Birth Complications Research Articles

Determinants of adolescent childbearing in Ethiopia, analysis of 2016 Ethiopian demographic and health survey: a case-control study

Pregnancy and birth complications experienced by adolescents are also problems of older women. But it is severe among the young due to physical immaturity and social condemnation from basic reproductive health services. The study was aimed to analyze determinants of adolescent childbearing in Ethiopia using the Ethiopian demographic and health survey. The data source for this study was the 2016 demographic and health survey. Records of 359 cases and 1436 randomly selected controls (1:4 ratio) were included in the analysis. Adolescent childbearing was the main outcome variable and the independent variables were sociodemographic and sexual & reproductive factors. Multivariable logistic regression analysis was used to identify factors associated with adolescent childbearing. The mean age of girls at first cohabitation was 15.28 ±1.64 and the mean age of first birth was 16.47±1.35. Adolescent childbearing was found to be higher in the Afar region (34.8%), and the lowest was in Addis Ababa city (4.1%). Finding from the multivariable analysis showed that place of residence, survey time age, and age at first sexual intercourse were the factors that have an association with adolescent childbearing. The odd of childbearing was higher among rural residents (AOR = 1.74; 95 % CI: 1.12, 2.72), early (<18 years) initiation of sexual intercourse (AOR =12.5; 95% CI: 5.97,25.18) and the risk is also higher among older teenagers (AOR =7.92; CI:3.92,15.90). Place of residents, age, and timing of first sexual intercourse was found to be the influencing factors of adolescent childbearing. Our finding indicates that the place of residence of the adolescent mothers must be considered in planning policies that attempt to disrupt successive cycles of socioeconomic deprivation. Public health interventions should focus their programs to be based on community and aim on prevention of early sexual intercourse and marriage.

Reproductive Outcomes of In Vitro Fertilization and Fresh Embryo Transfer in Infertile Women With Adenomyosis: A Retrospective Cohort Study.

BackgroundAdenomyosis is commonly encountered in infertile women; however, it is still unclear whether adenomyosis has a detrimental effect on in vitro fertilization and embryo transfer (IVF-ET) outcomes.MethodWe enrolled 1146 patients with adenomyosis and 1146 frequency-matched control women in a 1:1 ratio based on age, BMI, and basal follicle-stimulating hormone (FSH) level. After controlling for other factors, the rates of clinical pregnancy, miscarriage, live birth, and obstetric complications were compared between two groups.ResultsThere was no significant difference in clinical pregnancy rate between the two groups (38.1% vs. 41.6%; P=0.088). The implantation rate (25.6% versus 28.6%, P=0.027) and live birth rate (26% versus 31.5%, P=0.004) were significantly lower in the women with adenomyosis than in the controls. The miscarriage rate in the adenomyosis group was higher than that in the control group (29.1% versus 17.2%, P=0.001). After adjusting for confounding factors, multivariate analysis showed the clinical pregnancy rate was not statistically different between the two groups (OR: 0.852, P=0.070). In the adenomyosis group, the rate of miscarriage(OR: 1.877, P=0.000), placenta previa (OR: 2.996, P=0.042)and preeclampsia (OR: 2.287, P=0.042)were increased significantly, while live birth rate (OR: 0.541, P=0.000) was reduced significantly than control group.ConclusionAdenomyosis has negative effect on IVF-ET outcomes in which miscarriage risk increased, live birth rate reduced and obstetric complications increased.

Sociocultural Determinants of Nutritional Status Among Children Under Five Years of Age: An Ethnographic Study From Gujarat.

BackgroundThe magnitude of child malnutrition, including severe child malnutrition, is high in India, and Gujarat has a higher prevalence of child malnutrition. Prior studies have employed anthropometric measures to identify the prevalence and associated factors of children’s undernutrition. The present study explored community-level determinants of malnutrition among malnourished and well-nourished children in Devbhumi Dwarka district of Gujarat State, India.MethodsA qualitative research employing focused ethnographic methodologies was used. In-depth observations of 60 families in a home food environment were carried out. Each child was observed at their respective homes for three consecutive days. Data were analyzed using thematic analysis techniques.ResultsThe study revealed that lack of knowledge on malnutrition, inadequate feeding practices, poor socioeconomic status, insufficient hygiene and sanitation practices, lack of food variety, use of health facilities, and birth complications were the major community-based determinants of malnutrition.ConclusionThe study identified community-level determinants of malnutrition among children under five years in the Devbhumi Dwarka district. To tackle the immediate and underlying causes of malnutrition, interventions are urgently needed to create community awareness about malnutrition as a disease and optimal infant and young child feeding (IYCF) practices using behavior change communication strategies.

Challenges in the cross-sectoral collaboration on vulnerable pregnant women: a qualitative study among Danish general practitioners

BackgroundVulnerable pregnant women, defined as women threatened by social, psychological, or physical risk factors, need special support during pregnancy to prevent complications in pregnancy, birth, and childhood. Proper cross-sectoral collaboration in antenatal care is paramount to delivering sufficient supportive care to these women. General practitioners (GPs) often face barriers when assessing vulnerable pregnant women and may; as a result, under-identify and underreport child abuse. Little is known about how the cross-sectoral collaboration in antenatal care affects the GP’s opportunities of managing vulnerable pregnant women. This study explores GPs’ perceived barriers and facilitators in the antenatal care collaboration on vulnerable pregnant women and in the reporting of these women to social services.MethodsA qualitative study with semi-structured focus group interviews among twenty GPs from the Region of Southern Denmark. A mixed inductive and deductive analytic strategy was applied, structured according to the Theoretical Domains Framework (TDF).ResultsThree themes emerged: I) collaborative experience, II) motivation, and III) organizational working conditions. Barriers were lacking experience, i.e. knowledge, skills, and attention to antenatal care collaboration and reporting, inadequate organizational working contexts, i.e. insufficient pathways for communication between health care and social care systems, and laws restricting feedback on the consequences of reporting. This decreased the GPs motivation, i.e. poor confidence in navigating the system, fear of breaking the patient alliance when collaborating in antenatal care and reporting with the social services. GPs motivation to collaborate and report was increased by knowing the working contexts of their collaborative partners in the antenatal care and social services system and by a strong doctor-patient relationship enabling them to describe the vulnerability to collaborators.ConclusionsGPs experience system-related barriers to collaborating and reporting on vulnerable pregnant women within the health care sector and in the interplay with the social services sector. Organizational development of cross-sectoral antenatal care collaboration should imply user involvement of all collaborative partners. Results suggest that health authorities should consider establishing accessible communication pathways between the GPs and the social services to improve options for proper cross-sectoral communication and feedback to GPs, thereby improving care trajectories of vulnerable pregnant women.

Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes.

Abnormal uterine artery Doppler (UtAD) studies early in gestation have been associated with adverse pregnancy outcomes. However, their association with complications in the third trimester is weak. We aim to review the prediction ability for perinatal complications of these indices in the third trimester. Abnormal UtAD waveforms in the third trimester are associated with preeclampsia, small-for-gestational age infants (SGA), preterm birth, perinatal death, and other perinatal complications, such as cesarean section for fetal distress, 5 min low Apgar score, low umbilical artery pH, and neonatal admission to the ICU, particularly in SGA infants. UtAD prediction performance is improved by the addition of maternal characteristics as well as biochemical markers to prediction models and is more precise if the evaluation is made closer to delivery or diagnosis. This review shows that the prediction accuracy of UtAD for adverse pregnancy outcomes during the third trimester is moderate at best. UtAD have limited additive value to prediction models that include PlGF and sFlt-1. Serial assessments rather than a single third trimester evaluation may enhance the prediction performance of the UtAD combined models.

Statistical Analysis on the Factors and Causes Affecting Maternal and Infant Mortality in Nigeria

Maternal and infant deaths are devastating medical complication in many countries, in which Nigeria is not exempted. It has been realized that complication of child birth and pregnancy are leading causes of death among women of reproductive ages. Therefore, this study aimed at determining the factors responsible for maternal and infant mortality in Nigeria between 2000 and 2019. The descriptive statistics of the skewness shows that the distribution of the data is fairly symmetrical and the time plot displays a downward and gradual decreasing trend for both maternal and infant mortality over the considerable years. The trend analysis of the model produces forecast performance with percentage accuracy measures of MAPE with 3% and 2% for both maternal and infant mortality. The exploratory data analysis (EDA) of maternal and infant mortality under the study shows that the prevalence of undernourishment rate is not significant to the model at 5% level of significant. Therefore, prevalence of undernourishment rate is the major factor affecting the death of the child and mother at the child birt h. Hence, the government are hereby implored to improve on training levels of pregnant women at the antenatal stages and empowering families and communities to reduce maternal and infant deaths.

Factors associated with preterm births in sacred heart hospital, Lantoro, Abeokuta, Ogun state

This research was carried out to ascertain the factors associated with preterm births in Sacred Heart Hospital, Lantoro, Abeokuta, Ogun State, Nigeria. The Objectives were to assess the Knowledge of mothers on the causes of preterm labour during ANC, assess causes of preterm birth in Sacred Heart Hospital, Lantoro, Abeokuta, determine the socio-demographic factors that influence preterm delivery in mothers attending Sacred Heart Hospital, Lantoro, Abeokuta and Investigate the possible options to the management of preterm labour. The significance of this study is to empower clients and health care professionals to understand and prevent preterm births, minimize the complications of preterm births and give better care to premature babies. Nurses could educate pregnant women based on the findings of this study to avoid practices that predispose them to preterm births. Early detection and prompt treatment of disease conditions associated with premature births. It will also serve as a base-line for future studies. Research design was retrospective/cross sectional study. Data was collected from the records of women who delivered in the hospital between January 2016 and December 2018. Sample size was determined by the use of Cochran’s formula to select 162 respondents from the ANC using self–structured questionnaire. Quantitative data was collected using abstract form questionnaire with 4 sections on socio-demographic, knowledge of causes of preterm births, preterm delivery among respondents and available options for the management of preterm births. Findings from the analysis revealed that 62% of nursing mothers have heard of preterm births, 57.1% have poor knowledge of causes. Majority (89.3%) were married and from monogamous homes (89.3%). Previous preterm births (78.6%) and pre-eclampsia (82.1%), the highest risk factor. Eighty-nine percent of mothers had babies with low apgar score while 80% had slow development. Almost all mothers (100%) opted for Kangoro Mother Care. Recommendations were made based on the findings that nurses should update their knowledge and skills on the causes, prevention and special care of preterm babies so as to guide the mothers aright thereby reducing infant morbidity and mortality associated with premature births.

Implementation of assistance for one pregnant woman one cadre (OPOC) in Banjarnegara District, Central Java Province, Indonesia.

The high maternal mortality rate caused by late detection of risk factors for pregnant women is a major health problem in Banjarnegara District. One of the efforts made to overcome this problem is the implementation of assistance for one pregnant woman by one cadre (OPOC). The application of OPOC consists of four mentoring activities, namely reminders about antenatal care schedule, detecting risk factors, monitoring fetal movements, and carrying out delivery planning and handling complications. Therefore, this study aims to describe the implementation of OPOC as well as to evaluate cadres' performance in Banjarnegara District. A quantitative cross-sectional design was used, where a total of 200 cadres were selected as respondents using a representative purposive sampling method. The results showed that reminding mothers about their antenatal care schedule, detecting risk factors, monitoring of fetal health through movements, and making commitments for birth planning and complications prevention were carried out by 199 (99.49%), 129 (64.84%), 138 (69.05%), and 159 (79.42%) respondents, respectively. More than 92% of them know their duties and responsibilities as companions for pregnant women, but only 28% have knowledge about the benefits of assisting. Furthermore, 93% often carry out OPOC assistance. The knowledge of cadres about OPOC assistance was good, but some of them are not knowledgeable about its benefits. These findings show that they need guidance, training, and motivation from public health centers.

Explore the Role of Homoeopathy in Maternal Health Care Practices in UP and India

On 13th December 1986, the famous actor of Indian cinema Mrs. Smita Patil died of child birth complications technically known as puerperal sepsis (HT, 13th Dec, 1986). 36 years later, in 2022, Dr. Archana of Dausa, Rajasthan died by suicide as she was arrested after a pregnant woman died of Post Partum Haemorrhage (PPH) in her private hospital (TNN. March 30th 2022). This clearly reflects the challenge that maternal health throws at the health fraternity. A woman’s struggle in the stage of pregnancy is full of turbulents. The struggle of mothers continues in India even today and that too in the state of UP even on a large scale. The current Maternal Mortality Ratio in India is 103 per 10000 live births &amp; for the state of UP, it is 167 (SRS, 2019). Similarly, the Maternal Mortality Rate of India is 6.5 per 100,000 pregnant women in the age group of 15-49 years where as in UP, it is 14.7 per 100,000 pregnant women in the age group of 15-49 years. The high Maternal Mortality both in India and UP stand as a testimony to this fact as reducing this indicator is a priority. The target of achieving the SDG target of 70 per one lakh live births is a long way. The current article focuses on the initiatives of the role of homoeopathy in public health system to address maternal mortality. Basically, there are three approaches to reduce maternal mortality. These are addressing the three crucial delays related to the maternal mortality. The article focuses exclusively on these approaches while relating to homoeopathy. There are three objectives of the article. The first is to find out the current status of Homoeopathy in the maternal health practices, the second is to find out the details of the current &amp; past implementation strategies in the homoeopathic context and the third is to find out the link between Homoeopathy &amp; maternal health practices. The study uses secondary data. The gap that the article worked on is to explore a link between Homoeopathy &amp; maternal health &amp; its modalities. It deciphers whether there is a functional link currently or not &amp; suggests future strategies based on the functionality of the link. It will be a step in the right direction to fulfill the plans to achieve the maternal health target of SDG by 2030 especially for maternal mortality related goals. For the benefit of the readers, the article includes its expected outcome, relevance to society &amp; policy making through the context of the identified issues &amp; the research gap. Through all these sections, the current article puts an effort to fulfill the three cited objectives of the current study related to incorporation of homoeopathy in maternal care.

Pharmacometabolomics Profiling of Preterm Infants Validates Patterns of Metabolism Associated With Response to Dexamethasone Treatment for Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is one of the most common health complications of premature birth. Corticosteroids are commonly used for treatment of BPD, but their use is challenging due to variability in treatment response. Previous pharmacometabolomics study has established patterns of metabolite levels with response to dexamethasone. We obtained additional patient samples for metabolomics analysis to find associations between the metabolome and dexamethasone response in a validation cohort. A total of 14 infants provided 15 plasma and 12 urine samples. The measure of treatment response was the calculated change in respiratory severity score (deltaRSS) from pre-to-post treatment. Each metabolite was assessed with paired analysis of pre and post-treatment samples using Wilcoxon signed rank test. Correlation analysis was conducted between deltaRSS and pre-to-post change in metabolite level. Paired association analysis identified 20 plasma and 26 urine metabolites with significant level difference comparing pre to post treatment samples (p < 0.05). 4 plasma and 4 urine metabolites were also significant in the original study. Pre-to-post treatment change in metabolite analysis identified 4 plasma and 8 urine metabolites significantly associated with deltaRSS (p < 0.05). Change in urine citrulline levels showed a similar correlation pattern with deltaRSS in the first study, with increasing level associated with improved drug response. These results help validate the first major findings from pharmacometabolomics of BPD including key metabolites within the urea cycle and trans-4-hydroxyproline as a potential marker for lung injury. Ultimately, this study furthers our understanding of the mechanisms of steroid response in BPD patients and helps to design future targeted metabolomics studies in this patient population.

Association of Maternal Versus Fetal Ehlers-Danlos Syndrome Status with Poor Pregnancy Outcomes.

The majority of research papers published on obstetrical outcomes in Ehlers-Danlos syndrome (EDS) have focused on the contribution of maternal EDS to the risk of poor pregnancy outcomes. The purpose of our study was to further clarify the fetal versus maternal contribution of EDS to poor pregnancy outcomes. A web-based, anonymous questionnaire was developed to collect pregnancy histories of families with a member with EDS. The survey was disseminated via social media through the Ehlers Danlos National Foundation. Population descriptors (age, gender, EDS diagnosis, age of diagnosis) and pregnancy descriptors (number of pregnancies, live births, and birth complications) were collected. To identify fetal and maternal contribution of EDS to poor pregnancy outcomes, three groups were compared based on maternal or infant diagnosis (EDS versus non-EDS). The rate of birth complications, treatment for preterm birth, and occurrence of preterm birth, as well as gestational age at preterm birth, were different depending on maternal/ infant EDS status, and these differences were significant when comparing infant EDS status but not when comparing maternal EDS status. The occurrence of PPROM is increased in the non-EDS mother/EDS infant group compared to both EDS mother/non-EDS infant and EDS mother/EDS infant groups (38.9%, 12.5%, 14.8%, p = 0.025). This study identifies that poor outcomes in EDS pregnancies differ depending on the maternal and the fetal EDS status. These insights into maternal and fetal association with certain poor pregnancy outcomes in pregnancies complicated by EDS can further guide physicians in educating, managing, and treating these women during pregnancy.

Gestational age, birth weight, and perinatal complications in mothers with diabetes and impaired glucose tolerance: Japan Environment and Children's Study cohort.

We aimed to determine the risk of perinatal complications during delivery in mothers with non-normal glucose tolerance in a large Japanese birth cohort. We analysed data of 24,295 neonate-mother pairs in the Japan Environment and Children's Study cohort between 2011 and 2014. We included 67 mothers with type 1 diabetes, 102 with type 2 diabetes (determined by questionnaire), 2,045 with gestational diabetes (determined by diagnosis), and 2,949 with plasma glucose levels ≥140 mg/dL (shown by a screening test for gestational diabetes). Gestational age, birth weight, placental weight, and proportions of preterm birth, and labour and neonatal complications at delivery in mothers with diabetes were compared with those in mothers with normal glucose tolerance. Mean gestational age was shorter in mothers with any type of diabetes than in mothers without diabetes. Birth weight tended to be heavier in mothers with type 1 diabetes, and placental weight was significantly heavier in mothers with type 1 and gestational diabetes and elevated plasma glucose levels (all p<0.05). The relative risks of any labour complication and any neonatal complication were 1.49 and 2.28 in type 2 diabetes, 1.59 and 1.95 in gestational diabetes, and 1.22 and 1.30 in a positive screening test result (all p<0.05). The relative risks of preterm birth, gestational hypertension, and neonatal jaundice were significantly higher in mothers with types 1 (2.77; 4.07; 2.04) and 2 diabetes (2.65; 5.84; 1.99) and a positive screening test result (1.29; 1.63; 1.12) than in those without diabetes (all p<0.05). In conclusion, placental weight is heavier in mothers with non-normal glucose tolerance. Preterm birth, gestational hypertension, and jaundice are more frequent in mothers with types 1 and 2 diabetes. A positive result in a screening test for gestational diabetes suggests not only a non-normal glucose tolerance, but also a medium (middle-level) risk of perinatal complications.

Development of Android-Based Media in Support of Birth Planning and Complications Prevention Programs

In Indonesia, AKI and AKB until now are still high, related to the problem of pregnancy, childbirth, and postpartum based on data released by the Ministry of Health, among others: AKI amounting to 305/100.000 live births. AKB (Neonate 15/1000 Live births and 24/1000 live births( KLH) in 2018 (Kemenkes, RI 2018). AKI in South Sumatra Province in 2015 amounted to 165/100,000 KH. AKI is one of the indicators of the degree of health of a country that shows the ability and quality of health services. The high AKI and the slow decline of this figure show that maternal and child health services (KIA) urgently need to be the main priority in terms of reach and quality of service.&#x0D; Maternal mortality is caused by multiple factors, which result from the interaction of various aspects, both clinical elements, parts of the healthcare system, and non-health factors that affect the delivery of clinical services and the optimal implementation of the healthcare system. The dominant aspects of maternal mortality in 2017 were bleeding in 37 cases, hypertension in pregnancy at 35 points, and 21 issues due to other factors (Dinkes Prov. Sumsel, 2017). First aid is a breakthrough effort to accelerate the decline in maternal and newborn mortality through activities to improve access and quality of care, as well as an exercise to build community potential, especially community concern for preparation and action in saving mothers and newborns through pregnancy, childbirth and postpartum (Ministry of Health, 2009 in Putri Andanawarih, 2018). One of the efforts to reduce AKI due to complications of pregnancy and birth is through first aid. First aid includes recording pregnant women, savings of pregnant women, preparation of prospective blood donors, family roles, helper plans, transportation to health facilities, and stamping stickers in the built house. At the Palembang City Health Center, the Purpose of The Research is to discover the "Development of Android-Based Health Promotion Methods in implementing the Birth Planning and Complication Prevention (P4k) Program of Palembang city and Jogyakarta in 2021". Benefits are expected as input to take a policy in applying first aid in Palembang City. The type of research carried out is Analytical research with experimental research design, which is where independent variables (Knowledge and attitudes) and dependent variables (Behavioral Changes in the Application of Childbirth Planning and Prevention of Complications (P4K). The study results showed a significant difference in maternal knowledge and attitudes before and after intervention giving health promotion through android applications with first aid with a value of 0.00 (&lt;α0.05) and no association in the Control group. As for the distinct group of mothers, the most dominant case group is maternal education which can affect behavior changes. It is recommended that health workers should continue to improve information communication and education to pregnant women and conduct counseling and health promotion activities for the public. Health workers for education related to first aid and readiness to face childbirth complications.

The Impact of Mode of Delivery on Maternal and Neonatal Outcomes during Periviable Birth (22-25 Weeks).

The objective of our study was to compare the maternal and neonatal complications of periviable birth by the delivery route. A retrospective cohort study of periviable deliveries (220/7-256/7weeks) from 2013 to 2020 at a tertiary teaching institution was conducted. Deliveries were grouped by the mode of delivery. Excluded deliveries included pregnancy termination, anomaly, or undesired neonatal resuscitation. The primary composite maternal outcome included death, intensive care admission, sepsis, surgical site infection, unplanned operation, or readmission. Secondary outcomes included maternal blood loss, length of stay, neonatal survival, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and retinopathy of prematurity (ROP). Outcomes were compared using Student's t-test, Wilcoxon-Mann-Whitney and Chi-squared tests. Relative risk (RR) and 95% confidence intervals were calculated with log-binomial regression. p-Values <0.05 were considered significant. Demographic and intervention variables associated with the outcome and the exposure were included in an adjusted relative risk (aRR) model. Subgroup analyses of singleton pregnancies and 220/7 to 236/7 weeks deliveries were conducted. After exclusion, 230 deliveries were included in the cohort. Maternal characteristics were similar between cohorts. For the primary outcome, cesarean delivery was associated with a trend toward increased maternal morbidity (22.6 vs. 10.7%, RR = 2.11 [1.03-4.43], aRR = 1.95 [0.94-4.03], p-value 0.07). Administration of magnesium sulfate, antenatal corticosteroids, and tocolytics were similar between cohorts. Neonatal survival to discharge was not different between the groups (54/83, 65.1% vs. 118/191, 61.8%, aRR = 0.93 [0.77-1.13]). Among the 172 neonates discharged alive, there was no difference in BPD, IVH, NEC, PDA, ROP, or intact survival. Periviable birth has a high rate of maternal morbidity with a trend toward the highest risk among women undergoing cesarean delivery. These risks should be included in shared decision-making. · Periviable birth has high maternal morbidity (19%) and is highest after cesarean delivery (23%).. · Route of delivery does not impact neonatal survival or intact neonatal survival.. · Head entrapment is rare during vaginal breech delivery..

Global, Regional, and National Incidence and Mortality of Neonatal Preterm Birth, 1990-2019

Preterm birth complications are the leading cause of death in children younger than 5 years worldwide. Despite advancing knowledge of risk factors and mechanisms related to preterm labor, the preterm birth rate has risen in most industrialized countries. Moreover, the burden of neonatal preterm birth remains unclear across the world. To determine the trends in incidence and mortality of neonatal preterm birth at the global, regional, and national levels to quantify its burden from 1990 to 2019 using data from the 2019 Global Burden of Disease study. Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of neonatal preterm birth between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. The percentage of relative changes in incident cases and deaths as well as the estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends. Correlations of EAPC of ASIRs and ASMRs with sociodemographic index (SDI) and universal health coverage index were evaluated by Pearson correlation analyses. Infants born alive before 37 completed weeks of gestation between 1990 and 2019. Incident cases, deaths, ASIRs, and ASMRs of neonatal preterm birth. Globally, the incident cases of neonatal preterm birth decreased by 5.26% from 16.06 million in 1990 to 15.22 million in 2019, and the deaths decreased by 47.71% from 1.27 million in 1990 to 0.66 million in 2019. The overall ASIR (EAPC = -0.19 [95% CI, -0.27 to -0.11]) and ASMR (EAPC = -2.09 [95% CI, -1.99 to -2.20]) decreased in this period. The ASIR of neonatal preterm birth increased by a mean of 0.25% (95% CI, 0.13%-0.38%) in high-SDI regions from 1990 to 2019. The ASMR of neonatal preterm birth increased by a mean of 2.09% (95% CI, 1.99%-2.20%) in Southern Sub-Saharan Africa in this period. A positive correlation was observed between EAPC of ASIR and SDI or universal health coverage index in 2019, while a negative correlation was observed between EAPC in ASMR and SDI or universal health coverage index in 2019 at national levels. Preterm birth remains a crucial issue in children worldwide, with an increasing trend in ASIR in high-SDI regions and in ASMR in Southern Sub-Saharan Africa between 1990 to 2019. Efforts to reduce both the incidence and mortality of preterm births are essential.

The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis.

IntroductionNegative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.MethodThree hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.ResultsPrimipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.DiscussionThe present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.

Labor Epidural Analgesia and Autism Spectrum Disorder: Is There an Association?

(JAMA. 2021;326:1155–1157) Autism spectrum disorder (ASD) is a disorder with known genetic and environmental factors. These factors include birth complications, maternal preeclampsia, obesity, diabetes, prenatal exposure to anticonvulsants, prenatal exposure to asthma medications, and prematurity. Most researchers conclude that an increase in the diagnosis of ASD throughout the years can be attributed to the increased awareness of ASD, but some question whether factors causing or contributing to ASD are going undetected.

The Challenges of Treating Glucokinase MODY during Pregnancy: A Review of Maternal and Fetal Outcomes.

Background: The optimal treatment strategy for the follow-up and management of women with glucokinase maturity-onset diabetes of the young (GCK−MODY)during pregnancy remains unknown. Data regarding maternal and fetal outcomes are lacking. Aim: This paper summarizes the existing literature regarding the maternal and fetal outcomes of women with glucokinase MODY to guide future treatment strategy. Methods: A literature search was conducted in Pubmed, Embace, and Cochrane library with citation follow-up using the terms: glucokinase, MODY, diabetes, pregnancy, gestation, and outcomes. We searched for articles with known fetal mutational status. Relevant outcomes included: birthweight, large for gestational age (LGA), small for gestational age (SGA), macrosomia, cesarean delivery (CD), shoulder dystocia, congenital anomalies, miscarriages, preterm births, and long-term outcomes. Results: Fourteen relevant manuscripts were identified describing maternal and fetal outcomes. The percentage of LGA and macrosomia in 102 glucokinase -unaffected offspring (GCK−) was significantly higher than in the glucokinase -affected offspring (GCK+) (44% vs. 10%, p < 0.001 and 22% vs. 2%, p < 0.001, respectively). Among the 173 GCK(+) offspring, only 5% were SGA, which can be expected according to the normal distribution. We observed higher rates of CD and shoulder dystocia in the GCK(−) offspring. Conclusions: GCK(−) offspring have significantly higher birthweights and more birth complications. The optimal treatment strategy to guide management should take into consideration multiple variables other than fetal mutational status.

Awareness and Practice of Birth Preparedness and Complications Readiness among Pregnant Women in the COVID-19 era in Fako Division, Cameroon

Background: Birth Preparedness and Complication Readiness is a strategy to enhance the timely use of skilled maternal and neonatal care, especially during childbirth, based on the theory that preparing for childbirth and readiness for complications reduces delays in obtaining this care and reducing possible pregnancy risk. Sustainable Development Goal 3 has as one of its targets to reduce the global maternal mortality ratio to less than 70 per 100,000 births, with no country having a maternal mortality rate of more than twice the global average.&#x0D; Following the intensity of the problem, it is necessary to investigate ways to curb marternal mortality which is an essential component which should begin with awareness, and practice of birth preparedness readiness and complications and inturn vital in the management and development of intervention measures.&#x0D; Objective: of this study was to investigate the awareness and practice of birth preparedness and complication readiness among pregnant women in Fako Division.&#x0D; Methods: This was a community -based cross sectional study carried out in the Fako division of the South West Region, Cameroon. 163 pregnant women of ≥28 weeks gestational ages seen at the antenatal consultation units were selected using convenient sampling method. Data collected was analysed with SPSS version 25.0 and Microsoft excel 2010.&#x0D; Results: Of the 163 pregnant women included in this study, 129 (79.1%) were aware of birth preparedness and complication readiness. 136 (83.4%) had knowledge in recognising danger signs in pregnancy and Vaginal bleeding was the most frequent mentioned danger sign (72.4%). 80(49.1%) had excellent knowledge on danger signs, 59(36.2%) had good knowledge while 24(14.7%) had poor knowledge on key danger sign in pregnancy. The practice of birth preparedness and complication readiness, 47.9% had optimal practice, 37.4% had standard practice while 14.7% had poor practice.&#x0D; Conclusion: The findings of this study revealed that the awareness of birth preparedness and complication readiness was high. Few pregnant women lacked adequate preparations as required by the BPCR plan. The findings also indicated that the knowledge on danger signs in pregnancy among pregnant women in the BHD are high. Women’s knowledge of danger signs during pregnancy positively influenced their decisions regarding when to seek medical care and when to take appropriate action.

FACTORS INFLUENCING ACCESS TO ANTENATAL CARE BY PREGNANT WOMEN IN DEDZA DISTRICT: LESSONS FROM MAGANGA VILLAGE IN TRADITIONAL AUTHORITY TAMBALA’S AREA, MALAWI

Malawi has registered a big number of maternal deaths and newborn or birth complications over the years. This is prevalent in many rural areas and villages across the country. The reason behind these maternal deaths and newborn complications is delayed access to early Antenatal Care visits (ANC). ANC is distinct and special care given to pregnant women to ensure improved health outcomes i.e., to avoid maternal deaths and newborn complications. Chiphwanya Health Centre which is found in Dedza district, the central region of Malawi, is well vested in this task. This research study was, therefore, conducted to assess factors leading to delayed access to ANC care in Maganga Village which surrounds the aforementioned health centre. The study adopted a mixed-method where both qualitative and quantitative data were collected and analysed. Quantitative data were collected from pregnant women while qualitative data was collected from guardians and health personnel. The results indicate that 43% of women and 50% of stakeholders considered traditional beliefs as the key contributor to delayed access to ANC. Over 20% of pregnant women and 6.7% of key stakeholders attributed distance as a reason for delayed access to ANC services. It can be concluded that delayed access to ANC portrayed in this area is due to traditional beliefs and distance. Hence, the need for awareness campaigns so that the community is well informed of the importance of ANC and the local leaders should have a touch on issues regarding ANC.&#x0D;