthood said they wanted genetically related offspring.[4] However, medical or surgical therapies can limit reproductive potential.[5] Recent findings indicate that some TGD adults who underwent medical or surgical paths to affirmation regret decisions that may have led to their inability to have genetic children. Perhaps they did not know it was an option, faced barriers to care, or were not interested at the time.[6] Many medical professional societies, including the World Professional Association for Transgender Health (WPATH), the Endocrine Society, and the American College of Obstetrics and Gynecology, encourage providers to educate and counsel patients about the consequences of treatment and viable options for fertility preservation as early as possible.[7]  This paper argues that TGD patients who pursue gender-affirmation interventions must be aware of the impact treatments can have on fertility and, ultimately, parenthood and that a design tool may help them understand the risks and make informed decisions.            l.     Gender Affirmation Options Some TGD individuals do not use medical or surgical therapies to feel affirmed in their identity.[8] Non-medical paths to affirmation include social and legal measures.[9] These reversible paths do not impact the individual’s future fertility potential. TGD individuals can follow different paths of gender-affirming care through social, legal, medical, and surgical affirmation.[10] Social affirmation can include using gender-affirming pronouns, names, and clothing.[11] Legal affirmation can include changing the gender and name on a birth certificate and other records in states where this is permissible.[12] Social and legal affirmations are reversible and do not impact fertility potential. Medical affirmation involves the use of gender-affirming hormone therapy. Feminizing or masculinizing hormone therapy allows for the development of secondary sex characteristics that more closely align with the individual's gender identity.[13] No set regimen for treatment exists, as a patient’s goals will determine their individualized plan.[14] Some standard feminizing agents include estrogen, androgen-reducing medications, and progestins, while the common masculinizing agent is testosterone.[15] Gender-affirming hormone therapy is not currently seen as a definitive cause of infertility, as it is possible to discontinue treatment and see a noted reversal of intended effects.[16] Research findings suggest that hormone therapy should stop for a minimum of three months to reverse any treatment effects.[17] The only available data on long-term hormonal therapy use is inconsistent, based on observational studies with varying duration and doses.[18] Individuals can stop gender-affirming hormone therapy, but its lasting impact on fertility is unknown.[19] A TGD individual may choose to undergo surgical interventions that do not impact fertility. These interventions can masculinize or feminize body parts to allow a patient’s physical appearance to align with their gender identity.[20] This care could include breast augmentation for TGD women and Adam’s apple reduction or breast reduction for TGD men.[21] Other surgical interventions will impact TGD individuals’ fertility. Genital surgery for a TGD woman can include the removal of the penis and scrotum (penectomy and orchiectomy) and the construction of a vagina and labia (vaginoplasty and valvuloplasty).[22] A TGD man can have removal of the ovaries and uterus (oophorectomy and hysterectomy) and construction of a penis and scrotum (metoidioplasty, phalloplasty, and scrotoplasty).[23] Following these gender-affirming surgeries, individuals are infertile due to the removal of their reproductive organs.[24] These procedures are irreversible and directly impact reproductive capacity in TGD individuals. ll.     Fertility Counseling to Explain Paths to Parenthood Patients receiving gender-affirming care should have the opportunity to learn about the various ways to achieve parenthood, including fertility preservation. Family formation methods include sexual intercourse, artificial insemination, surrogacy, and adoption or foster care.[25]  These methods apply to non-TGD people as well. Patients may not be aware of the various means of family-building, so accurate and expansive fertility counseling is essential before initiating medical or surgical affirming care. The frequency with which TGD individuals receive fertility counseling and how thorough it is, is unclear. When surveyed about fertility preservation, healthcare providers reported a lack of confidence in discussing fertility preservation with patients due to gaps in their knowledge on best practices, success rates, and regret rates in patients who did not preserve fertility. They also had varied perceptions of their role in treating patients and whether they should discuss family planning.[26] Patients have reported receiving an overview of fertility options from their primary transgender-healthcare providers before being referred to reproductive specialists.[27] While this is an essential step for patients seeking more information about their opportunities for parenthood, only 16 percent of Society for Assisted Reproductive Technology member clinics share information about options for transgender individuals on their websites.[28] Providers of transgender health care do not, and may not be trained to, provide adequate counsel to patients. Patients also cannot give informed consent for fertility or gender-affirming care interventions without more information on the benefits and burdens of all available treatments. Current literature demonstrates a need for a decision aid that thoroughly details not only the opportunities for parenthood but the perceived cost, rates of success, and risks associated with each option.[29] This tool could foster a more informed dialogue between an individual and their care team. A fertility decision aid would also allow for a more robust informed consent process for all individuals pursuing gender-affirming care. Regardless of the affirmation path chosen, a TGD individual should have early and frequent conversations with their care team regarding fertility. The World Professional Association for Transgender Health (WPATH) asserts that healthcare professionals should discuss fertility preservation options before initiating gender-affirming hormone therapy or surgery. The American College of Obstetrics and Gynecology states that “fertility and parenting desires should be discussed early in the process of transition, before the initiation of hormone therapy or gender affirmation surgery.”[30] The Endocrine Society writes that “all individuals seeking gender-affirming medical treatment should receive information and counsel on options for fertility preservation prior to initiating puberty suppression in adolescents and prior to treating with hormonal therapy in both adolescents and adults."[31] These conversations are essential even if the patient is not interested in parenthood at the time. WPATH addresses the potential for regret, as cases of individuals who received hormone therapy and genital surgery and later desired genetically related children have been identified.[32]  TGD patients pursuing gender-affirming care should assess their individual fertility goals to better understand the many ways to build a family. Surveys of TGD adults show that participants want to become parents in various ways. In one study, 31.3 percent of those surveyed wanted to become parents through adoption, 25 percent wanted children through sexual intercourse, 15.6 percent through surrogacy, 12.5 percent using donor sperm, 9.4 percent using a known sperm donor, and 6.3 percent through the foster care system.[33] TGD women showed a significant interest in adoption (75 percent of participants), whereas more than half of TGD men wanted to become parents through sexual intercourse or pregnancy (58.3 percent).[34] These fertility goals should be acknowledged and discussed with the care team to guide decision-making about fertility preservation. lll.     Fertility Preservation Individuals who wish to share their genetic makeup with their child will usually need to speak with a reproductive specialist about fertility preservation options. They are the same as those for cisgender individuals using fertility services before cancer treatment or elective preservation.[35] For TGD adults with ovaries, this includes freezing embryos (using donor or partner sperm) or ovarian tissue.[36] While no longer viewed as an experimental treatment, professionals offer tissue freezing to few patients due to a lack of data on its safety and efficacy.[37] For TGD adults with testicles, freezing sperm and preserving testicular tissue can preserve the ability to have biological children.[38]  Fertility preservation numbers for TGD adults remain low. A study showed that 76.6 percent of TGD men and 76.1 percent of TGD women considered fertility preservation, but only 3.1 percent and 9.6 percent, respectively, initiated it.[39]  Success rate, cost, need for travel, and elevated risk of gender dysphoria likely lead to lower use of fertility preservation.[40]  According to the American Society for Reproductive Medicine, the average cost of an IVF cycle in the US is $12,400.[41] Intrauterine insemination can range in cost from a few hundred dollars to $2,000 per cycle.[42] There are also associated costs to freeze and store sperm and eggs.[43]  Insurance coverage and physical location impact the costs and how the patient bears the costs.[44] For those who do not have sufficient or any insurance coverage,  fertility preservation may not be feasible.  Of additional significance for this population, fertility preservation techniques can exacerbate gender dysphoria as the patient must produce gametes associated with the gender they do not recognize.[45] For TGD women, masturbating in a clinical setting or sperm banking for sperm cryopreservation can cause severe distress.[46] Furthermore, fertility preservation for TGD men can be challenging and invasive. A transvaginal ultrasound exam is a requirement for the cryopreservation of embryos and oocytes.[47] This exam can cause significant distress as the procedure does not align with their male identity.[48] Controlled ovarian stimulation cycles require two weeks of daily gonadotropin injections, and the patient is given anesthesia for oocyte retrieval.[49] Furthermore, TGD men undergoing fertility preservation must discontinue testosterone use, and menstruation can resume.[50] lV.     Other Paths to Parenthood      a.      Adoption TGD adults can also pursue parenthood through adoption systems, though foster care is a temporary option. While almost one-third of surveyed TGD adults consider adoption a means to parenthood, cost and fear of discrimination can prevent them from following through.[51] TGD individuals have expressed a reluctance to pursue adoption due to the fear of discrimination by adoption agencies, attorneys, or families.[52] Nineteen states in the US allow child welfare agencies to refuse to provide services to LGBTQ+ families if it conflicts with the religious beliefs of the relevant people in the agency.[53] Nineteen states have no laws about discrimination during the adoption process based on sexual orientation or gender identity.[54] Only 29 states have statutory or regulatory protections against discrimination based on orientation and gender identity.[55]        b.     Surrogacy There are two types of surrogacies: traditional and gestational.[56] In traditional surrogacy, professionals fertilize the surrogate’s egg by the sperm of an intended parent or a sperm donor through intrauterine insemination. In gestational surrogacy, the surrogate undergoes IVF to implant the fertilized embryo.[57] Egg donation can be used for gestational surrogacy if necessary. Those considering surrogacy need to understand the specific laws in their state, as they can differ significantly.[58]      c.     Intercourse TGD individuals who have not undergone genital surgery can have intercourse with the intention of causing pregnancy. TGD men who have not had genital surgery can bear children. For those who have initiated hormonal therapy, limited data has been collected on the impact of gender-affirming hormone therapy on conception.[59] TGD men have gotten pregnant after discontinuing testosterone use.[60] TGD women who have not had genital surgery can have intercourse with a person with ovaries and produce sperm to fertilize an egg. Gender-affirming hormone therapy possibly affects sperm viability.[61] V.     A Decision Aid to Support Informed Consent and Shared Decision Making For individuals pursuing gender-affirming care, time is of the essence when considering fertility preservation. In one review, transgender health doctors reported that most patients did not want to postpone treatment for fertility preservation procedures, even if they wanted children;[62] any delay in treatment can be distressing for those with gender dysphoria.[63] Providers face several challenges when counseling patients about fertility. The WPATH guidelines pose an ethical dilemma for transgender health providers as limited data offers guidance about discussing fertility risks and recommendations with patients.[64] For TGD patients, limited and contradictory data about fertility outcomes before, during, and after gender affirmation exists, particularly for the lasting impact of gender-affirming hormone therapy.[65] For TGD women who have taken estrogen and stopped to pursue fertility preservation, data on sperm quality is mixed.[66]  The data on when normal ovarian function resumes is variable for TGD men using testosterone who have stopped to pursue fertility preservation.[67] Much data comes from the oncofertility literature, which indicates that when providers use standardized counseling practices when discussing fertility with their patients, more patients undergo fertility preservation, and patient satisfaction increases.[68]  For individuals seeking gender-affirming care, there is a need for a decision aid that providers can utilize across multiple clinics and programs.[69],[70] Patients must be aware of the benefits, risks, and alternatives of any intervention to provide truly informed consent. When discussing fertility for TGD patients, this includes which fertility options are available at each stage of transition and the potential for a live birth with each option.[71] Furthermore, a decision aid would allow for shared decision-making, where the patient is an active participant and co-designer of their treatment plan.[72] Shared decision-making acknowledges the healthcare provider’s beneficence, knowledge, and experience while equally valuing the right to patient autonomy and respecting the ability of the patient to inform the provider.[73] A decision aid can help initiate the conversations between a patient and their provider that allow for a true partnership in decision-making. A recent study investigated the efficacy and impact of a web-based fertility decision aid targeted at TGD adolescents and young adults.[74] This tool, titled Aid for Fertility-Related Medical Decisions (AFFRMED), significantly increased fertility knowledge in both youth and their parents while improving youth’s perceived ability to make fertility decisions.[75] Youth participants and their parents found the tool “feasible, acceptable, and usable.”[76] This initial study was small, with only eight adolescents or young adults and seven parents participating.[77] At large, the effectiveness of the trial will be the next step in determining the legitimacy of the aid for clinical use.[78]  A similar decision-making tool designed for TGD adults would also be useful. The tool can present an average range of expected costs as much variability exists and costs change over time.  This tool should also include general information on what is required to pursue each path to parenthood. For example, a patient undergoing fertility preservation needs to know what steps are necessary after the cryopreservation of gametes for live birth.[79] CONCLUSION Individuals pursuing gender-affirming care must closely consider the impact of their medical and surgical care on their desire to become parents as early in their affirmation journey as possible. A decision aid can be helpful if it outlines the risks to fertility and options to preserve fertility, with the specific data necessary to make an informed choice. The tool should include the methods of fertility preservation, each step of the protocol and respective risks for each method, the expected timeline from initiation to completion, general success rates, options for remaining gamete disposition, and the average cost of treatment.  This should include a list of steps to initiate the process for each method and any potential barriers or obstacles. For surrogacy, the tool should include the two types and the average cost. For intercourse, the aid should include information on risks for discontinuing gender-affirming hormone therapy and general success rates. Clinics and providers could elect to tailor the decision aid for their population to include specific information about local laws and the availability of services. With a standardized fertility decision aid, TGD individuals can have a more thorough understanding of the opportunities and limitations placed on their reproductive capacity. Healthcare providers can feel more confident that their patients have access to relevant information regarding family-building before initiating medical or surgical affirmation. This allows for a more substantial informed consent and shared decision-making process, regardless of the decision made. A trial-tested decision-making tool for TGD adolescents and young adults exists that can serve as a model for creating aid for TGD adults of all ages. A fertility decision aid designed explicitly for TGD adults of reproductive age would be invaluable to support patients and healthcare providers in transgender health.  - [1] Herman, J.L., Flores, A.R., O’Neill, K.K. (2022). How Many Adults and Youth Identify as Transgender in the United States? The Williams Institute, UCLA School of Law [2] Moravek M. B. (2019). Fertility preservation options for transgender and gender-nonconforming individuals. Current opinion in obstetrics & gynecology, 31(3), 170–176. https://doi.org/10.1097/GCO.0000000000000537 [3] Moravek (2019). [4] Moravek (2019). [5] Access to fertility services by transgender persons: an Ethics Committee opinion. (2015). Access to fertility services by transgender persons: an Ethics Committee opinion. Fertility and Sterility, 104(5), 1111–1115. https://doi.org/10.1016/j.fertnstert.2015.08.021 [6] Harris, R. M., Kolaitis, I. N., & Frader, J. E.. (2020). Ethical issues involving fertility preservation for transgender youth. Journal of Assisted Reproduction and Genetics, 37(10), 2453–2462. https://doi.org/10.1007/s10815-020-01873-9 [7] Bizic, M. R., Jeftovic, M., Pusica, S., Stojanovic, B., Duisin, D., Vujovic, S., Rakic, V., & Djordjevic, M. L. (2018). Gender Dysphoria: Bioethical Aspects of Medical Treatment. BioMed research international, 2018, 9652305. https://doi.org/10.1155/2018/9652305 [8] Rafferty, J., COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, COMMITTEE ON ADOLESCENCE, & SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4), e20182162. https://doi.org/10.1542/peds.2018-2162 [9] Rafferty (2018). [10] Rafferty (2018). [11] Rafferty (2018). [12] Rafferty (2018). [13] Rafferty (2018). [14] WPATH (2012). [15] WPATH (2012). [16] Bizic (2018). [17] Bizic (2018). [18] Moravek (2019). [19] Finlayson, C., Johnson, E. K., Chen, D., Dabrowski, E., Gosiengfiao, Y., Campo-Engelstein, L., Rosoklija, I., Jacobson, J., Shnorhavorian, M., Pavone, M. E., Moravek, M. B., Bonifacio, H. J., Simons, L., Hudson, J., Fechner, P. Y., Gomez-Lobo, V., Kadakia, R., Shurba, A., Rowell, E., & Woodruff, T. K.. (2016). Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity. Transgender Health, 1(1), 99–107. https://doi.org/10.1089/trgh.2016.0008 [20] Cheng, P. J., Pastuszak, A. W., Myers, J. B., Goodwin, I. A., & Hotaling, J. M.. (2019). Fertility concerns of the transgender patient. Translational Andrology and Urology, 8(3), 209–218. https://doi.org/10.21037/tau.2019.05.09 [21] Cheng (2019). [22] WPATH (2012). [23] WPATH (2012). [24] Bizic (2018). [25] Tornello, S. L., & Bos, H. (2017). Parenting Intentions Among Transgender Individuals. LGBT health, 4(2), 115–120. https://doi.org/10.1089/lgbt.2016.0153 [26] Sterling (2020). [27] Sterling (2020). [28] Sterling (2020). [29] Sterling (2020). [30] Health care for transgender and gender diverse individuals. ACOG Committee Opinion No. 823. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e75–88. [31] Hembree (2017). [32] WPATH (2012). [33] Tornello (2017). [34] Tornello (2017). [35] Moravek (2019). [36] Wiesenthal (2022). [37] Choi, J. Y., & Kim, T. J.. (2022). Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population. Biomedicines, 10(9), 2279. https://doi.org/10.3390/biomedicines10092279 [38] Wiesenthal (2022). [39] Mayhew (2020). [40] Sterling (2020). [41] American Society of Reproductive Medicine. (n.d.). Is in vitro fertilization expensive? In Vitro Fertilization (IVF). Retrieved November 28, 2022, from https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q06-is-in-vitro-fertilization-expensive/ [42] American Society of Reproductive Medicine. (n.d.). The difference between IUI and IVF - A patient education micro-video. Reproductive Facts. Retrieved November 20, 2022, from https://www.reproductivefacts.org/resources/educational-videos/videos/asrmsart-micro-videos/videos/the-difference-between-iui-and-ivf/ [43] Family Equality (2019). [44] Sterling (2020). [45] Bizic (2018). [46] Bizic (2018). [47] Choi (2022). [48] Bizic (2018). [49] Choi (2022). [50] Choi (2022). [51] Tornello (2017). [52] Brown, C.. (2021). Exploring trans people’s experiences of adoption and fostering in the United Kingdom: A qualitative study. International Journal of Transgender Health, 22(1-2), 89–100. https://doi.org/10.1080/26895269.2020.1867396 [53] Movement Advancement Project. "Equality Maps: Foster and Adoption Laws." https://www.lgbtmap.org/equality-maps/foster_and_adoption_laws. Accessed 10/28/2022. [54] Movement Advancement Project. “Equality Maps: Foster and Adoption Laws” (2022). [55] Movement Advancement Project. “Equality Maps: Foster and Adoption Laws” (2022). [56] Torres, G., Shapiro, A., & Mackey, T. K.. (2019). A review of surrogate motherhood regulation in south American countries: pointing to a need for an international legal framework. BMC Pregnancy and Childbirth, 19(1). https://doi.org/10.1186/s12884-019-2182-1 [57] Family building through gestational surrogacy. Committee Opinion No. 660. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e97–103. [58] Family building through gestational surrogacy (2016). [59] Light, A. D., Obedin-Maliver, J., Sevelius, J. M., & Kerns, J. L.. (2014). Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning. Obstetrics & Gynecology, 124(6), 1120–1127. https://doi.org/10.1097/aog.0000000000000540 [60] Obedin-Maliver, J., & Makadon, H. J.. (2016). Transgender men and pregnancy. Obstetric Medicine, 9(1), 4–8. https://doi.org/10.1177/1753495x15612658 [61] Choi (2022). [62] Bizic (2018). [63] Finlayson (2016). [64] Moravek (2019). [65] Mayhew, A. C., & Gomez-Lobo, V.. (2020). Fertility Options for the Transgender and Gender Nonbinary Patient. The Journal of Clinical Endocrinology & Metabolism, 105(10), 3335–3345. https://doi.org/10.1210/clinem/dgaa529 [66] Mayhew (2020). [67] Mayhew (2020). [68] Sterling (2020). [69] Kolbuck, V. D., Sajwani, A., Kyweluk, M. A., Finlayson, C., Gordon, E. J., & Chen, D.. (2020). Formative development of a fertility decision aid for transgender adolescents and young adults: a multidisciplinary Delphi consensus study. Journal of Assisted Reproduction and Genetics, 37(11), 2805–2816. https://doi.org/10.1007/s10815-020-01947-8 [70] Sterling (2020). [71] Sterling (2020). [72] De Snoo-Trimp, J., De Vries, A., Molewijk, B., & Hein, I.. (2022). How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool. BMC Medical Ethics, 23(1). https://doi.org/10.1186/s12910-022-00837-1 [73] What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?. (2020). What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?. AMA Journal of Ethics, 22(5), E423–429. https://doi.org/10.1001/amajethics.2020.423 [74] Chen, Diane. (2021, June 3 - 2021, October 9). Fertility Decision-Making in Youth and Young Adults. Identifier NCT05175170. https://clinicaltrials.gov/ct2/show/NCT05175170 [75] Chen, D., Kolbuck, V. D., Sajwani, A., Shen, E., Finlayson, C., & Gordon, E. J.. (2022). 51. Feasibility, Acceptability, and Preliminary Efficacy of AFFRMED (Aid For Fertility-Related Medical Decisions), a Web-Based Fertility Decision Aid for Transgender and Non-binary Youth and their Parents. Journal of Adolescent Health, 70(4), S27–S28. https://doi.org/10.1016/j.jadohealth.2022.01.164 [76] Chen (2022). [77] Chen (2022). [78] Chen (2022). [79] Moravek (2019).

The Silent Suffering: A Perspective on Postpartum Depression

Postpartum Depression (PPD) is a major health concern as it is affecting around 15
 per cent of the mothers after delivery. The present paper attempts to explore the different
 theoretical perspectives of PPD and its risk factors and impacts. For the purpose of the
 study, a detailed literature search was done and a total of 1467 articles were identified
 from the year 1950-2021 from various databases namely, PubMed, WebMD, SAGE,
 Springer, NCBI, Google Scholar, ResearchGate, WHO, APA, Frontiers, Healthline, Scirp,
 PsycINFO and BMC pregnancy and childbirth, maintaining the inclusion and exclusion
 criteria. At last, only 91 articles were selected, and a detailed discussion and conclusion
 have been made accordingly. Findings suggest that it is essential nowadays to protect the
 health of both the mother and child, and it is a matter of great medical and social
 importance. Hence, keen attention must be paid to the maternity quality care.

Weight-for-age z-scores of Japanese children using the World Health Organization Child Growth Standards.

Acta PaediatricaEarly View BRIEF REPORTOpen Access Weight-for-age z-scores of Japanese children using the World Health Organization Child Growth Standards Masayuki Kobayashi, Masayuki Kobayashi orcid.org/0000-0003-1688-3277 School of Medicine, Tohoku University, Sendai, JapanSearch for more papers by this authorMami Ishikuro, Corresponding Author Mami Ishikuro m_ishikuro@med.tohoku.ac.jp orcid.org/0000-0002-2884-0023 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Correspondence Mami Ishikuro, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan. Email: m_ishikuro@med.tohoku.ac.jpSearch for more papers by this authorTaku Obara, Taku Obara orcid.org/0000-0002-3674-1674 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, JapanSearch for more papers by this authorShinichi Kuriyama, Shinichi Kuriyama Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Department of Disaster Public Health, International Research Institute of Disaster Science, Tohoku University, Sendai, JapanSearch for more papers by this author Masayuki Kobayashi, Masayuki Kobayashi orcid.org/0000-0003-1688-3277 School of Medicine, Tohoku University, Sendai, JapanSearch for more papers by this authorMami Ishikuro, Corresponding Author Mami Ishikuro m_ishikuro@med.tohoku.ac.jp orcid.org/0000-0002-2884-0023 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Correspondence Mami Ishikuro, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan. Email: m_ishikuro@med.tohoku.ac.jpSearch for more papers by this authorTaku Obara, Taku Obara orcid.org/0000-0002-3674-1674 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, JapanSearch for more papers by this authorShinichi Kuriyama, Shinichi Kuriyama Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Graduate School of Medicine, Tohoku University, Sendai, Japan Department of Disaster Public Health, International Research Institute of Disaster Science, Tohoku University, Sendai, JapanSearch for more papers by this author First published: 10 January 2023 https://doi.org/10.1111/apa.16662AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abbreviations WAZ weight-for-age z-scores WHO World Health Organization Rapid infant weight gain is known to predict childhood obesity. It is generally defined as a change in the weight-for-age z-score (WAZ) of more than 0.67 standard deviations between two time-points during the first 2 years.1 However, there are various z-score references and this can lead to differences in the prevalence of rapid infant weight gain. The widely used World Health Organization (WHO) Child Growth Standards were created from longitudinal anthropometric data on healthy, exclusively breastfed children from Brazil, Ghana, India, Norway, Oman and the USA.2 While we were studying associations between rapid infant weight gain and childhood obesity in Japan, we saw that the WHO standards produced characteristic WAZ transitions (Figure 1). We plotted percentiles on 10 021 children from the Japanese Government's National Growth Survey on Preschool Children 2000.3 The z-score calculations were conducted using the WHO's igrowup macro, with SAS version 9.4 (SAS Institute). FIGURE 1Open in figure viewerPowerPoint The distribution of WAZ measurements for each weight percentile of the Japanese Government's National Growth Survey on Preschool Children 2000, according to the WHO Child Growth Standards. The percentiles are shown at birth and on the 30th day, monthly before 2 years of age, and then every 6 months. Figure 1 shows three main traits of Japanese children's growth. First, they were relatively light at birth compared to international data: the WAZ 50th percentiles for males and females were −0.73 and −0.63, respectively. Second, they showed a remarkable catch-up of approximately 3 months, based on the WHO standard, and the overall distribution was almost maintained between approximately 3–7 months. During this period, the WAZ distribution for males was consistent with the expected WHO distribution, while females who were less than the 50th percentile exceeded the ideal WHO distribution. Third, most Japanese children gradually fell below the WHO standard after 7 months. It is important to note, when interpreting Figure 1, that the Japanese data3 and WHO standards were different.2 The Japanese data were cross-sectional, not necessarily singleton term births and did not consider maternal smoking or specific modes of nutrition. However, other countries, as well as Japan, may not follow the WAZ based on WHO standards. The growth traits of Japanese children should be divided into the lower birth weight trend and notable catch-up after birth. Multiple gestation, preterm delivery and maternal smoking are known risk factors for lower birth weights in Japan.4 Kato et al. performed a regression analysis on nearly 41 million Japanese children born from 1980 to 2004. They reported that the decrease in birth weights was not fully explained by trends in multiple gestations, gestational age, gender, birth order and fathers' age.4 They did suggest associations with population trends, such as lean women and calorie intake.4 Pre-pregnancy health education is clearly essential for tackling lower birth weights in Japan. The main reason for the notable catch-up in Japan may be the mode of nutrition. Exclusive breastfeeding results in slower weight gain in infancy than formula or mixed-feeding and studies have also confirmed this trend in Japan.5 Government data for 2000 showed that more than 60% of Japanese infants were not exclusively breastfed at 4–5 months.3 The WAZ transition (Figure 1) suggests that the WHO standards, which are based on exclusive breastfeeding, may not be suitable for assessing the growth of mixed-fed or formula-fed infants. These modes are common in Japan. Another possible reason for the notable catch-up is postnatal nutritional education, based on the original Japanese growth charts; they are updated every 10 years based on national surveys and published in the maternal and child health handbooks of Japan, which record the health status of mothers and children. Weight and height measurements from infant examinations and home measurements are plotted and parents are encouraged to maintain standard values. Postnatal nutritional education could have resulted in the distribution of WAZ in infancy approaching the WHO standards by compensating for the expected decline in WAZ from reduced Japanese birth weights. Although Japanese infants tend to be lighter from birth to 5 months, the distributions after this age showed little change from the previous national survey.3 This study did not have the data to assess weight-for-length/height and BMI-for-age z-scores or detailed nutritional status. However, the Japanese trends for the length/height-for-age z-scores for each weight percentile (Figure S1) were similar to the WAZ. This suggests that the WAZ shared the same background as other anthropometric indices. The degree of change in the WAZ differed between males and females, especially in the lower percentiles. The high level of neonatal care in Japan may have improved the prognosis for stunted infants, in comparison with other countries. However, further research is needed to explain the differences between the sexes and the growth traits in the lower percentiles. It is useful to assess local populations using international standards, because they can describe local characteristics and may reflect changes in birth weight trends and subsequent nutritional status, especially in early infancy. Children who exactly track the 50th percentile for weight in Japan are regarded as having rapid infant weight gain from birth to 6 months if their WAZ is based on the WHO standard. However, more work is needed to determine whether rapid infant weight gain is problematic and whether WHO or Japanese standards are better for evaluating this, especially in terms of nutrition. FUNDING INFORMATION Supported by the Japan Agency for Medical Research and Development (grant number, JP21tm0124005) and the Japanese Ministry of Health, Labour and Welfare's Health Research on Children, Youth and Families Program (grant number, JP19DA1001). CONFLICT OF INTEREST None. Supporting Information Filename Description apa16662-sup-0001-FigureS1.tiffTIFF image, 643.2 KB Figure S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. REFERENCES 1Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 2006; 95(8): 904- 908. doi:10.1080/08035250600719754 2 WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006; 450: 76- 85. doi:10.1111/j.1651-2227.2006.tb02378.x 3 Ministry of Health, Labour and Welfare. The report of national growth survey on preschool children in 2000. Accessed October 8, 2022. https://www.mhlw.go.jp/houdou/0110/h1024-4.html (in Japanese). 4Kato N, Sauvaget C, Yoshida H, Yokoyama T, Yoshiike N. Factors associated with birthweight decline in Japan (1980-2004). BMC Pregnancy Childbirth. 2021; 21(1): 337. doi:10.1186/s12884-021-03819-0 5Tanaka H, Ishii H, Yamada T, Akazawa K, Nagata S, Yamashiro Y. Growth of Japanese breastfed infants compared to national references and World Health Organization growth standards. Acta Paediatr. 2013; 102(7): 739- 743. doi:10.1111/apa.12262 Early ViewOnline Version of Record before inclusion in an issue FiguresReferencesRelatedInformation

About the Contributors

Previous article FreeAbout the ContributorsPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreMegan Burke is associate professor of philosophy at Sonoma State University and the author of When Time Warps: The Lived Experience of Gender, Race, and Sexual Violence (Minneapolis: University of Minnesota Press, 2019). Their work in feminist phenomenology and trans philosophy can be found in Feminist Theory, Hypatia, Journal of Speculative Philosophy, philoSOPHIA, Simone de Beauvior Studies, and various anthologies, including 50 Concepts for a Critical Phenomenology, edited by Gail Weiss, Ann V. Murphy, and Gayle Salamon (Evanston, IL: Northwestern University Press).Rosa Campbell ([email protected]) is a doctoral candidate in history at the University of Cambridge. Her research considers the global history of feminism. Her cowritten article, “Striking from the ‘Second Shift’: Lessons from the ‘My Mum Is on Strike’ Events on International Women’s Day 2019,” with Claire English, appeared in Feminist Review (126, no. 1 [2020]: 151–60). Her work has also appeared on a wide range of public platforms, including Public Books, the White Review, the Victoria and Albert Museum Blog, Lit Hub, and Meanjin. She is an editorial fellow at History Workshop Online, an associate research fellow at Birkbeck, and fellow of the Raphael Samuel History Centre.Agata Chełstowska ([email protected]) is a postdoctoral researcher at the Sociology Institute, Jagiellonian University (Poland), and a lecturer at the University of Warsaw, American Studies Center. Her current research on the criminalization of abortion is part of an international research project “CrimScapes: Navigating Citizenship through European Landscapes of Criminalization.” She has been a visiting researcher at the New School for Social Research, New York, and Copenhagen University, Denmark. Her research interests lie at the intersections of gender, health, law, and social movements. Her work on the economic aspects of abortion appeared in Reproductive Health Matters (2011).Martina Ferrari is assistant professor in contemporary continental philosophy at Villanova University. She works in nineteenth- and twentieth-century continental philosophy (especially phenomenology), feminist philosophy, and decolonial thought. Her work has been published in Hypatia, the Journal of Speculative Philosophy, Chiasmi International, Symposium, and the International Journal of Feminist Approaches to Bioethics. She has coedited, with Bonnie Mann, a volume on Simone de Beauvoir titled “On ne naît pas femme : on le deviant”: The Life of a Sentence (Oxford: Oxford University Press, 2017) and cofounded Puncta: Journal of Critical Phenomenology. She earned her PhD at the University of Oregon in 2021.Donna Ferrato is an independent photojournalist and activist who has illuminated the diverse experiences of women for over fifty years. By capturing the extremes—trust and trauma, pain and pleasure, life and death—her body of work tells a story much greater than the sum of its parts. Ferrato first received critical acclaim for her work capturing the horrors of domestic violence in her iconic book Living with the Enemy (New York: Aperture, 1991). Her most recent publication, Holy (Brooklyn, NY: Powerhouse, 2019), won the 2021 Lucie Foundation Photobook Award for Best Independent Single Author Photo Book. Ferrato has participated in over five hundred one-woman shows and has received awards such as the Robert F. Kennedy Award for Humanistic Photography (1987), the Kodak Crystal Eagle for Courage in Journalism (1997), and most recently a public art grant to create awareness around gender-based violence, unveiled in 2022. She founded a nonprofit called Domestic Abuse Awarenes, and in 2014 launched a campaign called I Am Unbeatable, which features women who have left their abusers. In 2016, Time magazine declared her photograph of a woman being hit by her husband one of the “100 Most Influential Photographs of All Time.” She is based in New York City, where she continues to fight for women’s rights.Jennifer Fluri is professor of geography at the University of Colorado, Boulder. She is a feminist political geographer concentrating on conflict, security, and aid/development in South and Southwest Asia and is particularly interested in understanding the spatial organization and corporeal representations and experiences of individuals and groups working and living within conflict zones. Her current research examines gender, security, and development in Afghanistan, with a focus on women’s leadership and influence at multiple scales. This project includes analyses of geopolitical changes, including the US withdrawal, the Taliban resurgence, and the experiences and responses of people in Afghanistan.Rebecca Hall is assistant professor in the Department of Global Development Studies at Queen’s University, Canada. A feminist political economist, she has conducted research exploring the gendered dynamics of resource extraction in Canada, social reproduction and caring labors, ongoing processes of settler colonialism, and gender violence. Her 2022 book, Refracted Economies: Diamond Mining and Social Reproduction in the North (Toronto: University of Toronto Press), examines the gendered dynamics of diamond mining in the Northwest Territories, Canada.Agata Ignaciuk ([email protected]) is assistant professor in the Department of the History of Science, University of Granada (Spain). Between 2017 and 2019, she was a Marie Skłodowska Curie Actions COFUND Research Fellow at the University of Warsaw’s Institute of Ethnology and Cultural Anthropology. Her research focuses on gender and the history of sexual and reproductive health and rights. Her work has appeared in the Journal of Women’s History, Gender and History, Social History of Medicine, Technology and Culture, and Slavic Review.Candace Johnson is professor of political science at the University of Guelph, Ontario, Canada, where she is the codirector of the grounded and engaged theory lab (getlab.ca). Her research focuses on reproductive justice and the complexities of feminist solidarity across borders. She is the author of Maternal Transition: A North-South Politics of Pregnancy and Childbirth (New York: Routledge, 2016), and coeditor, with Stephen Henighan, of Human and Environmental Justice in Guatemala (Toronto: University of Toronto Press, 2018). She has also published articles in Feminist Theory; International Feminist Journal of Politics; Journal of International Political Theory; Politics, Groups, and Identities; PhiloSophia; the Canadian Journal of Political Science; and Polity, and has twice received the Jill Vickers Prize for her work on gender and politics.Serene J. Khader is professor of philosophy and women’s and gender studies at the CUNY Graduate Center and Jay Newman Chair in Philosophy of Culture at Brooklyn College. She is interested in the normative questions that arise out of feminist political praxis, especially in transnational contexts. She is the author of Decolonizng Universalism: A Transnational Feminist Ethic (Oxford: Oxford University Press, 2019) and Adaptive Preferences and Women’s Empowerment (Oxford: Oxford University Press, 2011).Bonnie Mann is professor of philosophy at the University of Oregon, the coeditor in chief of Hypatia: A Journal of Feminist Philosophy, and the author of Women’s Liberation and the Sublime: Feminism, Postmodernism, Environment (Oxford: Oxford University Press, 2006) and Sovereign Masculinity: Gender Lessons from the War on Terror (Oxford: Oxford University Press, 2014). Her work on feminist phenomenology can be found in Puncta, Hypatia, Avant, Sapere Aude, Feminist Theory, Philosophy Today, and various anthologies, including “On ne naît pas femme : on le devient”: The Life of a Sentence (Oxford: Oxford University Press, 2017), which she coedited with Martina Ferrari.Sandra McEvoy is a clinical associate professor of political science and women’s, gender, and sexuality studies at Boston University. McEvoy’s primary research interests include the dynamics of political change, including women’s participation in political violence, and gender-focused strategies that incorporate perpetrators of political violence into long-term conflict resolution strategies. She has written extensively on the Northern Irish conflict, including the gendered motivations for women’s participation in political violence and the impact that such participation has on notions of men and masculinity. McEvoy’s secondary area of interest explores the vulnerabilities of LGBT+ populations during conflict and natural disasters.Julia McReynolds-Pérez ([email protected]) is an associate professor of sociology at the College of Charleston. Her research focuses on feminist activism and abortion rights in Argentina and throughout Latin America. She has published work on abortion activism and access in BMC Pregnancy and Childbirth, Sexual and Reproductive Health Matters, and previously in Signs. She has also published on gender and Argentine feminist drumming groups in Gender & Society and has an article forthcoming on the use of humorous memes and images of fetuses in the Argentine abortion debates of 2018 in Mobilization.Siri Suh ([email protected]) is associate professor of sociology at Brandeis University, with research interests in global maternal and reproductive health, population and development, and feminist studies of science, medicine, and technology. Her research on global abortion politics has been published in Social Science and Medicine, Frontiers in Sociology, Global Public Health, and Medical Anthropology. Her book, Dying to Count: Post-Abortion Care and Global Reproductive Health Politics in Senegal, was published in 2021 by Rutgers University Press. Suh’s current research, funded by the Hewlett Foundation, explores authorized and off-label use of misoprostol in Burkina Faso and Senegal.Sarah Tobias is associate director of the Institute for Research on Women at Rutgers University and an affiliate faculty member in the Women’s, Gender, and Sexuality Studies Department. Most recently, she coedited “The New Status Quo: Essays on Poverty in the United States and Beyond,” a special issue of Feminist Formations (Spring 2021) with Nicole R. Fleetwood, and The Perils of Populism (New Brunswick, NJ: Rutgers University Press, 2022) with Arlene Stein. She is currently working on an edited volume, Feeling Democracy: Emotional Politics in the New Millennium (New Brunswick, NJ: Rutgers University Press, 2023), and a project on feminist and queer democracy.Jane Ward is professor of feminist studies at the University of California, Santa Barbara. She is the author of multiple books, including The Tragedy of Heterosexuality (New York: New York University Press, 2020) and Not Gay: Sex between Straight White Men (New York: New York University Press, 2015). Jane is also an organizer, crafter, green witch, and a parent to one cat, six chickens, and one human child. Previous article DetailsFiguresReferencesCited by Signs Volume 48, Number 2Winter 2023 Article DOIhttps://doi.org/10.1086/722518 © 2023 The University of Chicago. All rights reserved.PDF download Crossref reports no articles citing this article.

Meta-Analysis the Effects of Education, Pregnancy Planning, Husband Support, and Distance to Health Facilities on the Utilization of Antenatal Care Service

Background: Antenatal care (ANC) is comprehensive and quality antenatal care provided to pregnant women in the form of antenatal checks to prevent causes of morbidity and mortality in pregnant women and children. The decrease in the number of visits of pregnant women to health facilities has resulted in high maternal mortality due to complications of pregnancy and childbirth. This study aimed to analyze the effect of education, pregnancy planning, husband's support, and distance to health facilities on the utilization of ANC. Subjects and Method: This was a meta-analysis. Population was pregnant women. Intervention: higher education, planned pregnancies, strong husband support, and distance to close facilities. Comparison: low education, unplanned pregnancies, weak spousal support, and long distances to facilities. Outcome: utilization of ANC. The articles used were obtained from Google Scholar, BMC Pregnancy and Childbirth, PubMed, and Science Direct. The keywords used “Antenatal Care” AND “Utilization of ANC” AND “Husband Support and ANC”. The articles used were full text in English from 2009 to 2022. Articles were selected using the PRISMA diagram and analyzed using the Review Manager 5.3 application. Results: 14 cross-sectional studies showed that mothers with higher education (aOR=2.93; 95% CI=1.93 to 4.45; p=0.001); planned pregnancy (aOR= 1.99; 95% CI= 1.26 to 3.15; p=0.003); had husband support (aOR=2.89; 95% CI= 1.23 to 6.81; p=0.020); and closer distance to health facilities (aOR=3.07; 95% CI=1.43 to 6.55; p=0.003) had high and significant posibility to utilize ANC. Conclusion: Higher education, pregnancy planning, husband's support, and proximity to health facilities influence the utilization of antenatal care. Keywords: antenatal care, pregnant women, morbidity.

Trends, Topics, and Visualization Analysis of Global Scientific Production on Maternal Mortality from Postpartum Hemorrhage: A 5-year Bibliometric Analysis

Abstract BACKGROUND: Maternal death generates a great impact on public health, and it is recognized that its main cause is postpartum hemorrhage (PPH). Therefore, the objective was to analyze the bibliometric profile of the world scientific production on maternal mortality due to PPH. MATERIALS AND METHODS: Bibliometric study that included original articles indexed in Scopus, identified by means of a search strategy that included MESH terms and logical operators. Bibliometric indicators were estimated with the SciVal tool, and the VOSwiever program was used for co-occurrence networks by key terms and co-authorship by country. RESULTS: There has been an increase in the number of publications in the past 5 years. Regarding co-occurrence, the most frequent terms were “postpartum hemorrhage” and “maternal mortality.” The United States and the United Kingdom are positioned as those with the highest density of publications; in addition, Australia evidences collaboration with Canada and South Korea. Publications with national collaboration were more frequent (36%). BMC Pregnancy and Childbirth is the most productive journal, although BJOG: An International Journal of Obstetrics and Gynecology has a higher normalized impact. The authors with the highest scientific output belong to an institution in the Netherlands. Vrije Universiteit Amsterdam and Leiden University are the most productive. CONCLUSION: Scientific activity on maternal mortality due to PPH is increasing and its main means of dissemination are high-impact journals. National collaboration was more frequent, with the active participation of authors and institutions from the Netherlands and the United States.

Prevention of Fetal Neural Tube Defect with Folic Acid Supplementation

Neural tube defects (NTDs), such as spinal cord and brain defects, are due to abnormal embryonic development of the neural tube and associated with increased fetal and infant mortality, morbidity, lifelong disability, and high economic costs. Globally, more than 260,000 pregnancies are estimated to be affected by NTDs, and 75% of the NTD live births result in under-5 deaths.1 Majority of NTDs are folic acid-sensitive; with much of the NTD burden preventable through consumption of folic acid before and during early pregnancy (periconception). An association between low folate status of women of reproductive age (WRA) and risk of NTD-affected pregnancy was first proposed in 1965 by Hibbard et al.2 and was subsequently substantiated in several randomized controlled trials which demonstrated the effectiveness of folic acid supplementation during periconception in preventing the first occurrence of NTDs.3 These findings resulted in a recommendation in 1992 by the U.S. Public Health Service that WTA consume 400 μg of folic acid daily to prevent occurrence of an NTD-affected pregnancy.4 This recommendation together with other large-scale, global intervention studies demonstrated the efficacy of a daily periconceptional supplement of 400 μg in preventing a large percentage of NTDs.5
 Folic acid is a synthetic, oxidized form of folate that acts as a coenzyme in the biosynthesis of DNA and RNA. With 4 mg folic acid daily, it may take 20 weeks to reach red-blood-cell folate levels between 1050 and 1340 nmol/L, which is optimal for reduction of the neural tube defect risk. Therefore, folic acid supplementation should be started 5–6 months before conception. The residual risk with optimal red-blood-cell folate levels is reportedly 4.5 per 10,000 total births whereas the residual risk in pooled data from countries with mandatory folic acid fortification is 7.5 per 10,000 pregnancies, regardless of pre-fortification rates.6 In one study, the optimal RBC folate level was achieved in 80.4% of women who started FA 400 μg 4–8 weeks before their last menstrual period (LMP) compared to only 53.6% in women who started 4–8 weeks after their LMP (P < 0.001). 7 A worldwide survey of folic acid supplementation in WRA showed inadequate compliance to folic acid intake.8 A systematic review and meta-analysis of pooled prevalence estimates of folic acid compliance showed 32–51% in North America, 9–78% in Europe, 21–46% in Asia, 4–34% in the Middle East, 32–39% in Australia/New Zealand, and 0% in Africa. Poor compliance was secondary to many factors. In the United States, the recommendation of 400 μg supplemental intake of folic acid daily has limitations as many pregnancies, including up to 50% of all pregnancies are unplanned.9 In many countries, particularly among low- and middle-income countries, many barriers exist for the access of WRA to folic acid supplements, such as procurement of the micronutrients in a relatively costly prepackaged form and ineffective distribution system. An evaluation of NTD trends in multiple countries indicated that, regardless of form, timing, or intended target, issuing recommendations on folic acid use alone, in the absence of fortification, had no detectable impact on NTD incidence. Thus, food fortification with folic acid has been a component of national public health strategies; in particular, where folate status is insufficient and a fortifiable food vehicle, processed by a centralized industry is consumed regularly by WRA.10,11 Other factors associated with poor compliance in folic acid intake include low income, smoking during pregnancy, alcohol consumption, multiple pregnancy, geographic location, and religious beliefs. On the other hand, preconception counselling, previous infertility therapy, multivitamin intake before pregnancy, older age planned pregnancy, previous infertility therapy, and multivitamin intake before pregnancy increased compliance.12-16 Women who also believed that they had good general and obstetric health (e.g., no history of illness or miscarriage) had attitudes of not being susceptible to the health consequences of not taking folic acid supplements and were the low users of folic acid supplement.17
 In the Philippines, although WRA are advised to consume 320 ug dietary folate equivalent per day,18 about 0.9 % (around 1 in 5) are folate-deficient based on red cell folate count, while 38.7% (around 2 in 5) are folate-deficient based on serum folate.19 Congenital malformations including NTDs remain in the top ten leading causes of infant mortality from 1960 to 2005.20 In the index paper of Bernardo21 a cross-sectional, cluster sampling survey of 184 healthy, pregnant women, of age 15–49 years was conducted in the Batangas province from May to July 2017 to assess the level of knowledge, attitude, and perceived practice among the subjects on the importance of folate periconceptionally. A pretested interview questionnaire was used. The mean scores were 77% (moderate level) for knowledge, 82% for positive attitude, and 71% for positive perceived practice. The scores in the survey were related to patient’s age, civil status and to some extent, education. The study suggested that while respondents knew about folate (70%), they had low knowledge of the effect of its deficiency especially as it can lead to infant death. Knowledge had significant and positive moderate correlation with attitude (r = 0.7) and perceived practice (r = 0.5), but there was a weak positive correlation between attitude and perceived practice (r = 0.4). This likely indicates failure to emphasize the translation of knowledge and awareness properly and sufficiently into actual practice. As recommended by the author, education is the principal means to achieve the desired outcome. However, it is not clear in the study whether some amount of educational intervention besides determination of prevalence was included. As in any prevalence study, the golden opportunity to improve health outcomes is to accompany the survey with educational intervention, which in many instances, is required by the institutional board review. Some regression analysis of the data may also have been useful to determine which factors contributed most to the outcome measures.
  
 Enrique M. Ostrea, Jr., MD Wayne State University Hutzel Women’s Hospital Children’s Hospital of Michigan Detroit, Michigan, United States of America; National Institutes of Health University of the Philippines, Manila
  
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 Bernardo A. Assessment of knowledge, attitude, and perceived practices on the importance of folate among Filipino women of child-bearing age in the province of Batangas. Acta Med Philipp. May 2021, doi:10.47895/amp.vi0.1462.

Audit identified modifiable factors in Hospital Care of Newborns in low-middle income countries: a scoping review

BackgroundAudit of facility-based care provided to small and sick newborns is a quality improvement initiative that helps to identify the modifiable gaps in newborn care (BMC Pregnancy Childbirth 14: 280, 2014). The aim of this work was to identify literature on modifiable factors in the care of newborns in the newborn units in health facilities in low-middle-income countries (LMICs). We also set out to design a measure of the quality of the perinatal and newborn audit process.MethodsThe scoping review was conducted using the methodology outlined by Arksey and O’Malley and refined by Levac et al, (Implement Sci 5:1-9, 2010). We reported our results using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We identified seven factors to ensure a successful audit process based on World Health Organisation (WHO) recommendations which we subsequently used to develop a quality of audit process score.Data sourcesWe conducted a structured search using PubMed, CINAHL, EMBASE, LILACS, POPLINE and African Index Medicus.Study selectionStudies published in English between 1965 and December 2019 focusing on the identification of modifiable factors through clinical or mortality audits in newborn care in health facilities from LMICs.Data extractionWe extracted data on the study characteristics, modifiable factors and quality of audit process indicators.ResultsA total of six articles met the inclusion criteria. Of these, four were mortality audit studies and two were clinical audit studies that we used to assess the quality of the audit process. None of the studies were well conducted, two were moderately well conducted, and four were poorly conducted. The modifiable factors were divided into three time periods along the continuum of newborn care. The period of newborn unit care had the highest number of modifiable factors, and in each period, the health worker related modifiable factors were the most dominant.ConclusionBased on the significant number of modifiable factors in the newborn unit, a neonatal audit tool is essential to act as a structured guide for auditing newborn unit care in LMICs. The quality of audit process guide is a useful method of ensuring high quality audits in health facilities.

A guide to caesarean wound healing

British Journal of MidwiferyVol. 29, No. Sup8a A guide to caesarean wound healingEllen Kitson-ReynoldsEllen Kitson-ReynoldsMidwifery Programmes Lead and Manager; Lead Midwife for Education, University of SouthamptonSearch for more papers by this authorEllen Kitson-ReynoldsPublished Online:4 Aug 2021https://doi.org/10.12968/bjom.2021.29.Sup8a.1AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Abell D, Pool AW, Sharafuden S, Skelton V, Dasan J et al.. Enhanced recovery in obstetric surgery (Kings EROS): early results from one of the UKs first programmes. European Journal of Anaesthesiology. 2014; 31:192 Crossref, Google ScholarAmbler G, Casey C. 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Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database of Systematic Reviews. 2014; 10. https://doi.org/10.1002/14651858.CD007482.pub3 Google ScholarSmith and Nephew. PICO Single Use Negative Pressure Wound Therapy System. https://www.smith-nephew.com/key-products/advanced-wound-management/pico/ (accessed 13 March 2021) Google ScholarStannard JP, Gabriel A, Lehner B. Use of negative pressure wound therapy over clean, closed surgical incisions. International Wound Journal. 2012; 9(1):32–39. https://doi.org/10.1111/j.1742-481X.2012.01017.x Crossref, Google ScholarStapleton H. Wound healing in obese women following caesarean section. 2015; 23(3):34 Google ScholarStrugala V, Martin R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications. 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Postcesarean wound infection: prevalence, impact, prevention, and management challenges. International Journal of Women's Health. 2017; 9:81–88. https://doi.org/10.2147/IJWH.S98876 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 August 2021Volume 29Issue Sup8aISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 4 August 2021 Published in print 2 August 2021 Information© MA Healthcare LimitedPDF download

Prevalence and characteristics of Palestine refugee mothers at risk of postpartum depression in Amman, Jordan: a cross-sectional study

BackgroundPostpartum depression (PPD) is a major public health concern because it adversely affects maternal health and children's physical and mental development. The prevalence of PPD in Arab countries is higher than the worldwide prevalence. Additionally, refugee women are more likely to develop PPD than women in the general population, but little research of refugee women in Arab countries is available. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have provided primary health care to Palestine refugees since 1950 and began the Mental Health and Psychosocial (MHPSS) programme in Jordan in 2017 to enhance the psychosocial and social wellbeing of Palestine refugees. We assessed the prevalence of PPD and examined associated factors among Palestine refugee women living in Amman, Jordan. MethodsThis cross-sectional descriptive study was done between April 21 and May 21, 2018. Eligible participants were Palestine refugee mothers who had given birth 3–16 weeks previously and were attending any of five UNRWA health centres in Amman that were launching the MHPSS programme. Data were gathered in face-to-face structured interviews that included the Edinburgh Postpartum Depression Scale (EPDS) to assess PPD, the Maternal Social Support Scale to assess levels of perceived social support, and a structured questionnaire about sociodemographic, obstetric or paediatric, psychological, and social factors. Participants with scores greater than 12 in the EPDS were classified as having depressive symptoms. Logistic regression was used to identify factors associated with depressive symptoms. The study protocol was approved by the Department of Health, UNRWA Headquarters, Amman, Jordan, and Nagasaki University. Each participant provided written informed consent. Findings251 women participated in the study, with a mean age of 27·2 years (range 18–42, SD 5·43). 123 (49%) women were classified as having PPD. Logistic regression showed that factors associated with PPD were perceived low levels of social support (adjusted odds ratio 3·76, 95% CI 1·92–10·93) and experiencing stressful life events (one event 3·92, 1·51–9·91; two events 5·77, 2·33–14·27; and three or more events 14·8, 5·23–41·89). InterpretationThe prevalence of PPD among Palestine refugee women in Amman was higher than that reported in a previous study of the general childbearing population (women aged 18–45 years) in Irbid in Jordan (22%, Mohammad et al. Midwifery 2011; 27: e238–45) but similar to findings in the West Bank (47%, Quandil et al. BMC Pregnancy Childbirth 2016; 16: 375) and in Syrian refugee women in Jordan (49·6%, Mohammad et al. Res Nurs Health 2011; 41: 519–245). Our findings highlight the need to address this disorder in Palestine refugee mothers. Periodical PPD screening, raising awareness about PPD, providing information to husbands and families, and building a support system for mothers could alleviate the risk of PPD. Future studies should examine whether factors of antenatal depression, which were not assessed in this study, correlate with having PPD to clarify the need for early intervention in mothers. FundingNagasaki University.

Pregnancy sickness: new findings

British Journal of MidwiferyVol. 29, No. 2 EditorialPregnancy sickness: new findingsAlexandra UytenbogaardtAlexandra UytenbogaardtEditorSearch for more papers by this authorAlexandra UytenbogaardtPublished Online:2 Feb 2021https://doi.org/10.12968/bjom.2021.29.2.65AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Gadsby R, Ivanova D, Trevelyan E, Hutton JL, Johnson S. The onset of nausea and vomiting of pregnancy: a prospective cohort study. BMC Pregnancy and Childbirth. 2021. 21(10). https://doi.org/10.1186/s12884-020-03478-7 Google Scholar FiguresReferencesRelatedDetails 2 February 2021Volume 29Issue 2ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 2 February 2021 Published in print 2 February 2021 Information© MA Healthcare LimitedPDF download

AJRH gets new numbers and a social science editor.

The African Journal of Reproductive Health (AJRH) is pleased to announce major restructurings as part of its commitment to strongly address the challenge of reproductive health and rights, especially within the context of the African region, going forward.  Beginning from 2021 and thereafter, the journal will publish 6 issues a year, rather than the 4 issues it currently publishes. This is in recognition of the increasing numbers of excellent papers currently being submitted from various parts of the world for consideration for publication in the journal, and to ensure that accepted papers are not unduly held back before publication.  Thus, the six issues of the journal will now be published in February, April, June, August, October and December each year. The journal will test this publication model in 2021 and 2022, and if the challenge of large numbers of submissions persists, we will migrate to 12 issues a year. As a consequence of our expectation of an increased workload, and to further improve the turnaround time for manuscripts submitted to the journal, we have recruited a new editor to work with existing editor and deputy editors in managing the academic and technical aspects of the journal. We are pleased that Dr Lorretta Favour Chizomam Ntoimo, a sociologist/demographer, and the acting head of the Department of Demography and Social Statistics, at the Federal University Oye-Ekiti, Nigeria, has accepted to join the journal as its social science editor. Thus, apart from Professor Akhere Omonkhua who currently functions excellently as the science editor, Dr Ntoimo will join as editor and will be responsible mainly for papers that have social science and related contents. Dr Lorretta Ntoimo is an excellent and active social science practitioner and researcher, one of the best known in the region with vast knowledge and experiences in formative, interventional, and translational research, in research design in the field of reproductive health, in data analysis (including complex data analysis), and in research knowledge transfer into policy and practice. She has a Bachelors (Honours) degree in Sociology, Masters in Sociology/Demography, and a Ph.D. in Demography and Population Studies from the University of Ibadan, Nigeria. Among several other accomplishments, Dr Ntoimo was a recipient of the Fogarty International Centre/University Research Centre postdoctoral fellowship at the Demography and Population Studies Programme, University of Witwatersrand, South Africa in 2014. She also serves as a research associate at the Women’s Health and Action Research Centre in Nigeria, implementing intervention research in maternal and newborn health, and as an academic associate and trainer at the World Bank Centre of Excellence in Reproductive Health Innovation, University of Benin, Nigeria. Dr. Ntoimo is highly motivated and results-oriented, participating actively as a collaborator, field/regional supervisor, qualitative and quantitative data analyst, and project coordinator in several maternal, child, adolescent, and family health research projects sponsored by the MacArthur Foundation, African Population and Health Research Centre, South African National Research Foundation, Centre of Excellence in Human Development, the World Health Organization, International Development Research Centre, Canada, among several others. She serves in the editorial board of several journals including Sage Open, International Journal of Population Studies, and the Journal of Population and Development Studies, University of Lagos, Nigeria. She has also served as guest editor in a special edition on Family Demography and Post-2015 Development Agenda published by Development Southern Africa in 2017. She was guest editor of a special edition on family demography in Africa published by African Population Studies in 2017. Dr.  Ntoimo has  served as  a  reviewer  to more than 23 journals including Population, African Population Studies, Demographic Research, Social Science Research, Qualitative Sociology, BMC Public Health, European Journal of Social Psychology, and BMC Pregnancy and Childbirth, the African Journal of Reproductive Health among others. She has over 50 publications in reputable journals and books and has co-edited one textbook. She has presented papers, served as a discussant, and as a session and side meeting organiser in several international and local conferences. Dr. Ntoimo is a member of several professional bodies including the Population Association of Nigeria, Nigerian Anthropological and Sociological Association, International Union for the Scientific Study of Population, Union of African Population Studies, and International Sociological Association. She also serves on the Board of the Sociology of Population Research Committee of the International Sociological Association. As social science editor, we are convinced that Dr. Ntoimo will bring in considerable traction and a new direction to the AJRH. Our vision to accelerate the pace of development of the science of reproductive and women’s health in Africa through inter-disciplinary partnerships is on the ascendancy, while our current restructuring efforts will enable the journal to reach the pinnacle of its development sooner than later.  The journal’s open-access policy in several international databases will continue as we believe this would ensure increased visibility for the journal and all manuscripts contained therein. Being indexed in some of the major international publishing outlets including PubMed/Index Medicus, Scopus, African Journals online, Sabinet, and several others has been a major substantive development of the AJRH over the past years, while we will continue to work on increasing the journal’s ranking and impact over time. We warmly welcome Dr. Ntoimo to the AJRH family, as we challenge her to work hard with the rest of the editorial board to bring more energy and momentum to the journal.

Neurologic consequences of arbovirus infections: New challenges

Arbovirus includes several families of viruses that are spread by arthropod vectors, most commonly mosquitoes, ticks, and sand flies. The families of viruses included in the arbovirus group are Flaviviridae, Togaviridae, Bunyaviridae, and Reoviridae. These large families of viruses have a common feature, an RNA genome that allows these viruses to rapidly adapt to ever-changing host and environmental conditions. The arbovirus infections are associated with a wide spectrum of neurologic manifestations, we review mainly dengue, chikungunya and Zika infections that have rapidly expanded their geographic distribution. Dengue is the most widespread arboviral disease, with an estimated 70–140 million cases occurring annually. Neurological dengue is classified as a form of Severe Dengue. Neurologic involvement occurs in 4%–5% of confirmed dengue cases (Puccioni-Sohler et al., 2009). The main neurologic manifestations are: encephalitis, meningitis, myelitis and Guillain Barre syndrome. Associated neurologic clinical manifestations of chikungunya virus include: meningoencephalitis, seizures, Guillain-Barre syndrome, myelopathy, encephalomyeloradiculitis and neuropathies (Samra et al., 2017) On February 1st, 2016 the World Health Organization (WHO) declared Zika virus infection an international public health emergency due to 2015 reports from Brazil of cluster of microcephaly cases and other neurological disorders , following a cluster of Guillain Barre Syndrome cases in French Polynesia in 2014 (Miranda-Filho Dde et al., 2016; Cao-Lormeau et al., 2016). The Zika virus (ZIKV) infection represents a major global health problem. By 2017 the WHO estimated that nearly 100 million people, and more than 1 million pregnant women in the Americas, were infected, suggesting that tens of thousands of children may have had the congenital ZIKV syndrome (Aragao et al., 2017; Lebov et al., 2019). The ZIKV infection mainly the Asian lineage, has a neurotropism with a wide spectrum of neurologic consequences and represent neuropathological agent with several neurological complications. The neurologic spectrum of Zika virus (ZIKV) infection includes: 1) Congenital Zika Syndrome by affecting the neural stem cells of the human fetal brain (Mlakar et al., 2016); 2) Guillain-Barré Syndrome by an autoimmune response against peripheral myelin and/or axonal components or probable direct inflammatory reaction (Cao-Lormeau et al., 2016); 3) Sensory neuropathy by infecting directly the peripheral neurons and causing substantial cell death and pathogenic transcriptional dysregulation (Oh et al., 2017; Medina et al., 2016); 4) Encephalitis/meningoencephalitis and myelitis by a direct viral inflammatory process on the central nervous system; 5) Acute Disseminated Encephalomyelitis and optic neuropathy; 6) Seizures and Epilepsy; 7) Childhood arterial ischemic stroke by probable inflammatory reaction and endothelial injury. The Zika, Dengue and Chikungunya arbovirus infections and its neurologic consequences represent a major global health problem [1] Aragao MFVV, Holanda AC, Brainer-Lima AM, et al. Nonmicrocephalic Infants with congenital Zika syndrome suspected only after neuroimaging evaluation compared with those with microcephaly at birth and postnatally: how large is the Zika virus "Iceberg"? AJNR Am J Neuroradiol. 2017 Jul;38(7):1427-1434. [2] Cao-Lormeau VM, Blake A, Mons S, Lastère S, et al. Guillain-Barré syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016 Apr 9;387(10027):1531-1539. [3] Lebov JF, Arias JF, Balmaseda A, et al. International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol. BMC Pregnancy Childbirth. 2019 Aug 7;19(1):282 [4] Medina MT, England JD, Lorenzana I, Medina-Montoya M, et al Zika virus associated with sensory polyneuropathy. J Neurol Sci. 2016 Oct 15;369:271-2. [5] Miranda-Filho D de B, Martelli CM, Ximenes RA, et al.. Initial description of the presumed congenital Zika syndrome. Am J Public Health. 2016 Apr;106(4):598-600. [6] Mlakar J, Korva M, Tul N,et al. Zika virus associated with microcephaly. N Engl J Med. 2016 Mar 10;374(10):951-8. [7] Oh Y, Zhang F, Wang Y, et al. Zika virus directly infects peripheral neurons and induces cell death. Nat Neurosci. 2017 Sep;20(9):1209. [8] Puccioni-Sohler M, Soares CN, Papaiz-Alvarenga R, et al. Neurologic dengue manifestations associated with intrathecal specific immune response. Neurology. 2009 Oct 27;73(17):1413-7. [9] Samra JA, Hagood NL, Summer A, Medina MT, et al. Clinical features and neurologic complications of children hospitalized with Chikungunya virus in Honduras. J Child Neurol. 2017 Jul;32(8):712-716.

Prevalence of male partners involvement in antenatal care visits \u2013 in Kyela district, Mbeya

BackgroundIn most countries in the world, promotion of maternal and child health is perceived as women’s role and men do not feel that they are responsible and see no reason to accompany their partners to Antenatal Care (ANC) clinics [Vermeulen, E., et al., BMC Pregnancy Childbirth 16:66, 2016]. Male involvement in Reproductive, Maternal, Neonates and Child and Adolescent Health (RMNCAH) programs in Tanzania is low. In Prevention of Mother to Child Transmission (PMTCT) program, the data shows only 30% attend couple counseling and only 8% for HIV counseling with their partners. There is limited data on prevalence of male involvement in ANC visits in Kyela. The purpose of this study was to determine prevalence of male involvement in ANC services and assess factors influencing male partners’ involvement in ANC visits in Kyela district in Mbeya. The findings from this study will serve as a baseline in efforts to increase male involvement in ANC care in Kyela.MethodsHospital based cross-sectional study was undertaken in Kyela district, Mbeya from October 2017 to November 2017. Data was collected using structured questionnaire and analyzed using SPSS version 20. Factors with P values of < 0.05 in univariate logistic regression were included in a multivariable logistic regression model to determine predictor variables that are independently associated with the outcome. Significant difference was defined as a P- value less than 0.05 and Odds Ratio (OR) that did not include 1.0.ResultsAbout 174 pregnant women who were visiting the ANC in their second to fourth visits or higher. About, 56.9% (99) attended with their male partners and 51% (52) of these reported to be accompanied by male partners to ANC because the women had requested their partners to accompany them. Attendance of male partners to ANC was significantly associated with male partner awareness of ANC visiting dates OR 24.1, 95% CI 6.8, 86.5, and P < 0.0001.ConclusionPrevalence of male attendance to the ANC in Kyela district is not adequate as fearing of HIV testing seemed to decrease male attendance to ANC services. So, there is high need to improve ANC health services with a focus on male friendly services.

Worrying in the wings? Negative emotional birth memories in mothers and fathers show similar associations with perinatal mood disturbance and delivery mode

Negative birth experiences can lead to symptoms of post-traumatic stress disorder in new mothers but have received much less attention in new fathers. A sample of 314 first-time expectant couples rated their symptoms of anxiety and depression in the third trimester and at 4-month post birth (227 vaginal delivery, 87 caesarean section), when they also completed the emotional memories subscale of the BirthMARQ (Foley et al. BMC Pregnancy Childbirth, 14, 211, 2014). We first examined mode of delivery (vaginal birth versus caesarean section) as a predictor of mothers’ and fathers’ BirthMARQ scores. Next, we used actor-partner interdependence model (APIM) to investigate intra- and interpersonal associations between birth experiences and maternal/paternal latent factors for antenatal and postnatal depression/anxiety. Reports of negative birth experiences were more common for mothers than fathers and for parents of babies born by caesarean section than by vaginal delivery. Within-couple agreement was moderately strong and, for both parents at both time-points, individual differences in negative birth memories were associated with symptoms of depression and anxiety. Negative birth memories also played a mediating role in the association between birth via caesarean section and reduced postnatal maternal wellbeing. Given the striking similarities between mothers and fathers in links between birth experiences and wellbeing, our findings highlight the need for partner-inclusive intervention strategies.

Engaging pregnant women in observational research: a qualitative exploratory study

BackgroundRecruitment of pregnant women to population health research can be challenging, especially if the research topic is sensitive. While many pregnant women may be inherently interested in research about pregnancy, there is the possibility that the nature and timing of the project may give rise to anxiety in some women, especially if the topic is sensitive or it brings about new awareness of potential pregnancy complications. Research staff undertaking recruitment need to be skilled at strategies to manage the environment, and have well developed communication and interpersonal skills to explain and promote the study and facilitate each woman’s informed decision-making regarding participation.However, the skills needed by recruitment staff to successfully engage pregnant women with a research topic are not well understood. This study aimed to address this evidence gap by providing insight into the dynamics between a pregnant woman and recruitment staff at the time of the offer to participate in an observational study about alcohol use in pregnancy.MethodsNaturalistic inquiry guided a qualitative exploratory descriptive approach. Experienced recruitment staff from the Asking Questions about Alcohol in Pregnancy (AQUA) study (Muggli et al., BMC Pregnancy Childbirth 14:302, 2014) participated in individual semi-structured interviews and were asked about their experiences and approaches to engaging pregnant women. Interviews were transcribed verbatim and analysed using inductive content analysis.ResultsPregnant women brought with them an inherent interest or disinterest in alcohol research, or in research in general, which formed the basis for engagement. Women responded favourably to the invitation to participate being delivered without pressure, and as part of a two-way conversation. Engagement with a sensitive topic such as alcohol use in pregnancy was facilitated by a non-judgmental and non-targeted approach. Influences such as privacy, distractions, partner’s opinion, time factors and level of clinical support either facilitated or hindered a woman’s engagement with the research.ConclusionsThese results provide an in-depth explanation of barriers and enablers to recruitment of pregnant women in antenatal clinics to studies that may inform strategies and the training of recruitment staff.