Lack Of Prenatal Care Research Articles

Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022.

To identify trends in stillbirth rates attributed to congenital syphilis in the United States by describing congenital syphilis-related stillbirths and comparing characteristics of pregnant people who had congenital syphilis-related stillbirths with those of people who had preterm and full-term liveborn neonates with congenital syphilis. Cases of congenital syphilis reported to the Centers for Disease Control and Prevention during 2016-2022 were analyzed and categorized as stillbirth, preterm live birth (before 37 weeks of gestation), or term live birth (37 weeks or later). Cases with unknown vital status or gestational age were excluded. Frequencies were calculated by pregnancy outcome, including pregnant person demographics; receipt of prenatal care; syphilis stage and titer; and timing of prenatal care, testing, and treatment. Overall, 13,393 congenital syphilis cases with vital status and gestational age were reported; of these, 853 (6.4%) were stillbirths. The number of congenital syphilis-related stillbirths increased each year (from 44 to 231); the proportion of congenital syphilis cases resulting in stillbirth ranged from 5.2% to 7.5%. Median gestational age at delivery for stillborn fetuses was 30 weeks (interquartile range 26-33 weeks). People with congenital syphilis-related stillbirths were more likely to have titers at or above 1:32 (78.9% vs 45.5%; P<.001) and to have received no prenatal care (58.4% vs 33.1%; P<.001) than people with liveborn neonates with congenital syphilis. The risk of stillbirth was twice as high in persons with secondary syphilis compared with those with primary syphilis (11.5% vs 5.7%, risk ratio 2.00; 95% CI, 1.27-3.13). Across all congenital syphilis cases, 34.2% of people did not have a syphilis test at their first prenatal visit. Stillbirths occurred in more than 1 in 20 pregnancies complicated by congenital syphilis. Risk factors for stillbirth included high titers, secondary stage, and lack of prenatal care. If the prevalence of congenital syphilis continues to rise, there will be a corresponding increase in the overall stillbirth rate nationally.

The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

Contribution of Syphilis to Adverse Pregnancy Outcomes in People Living With and Without HIV in South Brazil: 2008 to 2018.

Syphilis coinfection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis coinfection on pregnancies in south Brazil. Data were extracted from hospital records between January 1, 2008, and December 31, 2018. Preterm birth (PTB), low birth weight (LBW <2500 g), and a composite adverse infant outcome (AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis, stillbirth, congenital syphilis) were evaluated among pregnancies without HIV and syphilis (PWOH + S), PLH monoinfection, syphilis monoinfection (PLS), and PLH with syphilis (PLH + S). Among 48,685 deliveries where patients were tested for HIV and syphilis, 1353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis coinfected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were lost to follow-up before HIV diagnosis. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. Thirty-seven percent of PLH + S did not initiate antiretroviral therapy versus 15.4% of PLH monoinfection ( P < 0.001). Less than half (37.6%) of PLH + S had VDRL titers ≥1:16 compared with 21.7% of PLS only ( P < 0.001). Among PLH, syphilis coinfection and unknown/high VDRL titers (≥1:16) increased AIO risk more (adjusted relative risk [aRR], 3.96; 95% confidence interval [CI], 3.33-4.70) compared with low VDRL titers (≤1:8; aRR, 3.51; 95% CI, 2.90-4.25). Unsuppressed viremia (≥50 copies/mL) was associated with risk of PTB (aRR, 1.43; 95% CI, 1.07-1.92) and AIO (aRR, 1.38; 95% CI, 1.11-1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS monoinfection. Syphilis coinfection worsens AIOs in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV viral load suppression are paramount for optimal obstetric care.

Outcome and predictors of failure of abdominal surgical repair of high vesico-vaginal and vesico-uterine fistulae at Gezira Hospital for Renal Disease and Surgery

BackgroundUrogenital fistula can arise from various causes, leading to the development of diverse surgical procedures. The prevention and treatment of obstetric fistula continue to pose challenges in low-income countries.AimTo assess the outcomes and predictors of failure of surgical repair for urogenital fistulas, specifically high vesico-vaginal fistula (VVF) and vesico-uterine fistula (VUF), within our context.MethodsConducted a prospective hospital-based study involving 100 female patients with urogenital fistula (95 VVF and 5 VUF) who underwent abdominal surgical repair at Gezira Hospital for Renal Diseases and Surgery from 2018 to 2023. Collected data encompassing demographics, obstetric history, fistula etiologies, Swab test, cystoscopy findings, urine diversion, ureteric re-implantation, and repair outcomes.ResultsThe majority of women were aged 20–29 years (39%), illiterate (62%), and had a low socio-economic status (87%). Lack of antenatal care was noted in 77% of patients. Fistula etiologies were predominantly obstetric (70%), mainly due to spontaneous vaginal delivery (SVD), with the remaining 30% attributed to gynecological causes (hysterectomy). In terms of fistula characteristics, all patients had a high-level fistula, 95% had a single fistula, and 69% had a posterior wall fistula. Successful closure was achieved in 84% of cases, with 11% experiencing ureteric involvements. The analysis of failures pointed to recurrent fistulae (50%), larger fistula size (31%), and the presence of multiple fistulae (19%) as notable predictors of unsuccessful repair.ConclusionVVF was the prevalent type of urogenital fistula in our population. Risk factors included being in the third decade of life, illiteracy, low socioeconomic status, and a lack of prenatal care. Obstetric causes, particularly prolonged and obstructed labor through SVD, dominated the etiology. Surgical procedures resulted in successful closure in 84% of cases. Recurrent fistulae, larger size, and multiple occurrences emerged as predictors of surgical repair failure.

Retrospective Cohort Study of Syphilis-Related Stillbirths in Winnipeg, Manitoba From 2017–2020

ObjectiveSyphilis-related stillbirths (SRSBs) disproportionately affect marginalized women with 11% of all local stillbirths having maternal syphilis as a contributory factor in 2020. This study describes the incidence and perinatal factors associated with SRSB. MethodsThis was a retrospective cohort study of all stillbirths occurring from 1 January 2017 to 31 December 2020, at a single tertiary-level referral hospital in Winnipeg, Manitoba. Cases that met criteria for SRSB were identified from hospital records and included in the final analysis. Maternal demographics, comorbidities, prenatal care attendance, sexually transmitted infection testing, treatment, and diagnostic investigations at time of stillbirth were collected from hospital charts using a standardized data collection form. Descriptive statistics were performed to present the results. ResultsThe proportion of SRSB increased over the period of study from 0%–11%. Eleven cases were identified as SRSB, with diagnosis occurring intrapartum in 7 cases and antenatally in 4 cases. Of the 4 antenatal cases, only 2 had identifiable treatment responses indicated by microbiological and pathology workup. Commonly identified risk factors for SRSB were homelessness, mental illness, substance use, sexually transmitted co-infections, and lack of prenatal care. ConclusionsCases of SRSB are rising in Winnipeg with 11% of all stillbirths having maternal syphilis as a contributory factor by 2020. SRSBs disproportionately affect marginalized women. The dramatic and rapid changes in the epidemiology of syphilis in Winnipeg are likely shared by other Canadian regions and warrant increased prevention strategies to improve outcomes.

Restrição de Crescimento Intrauterino e os fatores de risco associados no Brasil

Introduction: Intrauterine Growth Restriction is defined as the inability of the fetus to reach its growth potential and can be caused by maternal, placental and fetal factors. Objective: The study aims to make a major social contribution, in order to help the health sectors develop actions aimed at improving the quality of life of pregnant women, promoting changes in behaviors that are harmful to the fetus and thus contributing to reducing infant morbidity and mortality. Methodology: A bibliographic survey was carried out in the Scielo, PubMed and VHL databases, between 2010-2020, with the descriptors and their combinations in Portuguese and English, using the Boolean operators: "fetal growth retardation" OR "intrauterine growth retardation" OR "intrauterine growth restriction" AND "risk factors" AND "intrauterine growth restriction" AND "Brazil". After applying inclusion and exclusion criteria, 10 articles were selected. Results: Analysis of the articles showed that Intrauterine Growth Restriction is strictly related to five themes: evolution in prenatal treatment; socioeconomic factor; low birth weight; fetal mortality and serum leptin concentration, eclampsia and HIV. Conclusion: The analyses available on the main categories related to IUGR showed that lack of prenatal care, poor socioeconomic situation, low leptin concentration during pregnancy, pre-eclampsia and viral infections such as HIV are risk factors for IUGR in Brazil.

Reflections on the difficulties in treating gestational syphilis: from the patient to the health system

Syphilis, an infection caused by the bacterium Treponema pallidum, is a worldwide systemic disease with a chronic course that affects only humans as its host. Transmission can occur through sexual or vertical means. Newborns of mothers with untreated syphilis or those who did not undergo proper treatment may present with either an asymptomatic or severe systemic symptoms. The aim of this study was to conduct a literature review on patient behavioral factors and public health actions that can impact the treatment of gestational syphilis. Articles published in Portuguese, available in full text in the databases Medline, Scielo, Biblioteca Virtual da Saúde (BVS), Lilacs, and PubMed, were considered. Official publications from the Ministry of Health within the same time frame were also taken into account. The results indicate that the main difficulties related to the treatment of gestational syphilis include: deficiencies and/or lack of prenatal care; a shortage of information aimed at pregnant women about the disease; limited access to the primary medication or a failure to seek it; limited adherence of partners to treatment and the use of condoms in sexual relationships. It is necessary to adjust prevention campaigns and monitoring/treatment follow-up for syphilis cases in pregnant women to reduce the negative impact on public health of a treatable and curable disease.

Spectrum of MRI findings of foetal alcohol syndrome disorders—what we know and what we need to know!

The exposure to alcohol in utero has been known to damage the developing foetus. Foetal alcohol spectrum disorders is an umbrella term that highlights a range of adverse effects linked to alcohol exposure in utero. Multiple studies have shown specific brain abnormalities, including a reduction in brain size, specifically in the deep nuclei and cerebellum, and parietal and temporal lobe white matter changes. While studies ascertained that other prenatal risk factors, such as maternal use of illicit drugs or lack of pre-natal care, and post-natal risk factors, such as physical or sexual abuse and low socioeconomic status, may be involved in the pathology of variances in foetal neurological abnormalities, prenatal alcohol exposure remained the strongest factor for effects on brain structure and function. Particularly, the number of days of alcohol consumption per week and drinking during all three trimesters of the pregnancy indicating the strongest relationship with brain abnormalities. Further studies are needed to explain pre-natal risk factors in isolation as well as in combination for neurodevelopmental outcomes. The diverse phenotypic presentations described indicate that the diagnostic criteria of foetal alcohol spectrum disorder must be refined to better represent the range of neurologic anomalies.

Obstetric outcomes of delayed initiation of antenatal care at a university teaching hospital in southwest Nigeria

Background: Antenatal care (ANC) is vital for the health of both mother and fetus. Generally, it has been observed that lack of prenatal care or inadequate utilization of antenatal care culminates in adverse maternal outcomes including maternal mortality.Objective: To compare the obstetric outcomes in pregnant women that commenced ANC in the third trimester with those that initiated ANC contacts early.Materials and Methods: This was a prospective cohort study conducted on antenatal attendees that booked and delivered at the Department of Obstetrics and Gynaecology of Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, southwest Nigeria from 1st of January, 2015 to 31st December, 2015. Data gathered were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were used to examine the data, with results expressed as numbers and percentages. Associations between maternal factors, obstetric outcomes and delayed commencement of ANC were examined by Pearson Chi-square. The significance levels were set at p<0.05.Results: During the study period, 1633 women received antenatal care and delivered in our centre. Out of these 1633 women, 547(33.5%) had delayed initiation of antenatal care. Women with pre-existing medical illnesses were likely not to experience delayed initiation of ANC (X2 =8.31 p value=0.02). Women who initiated antenatal care in the third trimester were more likely to develop preeclampsia (X2 =7.86 p value=0.02) and prelabour rupture of the fetal membranes (X2 =11.59, p value=0.003).Conclusion: The proportion of women who delayed initiation of ANC was high and they may be predisposed to developing preeclampsia. There is, therefore, a pressing need to increase advocacy on the need for early booking for antenatal care.

Treponema pallidum causing congenital syphilis with severe multisystem involvement.

In recent years there has been an upsurge in sexually transmitted diseases, including syphilis. This growth, along with the migratory movements and the lack of prenatal care, is leading to an increase of congenital syphilis. We present a case of maternal syphilis with systemic involvement in an Ecuadorian pregnant.

A rare clinical image of anencephaly

Anencephaly is a medical condition where the fetus has no calvarium with no or lack of the brain tissue. This belongs to neural tube defects where the neural tube fails to close. In rural areas, the lack of prenatal care and prenatal follow-up of the mother mostly leads to this malformation in the fetus. A pregnant mother of 36 weeks of gestation with no history of diabetes mellitus, epilepsy, or known exposure to teratogenic agents was taken to the hospital with labor pain. The case was taken to the C-section due to fetal distress. The baby didn’t cry immediately after the birth, resuscitation was performed immediately. There was no calvarium, no scalp, external presence of hemorrhagic tissue, and lack of cerebral hemisphere was noted. The left leg of the fetus was not developed completely. The father and family members were informed and counseled about the condition. The economic condition of the family couldn’t afford the higher medical management. The baby passed after 5 hrs of life. Counseling of the mother was done and the importance of prenatal care during pregnancy was informed to the family. Anencephaly does not support life, prevention is the only way to avoid this condition. With proper prenatal care and counseling, this can be achieved. The most important part of the treatment for the mother is counseling to overcome or avoid postpartum depression and its complications.

Factors Associated with the Duration of Breastfeeding: The Practices of Mexican Mothers in a Megacity and in the Agricultural Town.

Breast milk is irreplaceable for healthy development. In Mexico, by 2019, the prevalence of exclusive breastfeeding (EBF) was low and the use of breastmilk substitutes (BMSs) was high. The aim of this work was to evaluate the maternal and child characteristics related to breastfeeding (BF) duration and to the introduction of BMSs for residents of Mexico City (CdMX) and an agricultural town in Morelos. A cross-sectional study was conducted with 160 mother-child binomials (0-15 months of age) from the megacity CdMX and the agricultural town. EBF and total breastfeeding (TBF) duration, age of transition to BMSs, and the introduction of complementary feeding (CF) were assessed. Associations with maternal and infant factors were assessed using Cox models. The prevalence of EBF in the joint samples at 5.9 months was 32.6% and 5.8% at 6 months. EBF was favored under the following conditions: living in CdMX, receiving prenatal care, no newborn hospitalization, and breastmilk provided as first food at birth. TBF was prolonged under the following conditions: older mother, female children, rooming-in care during puerperium, receiving BF upon discharge after birth, cohabiting with extended family, and having no siblings. The introduction of BMSs predominated under the following conditions: living in an agricultural town, BMSs given after birth before discharge, younger mother, worker mother, and lack of prenatal care. The early introduction of CF (before the fourth month) was 2% for CdMX and 14% for the agricultural town. The agricultural population had a higher risk of the premature interruption of EBF/TBF and the early introduction of BMSs and CF. Protective factors were family-friendly environments and being born in a baby-friendly hospital.

Social Determinants of Health and Hirschsprung-associated Enterocolitis

BackgroundHirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). The objective of this study was to examine the association of social determinants of health (SDOH) with HAEC. MethodsA review of patients who underwent primary pull through for HD at our institution from 2014 to 2021 was performed. Clinical, surgical, and SDOH data were collected. HAEC was defined by an international scoring system. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests. ResultsOne hundred patients were identified with 29 patients (29%) having at least one episode of HAEC during a median follow-up of 31 months (IQR: 11.7–55.7). Children who utilized public transportation for clinic visits, had one or more missed appointments, had any reported safety concerns, were involved with Child Protective Services, had parents/guardians who were not married, lived with people other than their immediate family, or had mothers who reported drug use or lack of prenatal care were found to have a higher likelihood of developing HAEC (p<0.04 for all). Age at HD diagnosis, age at pull through, operative approach, length of aganglionic colon, and Trisomy 21 were not significant predictors of HAEC. ConclusionsIn our series of 100 patients undergoing primary pull through, there was a significant correlation of HAEC with several social determinants of health elements while anatomical and clinical factors were not associated with HAEC. Attention to social determinants of health and identifying high-risk patients may serve to prevent morbidity and mortality from HAEC. Level of EvidenceIII

HPR37 Achieving Better Birth Outcomes Among Black Women: A Linked EMR/Claims Analysis of Visit History and Outcomes

A lack of prenatal care is associated with poor birth outcomes, particularly among Black women; however, the association of other prior care and outcomes is less studied. This study examined the correlation between historical healthcare use and birth outcomes among Black women who received prenatal care.

Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment.

Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment.

Social Determinants of Preterm Birth Amongst Non-Hispanic Black Women

Efforts to recognize risk factors for preterm birth (PTB) are essential as this is a leading cause of perinatal mortality in the US. This study aims to identify risk factors that may be drivers of higher preterm birth rates amongst non-Hispanic black women. Population-based retrospective case-control study of the US birth records (2012—2016). Factors potentially associated with preterm birth and considered as indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women delivering preterm (< 37 weeks gestation) and term (≥ 37 weeks gestation). Multivariate logistic regression quantified the association between social determinants and PTB such as maternal age, insurance type, education level, and amount of prenatal care, and reported as odds ratios (95% confidence interval, CI). Of 2,763,235 live births to Black women in the US during the study period, 340,480 (12% of births to Black women) occurred < 37 weeks. Factors most strongly associated with preterm birth (P< .001), presented as odds ratio (95% CI) included no prenatal care 3.0 (95% CI, 2.9—3.1) or insufficient prenatal care 2.7 (95% CI, 2.7—2.8); smoking during pregnancy 1.4 (95% CI, 1.43—1.47), age ≥ 35 years 1.3 (95% CI, 1.3—1.35), unmarried 1.18 (95% CI, 1.17—1.19), lack of high school diploma 1.1 (95% CI, 1.12—1.40), lack of father of baby listed on birth certificate 1.22 (1.21—1.23), and Black paternal race 1.10 (1.08—1.12). Utilization of government-funded resources of Medicaid and WIC had opposite influence on PTB risk in Black women, OR 1.08 (1.07—1.09) and 0.83 (0.83—0.84), respectively. Non-Hispanic Black women with older age, smokers, Medicaid insurance, lower education, unmarried, lack of prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Addressing these indicators of SDH that contribute to the risk of PTB, specifically amongst Black women, may help to address the racial disparity in adverse perinatal outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

COVID-19 and mental health of pregnant women in Ceará, Brazil.

ABSTRACTOBJECTIVE To assess the perceptions of pregnant women about COVID-19 and the prevalence of common mental disorders during the implemented social distancing period.METHODS This was an observational, cross-sectional study using digital media, of pregnant women exposed to social distancing due to the COVID-19 pandemic, in Fortaleza, Ceará, Northeastern Brazil. Common mental disorders were estimated using the modified Self-Report Questionnaire-20 (SRQ-20) scale, and the feelings towards COVID-19 were assessed using the Fear of COVID-19 scale through telephone calls made in May 2020. COX multivariate regression models were used to verify the associations.RESULTS Of the 1,041 pregnant women, 45.7% (95%CI: 42.7–48.8) had common mental disorders (CMD). All items of the Fear of COVID-19 Scale showed a significant association with the prevalence of CMD (p < 0.001). A CMD risk gradient was observed, going from a prevalence ratio of 1.52 (95%CI: 1.13–2.04) in pregnant women with two positive items to 2.70 (95%CI: 2.08–3.51) for those with four positive items. Early gestational age and the lack of prenatal care were also associated with CMD.CONCLUSIONS The prevalence of common mental disorders in pregnant women was high during the period of social distancing and was aggravated by negative feelings towards COVID-19.

Preterm Delivery; Who Is at Risk?

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

An overview of non-genetic intellectual disability among Egyptian children and adolescents

BackgroundIntellectual Disability has gained greater emphasis than all other developmental disabilities. It is essential for early detection and intervention of ID to classify children at high risk of non-genetic ID, which would support both clinical practice and public health. Its etiology has been investigated in several studies, with limited information from developing countries. This study aimed to estimate etiology, sociodemographic characteristics, risk factors, and co-morbidities related to ID. Methods134 children and adolescents with ID were included in the study fulfilling the diagnostic criteria for ID according to DSM-5. A structured questionnaire focusing on demographic, socioeconomic, pre, and postnatal variables was administered to parents of children and adolescents by trained interviewers. ResultsThe mean age was 8.25 ± 3.37 years, 76.1% males, 39.6% mild ID, 29.9% moderate, 26.1% severe ID, and 4.5% profound ID. Advanced maternal age above 35 years (AOR = 6.79; 95% CI = 2.05–22.46; P = 0.001), lack of prenatal care during pregnancy (AOR = 0.131; 95% CI = 0.131; P = 0.007), prematurity (AOR = 8.494; 95% CI = 1.08–66.84; P = 0.042), perinatal anoxia (AOR = 43.549; 95% CI = 2.25–842.99; P = 0.013) and autism (AOR 9.160; 95% CI = 1.57–53.37; P = 0.014) were significantly independent factors associated with increased risk of severe/profound nongenetic ID. ConclusionThis study’s findings suggest a complex interaction between prenatal, perinatal, neonatal, and socioeconomic disadvantages and severe form of ID, suggesting that with effective antenatal, perinatal, and neonatal healthcare measures, this incidence can be minimized.

Who Makes the Choice: Ethical Considerations Regarding Instituting Breastfeeding in a Mother Who Has Compromised Mental Capacity.

This case reports an ethical dilemma in which a mother who had recently delivered a baby through cesarean section after sustaining life-threatening injuries in a car accident did not have documented wishes whether she wanted to breastfeed. Her medical condition rendered her temporarily mentally incapacitated and critically ill, and the lactation medicine team was consulted about whether lactation choice should be preserved by pumping. Complicating considerations in this case were (1) lack of family or designated decision-makers available at the time of injury and emergent delivery, (2) lack of prenatal care, and (3) complex social situation, including prior history of illicit substance use, and state removal of other children into foster care. This case raises important ethical considerations regarding breastfeeding decision-making when a mother is incapable of making the decision, and if there is an intrinsic right for an infant to be breastfed in situations where maternal choice to lactate or to formula feed is unknown. Ultimately, the mother chose to discontinue breastfeeding once she was able to voice her own opinion. The issues discussed in this study may be relevant for future cases when providing guidance on the ethical argument to preserve maternal choice when a mother is critically ill and mentally incapacitated.