Health Outcomes For Pregnant Women Research Articles

A concurrent mixed-method study exploring the experiences of interprofessional collaboration among Canadian midwives and obstetricians.

This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. A concurrent mixed-methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. Eighteen RMs across Canada completed a demographic survey and the Midwifery-Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery-Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi-structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife-physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician-midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter-Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. This study provides support for the Midwifery-Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. The authors adhered to Consolidated criteria for reporting qualitative research (COREQ).

Prevalence and determinants of utilizing skilled birth attendance during home delivery of pregnant women in India: Evidence from the Indian Demographic and Health Survey 2015-16.

Utilization of skilled birth attendance during home delivery of pregnant women is proven to reduce complications during and after childbirth. Though the utilization of skilled birth attendance (SBA) during home delivery has increased significantly in recent times, the rate of utilizing skilled birth attendance is still low in several regions across India. The objective of this study is to analyze the prevalence and to identify the determinants of the utilization of skilled birth attendance during home delivery of pregnant women in India. To conduct this study, data and information from the Indian Demographic and Health Survey 2015-16 have been utilized. The sample size for this study is a weighted sample of 41,171 women. The sample consisted of women who had given a live birth in the three years preceding the survey. For women with more than one child, only the first live birth was considered. The binary logistic regression model and the log-binary logistic regression analysis have been applied as the adjusted odds ratios (AORs) with 95% confidence intervals for identifying the determinants of home-based skilled birth attendance during delivery. That allows us to select the most appropriate model for our study objective by ensuring that the determinants of skilled birth attendance for home delivery are accurately assessed based on the characteristics of the data. The analyses show that only 18.8% of women had utilized skilled birth attendance during delivery. Women residing in urban areas are more likely to utilize skilled birth attendance during home delivery (AOR: 1.14; 95% CI: 1.08-1.20). Women having higher education levels are associated with increased use of SBA during home delivery (AOR: 1.15; 95% CI: 1.04-1.28). Exposure to media is associated with increased utilization of SBA (AOR: 1.17; 95% CI: 1.11-1.23). Overweight women are also more likely to avail the SBA during home delivery (AOR: 1.11; 95% CI: 1.03-1.19). Women belonging to affluent households have higher odds of utilizing skilled birth attendance (AOR: 1.41; 95% CI: 1.33-1.49). Having 3+ tetanus injections is associated with the utilization of SBA (AOR: 1.56; 95% CI: 1.43-1.69). Women having 4+ antenatal care visits were more likely to utilize SBA (AOR: 1.81; 95% CI: 1.71-1.92). Women belonging to the Hindu religion were 1.12 times more likely to utilize SBA (AOR: 1.12; 95% CI: 1.07-1.18). Women with 1 to 3 birth orders were 1.40 times more likely to utilize skilled birth attendance during home delivery (AOR: 1.40; 95% CI: 1.30-1.51). The percentage of women utilizing skilled birth attendance during home delivery is still very low which is a matter of serious concern. Several factors have been found to be associated with the utilization of SBA during home delivery in India. As skilled birth attendance has significant positive health outcomes for pregnant women and newborns, efforts to increase the rate of SBA utilization during home delivery should be undertaken.

Utilization of iron-folic acid supplementation and related factors in pregnant women in Leka Dulecha District, East Wollega Zone, Western Ethiopia: The case study.

To treat neural tube closure abnormalities and maternal anemia during pregnancy, iron and folic acid (FA) supplements are typically necessary. Ethiopian Ministry of Health plan to increase the numbers of pregnant women who take iron and FA supplements from 11% to 50%, and by 2029, to 90% by 2024. Hence, the main objective of this study was to investigate the degree of iron-folic acid supplementation (IFAS) and associated factors among pregnant women receiving antenatal care at Leka Dulecha Woreda public health facilities from May 1 to October 31, 2022. In this study, about 316 pregnant women who visited Leka Dulecha prenatal care services were selected. A facility-based cross-sectional study was conducted. Multivariable logistic regression was utilized to examine parameters associated with the utilization of IFAS. These findings suggest that maternal educational status (adjusted odds ratio, AOR = 2.00, 95% confidence interval, CI [1.5, 3.05]), the timing of the first prenatal consultation (AOR = 1.93, 95% CI [1.47, 2.62]), having a good understanding of anemia (AOR = 1.50, 95% CI [1.00, 2.11]), and a history of anemia during the current pregnancy (AOR = 1.60, 95% CI [1.11, 3.16]) are important factors to consider when promoting adherence to iron-FA supplementation among pregnant women. It is crucial for healthcare providers to address these factors to improve the overall health outcomes for pregnant women attending Leka Delecha Health Facility.

The Implications of Socioeconomic Status by ZIP Code on Maternal-Fetal Morbidity and Mortality in San Antonio, Texas.

Introduction Over the past 20 years, the number of pregnancy-related fatalities in the United States has been on the rise. Increases in maternal and fetal mortality have been attributed to low socioeconomic status (SES). This raises the question of whether all geographical locations are proportionally affected by this upward trend in pregnancy-related fatalities. San Antonio is one of the largest cities in the United States and is known for its economic segregation. This study aims to compare the maternal and fetal health outcomes of mothers from diverse socioeconomic backgrounds in San Antonio, Texas. Methods To analyze the relationship between pregnancy-related mortality rates and SES in San Antonio, Texas, the International Classification of Diseases (ICD)-10 codes for maternal and fetal demise and their associated risk factors were identified. The ICD-10 codes were used to compare the health outcomes of pregnant women from the highest SES ZIP Code (78255, median income $124,397) to women from the lowest SES ZIP Code (78207, median income $25,415) using the Texas Inpatient Public Use Data File for 2016, which contains information on 93-97% of all hospital discharges in San Antonio, Texas. Results Notably, pregnant women from the high SES ZIP Code were admitted to the hospital from clinics or a physician's office (68.8%), while pregnant women from the low SES ZIP Code were admitted to the hospital from non-healthcare facilities like home or workplace (62.5%). In addition, a greater percentage of patients from the low SES ZIP Code were Black (4.3% vs 1.3%) or Hispanic (88.5% vs 35.1%). Compared to women from the high SES ZIP Code, women from the low SES ZIP Code experienced more fetal deaths and a higher prevalence of maternal and fetal risk factors such as obesity (47.6% vs 32.5%), asthma (1.7% vs 1.3%), hypertension (0.8% vs 0%), substance abuse (0.5% vs 0%), diabetes mellitus (9.8% vs 7.8%), preeclampsia (7.7% vs 2.6%), and multiple C-sections (35.5% vs 28.6%). Finally, fetal mortality rates were higher in the low SES ZIP Code (1.1% vs 0%). Although there were no statistically significant maternal or fetal mortality differences between the ZIP Codes, the trend suggests that women's health outcomes in San Antonio are not equitable. Discussion Analysis reveals disproportionate health outcomes for women in south San Antonio. Further investigation is warranted to better understand the role social and medical factors play in these results. Investigating the relationship between SES and pregnancy-related mortality can help to better inform healthcare providers and identify ways to improve women's health outcomes in San Antonio, Texas.

The Effects of a Mindfulness-Based Intervention on Mental Health Outcomes in Pregnant Woman: A Systematic Review and Meta-Analysis.

Pregnancy stress, anxiety, and depression increase the risk of short-term and long-term health problems for the mother and fetus. Mindfulness-based intervention (MBI) is one of the most popular, nonpharmacological interventions used to treat mental health problems. The results of prior research indicate MBI has a less consistent effect on mental health problems in pregnant women. The purpose of this systematic review and meta-analysis was to clarify and determine the effect of MBI on mental health outcomes in pregnant women. Six databases, including Embase, Ovid MEDLINE, CINAHL, EBSCOhost, Cochrane Library, and ScienceDirect, were searched from their dates of inception to November 2021. Google Scholar was also used for the literature inquiry. The inclusion criteria followed the PICO (Patient/Problem, Intervention, Comparison, and Outcome) model in terms of only including studies that used mindfulness therapy, reported mental health outcomes, and applied randomized controlled trial and quasi-experimental approaches. The Cochrane risk of bias tool was applied to evaluate the quality of the studies. Review Manager 5 software with random effect with a standardized mean difference (SMD) was used to analyze level of effect. Thirteen studies (10 randomized controlled trials and three quasi-experimental studies) were included. MBI was found to have a small effect on mental health outcomes in pregnant women (p < .0001, SMDs = -0.48, 95% CI [-0.74, -0.22], I2 = 87%). Specifically, MBI had moderate effects on stress and anxiety (SMDs = -0.59, 95% CI [-1.09, -0.09], and SMDs = -0.55, 95% CI [-1.00, -0.10], respectively) and no significant effect on depression (SMDs = -0.33, 95% CI [-0.74, 0.08]). MBIs have a small but notable effect on mental health in pregnant women. The high heterogeneity found in this review may reflect the different types and durations of interventions used. Notably, none of the studies in the review examined intervention effects by trimester. Future research should use larger sample sizes and assess the effects of therapy for each trimester of pregnancy.

Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review.

Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. PRR1-10.2196/51792.

Evaluation of Pharmacotherapy Standards During Pregnancy Among Jordanian Pharmacy Colleges Graduates

Background: Pharmacists' knowledge of medication risks and benefits during pregnancy, as well as their competence in making appropriate therapeutic decisions to optimize medication use among pregnant women, is crucial. This study aims to evaluate the knowledge of Jordanian pharmacists regarding medication risks and safety during pregnancy and assess their abilities to make appropriate therapeutic decisions and optimize medication use. Methods: A self-administered questionnaire was sent to 400 randomly selected pharmacists practicing in Amman, Jordan. A validated questionnaire, consisting of six sections with predefined options, was employed. Results: A total of 233 pharmacists completed the questionnaire, resulting in a response rate of 58.2%. Nearly 73.4% of pharmacists (N = 171) correctly identified the drug of choice for hypertension during pregnancy. Over 70% of pharmacists (N = 169) determined the correct dose of aspirin to prevent preeclampsia. About 50% of pharmacists exhibited limited knowledge regarding drug risks and safety during pregnancy. There was a significant difference in the pharmacists' scores on all tests based on their marital status and years of experience (p = 0.04 and p = 0.01, respectively). Among pharmacists, 79.8% stated that they studied pharmacotherapy during pregnancy in their undergraduate courses. Conclusion: Pharmacists have demonstrated an inadequate level of preparedness in providing appropriate pharmaceutical care for pregnant women. Therefore, there is an urgent need to collaborate between national health authorities and academic institutions to empower pharmacists and enhance their knowledge and skills necessary to improve the health outcomes of pregnant women.

Deep hybrid model for maternal health risk classification in pregnancy: synergy of ANN and random forest.

Maternal health is a critical aspect of public health that affects the wellbeing of both mothers and infants. Despite medical advancements, maternal mortality rates remain high, particularly in developing countries. AI-based models provide new ways to analyze and interpret medical data, which can ultimately improve maternal and fetal health outcomes. This study proposes a deep hybrid model for maternal health risk classification in pregnancy, which utilizes the strengths of artificial neural networks (ANN) and random forest (RF) algorithms. The proposed model combines the two algorithms to improve the accuracy and efficiency of risk classification in pregnant women. The dataset used in this study consists of features such as age, systolic and diastolic blood pressure, blood sugar, body temperature, and heart rate. The dataset is divided into training and testing sets, with 75% of the data used for training and 25% used for testing. The output of the ANN and RF classifier is considered, and a maximum probability voting system selects the output with the highest probability as the most correct. Performance is evaluated using various metrics, such as accuracy, precision, recall, and F1 score. Results showed that the proposed model achieves 95% accuracy, 97% precision, 97% recall, and an F1 score of 0.97 on the testing dataset. The deep hybrid model proposed in this study has the potential to improve the accuracy and efficiency of maternal health risk classification in pregnancy, leading to better health outcomes for pregnant women and their babies. Future research could explore the generalizability of this model to other populations, incorporate unstructured medical data, and evaluate its feasibility for clinical use.

Virtual Reality Headset Simulating a Nature Environment to Improve Health Outcomes in Pregnant Women: A Randomized-Controlled Trial.

The single-blind randomized-controlled experimental study aimed to determine the effects of watching nature images through virtual reality (VR) headset on stress, anxiety, and attachment levels of pregnant women with preterm birth threats (PBTs). The participants were 131 primiparous pregnant women admitted to the perinatology clinic due to PBT between April 5, 2022 and July 20, 2022. The intervention group watched videos containing nature images accompanied by nature sounds in six sessions through VR headset three times daily for 2 days. Each session lasted for 5 min. The data were accumulated with the Information Form, Stress Subscale of Depression Anxiety Stress Scale-21, State Anxiety Inventory, Prenatal Attachment Inventory, and Information Form of Satisfaction Level of VR Headset. State anxiety and stress levels of pregnant women in intervention group were statistically significantly lower than those in controls. There was no difference in prenatal attachment levels concerning intragroup comparisons of intervention group.

Human milk EV-miRNAs: a novel biomarker for air pollution exposure during pregnancy

Exposure to ambient and near-roadway air pollution during pregnancy has been linked with several adverse health outcomes for pregnant women and their babies. Emerging research indicates that microRNA (miRNA) expression can be altered by exposure to air pollutants in a variety of tissues. Additionally, miRNAs from breast tissue and circulating miRNAs have previously been proposed as a biomarker for breast cancer diagnosis and prognosis. Therefore, this study sought to evaluate the associations between pregnancy exposures to ambient (PM10, PM2.5, NO2, O3) and near-roadway air pollution (total NO x , freeway NO x , non-freeway NO x ) with breast milk extracellular vesicle miRNA (EV-miRNA), measured at 1-month postpartum, in a cohort of 108 Latina women living in Southern California. We found that PM10 exposure during pregnancy was positively associated with hsa-miR-200c-3p, hsa-miR-200b-3p, and hsa-let-7c-5p, and was negatively associated with hsa-miR-378d. We also found that pregnancy PM2.5 exposure was positively associated with hsa-miR-200c-3p and hsa-miR-200b-3p. First and second trimester exposure to PM10 and PM2.5 was associated with several EV-miRNAs with putative messenger RNA targets related to cancer. This study provides preliminary evidence that air pollution exposure during pregnancy is associated with human milk EV-miRNA expression.

Patterns, Peculiarities and Associated Risk Factors of Anemia in Pregnancy: A Case Study of Pregnant Women Attending Antenatal Clinic in North-Central Nigeria

<i>Background: </i>Anemia is a prevalent medical disorder during pregnancy, posing a significant global public health burden. In developing countries like Nigeria, it remains a major cause of maternal and perinatal morbidity and mortality. <i>Aim: </i>To determine the red cell morphological patterns, peculiarities (clinical characteristics) of anemia, and associated risk factors including socio-demographic factors, associated with anemia among pregnant women attending antenatal clinic of a tertiary care hospital in North-Central Nigeria. <i>Materials and Methods: </i>A prospective, analytical study on 415 pregnant women attending antenatal clinic over a period of 4 months was conducted. The red cell morphology, Packed Cell Volume (PCV), genotype, and HIV status of each participant were determined. Using structured questionnaires, their bio-data, obstetric and medical histories, and results of routine investigations were documented. Statistical software (SPSS version 20, Chicago 11, USA) was used to analyze the data obtained. Continuous variables were presented as mean±SD, and categorical variables were presented as numbers and percentages. Chi-square tests were used for comparative analysis and the level of statistical significance was set at <i>p</i><0.05. In addition, the association between anemia and socio-demographic factors, clinical characteristics, and risk factors were tested using Chi-square test. <i>Results: </i>Mean age of the study participants was 29.7±5.3 years. The mean BMI was 28.0±7.2 kg/m2, and the mean parity was 1.9±1.7. In addition, 7.8% of the pregnant women were HIV positive. The mean packed cell volume was 32.7±3.1%, and 42.5% of the participants were anemic, with 29.0% and 13.5% having mild and moderate anemia, respectively. The most common blood picture indicated iron deficiency anemia, with microcytic hypochromia and normocytic hypochromia. Educational level (<i>p</i>=0.00) and socio-economic class (<i>p</i>=0.00) were significantly and independently related to anemia, while gestational age (<i>p</i>=0.55) was not significantly related. Moreover, a history of fever during the current pregnancy was significantly related to anemia (<i>p</i>=0.01), while genotype (<i>p</i>=0.33) was not. Anemia was significantly related to HIV-positive status (<i>p</i>=0.00). <i>Conclusion: </i>Pregnant women should be encouraged to receive antenatal care, where they can receive hematinic supplements, appropriate investigations and treatments for fever or HIV. Poverty is a contributing factor to poor health outcomes during pregnancy. Implementing national and local policies to boost the economy can help alleviate poverty and improve health outcomes in pregnant women.

Pregnancy and mental health outcomes during the COVID–19 pandemic in Colombia: A nationwide cross-sectional study

• The prevalence of anxiety, depression, and insomnia symptoms in pregnant women during the third wave of COVID-19 in Colombia were higher compared to the general population in Colombia before pandemic. • Threatened Preterm Labor and Intrauterine Growth Restriction were associated with mental health outcomes in pregnant women. • It is crucial to identify maternal-fetal conditions in pregnant women to mitigate possible poor mental health outcomes.

A Low-Cost Test for Anemia Using an Artificial Neural Network

BackgroundAnemia during pregnancy can complicate maternal and neonatal health and even lead to fatal consequences if not diagnosed early on. Around 99% of women who face maternal mortality are from middle or low-income countries. Early screening of anemia could facilitate improved health outcomes in pregnant women. Point of care techniques are preferred due to their ability to provide results rapidly and because they can be used by personnel with minimal or no training. Such techniques are especially useful in resource-constrained settings like rural parts of developing countries. ObjectivesThe aim of the study was to develop a tool using an Artificial Neural Network (ANN) to estimate hemoglobin values using color information recorded from blood sample images. Our method utilizes inexpensive consumables and a simple image acquisition setup that can be assembled easily. MethodsThis study explores a neural network model to estimate the hemoglobin content in an individual’s blood sample. Blood samples were collected from 86 volunteers and the images of blood drops were obtained using an image acquisition setup designed by the team. The color intensity values calculated from the blood drop images were used as feature descriptors for the samples. The features obtained from our samples were consequently fed to the Artificial Neural Network. ResultsOur neural network that gives the best result has the architecture of 11 neurons in each of the 5 layers. The best model gave estimated hemoglobin levels by analyzing color of blood samples with an accuracy of ±1.8 g/dl Limits of agreement (LOA) and bias 0.03 g/dl (with mean error of 0.75 g/dl). The model was subsequently tested with a validation set prepared from an additional 65 samples. The estimated hemoglobin levels gave an accuracy of +2 g/dl to -1.9 g/dl Limits of agreement (LOA) and bias 0.06 g/dl (with mean error of 0.78 g/dl). ConclusionOptimization of sensitivity and specificity has been able to achieve the sensitivity and specificity values as 95.5% and 52% respectively. These results are at par with the contemporary measurement techniques indicating that our method can be used as a workable screening technique itself.

Socio-Demographic Factors Responsible for Uptake of Intermittent Preventive Treatment and Health Seeking Behaviours for Malaria in Pregnancy among Women of Reproductive Ages in Nigeria

Introduction Malaria in pregnancy is a serious public health concern that could result in detrimental health outcomes for pregnant women and their foetuses. In Nigeria, there is still a significant risk of the disease epidemic and adverse effects especially in pregnancy. The aim of this study is to assess the socio-demographic factors associated with Intermittent Preventive Treatment and health seeking behaviours for malaria in pregnancy among women of reproductive ages in Nigeria Methods Using the National Demographic Survey (NDHS) 2018 data, a cross sectional study was conducted to assess socio-demographic factors associated with Intermittent Preventive Treatment (IPT) for Malaria among Nigerian women of reproductive ages. Result Majority were between ages 30-39 years (39.5%), married/cohabiting (91.8%), Muslims (59.5%), from the north (68.9%), uneducated ( 49.9%), poor (47.5%), and grand parous (65.7%). 63.4% of the women had taken fansidar for malaria in pregnancy while only 6.1% had received healthcare for malaria from informal sources. Except for marital status, all socio-demographic variables (regions, highest educational level, wealth index, age group, religion and parity) were significantly associated with intake of IPT. Additionally, region, education, wealth index, age group, marital status and religion were associated with health seeking behaviour for malaria in pregnancy (P&lt;.05). After control for other variables, wealth index, highest educational level, married/cohabiting marital status and religion was significantly associated with intake of IPT while region, primary and secondary education, poorer and richest wealth index, widowed/separation influenced health seeking for malaria in pregnancy (P&lt;.05). Conclusion The National Malaria Elimination programme should evaluate existing policies that develop interventions that are centred on high risk population in order to prevent malaria in pregnancy while improving health seeking behaviours of women of reproductive ages.

Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

Promising Practices for Implementing Adverse Childhood Experiences and Resilience Screening in Obstetric Care.

Introduction: Adverse childhood experiences (ACEs) and resilience screening have the potential to improve health outcomes for pregnant women and their children. However, in the prenatal setting, guidance is lacking regarding both implementation of this screening as well as recommended follow up for patients. Methods: This is a summary of two pilots examining the feasibility and acceptability of ACEs and resilience screening during prenatal care in five medical centers in Kaiser Permanente Northern California (KPNC). Data includes qualitative and quantitative patient and clinician surveys as well as commentary on the challenges faced. Results: Patient and clinician survey data supports the feasibility and acceptability of ACEs and resilience screening in prenatal care. Trauma informed education for clinicians and staff regarding ACEs and resilience, scripts, workflows, and algorithms for follow up were essential. Most patients with ACEs don't desire mental health follow up but were satisfied with apps, books, and online resources. Conclusions: This commentary offers a practical model for obstetric practices to implement ACEs and resilience screening. This promising practice is feasible, valued by both clinicians and patients and does not necessarily require additional high-intensity referrals.

Community Health Educators and Maternal Health: Experimental Evidence from Northern Nigeria

The slow pace of improvement in service delivery and health outcomes for pregnant women and newborns in developing countries has been a major concern for policy makers in recent decades. This paper presents the results from a randomized controlled trial of a community health worker program designed to enhance uptake of child and maternal health services in Northern Nigeria. Three interventions were evaluated: the deployment of community health educators, health educators with the provision of safe birth kits, and health educators with community dramas. The results suggest that the interventions increased utilization of antenatal, postnatal, and infant care. Maternal and newborn health practices improved as well as health knowledge. In addition, the community health worker program was more effective when supplemented with additional program components.

Antenatal care positive responses to pregnant women in preventing and controlling malaria in pregnancy: the sub-Saharan African perspective.

The response to antenatal care (ANC) for maternal and offspring outcomes, especially in pregnant women has been thoroughly studied. However, despite the number of interventional studies on the treatment of sulfadoxine-pyrimethamine combination (IPTp-SP) uptake, the point in point cases of the positive responses of ANC in improving health conditions of pregnant women are not found in the literature. This review collected ANC responses to the positive health outcomes for pregnant women with malaria, the challenges faced regarding IPTp-SP uptake during ANC visits and the role of ANC in preventing and controlling malaria in sub-Saharan Africa. It elucidated ANC and uptake of optimal intermittent preventive IPTp-SP and further described ANC as a tool for heterogeneity for malaria prevention. ANC is seen as a microscope to malaria in pregnacy, maternal iron deficiency and anemia checkpoints, ANC and malaria treatment strategies, and ANC and the use of insecticide treated nets (ITN). The review further discussed ANC attendance influencing factors, limitations to ANC implications and the prospects in ANC visits on preventing malaria in pregnancy. A declining trend of malaria transmission in Africa has been observed in recent years. However, the burden of malaria in pregnancy remains a health concern. The rate of SP resistance, low uptake of IPTp-SP, low LLINs distribution, late gestational ANC visits and low turnaround for optimal ANC visits for first time mothers' aggrevated the malaria-endemic settings among pregnant women in sub-Saharan Africa.

Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review.

Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women’s and newborns’ health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.

Adverse Mental Health Sequelae of COVID-19 Pandemic in the Pregnant Population and Useful Implications for Clinical Practice.

The COVID-19 pandemic has increased risk of disturbances in the functioning of everyday life, directly or indirectly has influenced the risk of mental disorders in the most vulnerable populations, including pregnant women. The aim of this study was to analyze adverse mental health effects in the pregnant population during the COVID-19 pandemic, investigate risk factors for adverse mental health outcomes, identify protective factors, and create practical implications for clinical practice, bearing in mind the need to improve perinatal mental healthcare during such pandemics. Qualitative research was conducted in the electronic databases PubMed and Web of Sciences for the keywords COVID-19, pregnancy, depression, anxiety, and telemedicine for relevant critical articles (n = 3280) published from 2020 until October 2021, outlining the outcomes of control studies, meta-analysis, cross-sectional studies, face-to-face evaluation survey studies, remotely administered survey studies, and observational studies regarding the main topic; all were evaluated. Mental health problems among pregnant women linked to the COVID-19 pandemic, in most cases, show symptoms of depression, anxiety, insomnia, and PTSD and may cause adverse outcomes in pregnancy and fetus and newborn development, even at later stages of life. Therefore, useful implications for clinical practice for improving the adverse mental health outcomes of pregnant women associated with the COVID-19 pandemic are highly desirable. Our research findings support and advocate the need to modify the scope of healthcare provider practice in the event of a disaster, including the COVID-19 pandemic, and may be implemented and adopted by healthcare providers as useful implications for clinical practice.