Health Outcomes For Pregnant Women Research Articles

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<.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<.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.

Psychological Health Outcomes of Pregnant Women in the COVID-19 Pandemic: A Systematic Review of Descriptive Studies

Amaç: Bu çalışma, 2019 koronavirüs pandemisinde gebelerin psikolojik sağlık (stres, anksiyete ve depresyon) sonuçlarına ilişkin çalışmaları değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntemler: Çalışma, sistematik derleme niteliğinde olup, 15 Mayıs-10 Haziran 2020 tarihleri arasında İngilizce dilinde yayınlanan makaleler taranarak gerçekleştirilmiştir. Araştırmada, "COVID-19", “gebelik”, “stres”, “anksiyete” ve “depresyon” için referans anahtar kelimelerinin kombinasyonu oluşturularak, PubMed, Scopus, EBSCOHost, Web of Science ve Science of Direct elektronik veritabanları taraması 2019-2020 tarihleri arasında yapılmıştır. Bulgular: Tarama sonucunda tanımlayıcı/kesitsel çalışmalar ve editöre mektuplara ulaşılmıştır. Bağımsız iki araştırmacı tarafından yapılan kalite değerlendirmesi sonrası tam metnine ulaşılan toplam 6 makale bu sistematik derlemeye alınmıştır. Çalışmalar toplam 6.392 gebe ile yapılmış ve örneklem büyüklüğü 11-4124 arasında değişmektedir. Edinburgh Postnatal Depresyon Skalası (EPDS)’nın en sık kullanılan bireysel değerlendirme aracı olduğu görülmüştür. COVID-19 tanısı olan gebelerle yapılan bir çalışma bulunmaktadır. Gebelerin travma sonrası stres bozukluğunun, yaşanan travmaya bağlı olarak gelişen saldırı belirtileri ve kaçınma davranışları olduğu belirlenmiştir. Çalışmalarda depresyon riski prevalansının %26.0 (EPDS≥10) ile %34.2 (EPDS>13) arasında değiştiği, gebelerin anksiyete semptomlarının ve yüksek prenatal distres düzeylerinin olduğu tespit edilmiştir. Sonuç: Koronavirüs pandemisindeki gebelerin stres ve travma sonrası stres bozukluğu yaşadığı, anksiyete semptomları gösterdiği ve depresyon açısından risk altında olduğu sonucuna ulaşılmıştır.

The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support

BackgroundPregnancy has been shown to be times in a woman’s life particularly prone to mental health issues, however a substantial percentage of mothers report subclinical perinatal mental health symptoms that go undetected. Experiences of prenatal trauma, such as the COVID-19 pandemic, may exacerbate vulnerability to negative health outcomes for pregnant women and their infants. We aimed to examine the role of: 1) anxiety, depression, and stress related to COVID-19 in predicting the quality of antenatal attachment; 2) perceived social support and COVID-19 appraisal in predicting maternal anxiety and depression.MethodsA sample of 150 UK expectant women were surveyed during the COVID-19 pandemic. Questions included demographics, pregnancy details, and COVID-19 appraisal. Validated measures were used to collect self-reported maternal antenatal attachment (MAAS), symptoms of anxiety (STAI), depression (BDI-II), and stress related to the psychological impact of COVID-19 (IES-r).ResultsWe found that the pandemic has affected UK expectant mothers’ mental health by increasing prevalence of depression (47%), anxiety (60%) and stress related to the psychological impact of COVID-19 (40%). Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive (95% HDPI = [0.04, 0.39]) and anxiety symptoms (95% HPDI = [0.40, 0.69]). High depressive symptoms were associated with reduced attachment to the unborn baby (95% HPDI [-0.46, -0.1]). Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety (HPDI = [0.15, 0.46]), higher social support acted as a protective factor and was associated with lower anxiety (95% HPDI = [-0.52, -0.21]).ConclusionsThe current findings demonstrate that direct experience of prenatal trauma, such as the one experienced during the COVID-19 pandemic, significantly amplifies mothers’ vulnerability to mental health symptoms and impairs the formation of a positive relationship with their unborn baby. Health services should prioritise interventions strategies aimed at fostering support for pregnant women.

Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: A systematic review and meta-analysis.

Interventions to reduce household air pollution (HAP) are key to reducing associated morbidity and mortality in low- and middle- income countries (LMICs); especially among pregnant women and young children. This systematic review aims to determine the effectiveness of interventions aimed to reduce HAP exposure associated with domestic solid biomass fuel combustion, compared to usual cooking practices, for improving health outcomes in pregnant women and children under five in LMIC settings. A systematic review and meta-analysis was undertaken with searches undertaken in MEDLINE, EMBASE, CENTRAL, GIM, ClinicalTrials.gov, and Greenfile in August 2020. Inclusion criteria were experimental, non-experimental, or quasi-experimental studies investigating the impact of interventions to reduce HAP exposure and improve associated health outcomes among pregnant women or children under 5years. Study selection, data extraction, and quality assessment using the Effective Public Health Practice Project tool were undertaken independently by two reviewers. Seventeen out of 7293 retrieved articles (seven pregnancy, nine child health outcome; 13studies) met the inclusion criteria. These assessed improved cookstoves (ICS; n=10studies), ethanol stoves (n=1study), and Liquefied Petroleum Gas (LPG; n=2studies) stoves interventions. Meta-analysis showed no significant effect of ICS interventions compared to traditional cooking for risk of preterm birth (n=2studies), small for gestational age (n=2studies), and incidence of acute respiratory infections (n=6studies). Although an observed increase in mean birthweight was observed, this was not statistically significant (n=4). However, ICS interventions reduced the incidence of childhood burns (n=3; observations=41723; Rate Ratio: 0.66 [95% CI: 0.45-0.96]; I2 : 46.7%) and risk of low birth weight (LBW; n=4; observations=3456; Odds Ratio: 0.73 [95% CI: 0.61-0.87]; I2 : 21.1%). Although few studies reported health outcomes, the data indicate that ICS interventions were associated with reduced risk of childhood burns and LBW. The data highlight the need for the development and implementation of robust, well-reported and monitored, community-driven intervention trials with longer-term participant follow-up.

Initial development and testing of a measure of credibility of mobile health apps: a clinical study among women seeking prenatal care

ABSTRACT As misinformation is linked to poor health outcomes for pregnant women, and mobile apps provide free and unregulated access to information, it is important to understand the role of credibility in mobile health. The purpose of this study was to develop and assess a reliable scale for measuring mobile health (mHealth) credibility. Based on a previous measure for assessing web credibility, we also sought to identify source credibility dimensions for mobile apps. The mHealth credibility scale included seven items. Three scale dimensions were identified: concern, character, and competence. Both referent source for mobile apps and app developer were significantly associated with perceived mHealth credibility. This study is a first attempt to both design and test a measure of credibility for mobile health apps. This mHealth credibility scale can be used to guide future app development, communication, and medical research.

Maternal mindful eating as a target for improving metabolic outcomes in pregnant women with obesity.

Background:Maternal diet and eating behaviors have the potential to influence the metabolic milieu in pregnancies complicated by obesity, with implications for the developmental programming of offspring obesity. Emerging evidence suggests that mindfulness during eating may influence metabolic health in non-pregnant populations, but its effects in the context of pregnancy is less well understood. This study explored the individual and combined effects of mindful eating and diet quality on metabolic outcomes among pregnant women with obesity.Methods:In 46 pregnant women (body mas index >30 kg/m2) enrolled in the MomEE observational study, mindful eating (Mindful Eating Questionnaire, MEQ) and energy-adjusted dietary inflammatory index (DII, from 7 days of food photography) was assessed at two time points and the mean pregnancy values computed. Rate of gestational weight gain (GWG) and fat mass gain per week were determined from measured weight and body composition using a three-compartment method, respectively, at each assessment. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and ghrelin concentrations were determined from fasting blood samples in late gestation (35–37 weeks). Linear regression was used to examine the association of the MEQ and its subscales (where higher values indicate more mindful eating) with metabolic outcomes, adjusting for covariates: maternal age, pregravid body mass index, race, parity, DII. The effects of the MEQ*DII interaction was also tested.Results:Total MEQ scores were not associated with rate of weight or fat mass gain, although greater distracted eating behavior was associated with greater adiposity gain (weight and fat mass). Mindful eating was inversely associated with insulin resistance, although this was attenuated to non-significance after additional adjustment for GWG. Total MEQ and the external eating subscale was significantly inversely associated with fasted ghrelin, such that less tendency to eat under the influence of external cues was associated with lower ghrelin concentrations. After false discovery rate adjustment for multiple testing, only the association of the total MEQ and external eating subscale with ghrelin levels trended towards significance. The DII was not associated with MEQ scores or outcome variables, nor did it moderate the effect of MEQ on any of the outcomes.Conclusion:This study generates early evidence to suggest that mindful eating holds potential as a tool to improve metabolic health outcomes in pregnant women with obesity, although further research is required on this topic. Prenatal lifestyle interventions should consider including mindfulness during eating to determine its efficacy for reducing adverse pregnancy and offspring health outcomes associated with maternal obesity.

Cystic fibrosis and caseload midwifery

Midwives must provide woman-centred, holistic care for the diverse UK childbearing population. As the NHS moves to adopt the recommendations made in the ‘Better Births’ report, is there an argument to invest in protected caseload midwifery contacts for women with cystic fibrosis? Caseload midwifery refers to a continuity model where a small team of midwives provide care throughout the antenatal, intrapartum and postnatal continuum. Cystic fibrosis affects multiple organ systems and requires specialist medical management during pregnancy. Living with cystic fibrosis has many psychosocial implications and pregnancy presents additional challenges. Health and wellbeing outcomes are improved when individuals are treated holistically in the non-pregnant population; therefore, during pregnancy, birth and postnatally, caseload midwifery may provide a legitimate intervention to improve health outcomes in pregnant women with cystic fibrosis.

An evaluation of strategies to achieve greater than 90% coverage of maternal influenza and pertussis vaccines including an economic evaluation

BackgroundMaternal immunisation is an essential public health intervention aimed at improving the health outcomes for pregnant women and providing protection to the newborn. Despite international recommendations, safety and efficacy data for the intervention, and often a fully funded program, uptake of vaccines in pregnancy remain suboptimal. One possible explanation for this includes limited access to vaccination services at the point of antenatal care. The aim of this study is to evaluate the change in vaccine coverage among pregnant women following implementation of a modified model of delivery aimed at improving access at the point of antenatal care, including an economic evaluation.MethodsThis prospective multi-centre study, using action research design, across six maternity services in Victoria, Australia, evaluated the implementation of a co-designed vaccine delivery model (either a pharmacy led model, midwife led model or primary care led model) supported by provider education. The main outcome measure was influenza and pertussis vaccine uptake during pregnancy and the incremental cost of the new model (compared to existing models) and the cost-effectiveness of the new model at each participating health service.ResultsInfluenza vaccine coverage in 2019 increased between 50 and 196% from baseline. All services reduced their average cost per immunisation under the new platforms due to efficiencies achieved in the delivery of maternal immunisations. This cost saving ranged from $9 to $71.ConclusionOur study demonstrated that there is no ‘one size fits all’ model of vaccine delivery. Future successful strategies to improve maternal vaccine coverage at other maternity services should be site specific, multifaceted, targeted at the existing barriers to maternal vaccine uptake, and heavily involve local stakeholders in the design and implementation of these strategies. The cost-effectiveness analysis indicates that an increase in maternal influenza immunisation uptake can be achieved at a relatively modest cost through amendment of maternal immunisation platforms.

Intimate partner violence and pregnancy during the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic has resulted in psychological sequelae in different populations, especially female victims of intimate partner violence (IPV) who are pregnant. Nonetheless, little is known about how IPV events and pregnancy are related to mental health outcomes for pregnant women during the pandemic, when this research took place. 155 pregnant women (82 primigravidas and 73 multigravidas women) were assessed using questionnaires for mental health status and IPV events. The results showed that primigravida women were less likely to experience intimate partner violence than multigravida women. Further, first time pregnancy was not related to symptoms of psychopathology nor perceived stress, even after controlling for the potential effect of IPV. In contrast, IPV was related to all measures of psychopathology, except for pregnancy-specific stress. The results provide information about the relationship of IPV, pregnancy and psychopathology during the COVID-19 pandemic. However, due to the study design (part of awider study), it is not yet possible to examine how IPV patterns with respect to pregnancy may have changed in response to the pandemic. In light of the relationship between IPV and mental health during the pandemic, assessment of IPV appears to be an important component in health assessments of pregnant women.

Sedentary behaviors and gestational diabetes mellitus: A systematic review.

Sedentary behaviors are activities that expend less energy than 1.5 metabolic equivalents, such as watching TV, sitting. We aim to systematically review the evidence to determine the association of sedentary behavior (SB) with the risk of gestational diabetes mellitus, and the associations of SB with health outcomes in pregnant women with gestational diabetes mellitus (GDM) and women at high risk of gestational diabetes mellitus. Two researchers independently performed a literature search using PubMed, Medline, EMBASE, CINAHL, the Cochrane Library, the Rehabilitation and Sports Medicine Source, and the Sedentary Behavior Research Database for studies published up to January 27, 2021. Randomized controlled trials, quasi-experimental studies, and observational studies were screened and selected if SB was assessed in the context of gestational diabetes mellitus. Two reviewers extracted the relevant information and independently assessed the included studies for quality and bias. Eighteen studies were included, involving 60 804 patients, and the timeline of the original study included was from 2006 to 2021. Our review showed that SB before pregnancy was not associated with the risk of gestational diabetes mellitus, while SB during pregnancy was uncertain about the risk of gestational diabetes mellitus. In addition, there were significant associations between SB time and metabolic outcomes. In addition, SB may cause some adverse maternal and fetal outcomes. SB is likely to be the intermediary variable between occurrence of GDM and adverse maternal and infant outcome, rather than a direct influencing factor. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Does institutional maternity services contribute to the fear of childbirth? A focus group interview study

BackgroundThe quality of institutional maternity services offered significantly determine the health outcomes of pregnant women and their infants. ObjectivesThe study aimed at understanding perceptions and experiences of new mothers diagnosed with the fear of childbirth in Kenya; regarding the institutional maternity services offered and if they contribute to the fear of childbirth (FOC). MethodsThis was a qualitative descriptive study. A total of 29 women who had given birth recently in a maternity institution, and had been screened with the fear of childbirth at 32 weeks’ gestation period participated in focus group interviews. The Framework for Assessing the Quality of Care of institutional maternity services (FAQC) developed by the University of Southampton was adopted in this study. Thematic analyses were used. ResultsIt was reported that institutional maternity services contributed directly and indirectly to FOC. The direct contribution included the performance of unintended caesarian sections, severe and prolonged labour pains and negative attitude of healthcare providers. The indirect contribution was in form of challenges in the provision of care and the experience of care in the maternity institutions. In the provision of care; human and physical resources, inadequate referral systems, and inadequate management of emergencies were reported. In the experience of care; lack of cognition, respect, dignity, equity and inadequacies in emotional support were reported. ConclusionThe study identified systemic challenges related to both the provision and the experience of care. Therefore, there is need to astutely analyze all critical steps identified in the FAQC, as this will greatly improve the uptake of institutional maternity services.

Association between Urinary Phthalate Metabolites and Biomarkers of Oxidative Stress in Pregnant Women - Tainan Birth Cohort Study (TBCS)

BACKGROUND AND AIM: Oxidative stress biomarkers were suggested to be intermediates link between phthalate exposure and adverse health outcomes in pregnant women. This study explored the relationship between urinary phthalate metabolites and biomarkers indicative of lipid peroxidation and oxidative and nitrosative DNA damage. METHODS: Measurements from 97 Taiwanese women were taken across three trimesters. Five oxidative/nitrosative stress biomarkers - 8-hydroxy-2′deoxyguanosine (8-OHdG), 8-nitroguanine (8-NO2Gua), 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA), 8-isoprostaglandin F2α (8-isoPF2α), and malondialdehyde (MDA), and 11 phthalate metabolites were measured in urine samples. Linear regressions in each trimester and a linear mixed-model regression were fitted to estimate percent changes in oxidative/nitrosative stress biomarkers resulting from any inter-tertile increase of phthalate metabolite level and the cumulative concentration of di (2-ethylhexyl) phthalate and dibutyl phthalate. RESULTS:The highest urine concentrations of phthalate metabolites and the greatest number of significant positive associations between phthalate metabolites and oxidative/nitrosative stress biomarkers were observed in the third trimester and through repeated measurements analysis, respectively. Of the biomarkers related to DNA damage, 8-OHdG (25.4% increasing for monoiso-butyl phthalate tertile increased) was more sensitive to phthalate exposure than 8-NO2Gua. Among the biomarkers of lipid peroxidation, HNE-MA (61.2% increasing for sum DEHP tertile increased) was more sensitive than 8-isoPF2α and MDA. CONCLUSIONS:Our results suggest an enhanced susceptibility to phthalate exposure in the third trimester. Future research is necessary to evaluate the mediating role of oxidative/nitrosative stress biomarkers in the link between phthalate exposure and adverse reproductive outcomes. KEYWORDS: Phthalate, Oxidative stress, Nitrosative stress, DNA damage, Lipid peroxidation, Pregnancy