Early pregnancy depressive symptoms and severe maternal morbidity.

Severe maternal morbidity and mortality across subtypes of hypertensive disorders in pregnancy.

Postpartum health-care utilization and blood pressure control by antihypertensive agent in hypertensive disorders of pregnancy.

Introduction: Satisfaction surveys have been used to collect clients' opinions, experiences, and needs across different services, helping ensure that services are appropriate for clients' needs. The present study aimed to determine which of the 17 selected service delivery indicators for small animals were significantly associated with overall client satisfaction at a small animal hospital in Accra, Ghana.Materials and methods: from March to October 2023, 208 respondents visiting the small animal teaching hospital in Accra, Ghana, were interviewed using purposive sampling. Principal component analysis (PCA) was used to select and condense the 17 indicators that impact overall client satisfaction into a few key factors to clarify the underlying patterns and variances.Results: The current results indicated that 16 out of the 17 indicators selected for their potential impact on clients’ overall satisfaction with small animal services were retained. The indicators were regrouped into five components based on common features, accounting for approximately 70% of the variance in overall satisfaction. The first component, comprising service quality, efficiency, staff attitude, staff effectiveness, service availability, and staff competence, explained 25.3% of the variance. The second component, composed of medicine availability, vaccination availability, service accessibility, and meeting client needs, indicated 16.3% of the variance. The third component, composed of service charges and total time spent, included 10.5% of the variance. The fourth component involved medicine costs and availability, accounting for 9.3% of the variance. The fifth component, which was determined by service timeliness and gender, accounts for 7.7% of the variance.Conclusion: The current findings emphasize important indicators that should be prioritized to improve overall client satisfaction with small animal services. Addressing the identified indicators could improve service delivery for small animals.

Background: Cardiovascular diseases are among the leading causes of maternal morbidity and mortality in the United States. During 2010–2020, 1 in 10 severe maternal morbidities (SMMs) during delivery hospitalization was heart disease (HD)-related. This report synthesizes science, including methodologies, challenges, and opportunities, and summarizes national estimates on HD during pregnancy, focusing on congenital heart disease (CHD), cardiomyopathies (CM), valvular heart disease (VHD), arrhythmias (ARR), and heart failure (HF). Methods and Results: We analyzed large nationwide databases, including the National Inpatient Sample and the Nationwide Readmissions Database. The prevalence of HD complicating deliveries ranges from approximately 20–40 cases per 10,000 deliveries. Increasing trends were observed in CHD, ARR, and HF. HF, particularly peripartum CM, is a leading cause of adverse maternal outcomes, including in-hospital mortality and SMM. VHD prevalence has declined, whereas ARR has become the most prevalent HD during pregnancy hospitalizations. Significant gaps exist due to inconsistent definitions and methodologies, limiting comparability and clinical utility. Proposed solutions include adopting standardized definitions, developing a core outcome set, improving data quality through structured documentation and standardized data models, and using validated algorithms and indices. Collaboration among multidisciplinary teams is essential to enhance research quality. Conclusion: The efforts aligning definitions of HD, outcomes, and indices with public health measures and initiatives present an opportunity to create a unifying framework that connects patient-level data to system-wide improvements. This integration helps ensure that advances in methodology translate into better care delivery, billing accuracy, research quality, and public health surveillance, and ultimately enhance outcomes for pregnant women with HD.

Pregnant and postpartum individuals' opioid overdose rates in the United States continue to rise, despite having safe and effective treatments in pregnancy and postpartum. This study examines the role of inpatient admissions to labor and delivery units for initiating or titrating medication for opioid use disorders (MOUD). We conducted a retrospective review of all pregnant and postpartum (up to 1 y) patients admitted to a public safety-net hospital in San Francisco, for MOUD initiation or titration from 2019 to 2023. We excluded patients stable on MOUD. Among 124 individuals, 130 pregnancies met inclusion criteria. Ninety percent of individuals were unstably housed or homeless, and 78% had mental illness. The majority of patients (82%) initiated methadone and 18% initiated buprenorphine. The median admission length was 6 days. Patients were initiated or titrated on MOUD a median of 2 times during pregnancy/postpartum. Those with fentanyl OUD (defined as fentanyl being the primary opioid used) required longer admissions and higher MOUD doses compared with non-fentanyl OUD, and were more likely to initiate methadone over buprenorphine. The majority of patients experienced child protective services (CPS) involvement (79%), remained united as a parent-infant dyad at discharge (57%), and transitioned directly to residential treatment (63%). In this study, admissions for opioid use complicating pregnancy increased among a diverse population with high rates of homelessness and mental illness. Inpatient labor and delivery units serve as critical access points for OUD treatment in the perinatal period, particularly for individuals facing structural barriers to care.

BackgroundThe association between maternal exposure to air pollution and congenital heart diseases (CHDs) has garnered increasing attention. However, investigations into critical weekly specific exposure windows for CHDs remain limited. This study evaluated the relationship between maternal ambient particulate matter exposure throughout the entire pregnancy period and the risk of CHDs, as well as explored critical weekly specific exposure windows.MethodBased on the Jiangsu Maternal and Child Health Monitoring Manual and the Environmental Health Department of Suzhou CDC, 19,914 pregnant women with complete hospital delivery records between 2021 and 2023 were included, and the concentration data for five air pollutants (PM10, PM2.5, NO2, CO, and SO2) in Suzhou City from 2020 to 2023 were obtained in this study. Distributed lag models (DLMs) incorporated in Cox proportional-hazards models were applied to assess the exposure-lag-response relationship between the weekly average exposure levels during pregnancy and the risk of CHDs, identifying the refined exposure windows.ResultsA 10 μg/m3 increase in maternal exposure to PM10 was positively associated with CHDs during gestational weeks 5–12 and weeks 18–22 (p < 0.05). The strongest association was observed in gestational weeks 5 and 6 (HR, 1.010; 95% CI, 1.000–1.020; HR, 1.010; 95% CI, 1.002–1.017). The association between maternal exposure to PM2.5 and the risk of CHDs was not observed during all gestational weeks.ConclusionOur study results demonstrate that exposure to high concentrations of PM10 increases the risk of CHDs, with susceptible exposure windows identified as gestational weeks 5–12 and weeks 18–22. Our study provides further evidence supporting the association between maternal exposure to ambient particulate matter and CHDs while also identifying critical windows. However, further studies are required to confirm these findings.

BackgroundGlobally, maternal mortality is off track in achieving the Sustainable Development Goals by 2030. Over the past two decades, China has dramatically reduced maternal mortality in more developed (eastern) and less developed (western) regions. An understanding of the social and health system factors associated with maternal mortality in China may be helpful for countries attempting to meet the 2030 targets and beyond.Methods and findingsWe analyzed provincial-level data on maternal mortality and social and health system factors from the National Health Statistics Yearbooks and China Statistical Yearbooks from 2004 to 2020. We investigated the factors associated with maternal mortality before and after 2013, the year that a historic national program, Reducing Maternal Mortality and Eliminating Neonatal Tetanus, came to an end. Bayesian kernel machine regression was employed to analyze social and health system factors (urbanization rate, per capita disposable income, average years of schooling, number of health technical personnel in maternal and child healthcare, number of hospital beds for obstetrics and gynecology, local fiscal expenditure on healthcare, prenatal booking rate, antenatal care rate, and hospital delivery rate) as a mixture and identify the factors with larger posterior inclusion probability and a higher value of the exposure–response relationship for the total and cause-specific maternal mortality. In the East, an increase in hospital delivery rate correlated with the decrease in total maternal mortality [posterior mean and standard deviation (SD): −14.8(1.5)] before 2013, and the urbanization rate was negatively associated with total maternal mortality [posterior mean and SD: −3.9(0.6)] after 2013. Hospital delivery, urbanization, local fiscal expenditure on healthcare, and antenatal care were the factors associated with reduced cause-specific maternal mortality in the East. In the West, an increase in antenatal care rate was associated with reduced total maternal mortality, with the posterior mean and SD of −33.8(6.8) and −11.5(4.1) before and after 2013, respectively. Hospital delivery and antenatal care were the factors associated with reduced cause-specific maternal mortality in the West. The main limitation of this study was the data constraints in the national statistics.ConclusionsCoverage of maternal care, health financing, and urbanization were the factors associated with the substantial reduction in maternal deaths in Eastern and Western China during 2004–2020. The improvement of the quantity and quality of antenatal care and hospital delivery may be a viable policy priority in less developed regions worldwide.

Globally, maternal mortality is off track in achieving the Sustainable Development Goals by 2030. Over the past two decades, China has dramatically reduced maternal mortality in more developed (eastern) and less developed (western) regions. An understanding of the social and health system factors associated with maternal mortality in China may be helpful for countries attempting to meet the 2030 targets and beyond. We analyzed provincial-level data on maternal mortality and social and health system factors from the National Health Statistics Yearbooks and China Statistical Yearbooks from 2004 to 2020. We investigated the factors associated with maternal mortality before and after 2013, the year that a historic national program, Reducing Maternal Mortality and Eliminating Neonatal Tetanus, came to an end. Bayesian kernel machine regression was employed to analyze social and health system factors (urbanization rate, per capita disposable income, average years of schooling, number of health technical personnel in maternal and child healthcare, number of hospital beds for obstetrics and gynecology, local fiscal expenditure on healthcare, prenatal booking rate, antenatal care rate, and hospital delivery rate) as a mixture and identify the factors with larger posterior inclusion probability and a higher value of the exposure-response relationship for the total and cause-specific maternal mortality. In the East, an increase in hospital delivery rate correlated with the decrease in total maternal mortality [posterior mean and standard deviation (SD): -14.8(1.5)] before 2013, and the urbanization rate was negatively associated with total maternal mortality [posterior mean and SD: -3.9(0.6)] after 2013. Hospital delivery, urbanization, local fiscal expenditure on healthcare, and antenatal care were the factors associated with reduced cause-specific maternal mortality in the East. In the West, an increase in antenatal care rate was associated with reduced total maternal mortality, with the posterior mean and SD of -33.8(6.8) and -11.5(4.1) before and after 2013, respectively. Hospital delivery and antenatal care were the factors associated with reduced cause-specific maternal mortality in the West. The main limitation of this study was the data constraints in the national statistics. Coverage of maternal care, health financing, and urbanization were the factors associated with the substantial reduction in maternal deaths in Eastern and Western China during 2004-2020. The improvement of the quantity and quality of antenatal care and hospital delivery may be a viable policy priority in less developed regions worldwide.

Background and Objectives: Adolescent pregnancy remains a major global public-health concern, particularly in low- and middle-income countries. Romania consistently reports the highest teenage birth rate in the European Union, with pronounced regional disparities. This study aimed to assess the incidence, sociodemographic predictors, and obstetric outcomes of adolescent pregnancies over a ten-year period in southeastern Romania. Materials and Methods: A retrospective, population-based study was conducted at the Clinical County Hospital “Saint Andrew the Apostle”, Constanța, from 1 January 2014 to 31 December 2023. All deliveries involving mothers aged ≤19 years were identified from institutional databases. Demographic variables (age, residence, education) and obstetric outcomes (mode of delivery, gestational age, neonatal parameters) were analyzed. Statistical tests included Pearson’s χ2, t-tests or Mann–Whitney U tests, and multivariate logistic regression to identify independent predictors of cesarean delivery and preterm birth. Results: Among 13,416 hospital deliveries, 1640 (12.2%) involved adolescent mothers (mean age 16.3 ± 1.4 years). Most originated from rural areas (64.6%) and had only primary education (42.8%). Cesarean section was performed in 58.3% of cases—significantly higher among rural (61.2%) and low-education (62.4%) groups (p < 0.05). The leading indications were cervical dystocia (19.2%) and cephalopelvic disproportion (16.9%). Preterm birth occurred in 30.5% and low birth weight in 27.1% of neonates. Multivariate analysis identified primiparity (OR 2.10; 95% CI 1.45–3.05; p < 0.001) and low education (OR 1.56; 95% CI 1.09–2.21; p = 0.015) as independent predictors of cesarean delivery, while rural residence and low education predicted prematurity (OR 1.84; 95% CI 1.12–3.02; p = 0.016). Conclusions: Adolescent pregnancy in southeastern Romania remains a persistent public-health challenge concentrated among rural and low-education populations. These patterns are consistent with previously described vulnerabilities in adolescent populations, including developmental and healthcare-access challenges, although such factors were not directly measured in this study. Community-based prevention, comprehensive sexual education, and adolescent-friendly obstetric pathways are urgently needed to reduce the burden of teenage pregnancy in Eastern Europe. These associations should be interpreted with caution, as the retrospective design precludes causal inference.

BackgroundExclusive breastfeeding (EBF) for the first six months is a cornerstone of optimal infant nutrition and development. However, sustaining EBF beyond early infancy remains a major challenge globally, including in Iran. This study aimed to examine early feeding patterns, determinants of EBF, and associated growth outcomes among infants in northeastern Iran.MethodsThis population-based cross-sectional study analyzed data from 548,318 neonates registered in the National Electronic Health System between 2018 and 2024. EBF status was assessed at two time points: during the first week of life and at six months of age, based on caregiver-reported feeding practices recorded by health workers during routine health visits. Continuous exclusive breastfeeding since birth was defined according to WHO criteria as the infant receiving only breast milk—with no intake of formula, other types of milk, liquids, or solid foods—except for oral rehydration solutions, or drops and syrups containing vitamins, minerals, or medicines. Independent variables included maternal education, occupation, place of residence, mode of delivery, neonatal hospitalization, prematurity, and infant anthropometric indicators.ResultsThis study included a total of 548,318 neonates over seven years. While EBF prevalence was 95.9% in the first week of life, it declined to 52.3% at six months. Rural residence, full-term birth, vaginal delivery, and maternal unemployment were positively associated with sustained EBF. Conversely, prematurity (OR 3.21; 95% CI 3.07,3.42), cesarean section (OR 2.26; 95% CI 2.21,2.33), urban residence (OR 1.83; 95% CI 1.63,2.13), history of neonatal hospitalization (OR 1.61; 95% CI 1.55,1.67), maternal employment (OR 1.52; 95% CI 1.46,1.59), and lower education (OR 1.25; 95% CI 1.23,1.31) significantly predicted non-EBF. Infants exclusively breastfed demonstrated better growth metrics up to six months, though differences narrowed by two years.ConclusionDespite high initiation rates, sustained EBF sharply declines by six months, particularly among urban, employed, less-educated, and immigrant mothers, as well as in cases of cesarean delivery or neonatal hospitalization. Tailored interventions including postpartum support, breastfeeding education, and workplace accommodations are critical to improve EBF continuation.Clinical trial numberNot applicable.

Severe Maternal Morbidity at the Intersection of Race and Disability: Evidence of Compounded Disparities in the U.S. Maternal Healthcare System.

To assess racial/ethnic differences in gestational diabetes mellitus (GDM) prevalence in Hawai'i. This retrospective cross-sectional study included hospital deliveries at Kapi'olani Medical Center for Women and Children (Honolulu, Hawai'i) from 2009 to 2019. For birthing people with multiple deliveries during the study interval, only the last delivery was included. Birthing people with pregestational diabetes, delivery < 29 weeks, and multifetal gestations were excluded. GDM was identified through ICD-9 and -1 0 codes. Race and ethnicity were self-reported. Maternal body mass index (BMI) was recorded at delivery admission. GDM prevalence was determined for each race and the odds examined using logistic regression, also adjusting for maternal age and BMI. For analysis, three racial groups were sub-grouped into six ethnic categories as described: the three major racial groups were: (i) Asian, (ii) Native Hawaiian/Pacific Islander, and (iii) White. Six major ethnic sub-categories in the Asian racial group included: East Asians-identified as (1) Chinese/Taiwanese, (2) Japanese/Okinawan, (3) South East Asians identified as Filipino, (4) Native Hawaiian and (5) Pacific Islander identified as Micronesian/Samoan, and (6) White. Of 57,031 deliveries, 31,663 were included in this study. Overall crude prevalence of GDM was estimated at 11.7%. The three Asian ethnic sub-categories had approximately twice the risk of GDM when compared to Whites (Filipina: OR 2.59, 95% CI=[2.27-2.96], Chinese/Taiwanese: OR = 2.38, 95% CI=[2.01-2.82], and Japanese/Okinawan: OR = 1.71, 95% CI=[1.47-1.99]). Native Hawaiians also had higher GDM prevalence estimates compared to Whites (OR = 1.50, 95% CI=[1.31-1.71]), though there was no significant difference for Pacific Islanders (OR = 1.14, 95% CI=[0.97-1.33]). Prevalence of GDM in hospitalized deliveries in Hawai'i's multi-ethnic population of women has increased nearly 2-fold in the last two decades. All Asian Americans remain at highest risk despite lower maternal BMI at delivery. NH women are younger yet have similar frequency of co-morbidities and comprise the largest proportion of GDM cases overall.

Obstructive sleep apnea in pregnancy: Nationwide assessment of obstetric characteristics and maternal morbidity at delivery.

We aimed to evaluate the incidence, hospital resource utilization, and risk factors associated with anesthesia-related complications during labor and delivery in North Carolina. Using data from the 2015-2020 State Inpatient Database, we conducted a retrospective cross-sectional analysis of a representative sample of hospital deliveries involving anesthesia-related complications. The State Inpatient Database is a collection of databases and software tools created for the Healthcare Cost and Utilization Project, which compiles inpatient discharge records from community hospitals across selected states. A combination of International Classification of Diseases, 10th Revision, Clinical Modification codes, International Classification of Diseases,10th Revision, Procedure Coding System codes, and Diagnosis Related Groups was used to extract variables. Descriptive statistics, proportions, and incidence rates of anesthesia-related complications were calculated. Simple and multivariable logistic regression models were used to identify factors associated with an increased likelihood of anesthesia-related complications. A stepwise regression approach was used to fit the model. The calibration of the model was assessed using the deviance-Pearson goodness-of-fit statistics. To assess the cost associated with anesthesia-related complications, we compared the mean length of stay and total hospital charges between deliveries with and without anesthesia-related complications. Among 592,868 hospital deliveries in North Carolina between 2015 and 2020, anesthesia-related complications were identified in 1735 cases, corresponding to an incidence rate of 2.9/1000 discharges (95% confidence interval 2.7-3.0). Spinal cord complications were the most prevalent (73.9%), followed by adverse effects (20.2%) and systemic complications (5.9%). During the 6-year study period, spinal cord complications increased from 65% to 70%, systemic complications rose from 5% to 9%, and adverse effects decreased from 30% to 20%. The highest incidence rates (per 100 discharges) were observed among women aged 40 to 55 years, Hispanic and Asian/Pacific Islander individuals (0.31), those with nontraditional insurance payers (0.39), patients undergoing more than three hospital procedures (0.49), those with a length of stay exceeding 3 days (0.57), women from higher-income households (0.32), and those with a higher (≥1) Charlson Comorbidity Index (0.41). Approximately 30% of deliveries were performed via cesarean section, with 37% of these cases associated with anesthesia-related complications. In the adjusted multivariable regression analyses, a higher risk of anesthesia-related complications also was observed among cesarean section deliveries, admissions to rural hospitals, other payers, and patients with a Charlson Comorbidity Index of ≥1. Although anesthesia-related complications during labor and delivery are relatively uncommon, they are linked to distinct demographic, clinical, and hospital-level risk factors. This analysis highlights key areas for quality improvement aimed at reducing complications, particularly among high-risk populations. Continued efforts to enhance maternal safety should focus on equitable access to provider resources, standardized clinical protocols, and robust monitoring strategies, both within North Carolina and more broadly.

Postpartum hemorrhage and short-term risk of cardiovascular disease.

Trends in Prenatal Opioid Use Disorder in California, 2010-2022.

Achievable benchmarks of care (ABCs) use performance data to derive objective and attainable targets for improvement initiatives. We applied the Pediatric Health Information System (PHIS) low-value care (LVC) Calculator to describe variation in LVC across hospitals and identify measures with the greatest potential for improvement. We applied the 16 LVC Calculator measures applicable to hospitalized patients younger than 18years old to PHIS hospitalizations from July 1, 2022, to June 30, 2024. We used hospital-level data to assess LVC variation using IQRs and calculate ABCs, defined as the average performance attained by top-performing hospitals. We then compared median hospital-level performance to ABCs to derive measure-level performance gaps, signifying objective improvement potential. Finally, we performed a quartile analysis identifying hospitals with consistently high or low LVC delivery across measures. A total of 401 683 hospitalizations at 43 children's hospitals were eligible for included measures. LVC delivery varied widely across hospitals for many measures. Ten measures demonstrated performance gaps of greater than 10%; the greatest performance gaps were observed for C-reactive protein and/or erythrocyte sedimentation rate for community-acquired pneumonia (39%), electrolyte testing in patients with febrile seizure (38%), and blood cultures in community-acquired pneumonia (35%). Five measures demonstrated ABCs of less than 5%. Quartile analyses demonstrated small cohorts of hospitals with consistently high or low performance across all measures. This analysis suggests measurable improvement potential for several low-value services and offers measure-specific deimplementation targets. Further study of high- and low-performing hospitals may identify hospital-level drivers of LVC trends.

Multi-jurisdiction linkage of PRAMS and hospital discharge data: Methods, key challenges, and practical applications.

Maternal and neonatal complications during childbirth remain a major concern in Namibia, particularly in public healthcare settings where nurses often serve as the first responders in emergency obstetric care. The background of the study was rooted in Namibia’s persistent struggle with maternal mortality and morbidity rates, which are often exacerbated by delayed interventions, limited resources, and systemic constraints within the public health sector. The statement of the problem centred on the gap in knowledge regarding how registered nurses cope with these high-stress situations, the impact on their professional practice, and the implications for patient care and maternal health outcomes. The study explored the experiences of registered nurses in managing complicated deliveries in public hospitals in Windhoek, Namibia. A qualitative research design was employed to gain an in-depth understanding of the experiences of registered nurses in managing complicated deliveries. Data were collected through semi-structured interviews with a purposive sample of ten registered nurses working in maternity wards across selected public hospitals. Thematic analysis was used to analyse the data. Findings revealed that nurses encountered multiple challenges including limited resources, inadequate staffing, and high patient load, which affected the quality of care provided during complicated deliveries. Participants reported experiencing emotional stress and professional pressure due to the critical nature of obstetric emergencies. Despite these challenges, nurses demonstrated resilience and utilized teamwork, clinical skills, and ongoing professional development to manage complicated cases effectively. The study also highlighted the need for improved training, better resource allocation, and psychosocial support for nurses to enhance maternal and neonatal outcomes. The study concluded that understanding nurses’ experiences provided valuable insights for healthcare policymakers and hospital management to develop strategies aimed at improving maternal health services and supporting healthcare providers in public hospitals.