Infant Health Outcomes Research Articles

Effects of maternal healthcare service utilization on modern postpartum family planning access in Bangladesh: insights from a National representative survey.

Access to modern family planning is critical for improving maternal and child health outcomes, yet it remains severely lacking in low- and middle-income countries, including Bangladesh. Maternal healthcare utilization during and after pregnancy is vital for promoting postpartum family planning. This study examined the effects of maternal healthcare service utilization on postpartum family planning uptake in Bangladesh. Reproductive calendar data from 4,081 women with recent live births were extracted from the cross-sectional 2017/18 Bangladesh Demographic and Health Survey and analyzed. The outcome variable was uptake of modern postpartum family planning methods and the exposure variables were different types of maternal healthcare services. Kaplan-Meier methods were used to calculate cumulative probabilities of modern postpartum family planning method uptake within 12 months post-delivery, and modified Poisson regression models were used to estimate the effects of utilizing maternal healthcare services on modern postpartum family planning method uptake. Modern family planning methods in the 12 month postpartum period were used by 72% of women, with over 60% starting after day 40. Less than 4% used long-acting family planning methods, while almost 40% relied on the oral contraceptive pill. Utilizing maternal healthcare services was associated with up to a 7% higher uptake of modern postpartum family planning methods compared to non-users. Three-quarters of Bangladeshi women use modern family planning within the 12 months postpartum, but often rely on less effective methods. Additionally, 25% of these women resort to traditional or no use of contraceptive methods, increasing the risks of unintended pregnancy, short birth intervals, and adverse maternal and infant health outcomes. Maternal healthcare services, including private facilities, should prioritize modern postpartum family planning provision, along with education and counseling on the benefits of long-acting contraception.

Effect of Antenatal Monthly Sulfadoxine-Pyrimethamine, Alone or with Azithromycin, on Gestational Weight Gain and Anemia during Pregnancy and One Month Postpartum in Malawi: A Randomized Controlled Trial Secondary Analysis.

Low gestational weight gain (GWG) and prenatal anemia are associated with adverse pregnancy, maternal and infant health outcomes. In a secondary analysis of a single-center, randomized, partially placebo-controlled, outcome assessor-blinded, controlled trial conducted in Malawi from 2003 to 2006, when antiretroviral treatment (ART) for HIV was not widely available, we studied whether GWG can be increased and the prevalence of maternal anemia decreased during pregnancy and at 1 month postpartum through the intermittent preventive treatment in pregnancy (IPTp) of maternal malaria and reproductive tract infections. The participants (≥15-year-old women with uncomplicated second trimester single pregnancies) received either sulfadoxine (1,500 mg) and pyrimethamine (75 mg; SP) twice (control group, n = 433), monthly SP (n = 439), or monthly SP and azithromycin (1,000 mg) twice (AZI-SP, n = 441) during pregnancy. The mean weekly GWG in the sample was 256 g/week. The participants in the monthly SP group gained, on average (95% CI), 4 g (-13 to 20; P = 0.671), and those in the AZI-SP group gained 25 g (8-41; P = 0.003) more weight per week than control group participants. Among HIV-positive participants (12%), the differences were larger and also significant between the monthly SP group and control group. Mean hemoglobin and anemia prevalence did not differ between the groups during pregnancy or postnatally. The data support a hypothesis that IPTp with monthly SP and two doses of azithromycin can increase GWG, especially among HIV-positive women who are not on ART, possibly through the reduction of infections, inflammation, and effects on the maternal gut microbiome.

Comprehensive Review of Gestational Diabetes: Pathophysiology, Pharmacological Management and the Role of Pharmaceutical Care.

This review addresses the significant part pharmacological treatment plays in treating gestational diabetes mellitus (GDM), therefore enhancing the results for mother and child. Talking about the frequency and relevance of GDM would help to underline the need for good management. The pathophysiology presents a thorough examination of the fundamental processes, clarifying how hormonal changes seen during pregnancy lead to insulin resistance and raised blood sugar levels. The pharmacological treatment approaches for GDM, including insulin treatment and oral hypoglycemic medications, are investigated in this paper. Taking into consideration the hazards of generating birth deformities and safety data, the paper also evaluates the safety of the drugs in diabetes pregnancy in order to offer best treatment results. Moreover, the function of pharmacists in GDM highlights their significance in patient education, ensuring adherence to medication and overseeing therapy in collaboration with multidisciplinary teams. Furthermore, the impact of pharmaceutical care on maternal and neonatal outcomes demonstrates how pharmaceutical interventions can effectively reduce complications like preeclampsia and neonatal hypoglycemia, highlighting the importance of personalized medication management. Finally, the challenges and future directions of GDM address the difficulties in pharmaceutical care, including patient compliance, healthcare access and emerging treatment methods, calling for more research and policy initiatives to improve pharmaceutical care frameworks and enhance health outcomes for both mothers and infants. This comprehensive review highlights the need for integrated pharmaceutical care in managing GDM and its potential to improve health outcomes for both mothers and infants.

Black Mothers’ Experiences of Having a Preterm Infant: A Scoping Review

Black mothers with preterm infants face unique challenges during their stay in the NICU and after discharge. Racism-related barriers impact access to care for Black preterm infants. Understanding their experiences in caring for preterm infants is crucial to developing equity-focused interventions to address racism in the NICU and promote Black preterm infant health outcomes. The purpose of this scoping review is to shed light on Black mothers’ experiences of having a preterm infant. A search was conducted in CINAHL, Medline, Maternity and Infant Care, and Google Scholar. A total of 287 articles were retrieved and screened. Twelve (12) articles included in the final review were from the United States. The findings highlight the need to address racism among healthcare providers in the NICU through training and education. Gaps in understanding the experiences of Black parents with preterm infants from other Western contexts remain and require further research.

Time to dietary diversity of complementary feeding improvements and its associated factors among infants aged 6–12 months in Ethiopia: evidence from performance monitoring for action

BackgroundInfant and Young Child Feeding significantly affect the health, development, and nutritional status of children under 2 years old, ultimately affecting their survival. The aim of this study is to determine the time to improvement in dietary diversity and associated factors in infants aged 6 to 12 months.MethodsThe study used secondary data from the PMA Ethiopia longitudinal panel survey, involving pregnant women from January to March 2024. The data management and analysis were performed using Stata version 17. The Kaplan–Meier survival curve (KM) and the log-rank test method were implemented. A Cox proportional-hazard regression model was used to explore the association between independent variables and the outcome variable. The strength of the association was indicated by the adjusted hazard ratio (AHR) with a 95% confidence interval. The threshold of p < 0.05 was applied to determine the significance of an association.ResultsThe study found that the proportion of infants with improved dietary diversity aged 6–12 months was 22% (95% CI: 19.5, 25%). Factors associated with improved dietary diversity in infants aged 6 to 12 months were married women (AHR = 9.3, 95% CI = 1.19, 8.30), women with a secondary school (AHR = 1.9, 95% CI = 1.05, 3.51), women with technical and vocational (AHR = 2.0, 95% CI = 1.01, 4.05) and women with a university degree (AHR = 2.9, 95% CI = 1.51, 5.38). Moreover, women in the highest wealth quintile (AHR = 3.5, 95% CI = 1.31, 9.41), women visiting PNC (AHR = 1.7, 95% CI = 1.13, 2.62), women visiting ANC 1–3, and more than four times were (AHR = 2.4, 95% CI = 1.51, 3.74) and (AHR = 3.6, 95% CI = 2.28, 5.67) times higher for improving dietary diversity.ConclusionThe findings of this study showed that the proportion of dietary diversity improvement was 22%. Which is relatively low. Marital status, educational status, wealth index, PNC, and ANC visits were identified as statistically significant factors associated with dietary diversity improvements. It suggests that public health interventions should focus on enhancing maternal knowledge and promoting regular healthcare visits to mitigate malnutrition and improve infant health outcomes in Ethiopia.

Association between adverse perinatal events and postpartum depressive symptoms in a North American prospective preconception cohort study.

Identifying risk factors for postpartum depression (PPD) is critical to inform early intervention efforts. This study investigated the impact of adverse perinatal events on PPD. We analyzed data from the Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study. Participants (N = 3559) aged 21-45 years completed questionnaires at preconception, during pregnancy, and postpartum. PPD was assessed at six months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). We fit generalized linear models to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for the associations of adverse perinatal events (preterm birth; birth size for gestational age; infant birthweight; and NICU admission) with PPD (EPDS score ≥ 13), adjusting for confounders including preconception mental health. A total of 9.8 % reported PPD. Preterm birth (i.e., <37 weeks gestational age; RR = 1.30; 95 % CI: 0.92, 1.82), particularly spontaneous preterm birth (RR = 1.38; 95 % CI: 0.90, 2.10), very preterm birth (<34 weeks; RR = 1.88; 95 % CI: 1.04, 3.35), very low infant birthweight (i.e., <1500 g; RR = 1.67, 95 % CI: 0.77, 3.60), and NICU admission (RR = 1.15; 95 % CI: 0.86, 1.55) were associated with increased PPD risk. Stratified analyses indicated preterm birth was more strongly associated with PPD among parous participants and participants with a history of mental health diagnoses. Adverse perinatal events were associated with an increased risk of PPD at 6 months postpartum. Early identification and management of depressive symptoms in those who have experienced adverse perinatal events are crucial for improving both parental and infant health outcomes.

Evidence‐Based Recommendations for Dietary Supplementation During Pregnancy: Is It Time for a Product Recall?

ABSTRACTBackgroundMicronutrient deficiencies in pregnant women are linked to serious health issues, including conception difficulties, spontaneous abortions, preterm births, low birth weight, birth defects and long‐term metabolic disorders. Despite the recognized importance of dietary supplementation during pregnancy, rigorous research and supplementation monitoring remain limited.ObjectiveThis study aimed to review the evidence on the impact of dietary supplementation on maternal and infant outcomes and to provide evidence‐based recommendations for dietary supplementation during pregnancy.MethodsA systematic search, analysis, and synthesis of randomized controlled trials (RCTs) were conducted between October and January 2022. Databases searched included PubMed, CINAHL with Full Text, Google Scholar and CrossRef. The study adhered to PRISMA guidelines and applied inclusion and exclusion criteria to identify relevant studies. A total of 51 RCTs were included and assessed for quality, categorizing articles as moderate or high quality.ResultsOf the 51 RCTs analyzed, 47 (92.16%) were of moderate quality, and 4 (7.84%) were of high quality. Findings revealed that recommended dietary supplementation doses for pregnant women are often set well below safety thresholds. Evidence supporting the efficacy of certain vitamins and minerals in pregnancy remains inconclusive. The study highlighted a dose–response conundrum, with an emphasis on identifying effective and safe doses.ConclusionMicronutrient deficiencies in pregnant women pose significant risks to maternal and infant health. Current dietary supplementation recommendations require enhancement and alignment with the latest and most robust evidence. This study provides a comprehensive overview of state‐of‐the‐art evidence and underscores the importance of bridging gaps in supplementation guidelines to optimize maternal and infant health outcomes.

Association between body mass index at birth and neonatal health outcomes in preterm infants: A retrospective analysis.

Studies on how birth body mass index (BMI) affects health outcomes in preterm infants are relatively limited. To analyze the association between BMI at birth and neonatal health outcomes in extremely low and very low birth weight preterm infants in China. Used data from the Chinese Premature Infant Informatization Platform (2022-2023). Preterm infants were categorized based on their birth BMI z-scores into three groups: low BMI group (< -2), normal BMI group (-2 to 2) and high BMI group (>2). The relationship between BMI and neonatal health outcomes was then analyzed. The final analysis included 1662 extremely low and very low birth weight preterm infants. The results indicated that low BMI was significantly associated with an increased risk of respiratory distress syndrome (RDS) (AOR 1.61, 95% CI 1.31-2.30), bronchopulmonary dysplasia (BPD) (AOR 1.34, 95% CI 1.00-1.80) and necrotizing enterocolitis (NEC) (AOR 1.57, 95% CI 1.01-2.42). High BMI was significantly associated with an increased risk of RDS (AOR 1.60, 95% CI 1.05-2.45). BMI at birth is significantly associated with the risks of RDS, BPD and NEC in ELBW and VLBW, highlighting the importance of monitoring BMI as an additional risk predictor in a population of neonates already at high risk for adverse outcomes.

Effect of Paternity Leave or Fathers' Parental Leave on Infant Health: a Systematic Review Protocol.

The objective of the systematic review will be to evaluate the effect of paternity leave or fathers' parental leave on infant mortality rate, hospitalization, vaccination compliance, and breastfeeding duration. Current studies indicate that paternity leave positively affects infant health, but there is a significant lack of synthesized research on its impact on key infant health indicators. A systematic review of the existing evidence will help identify best practices and guide further research and policy development in this area. The proposed systematic review will include studies such as experimental, quasi-experimental, and analytic observational studies, conducted among infants less than 1 year of age, exploring the effect of fathers' paternity leave or fathers' parental leave on the identified infant health outcomes. The review will follow the JBI methodology for systematic reviews of effectiveness. A 3-step search strategy will be used, with no date or language restrictions. Study selection will also follow a 3-step process, including critical appraisal to determine methodological quality. Each step will be conducted by 2 independent reviewers; disagreements will be resolved through discussion or with other team members. The team will extract data using standardized templates from JBI SUMARI, then synthesize and conduct meta-analysis, if possible. If not, narrative synthesis will be conducted. Finally, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to determine certainty of evidence will be used to create a summary of findings. This protocol has been registered in PROSPERO: CRD42024502533.

'Mob aren't staying when there's no support': Enablers and barriers of recruitment and retention of First Nations midwifery students - A qualitative study.

Aboriginal and Torres Strait Islander (hereafter referred to as First Nations) childbearing women report negative experiences from a lack of culturally safe maternity care. Evidence supports improved health outcomes for First Nations women and infants when cared for by First Nations midwives. There are barriers to First Nations students accessing university, particularly nursing and midwifery students, with a lack of evidence exploring the experiences of First Nations midwifery students. This study aims to understand the impact of the current strategies to improve recruitment and retention of First Nations midwifery students and identify further innovations. A semi-structured yarning circle was held with six Bachelor of Midwifery students at a university in Queensland, Australia. Three key categories emerged: student recruitment, student retention and student success. Enablers included culturally appropriate recruitment, partnerships with other First Nations peoples, incorporating First Nations ways of Knowing, Being, and Doing, culturally safe support, placements and mentorship, and identification and representation. Barriers included financial impacts, experiences of racism and lack of Cultural Safety and humility. Overall, students felt the university provided a culturally safe environment and implemented strategies that supported students' recruitment, retention and success in the degree. They suggested improvements to current strategies and new ideas for implementation. Strategies to improve recruitment and retention of First Nations midwifery students are imperative to close the gap in educational attainment and improve health outcomes for First Nations peoples. These strategies need to be multi-layered, culturally appropriate and implement a whole of university approach.

Frequency and factors influencing male gender involvement in maternal care in tertiary care hospitals of Peshawar Pakistan

Background: Men’s involvement in maternal care positively affects maternal and infant health outcomes. This participation may include attending antenatal and postnatal visits, decision-making in pregnancy and childbirth, and providing emotional and financial support. This study aimed to determine the frequency of men’s involvement in maternal care and the factors influencing their engagement. Methods: A cross-sectional study was conducted from 13th March to 25th May 2023 at Hayat Abad Medical Complex and Northwest General Hospital, Peshawar. Data were collected through structured interviews with 246 women using a questionnaire. Responses were analyzed using SPSS version 21, ensuring accuracy and reliability. Results: The respondents had a mean number of children of 3.44. Among husbands, 93.9% were over 25 years old, and nearly half had at least an undergraduate education. A significant proportion of husbands participated in maternal care, with 76.7% attending antenatal visits, 53.5% present during labor, and 54.3% assisting with postnatal care. Factors identified as barriers included cultural norms (43.7%), socioeconomic issues (33.1%), and lack of supportive environments at hospitals (26.9%), and distance to healthcare facilities (39.2%). Increasing husband’s age correlated positively with postnatal support (Pearson coefficient: 0.266, p &lt; 0.005) and was statistically significant for antenatal visits (p &lt; 0.001) and postnatal care (p = 0.048), though not for attendance during labor (p = 0.198). Conclusion: Husbands demonstrated a high level of involvement in antenatal visits compared to labor and postnatal care. Most women reported satisfaction with their partner’s participation. While cultural norms, economic factors, and distance posed challenges, they did not majorly hinder involvement. Increased paternal involvement in maternal care should be encouraged to improve maternal and child health outcomes.

Determinants of maternal and infant omega-3 status at 3 months postpartum: findings from the APrON longitudinal cohort study.

Omega-3 long-chain-polyunsaturated fatty acids (LCPUFAs) are important dietary components for maternal and infant health during pregnancy and lactation. This study investigated determinants of maternal and infant LCPUFAs status at 3 mo postpartum and the relationship between maternal serum, maternal milk, and infant LCPUFAs. This cross-sectional study included mothers (n = 1481) and their offspring (n = 526) at 3 mo postpartum from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. Maternal dietary intake (24-h recall), blood samples from mothers and infants, and maternal milk were collected. Fatty acid composition (relative % of total fatty acids) was determined by gas-liquid chromatography. Linear regression analyses explored associations between diet, sociodemographic factors, and fatty acid status. In a multivariable-adjusted analysis, maternal total dietary intake (supplement + food) was positively associated with the percentage of DHA (standardized ß [Sβ] = 0.394; ß = 0.394; 95% [confidence interval] CI: 0.192, 0.558; P < 0.001) in maternal serum phospholipids. Similar associations were found for DHA and eicosapentaenoic acid in maternal milk and plasma phospholipids of infants. Prepregnancy body mass index (BMI) was negatively associated with DHA (Sß = -0.073; ß = -0.003; 95% CI: -0.006, -0.001; P = 0.008) and positively associated with total saturated fatty acids (Sß = 0.086; ß = 0.111; 95% CI: 0.042, 0.180; P = 0.002) in maternal milk. Infants receiving formula combination with maternal milk had lower percentage of DHA (Sß = -0.177; ß = -0.390; 95% CI: -0.604, -0.175; P < 0.001) and arachidonic acid (Sß = -0.106; ß = -0.595; 95% CI: -1.122, -0.067; P = 0.027) in their plasma phospholipids compared with those who fed exclusively maternal milk. Maternal total dietary intake and prepregnancy BMI are independently associated with their serum fatty acid status during lactation, whereas maternal diet, milk fatty acid composition, and lactation status are important determinants of infant n-3 LCPUFAs fatty acid status. Future research should investigate the impact of these differences in fatty acid status on infant health outcomes.

The Role of Evidence-Based Practice in Enhancing Health Outcomes for Infants in the NICU.

The Role of Evidence-Based Practice in Enhancing Health Outcomes for Infants in the NICU.

ЗНАЧИМОСТЬ ЗДОРОВЬЯ ПОЛОСТИ РТА ВО ВРЕМЯ БЕРЕМЕННОСТИ

This article discusses the dynamic monitoring of oral health in pregnant women, emphasizing the increasing incidence of dental diseases during pregnancy. The study's objective was to identify changes in dental and periodontal conditions and assess the correlation between oral health, hemoglobin levels, and iron deficiency anemia. Conducted at based at the women's consultation department of Clinical Hospital No.5 in Volgograd, the research involved 200 pregnant women aged 18-40, who underwent initial and follow-up oral exams. Results showed a high caries prevalence, especially in the 18-20 age group, and a significant correlation between hemoglobin levels and caries progression in women with anemia. Acute caries progression was observed in a notable portion of the participants, with new carious lesions forming in previously intact teeth. Dynamic monitoring of oral health during pregnancy facilitates early detection and prevention of dental diseases, significantly improving maternal and infant health outcomes. The study highlights the importance of routine dental check-ups and preventive strategies, suggesting further research in this area. The findings could guide the development of clinical recommendations and increase awareness among healthcare professionals and pregnant women regarding the importance of oral care during pregnancy. This study also emphasizes the need for educational programs aimed at pregnant women, educating them about the impact of oral diseases on both maternal and fetal health. The results provide critical insights for formulating comprehensive preventive healthcare programs aimed at enhancing dental health and ensuring the well-being of mothers and their children during pregnancy and postpartum. A comprehensive approach that includes outreach to pregnant women helps develop sustainable oral health habits and increases their adherence to preventative measures. Overall, this research underscores the necessity for integrated healthcare approaches that consider both oral and general health, fostering better health outcomes for families and encouraging proactive involvement in preventive care.

Maternal and Infant Health Outcomes in US-Born and Non–US-Born Black Pregnant People in the US

With disparate Black maternal health outcomes in the US and a steadily expanding non-US-born Black population, it is beneficial to investigate Black maternal health outcomes by country of origin. To compare the prevalence of maternal morbidity and infant birth outcomes between US-born and non-US-born Black populations in the US. This cross-sectional study included all registered hospital births in the US from the 2021 National Vital Statistics Systems (NVSS) Natality Data. Eligible patients identified as Black, excluding those who were younger than 15 years, gave birth to twins or multiple infants, gave birth outside of a hospital, or were missing data for maternal morbidity, nativity, or study covariates. Maternal birthplace, characterized as born within the US or born outside of the US. Five maternal morbidities (ie, maternal transfusion, perineal laceration, ruptured uterus, unplanned hysterectomy, admission to intensive care unit) and two birth outcomes (low birthweight, preterm birth). Logistic regression analyses were utilized to calculate the associations of maternal morbidity and adverse birth outcome with maternal birthplace. Of a total 3 669 928 registered births in the US in 2021, 499 409 births to mothers who identified as Black were included in analysis; the majority of individuals were aged 20 to 24 years (117 173 [23.5%]), 25 to 29 years (142 890 [28.6%]), or 30 to 34 years (123 485 [24.7%]). Maternal birthplace in the US was associated with a decreased odds of experiencing any maternal morbidity (4411 of 403 822 births [1.1%]) compared with Black people born outside of the US (1593 of 95 587 births [1.7%]) (aOR, 0.67; 95% CI, 0.62-0.71). US-born Black people were significantly less likely to experience 3 of 5 maternal morbidities compared with non-US-born Black people: maternal transfusion (aOR, 0.87; 95% CI, 0.78-0.97), perineal laceration (aOR, 0.43; 95% CI, 0.39-0.48), and ruptured uterus (aOR, 0.63; 95% CI, 0.45-0.89). US-born Black people also had a nonsignificant decrease in odds for unplanned hysterectomy (aOR, 0.77; 95% CI, 0.56-1.05) and admission to intensive care unit (aOR, 0.92; 95% CI, 0.79-1.07). However, they were at increased odds of experiencing key adverse infant health outcomes, including low birthweight (aOR, 1.62; 95% CI, 1.58-1.67) and preterm birth (aOR, 1.51; 95% CI, 1.47-1.55). In this cross-sectional study, significant differences were observed in odds of maternal morbidity and birth outcomes by maternal birthplace within the Black pregnant population in the US. This suggests the need for increased assessment of nativity in Black maternal health research and specific strategies to reduce morbidity for non-US-born populations.

A Cross-Sectional Study of the Maternal Health Factors: The Interplay Between Breastfeeding Patterns, Gut Microbiota, Anemia, and Cardiovascular Risk in Lactating Mothers.

Objective This cross-sectional study explored the interplay between breastfeeding patterns, gut microbiota composition, anemia, and cardiovascular risk in lactating mothers. The study examined how these factors contribute to postpartum maternal and infant health outcomes. Methods Forty-five lactating mothers, with a mean age of 32.73 years, participated in the study. Data on breastfeeding patterns, gut microbiota composition, anemia, and cardiovascular risk factors were collected. Microbial diversity was assessed, and associations with comorbidities and infections were explored. Statistical analyses, including chi-square and Kolmogorov-Smirnov tests, were performed to evaluate the relationships between these variables. Results Among the participants, 35.6% practiced exclusive breastfeeding, and 46.7% were classified as obese (BMI ≥30). Gut microbiota analysis revealed a prevalence of Escherichia coli (31.1%) and Lactobacillus (26.7%). Mothers with lower microbial diversity exhibited higher rates of infections (31.1% yeast infections and 26.7% UTIs) and comorbidities, including gestational diabetes (42.2%) and hypertension (13.3%). Cardiovascular risk was elevated among obese mothers, with 37.8% requiring cardiac medications. Anemia was prevalent, with 42.2% of mothers on folic acid supplements and 31.1% on iron supplements. Conclusion The study highlighted significant associations between obesity, gut microbiota diversity, and cardiovascular risk. Exclusive breastfeeding was linked to a higher prevalence of anemia treatment, suggesting potential nutritional challenges. Further research is necessary to develop interventions targeting maternal health during lactation.

Design and analysis of a telemonitoring system for high-risk pregnant women in need of special care or attention

BackgroundHigh-risk pregnancies, characterized by underlying health issues or unusual circumstances, pose increased risks to both maternal and neonatal health during pregnancy and childbirth. Global guidelines emphasize the importance of early identification, monitoring, and intervention to mitigate these risks.MethodWe decided to design and implement a telemonitoring system for remotely monitoring and managing pregnancies in women with conditions such as hypertension, diabetes, or high-risk pregnancy. When a high-risk pregnant mom is discharged from the hospital, the Healthcare Center or Integrated Healthcare Services Center in her area is immediately notified via SMS to ensure her condition is monitored remotely. In addition to sending notifications, the patient’s medical record, post-discharge care recommendations, drug prescription, re-visit time, and contact details are also sent to them via the application. The high-risk pregnant mom is followed up and all her information is recorded in the application for further use. To evaluate the usability of the proposed telemonitoring system, we conducted a laboratory study involving 92 participants, including pregnant mothers’ care experts at hospitals, healthcare center experts, midwives at integrated healthcare services centers, and midwifery department experts with varying levels of digital skills. Participants performed activities related to the application’s services, while their satisfaction was measured using the QUIS 7.0 questionnaires covering multiple aspects of usability, including user interface, system capabilities, and online help, with ratings on a Likert scale.ResultThe usability evaluation revealed that the average satisfaction score across all usability dimensions was above 8, demonstrating a satisfactory level of system usage from all user perspectives. Additionally, the close alignment of mean and median scores, along with standard deviations below 1 for several dimensions, indicated consistent positive feedback among users.ConclusionOur telemonitoring system demonstrates promise for enhancing the management of high-risk pregnancies, facilitating better health outcomes for mothers and infants through effective remote monitoring and support. The usability test results underscore the platform’s effectiveness and user satisfaction, contributing valuable insights for future improvements in high-risk pregnancy care.

Considerations When Measuring Exclusive Breastfeeding.

Exclusive breastfeeding, as recommended by the World Health Organization (WHO) for the first 6 months of life, is a critical metric for evaluating maternal and infant feeding practices and health outcomes. Despite its importance, inconsistencies in defining and measuring breastfeeding exclusivity present challenges for research comparability and interpretation. Equally, research design, outcomes of interest, and study resources are necessary considerations when collecting and analyzing exclusive breastfeeding data, and may require the adaption of standardized questions and techniques to individual situations. This paper explores key considerations for researchers when operationalizing and measuring exclusive breastfeeding. We address the nuances of point prevalence and since-birth measures, highlighting their influence on study outcomes and data interpretation. Statistical approaches for analyzing exclusivity data, including logistic regression, survival analysis, and Kaplan-Meier methods, are also discussed. By outlining best practices for precise definitions, tailored data collection, and transparent reporting, this paper aims to provide an overview for precise definition, effective data collection, and clear interpretation.

Changes in traffic-related air pollution exposures and associations with adverse birth outcomes over 20 years in Texas.

Billions of dollars have been spent implementing regulations to reduce traffic-related air pollution (TRAP) from exhaust pipe emissions. However, few health studies have evaluated the change in TRAP emissions and associations with infant health outcomes. We hypothesize that the magnitude of association between vehicle exposure measures and adverse birth outcomes has decreased over time, parallelling regulatory improvements in exhaust pipe emissions. Using birth records in Texas from 1996 to 2016, we calculated residential exposure measures related to TRAP: nitrogen dioxide (NO2, a marker of the TRAP mixture), vehicle miles travelled within 500 m of homes (VMT500), a measure of traffic volume, and highway proximity. Using an accountability study framework, our analysis examined term birthweight, term low birthweight (TLBW) (<2500 g), preterm birth (PTB) (<37 weeks) and very preterm birth (VPTB) (<32 weeks). We implemented linear and logistic regression models to examine overall and time-stratified associations, including trends by race/ethnicity and socioeconomic groups. Among exposures for 6 158 518 births, NO2 exposures decreased 59% over time but VMT500 remained relatively stable. TRAP-related exposure measures were persistently associated with harmful birth outcomes [e.g. OR1996-2016 of 1.07 (95% CI: 1.04, 1.08) for TLBW comparing the highest vs lowest NO2 quintile]. The magnitude of associations decreased for total VMT500 and TLBW (-60%, OR1996: 1.08 to OR2016: 1.03 for the highest vs lowest quintile) and PTB (-65%) and VTPT (-61%), but not for term birthweight. We observed evidence of small improvements in birth outcomes associated with reductions in exhaust pipe emissions over a 20-year period in Texas.

Men as Midwifery Professionals: A Scoping Review.

Midwives provide skilled, primary, reproductive, and sexual health care to women, adolescent girls, and infants throughout the perinatal period, promoting health and safeguarding against obstetric emergencies and maternal and infant mortality. In many cultures, midwifery has been a predominantly female profession. However, in emerging research, the proportion of male midwives is growing to augment shortages of female midwives, prompting a need for further research that explores the contributions of male midwives in maternal and child health. The objective of this scoping review was to synthesize key findings from the literature regarding the growing, global workforce of male midwives. Specifically, we aimed to evaluate (1) the temporal nature of the publications, (2) the geographic distributions of the emerging literature, and (3) the key findings regarding male midwives' training and work experiences. We used Semantic Scholar and Google Scholar to identify relevant, peer-reviewed articles using the keywords "gender," "male," "men," "midwifery," and "nurse midwives," that met the inclusion criteria: (1) primary research papers, (2) published in the English language (for ease of understanding by the multinational, interdisciplinary authorship team), (3) explored male midwives' experiences during training/education and working, and (4) published between 2000 and 2023. Papers were excluded if they exclusively focused on females or nurses or other health professionals. Our initial search yielded 57 articles, with an additional nine obtained by reviewing the references. After excluding duplicates and reviewing based on inclusion criteria, 26 papers were included in the scoping review. All 26 articles were published between 2011 and 2023, with the majority (65%, n = 17) of articles focused on populations in the African region (Aims 1 and 2). Key findings (Aim 3) were as follows: 1. Training experiences of male midwives: Compared to other regions, male midwifery students in African, Middle Eastern, and Asian settings reported challenging training conditions, possibly influenced by sociocultural factors and gendered expectations of men in these settings. 2. Pregnant/birthing persons' delivery experiences and gendered preferences for their attending midwife: A significant number of birthing persons would choose female midwives over male midwives for their care, despite acknowledging similar skill sets. However, younger clients, urban residents, and non-traditional men expressed a need for gender equity and greater acceptance of men as midwifery professionals. 3. Professional work environment: Many of the male midwives faced professional challenges, often stemming from societal and professional prejudices, leading to feelings of alienation and marginalization within the midwifery profession. Despite these challenges, they remained dedicated to the profession and felt supported by their family, friends, and coworkers. Male midwives represent a growing proportion of the global obstetric workforce and provide an important contribution to addressing maternal morbidity and mortality. Further attention to providing equitable training opportunities, navigating caregiving within settings with strong cultural and religious influences, integrating cultural, geographic, and religious diversity into the midwifery curriculum, and providing male midwives with mentorship and role model support to grow and sustain their careers are urgently needed for improving maternal and infant health outcomes.