Pregnancy Care Research Articles

Satisfaction with Maternity Care Among Immigrant Women, Refugee Women and Non-immigrant Women: Results of the Pregnancy and Obstetric Care for Refugees (PROREF) Cross-Sectional Study.

Migration is a worldwide phenomenon leading to challenges for the health care system. There is conflicting evidence on the effect of migration on satisfaction with obstetric care. Our hypothesis was that satisfaction with obstetric care was lower in immigrant women or women with self-defined (sd) refugee status than in non-immigrant women. In the Pregnancy and Obstetric Care for Refugees (PROREF)-study, funded by the Germany Research Council (DFG), between June 2020 and April 2022 in three hospitals of tertiary care in Berlin women were interviewed 1-3days after giving birth with the Migrant Friendly Maternity Care Questionnaire (MFMCQ). The interview data was linked to the routine perinatal data of the hospital charts. Descriptive analysis and logistic regression analysis were performed to identify factors influencing satisfaction with obstetric care. A total of 3420 women could be included in the study, with an overall response rate of 77.5%. Satisfaction measured generally high with over 80% of women being satisfied with obstetric care at all three time points: during pregnancy, during labor and birth and after giving birth. We identified two factors associated with an increased chance of being satisfied with obstetric care: sd refugee status (OR 2.57, 95% Cl 1.48-4.44, p-value 0.0008) and being multipara (OR 1.40, 95% CI 1.18-1.67, p-value 0.000). Efforts on improving birth experience should focus on primipara. The reasons for non-immigrant women being less satisfied with care than women with sd refugee status are not fully understood.

Midwives' perspectives on women's dietary intake during pregnancy: A systems thinking approach.

Prenatal nutrition status and maternal dietary behaviours are known to impact maternal and child health outcomes. We aimed to inform strategies for improving prenatal diet quality and their integration into pregnancy care. Group Model Building (GMB) workshops were conducted with midwives from six health services. A Causal Loop Diagram (CLD) was developed to illustrate how the factors contributing to poor nutrition during pregnancy were interconnected and influenced each other and to identify priority action areas. Workshops were recorded and transcripts thematically analysed to provide a deeper understanding of the challenges of dietary advice provision and intervention opportunities. The GMB process created a CLD that included 51 factors that were perceived to be driving poor dietary intake in pregnancy. These were grouped into five priority areas for action: knowledge and education, food availability and access, personal and family circumstances, health system, and care. Thematic analysis of the workshop transcripts revealed four major themes related to midwives' perspectives on the challenges associated with delivering dietary advice in pregnancy care: hospital service provision, pregnancy care clinicians, psychosocial factors affecting women, and maternal diet and health. Intervention targets were identified as continuity of care, nutrition education, guidelines and resources, personalised dietary advice, dietary data collection, and dietitian referrals. Midwives' perspectives on the drivers of poor prenatal nutritional intake were multifaceted, spanning the personal, environmental and health system levels. Nutrition interventions should consider the health system and service context, along with pregnant women's dietary knowledge and education, access to healthy food, social, cultural, and personal circumstances, and clinical care experience.

Metal and Covalent Organic Frameworks Meet OB-GYN: Advancing Applications in Women's Health and Pregnancy Care.

Metal-organic frameworks (MOFs) and Covalent-organic frameworks (COFs) are promising materials for biomedical applications due to their high surface area, tunable porosity, and functional versatility. Functionalized or nanoparticle-containing MOFs and COFs have been largely explored in preclinical studies for drug delivery, photodynamic and photothermal therapies, and ROS generation targeting cancer cells, among others. Additionally, they have shown potential as carriers of imaging agents for precise biomarker identification and tumor detection. However, the application of nanomaterials in medicine, including MOFs and COFs, still does not meet the expectations set more than two decades ago. This is particularly important in the maternal-fetal field, where substantial maternal health risks during pregnancy and childbirth affect many women. Only recently a range of preliminary studies exist, as these risks have traditionally been viewed as inherent to pregnancy, leaving significant gaps in innovative solutions for women's health that nanomaterials have the potential to bridge. This review addresses this critical need, offering a summary of current research in obstetrics and gynecology and maternal-fetal applications of MOFs and COFs, identifying gaps, and aiming to guide future research to expand nanomedicine's impact in these areas.

Unintended pregnancy: Risk factors and perinatal outcomes in a nulliparous population

Abstract BackgroundPrevious studies have found that unintended pregnancies are associated with late prenatal care and adverse pregnancy outcomes. Unintended pregnancy in nulliparous individuals who establish early prenatal care is of particular interest because outcomes in these pregnancies are not confounded by outcomes from prior births or late initiation of prenatal care.ObjectiveThe purpose of this study is to investigate maternal risk factors and perinatal outcomes associated with unintended pregnancies in a nulliparous population who established early prenatal care.Study designThis is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐be (nuMoM2b), a prospective cohort study in which 10,038 nulliparous individuals were followed throughout their pregnancy from the first trimester. Participants who indicated their pregnancy intention on a standardized questionnaire were included in the analysis. Maternal characteristics and pregnancy outcomes of those reporting a planned pregnancy were compared with those reporting an unplanned pregnancy. Multivariable logistic regression with stepwise model selection was used to identify maternal characteristics associated with unplanned pregnancy.ResultsA total of 10,020 participants in the nuMoM2b study identified their pregnancies as either “planned” (58.5%, n = 5,859) or “unplanned” (41.5%, n = 4161). Compared with those having a planned pregnancy, those with unplanned pregnancies were more likely to be younger, non‐Hispanic Black or Asian, not married, of lower socioeconomic status, and to report alcohol or tobacco use prior to pregnancy, even after adjusting for covariates (all p values ≤ 0.04). Those with unplanned pregnancies were not more likely to have a history of mental illness. After controlling for potentially confounding factors, only treatment of mental illness during pregnancy or postpartum remained significantly associated with unplanned pregnancy (adjusted odds ratio 1.29, 95% confidence interval 1.01–1.64, p = 0.04).ConclusionsOur findings suggest that nulliparas who received early prenatal care for an unplanned pregnancy did not have more frequent adverse perinatal outcomes compared to planned pregnancies; however, they received treatment more frequently for mental illness during pregnancy and postpartum.

542-P: Development and Baseline Characteristics of a Novel Community-Based Nutrition-Lifestyle Therapy for Pregnant Women with Diabetes

Introduction and Objective: Socioeconomically disadvantaged (SED) pregnant Latina women are disproportionately burdened by type 2 and gestational diabetes. While diet and lifestyle therapy can help maintain glycemic control in pregnancy and plant-forward interventions have been successful in Latino populations, there is little data in pregnancy. This study evaluates a culturally tailored, plant-forward, dietary-lifestyle intervention delivered by community health workers (CHWs). We hypothesize that it will improve glycemic control in pregnant Latina women with diabetes, including time in continuous glucose monitoring (CGM) pregnancy range (TIR) 63-140 mg/dL, average glucose and glycemic variability. Methods: We performed a baseline analysis in the 12 out of target 30 participants currently enrolled. Participants are randomized to either plant-forward dietary-lifestyle intervention or to standard of care. The intervention arm receives 12 CHW-led classes. Standard of care group receives their regular pregnancy care visits. Both groups wear CGM unblinded as best practice for diabetes in pregnancy. Results: Of the 12 participants mean age was 33.17 ± 6.27 years and mean gestational age at enrollment was 22.05 ± 5.73 weeks. 41.67% have food insecurity and 8.13% have housing insecurity. 50% are primarily Spanish speaking and 67.77% have a high school education or less. Average baseline A1c was 5.78 ± 1.25%, range 4.5-9.3%. Mean CGM TIR 63-140 mg/dL was 78.39 ± 24.28%. Conclusion: This baseline data suggests a need for an effective, culturally and linguistically tailored dietary-lifestyle intervention in SED pregnant Latina women with diabetes. While on average goal pregnancy TIR of >70% was met, there is significant variation and several participants are not meeting this goal. Overall, results of this pilot study will increase understanding of the effect of high-quality CHW-led education interventions on glycemic profiles, and maternal and fetal pregnancy outcomes of this vulnerable population. Disclosure R. Pines: None. C. Axelrod: None. S. Bell: None. K. Nelson: None. E. Romero Gutierrez: None. K. Victoria: None. K.N. Castorino: Research Support; Abbott, Medtronic, Dexcom, Inc., Lilly Diabetes, MannKind Corporation, Eli Lilly and Company, Insulet Corporation. Speaker's Bureau; Dexcom, Inc. Advisory Panel; MannKind Corporation. Speaker's Bureau; Insulet Corporation. Funding National Institutes of Health NIMHD (P50MD017344 subaward SCON-00003510)

1241-P: Maternal, Fetal, and Neonatal Outcomes in Pregnant Women with Type 1 and Type 2 Diabetes in a Large Health Care System

Introduction and Objective: Type 1 (T1DM) and type 2 diabetes (T2DM) in pregnancy is associated with greater risk of adverse maternal, fetal and neonatal outcomes. Using real-world data from a large healthcare system, we aimed to identify risk factors and compare pregnancy outcomes between T1DM and T2DM individuals. Methods: ICD-10 codes were used to extract diabetes diagnosis and pregnancy outcomes from Electronic Health Records among people who gave birth between 1/1/2021 and 8/31/2023 at Sutter Health - a large, integrated health system in Northern California. Results: Among a total of 67793 deliveries, 300 (0.4%) and 1417 (2.1%) were complicated by T1DM and T2DM respectively. T1DM patients were younger, had higher HbA1c from 1st to 3rd trimester, while T2DM patients had greater pre-pregnancy BMI and less weight gain during pregnancy (all p < 0.05). Compared to T2DM, T1DM patients had a significantly higher rates (Table) of preeclampsia, c-sections, preterm delivery, NICU admission and neonatal hypoglycemia. Both T1DM and T2DM had greater rates in these adverse outcomes than those without. Conclusion: T1DM and T2DM adversely impact maternal, fetal and neonatal outcomes. Compared to T2DM, T1DM is associated with higher HbA1c levels during pregnancy and increased risk of adverse pregnancy outcomes. These differences are important in delivering tailored pregnancy care to individuals with diabetes. Disclosure T. Asuni: None. Y. Guo: None. R. Lane: None. D. Kerr: None. F. Farrokhi: None.

A Clearer Picture: MRI's Expanding Role in High‐Risk Pregnancy Care

A Clearer Picture: MRI's Expanding Role in High‐Risk Pregnancy Care

MicroRNAs in Preeclampsia: An Overview of Biomarkers and Potential Therapeutic Targets.

Preeclampsia (PE) remains a significant obstetric challenge, having complex pathophysiology and limited early diagnostic and therapeutic options. MicroRNAs (miRNAs) have emerged as critical regulators in PE, offering insight into the molecular mechanisms underlying placental dysfunction and impaired maternal adaptation. Differentially expressed miRNAs in both placental tissue and maternal circulation, such as miR-155, play key roles in regulating angiogenesis, trophoblast invasion, and inflammatory pathways, all of which are central to the development of PE. Ongoing investigations increasingly highlight miRNAs as promising non-invasive molecular indicators for the early diagnosis and risk stratification of PE. Furthermore, therapeutic strategies targeting miRNA pathways using mimics or inhibitors show promise in correcting molecular dysfunctions and improving maternal and fetal outcomes. However, clinical translation faces several challenges, including targeted delivery, off-target effects, and the assessment of long-term efficacy. Overall, miRNAs hold significant potential as both diagnostic tools and therapeutic agents, marking a promising direction for improving care in PE pregnancies.

Holistic Approaches During Pregnancy and Their Implications for Midwifery Practice

This literature review explores holistic approaches during pregnancy and their implications for midwifery practice. Holistic care addresses physical, psychological, social, and spiritual dimensions of maternal health, aiming to promote overall well-being and positive pregnancy outcomes. By synthesizing evidence from studies published between 2020 and 2025, this review highlights the benefits of integrating holistic methods such as stress reduction techniques, nutritional support, psychosocial counseling, and culturally sensitive care within midwifery. The findings suggest that holistic care enhances emotional resilience, reduces anxiety and depression, and strengthens the mother infant bond. However, challenges remain in standardizing holistic practices, ensuring adequate training for midwives, and overcoming systemic barriers. The review underscores the need for midwives to adopt a comprehensive, woman centered approach supported by ongoing education and interdisciplinary collaboration. Future research should focus on evaluating holistic interventions’ effectiveness and developing scalable models to improve maternal and neonatal outcomes globally. Ultimately, holistic pregnancy care offers a promising framework to enrich midwifery practice and support maternal well-being throughout pregnancy.

Choice of place of maternity care among women in a semi urban population

Objectives: Persistent home birth among pregnant women is a significant public health concern in Nigeria. Increasing the proportion of births attended by skilled health personnel has been emphasized as a viable measure of progress for positive maternal and newborn outcomes worldwide. This study assessed the choice of place for antenatal care (ANC) and childbirth among women in a semi-urban population in southwestern Nigeria. Materials and Methods: The study employed a cross-sectional design. A sample of 168 pregnant women in the third trimester of pregnancy and who had had a minimum of one previous childbirth was selected through a multistage sampling method from all the administrative wards in two local government areas in a state in southwestern Nigeria. A structured and pretested questionnaire was used for data collection. Data were analyzed using Statistical Package for the Social Sciences software, version 25; descriptive statistics were presented in tables, and inferential statistics were analyzed at a level of significance of 0.05. Results: The results revealed that many of the respondents had skilled ANC (140, 83.3%) and skilled attendants at birth (120, 71.4 %) in their last pregnancy. A significant relationship was found between women’s choice of place of maternity care and trust in the traditional birth attendants (χ2 = 7.714; P = 0.005), lack of transportation to the hospital (χ2 = 42.0; P = 0.000), perception of birth at hospital as not necessary (χ2 = 6.095; P = 0.014), flexible payment method for care in mission/spiritual home (χ2 = 16.095; P = 0.000), and the actual cost of hospital birth (χ2 = 24.381; P = 0.000). Husbands (114, 50%) were the major contributors to the women’s decisions in place of maternity care. Conclusion: The study concluded that most women utilized skilled care for pregnancy and childbirth, but not all the women who had ANC in the hospital utilized the hospital for childbirth as a result of personal and hospital-related factors. There is a need for health education intervention that can adequately inform and improve women’s self-efficacy to use skilled care in pregnancy and childbirth.

Growth in the first two years in children born to mothers infected with COVID-19 during pregnancy: a cohort study

IntroductionBecause the impact of COVID-19 on the growth of infants whose mothers were infected with this virus during pregnancy is unclear, this study investigated the effect of mothers’ infection with this virus during pregnancy on their infant’s growth during the first two years of life.MethodIn this prospective cohort study, the available information from 697 mothers referring to Iran’s health care centers for pregnancy and breastfeeding care was used to compare the growth of 367 children born to mothers infected with COVID-19 during pregnancy with that of 330 children born to mothers who were not infected and not exposed to COVID-19 during pregnancy. Their growth was evaluated for two years.ResultsConcerning the weight, height, and head circumference 6 months, 12 months, and 24 months after birth, although the values obtained in the exposed group were slightly higher than the non-exposed group, no statistically significant difference was observed (P > 0.05). Comparing the exposed group’s growth indices (weight, height, and head circumference) based on whether the mother was infected with COVID-19 during the first, second, or third trimester showed no significant difference (P > 0.05). The birth height of the babies whose mothers infected with COVID-19 in the first and second trimesters of pregnancy was slightly lower than those whose mothers were infected in the third trimester (P = 0.019). Children in the exposed group weighed 76.61 g more than those in the non-exposed group (P = 0.018).ConclusionMore long-term studies in different populations about growth of children are needed to generalized the findings.Clinical trial numberNot applicable (A cohort study).

From choice to labour: Understanding ‘aborting labour’ in Irish at-home early medication abortion experiences

This article analyses the process of having an early medication abortion (EMA) in Ireland under the Health (Regulation of Termination of Pregnancy) Act 2018 and addresses the experience of abortion seekers as aborting labourers. Drawing on literature from Social Reproduction Theory (SRT) with abductive analysis of empirical data following Charmaz's Constructivist Grounded Theory (CGT) methodology, I argue for a sociological understanding of abortion seekers as workers performing aborting labour with three interrelated facets: gestational, logistical, and hermeneutic. Based on secondary analysis of qualitative interviews with service users in the first large cohort study of abortion access post-Repeal, the Unplanned Pregnancy and Abortion Care Study , this article argues for a reappraisal of abortion seekers instead as gestational workers performing aborting labour in workplace conditions not of their choosing. Ireland's abortion policy relies primarily on EMA self-administered in the home for the provision of most abortion services. This has global relevance for understanding medication abortion provision in contexts where abortion is legal, but aborting labourers are not given a choice of method. I argue for a broader understanding of the structural inequalities aborting labourers face when engaging with neoliberal ‘choice-based’ abortion governance and the consequences these inequalities have on the production of new aborting subjectivities.

Home care in high-risk pregnancies: 10 years' experience

Home care in high-risk pregnancies: 10 years' experience

Advancing precision care in pregnancy through a treatable fetal findings list.

Advancing precision care in pregnancy through a treatable fetal findings list.

P450 Evaluation of care in pregnancy for patients with cystic fibrosis – can we do better?

P450 Evaluation of care in pregnancy for patients with cystic fibrosis – can we do better?

Caring for Pregnancy-Related Emergencies after Dobbs.

Background: Almost immediately after the landmark 2022 Dobbs decision overturning the legal right to abortion established under Roe v. Wade, important questions emerged about the possible effects of the state-level bans and severe restrictions on abortion that Dobbs allowed, including denial or dangerous delay in providing care that had been available pre-Dobbs. Theoretically, these new state-level abortion restrictions permit exceptions for what is variably described as a "threat to the life" of the pregnant woman. In practice, however, the actual determination of when a pregnant person has reached the threshold of this legal language is often vague and subjective. How clinicians have navigated patient care, including obstetric emergencies, in this context, and what it means for their experiences of work is an important area of study. Methods: Drawing on in-depth interviews with clinicians (n = 29), we document how the Dobbs-driven changes in pregnancy care have impacted clinicians both in states in which abortion is banned or severely restricted and those where it remains largely unrestricted. Results: It is not just clinicians in states that have severely restricted abortion who have been impacted; clinicians in states where abortion remains broadly legal are central to protecting patients' lives and health when they experience the dangers of pregnancy. Conclusions: We close by speculating on the consequences of this rising awareness of the importance of access to abortion care for obstetric patients and possibilities for shifts in public support for clinicians who provide abortion care.

Cover Image.

The cover image is based on the Original Article The Potential of Tele-Ultrasound, Handheld and Self-Operated Ultrasound in Pregnancy Care: A Systematic Review by S. S. Kariman et al., https://doi.org/10.1002/pd.6679.

Experiences of Obstetrician–Gynecologists in a Post-Dobbs Wisconsin: Establishing a Critical Evidence Base in an Abortion-Restricted State [ID 1270

INTRODUCTION: After the Dobbs decision, Wisconsin physicians faced the threat of an 1849 state law widely interpreted to criminalize the provision of abortion except in lifesaving emergencies. We sought to document how the post-Dobbs legal landscape and institutional responses to the 1849 law shaped the ability of obstetrician–gynecologists to provide health care to patients facing pregnancy-related risks and complications. METHODS: Between June 2022 and December 2023, we recruited 21 obstetrician–gynecologists from both rural and urban areas with varying hospital affiliations, scopes of practice, and individual demographics to participate in semistructured, remote interviews. Interviews explored experiences providing pregnancy care under the threat of a statewide abortion ban and in light of preexisting abortion restrictions and institutional policies. Investigators coded and analyzed qualitative data using a combined inductive–deductive approach. RESULTS: Wisconsin obstetrician–gynecologists experienced uncertainty and confusion after Dobbs and dismay over inadequate institutional guidance and support. The threat of criminalization and differing institutional interpretations of the 1849 law jeopardized evidence-based clinical practice, amplified preexisting barriers for pregnant patients, and resulted in inconsistent pregnancy care provision across the state. CONCLUSIONS/IMPLICATIONS: The threat of criminalization in post-Dobbs Wisconsin resulted in precarity for obstetrician–gynecologists and delayed and substandard care for pregnant patients. The absence of clear guidance and support from institutions and health care systems was a particularly harmful but potentially addressable barrier. Physician experiences in post-Dobbs Wisconsin contribute to a critical evidence base on the harms of abortion restrictions and remain relevant to states facing similar bans that criminalize or restrict health care.

Reliability and validity of measures of respectful care and discrimination for LGBTQ2S+ pregnant people.

Reliability and validity of measures of respectful care and discrimination for LGBTQ2S+ pregnant people.

Leveraging human centered design to enhance clinician communication during pregnancy care: Overcoming language barriers with Spanish-speaking patients.

Leveraging human centered design to enhance clinician communication during pregnancy care: Overcoming language barriers with Spanish-speaking patients.