Midwifery Research Articles

The impact of environmental health facilities and maternal behaviors on the incidence of diarrhea among children under five

The objectives of this study were to determine the prevalence of diarrhea among children under five and assess the relationship between its risk factors related to environmental health facilities and maternal behavior. A prospective case-control community-based study was conducted in the service area of Pasar Ikan Community Health Center, Teluk Segara Subdistrict, Bengkulu City, Indonesia. A total of 140 participants were included, comprising 70 cases and 70 controls. The study found that poor qualification of clean water resources (OR=4.026, p-value=0.000), inadequate utilization of clean water (OR=5.813, p-value=0.000), poor qualification of family latrines (OR=3.574, p-value=0.000), and inadequate utilization of family latrines (OR=3.377, p-value=0.001) were significantly associated with an increased risk of diarrhea prevalence among children under five. Furthermore, unhealthy mothers’ behaviors, including frequent feeding of children outside the home (OR=2.728, p-value=0.000) and poor personal hygiene (OR=3.377, p-value=0.001), were also significantly related to a higher prevalence of diarrhea in this age group. Therefore, both substandard environmental health facilities and unhealthy maternal behaviors were identified as significant risk factors for diarrhea prevalence in children under five. These findings emphasize the critical importance of improving environmental health facilities and promoting positive changes in mothers’ behavior to reduce the incidence of diarrhea in this vulnerable population.

Study of factors associated with the false-positive rate of second-trimester serological screening in 632,825 cases in Sichuan based on propensity score matching

To retrospectively analyze the results of second-trimester serological prenatal screening and explore the factors which may influence the false-positive rate (FPR). From January 2013 to December 2022, false-positive samples with follow-up outcomes from 632,825 second-trimester serological prenatal screening samples tested at Sichuan Provincial Maternity and Child Health Care Hospital were selected as the study group, while true-negative samples were 1 : 1 matched as the control group by propensity-score matching (PSM). Univariate and binary logistic regression models were used to analyze the influencing factors. This study was approved by the Medical Ethic Committee of Sichuan Provincial Maternity and Child Health Care Hospital (Ethic No. 20240607-270). The study and control groups were each matched with 305,998 cases. Univariate analysis showed that sampling season, the difference between ultrasound and gestational weeks calculated by last menstrual period (LMP), monthly median multiple of the median (mMoM) of alpha-fetoprotein (AFP), and monthly mMoM of free β -human chorionic gonadotropin (free β -hCG) were significantly different between the two groups (P < 0.05). Binary logistic regression analysis showed that Winter (OR = 0.938; 95%CI: 0.893 ~ 0.985), monthly AFP mMoM ≥ 1.11 (OR = 0.846; 95%CI: 0.761 ~ 0.941), monthly free β -hCG mMoM ≥ 0.89 (OR = 0.827; 95%CI: 0.737 ~ 0.929) are protective factors for FPR increase, whilst Spring (OR = 1.124; 95%CI: 1.072 ~ 1.179), Summer (OR = 1.121; 95%CI: 1.062 ~ 1.183), the difference between ultrasound and gestational weeks calculated by LMP of 8 ~ 14 days (OR = 1.319; 95%CI: 1.241 ~ 1.402), < 14 days (OR = 1.689; 95%CI: 1.542 ~ 1.850), monthly AFP mMoM of 0.90 ~ 0.94 (OR = 1.088; 95%CI: 1.046 ~ 1.131), and monthly free β -hCG mMoM of 1.05 ~ 1.10 (OR = 1.046; 95%CI: 1.000 ~ 1.094), ≥ 1.11 (OR = 1.062; 95%CI: 1.002 ~ 1.126) are risk factors for FPR increase. Sampling season, difference between ultrasound and gestational weeks by LMP, monthly AFP mMoM, and monthly free β -hCG mMoM are risk factors for FPR during serological prenatal screening. Screening laboratories should look for the cause of abnormal FPR through such factors and adjust them accordingly.

Analysis of a Chinese pedigree with female infertility due to WEE2 gene c.495del homozygous frameshifting variant induced fertilization disorder

To explore the genetic basis for a patient with repeated fertilization failure during assisted reproductive therapy, and to identify the source and mode of mutation. A couple treated at the Center for Reproductive Medicine, Gansu Provincial Maternal and Child Health Care Hospital in January 2024 for infertility with incomplete left tube obstruction was selected as the study subject. Relevant clinical data was collected. The couple was subjected to whole exome sequencing (WES), and the candidate variant was verified by Sanger sequencing of their family members and bioinformatic analysis. WES has identified a homozygous c.495del frameshifting mutation of the WEE2 gene in the female partner, whilst no relevant variant was suspected in the male partner. The elder brother of the female partner was homozygous for the above variant, while her parents, maternal and paternal aunts, uncle, grandmother, and grandmother were heterozygous for it. Based on the guidelines from the American College of Medical Genetics and Genomics, above variant was rated to be pathogenic. The homozygous c.495del frameshifting mutation of the WEE2 gene probably underlay the oocyte fertilization disorder in this couple, which has conformed to an autosomal recessive inheritance.

Severe Maternal Morbidity and Postpartum Care: An Investigation Among a Privately Insured Population in the United States, 2008-2019.

Objective: This study examines postpartum health care utilization among women with severe maternal morbidity (SMM) subtypes (e.g., blood transfusion, renal), focusing on both early (within 7 days) and late (8-42 days) postpartum periods. By including outpatient visits alongside inpatient and emergency department (ED) visits, the study offers a comprehensive view of postpartum health care needs among women with SMM. Methods: This retrospective cohort study used data from Optum's de-identified Clinformatics® Data Mart Database from 2008 to 2019. The primary outcomes were early and late postpartum inpatient readmissions, early and late ED visits, and outpatient care within 42 days after delivery. Multilevel logistic regression models were used to estimate the association between SMM subtypes and postpartum readmission, ED, and outpatient care. Results: Except for hemorrhage, most SMM subtypes increased the postpartum odds of health care utilization. Women with other medical SMM (e.g., puerperal cerebrovascular disorders or sickle cell disease with crisis) had 2.9 times the odds (odds ratio [OR]: 2.87, 95% confidence interval [CI]: 1.30-6.34) of experiencing early readmissions compared with those without other medical SMM. Women with sepsis had 4.5-fold elevated odds (OR: 4.53, 95% CI: 2.48-8.28) of late readmission, a 1.9-fold increased odds (OR: 1.85, 95% CI: 1.12-3.04) of early ED visits, and over a 2-fold increased odds (OR: 2.27, 95% CI: 1.67-3.08) of postpartum outpatient visits compared with those without sepsis. Conclusion: This study reveals that certain SMM subtypes significantly increase postpartum health care utilization, emphasizing the need for further research and interventions to improve outcomes for affected women.

The cost of maternity and neonatal care in Aotearoa New Zealand: A cost analysis by plurality and gestation using a population-based cohort.

Maternity services in New Zealand are largely delivered by autonomously practising community midwives. This model of care is unique and may result in differences in the distribution of maternity healthcare utilisation and costs compared to other countries. New Zealand-specific cost data are needed to inform economic analyses, local policy and healthcare resource planning. To provide estimates of the average total cost of maternity and neonatal healthcare for New Zealand women and infants, including cost impacts of multiple and preterm births. A whole-of-population linked dataset, including 262 687 pregnancies resulting in a live birth (from 1 January 2016 to 30 June 2020), was created by combining several sources of healthcare data to calculate an average per-pregnancy cost of healthcare, taking a public health system perspective, during antenatal, intrapartum, and postnatal periods to one year after birth. The mean cost of public healthcare was NZ$19 795 for both maternal and infant care to one year post-birth. The bulk of this cost was incurred during pregnancy and birth. Mean total cost to one year was NZ$69 895 for twin and NZ$201 448 for higher order multiple compared to singleton pregnancies at NZ$19 098. Mean total healthcare cost decreased as gestation increased. Most of the costs associated with pregnancy and childbirth were incurred during the birth and in the early neonatal period. Costs were disproportionately higher for multiple and preterm births. These cost data can usefully inform policy and assist healthcare decision-making around reproductive and neonatal technologies.

Facilitators and Barriers to Access to Midwife-Led Birth Settings for Racialized Women in the UK: A Scoping Review.

In UK maternity care, racialized women have worse experiences and clinical outcomes than White women. Midwife-led birth settings (MLBS), including home births and midwife-led units, both freestanding and alongside hospitals, are all available as choices for low-risk women in the UK. MLBS deliver optimal outcomes for low-risk women with uncomplicated pregnancies, including for racialized women, and can offer culturally specific care, possibly mitigating existing social inequalities. Evidence suggests that racialized women access MLBS less than White women. To map existing literature on facilitators and barriers to accessing MLBS for racialized women and to identify emerging themes. A scoping review of UK literature over the last 10 years using OVID, Ebsco Host, and gray literature. Search, selection, and data extraction were performed using PRISMA and JBI guidelines. Data were analyzed using inductive thematic analysis. Fourteen articles met the inclusion criteria, only one addressing the research question directly and others containing some relevant material. Six themes were identified: admission criteria, information giving, the role of antenatal groups, bias and assumptions, beliefs about birth, and MLBS as empowering. There is a lack of research on racialized women's access to MLBS. Community outreach, having midwifery services embedded in the community, defaulting to MLBS for women categorized as low risk, continuity of carer, and interventions achieving a reduction in care-giver bias may improve access and outcomes.

Evaluating the effect of a virtual reality digital therapeutic on maternal stress among expectant and postpartum Black and Latina mothers: a protocol paper

BackgroundMaternal mental health is vital to overall well-being, particularly among expectant and postpartum Black and Latina women who experience higher stress levels and mental health challenges. Traditional healthcare systems often fail to meet these needs, underscoring the need for innovative and accessible interventions. NurtureVR, a digital maternal mental health and educational program, leverages virtual reality to offer mindfulness, relaxation, and guided imagery to support these women.ObjectivesThis protocol aims to evaluate whether NurtureVR, a digital therapeutic, can reduce stress levels and mental health symptoms in pregnant and postpartum Black and Latina women, improve sleep, enhance pregnancy and childbirth experiences, and increase pregnancy and postpartum health literacy.MethodsThe Nurturing Moms study uses a pre- and post-intervention design with a 5-week NurtureVR program. Fifty participants, 25 expectant and 25 postpartum Black and Latina women, will be recruited through clinics, community organizations, and online platforms. The study involves three phases: baseline assessments of stress, mood, self-efficacy, demographics, and health history; daily use of NurtureVR for 15 minutes during the third trimester and six weeks postpartum; and follow-up assessments at six weeks postpartum. The program includes 49 modules on labor and delivery, stress during pregnancy, nutrition, breastfeeding, hormonal changes, 3D VR representations of fetal development, pain management simulations, and mindfulness exercises for labor. Participants will report stress, anxiety, mood, and pain levels following each VR session. Additional qualitative insights will be gathered through focus groups, and an optional survey will be administered one-year post-intervention to evaluate long-term effects.ConclusionsThe Nurturing Moms study seeks to create a more inclusive and equitable healthcare landscape, demonstrating that digital interventions like NurtureVR are essential for providing high-quality maternal care. By democratizing access to clinical research and healthcare, this decentralized trial promotes equity, improves the generalizability of findings, and accelerates the development of new treatments. The study’s innovative approach has the potential to improve maternal experiences of stress, sleep, and overall health outcomes for Black and Latina mothers and children, despite limitations such as sample size, language barriers, and the preliminary nature of a pilot and feasibility study.

Maternal Sensitization in Virgin Female Rats: Behavioral Effects of Enriched Environment.

In virgin female rats, the continuous presence of pups causes them to express typical maternal behaviors, a process known as maternal sensitization. Previous experience with pups accelerates maternal sensitization. It is also known that in primiparous rats, enriched environment (EE) increases the expression of maternal behaviors. Here, we investigated whether experience, other than pup exposure, affects the process of maternal sensitization and hypothesized that EE increases the expression of maternal behaviors and maternal motivation in virgin rats. Virgin adult females were housed in standard conditions or physical and social EE for 21 days. Then, females were exposed daily to pups until they expressed full maternal behaviors. Thereafter, females performed pup preference, pup motivation in a novel context, and resident-intruder tests. We found that initial pup rejection was higher in EE rats, but eventually, both groups became maternally sensitized simultaneously. The frequency and duration of pup licking were higher in EE rats. In the other tests, EE rats exhibited more entries to the open arms, retrieved more pups toward the closed arms, and were more aggressive towards an intruder. We conclude that housing in a social EE modulates aspects of the pup-induced maternal sensitization, particularly increasing pup licking and motivation in both familiar and novel circumstances.

Trajectories of Maternal Behavior, Infant's Respiratory Sinus Arrhythmia, and Emotional Recovery Following the Still Face Paradigm.

The development of emotion regulation is integral to children's socioemotional adjustment. Respiratory sinus arrhythmia (RSA) reflects parasympathetic regulation of cardiac arousal and is thought to be an indicator of emotion regulation. However, it is unclear how RSA is associated with positive maternal behaviors and infant emotional recovery in real time over the course of a recovery period following a social stressor. Mothers and their 5- to 6-month-old infants (N=143) completed the Still Face paradigm. Using a series of autoregressive latent trajectory models, the current study aimed to elucidate the associations among observed maternal warmth, infant RSA, and observed infant negative affect across a 5-min observation. The hypotheses were that trajectories of maternal warmth would predict trajectories of infant RSA and negative affect, and that trajectories of RSA would be associated with the infants' observed negative affect. Change in maternal warmth was associated with infant negative affect and RSA at the end of the reunion and change in RSA was associated with ultimate levels of negative affect. The results provide partial support for our hypothesis that maternal warmth supports infant physiological, and in turn, emotional recovery.

Paternal impact on the developmental programming of sexual dimorphism

Sexual dimorphism involves distinct anatomical, physiological, behavioral, and developmental differences between males and females of the same species, influenced by factors prior to conception and during early development. These sex-specific traits contribute to varied phenotypes and individual disease risks within and across generations and understanding them is essential in mammalian studies. Hormones, sex chromosomes, and imprinted genes drive this dimorphism, with over half of quantitative traits in wildtype mice showing sex-based variation. This review focuses on the impact of paternal non-genetic factors on sexual dimorphism. We synthesize current research on how paternal health before conception affects offspring phenotypes in a sex-specific manner, examining mechanisms such as DNA methylation, paternally imprinted genes, sperm RNA, and seminal plasma. Additionally, we explore how paternal influences indirectly shape offspring through maternal behavior, uterine environment, and placental changes, affecting males and females differently. We propose mechanisms modulating sexual dimorphism during development, underscoring the need for sex-specific documentation in animal studies.

Factors influencing concurrent wasting, stunting, and underweight among children under five who suffered from severe acute malnutrition in low- and middle-income countries: a systematic review

BackgroundWasting, stunting, and underweight in children are complex health challenges shaped by a combination of immediate, underlying, and systemic factors. Even though copious data demonstrates that the causation routes for stunting and wasting are similar, little is known about the correlations between the diseases in low- and middle-income nations.ObjectiveThe objective of this study is to evaluate the factors that concurrently affect wasting, stunting, and underweight in &amp;lt;5-year-olds with severe acute malnutrition (SAM).MethodThis review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched every electronic database that was available, from the medRxiv pre-print site, PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Google Scholar, and Scopus, in addition to the Science Direct search engine. We considered research conducted in low- and middle-income nations on &amp;lt;5-year-olds with SAM. The Newcastle Ottawa Scale was used to assess the quality of the studies.ResultsAfter screening and selecting 12 eligible studies, 1,434,207 records were included for analysis. The prevalence of factors influencing concurrent wasting, stunting, and being underweight was 26.42% in low-middle -income countries (LMI). The prevalence was higher in men, with wasting, stunting, and underweight at 14.2, 4.1, and 27.6%, respectively. Unprotected drinking water was associated with stunting [odds ratio = 0.68; 95CI (0.50, 0.92)]. Being male is another factor (aOR = 2.04, 95% CI: 1.13, 3.68). Lack of prenatal care follow-up was associated with a lower risk of wasting (OR = 2.20, 95% CI: 1.04, 4.64), while low birth weight (&amp;lt;2.5 kg), diarrhea, having a younger child, and being from a poor household were associated with wasting, stunting, and underweight. Other factors included body mass index (BMI) for age aOR = 2.11, 95% CI: (0.07, 0.895); maternal education: stunting [aOR = 1.52, 95% CI: (0.09, 0.89)], underweight [aOR = 1.97, 95% CI: (0.01, 0.73)], and open defecation, stunting [aOR = 1.62, 95% CI: (0.06, 0.32)], underweight [aOR = 1.92, 95% CI: (0.042, 0.257)]). Likelihood of being underweight increased with birth order (second born, aOR = 1.92, 95% CI 1.09–3.36; third born, aOR = 6.77, 95% CI 2.00–22.82).ConclusionInadequate dietary intake, illness, food insecurity, poor maternal and child care, poor hygiene and sanitation, and healthcare inaccessibility contribute to SAM.

Social norms and maternal health information-seeking behavior among adolescent girls: A qualitative study in a slum of Bangladesh.

Adolescent girls of reproductive age who actively seek information on maternal health often tend to have better health-seeking behaviors and maternal health outcomes. Due to scant research on reproductive aged adolescent girls' maternal health information seeking behavior in slum, in connection with social norms, we aimed for this particular study. Adopting an explorative qualitative research approach, we collected data from purposively selected married and unmarried adolescent girls aged 15-19 of different occupation by implying 12 in-depth interviews (IDIs), 2 focus group discussions (FGDs) with the same categories employed for IDIs, and 2 key informant interviews (KIIs) with a traditional birth attendant and a drug seller. Furthermore, the data were subjected to thematic analysis. Care's Social Norms Analysis Plot (SNAP) framework was undertaken as an interpretative tool for data that was emerging rather than serving as the foundation for the study's conduct and design. Thematic analysis was followed to analyze primary data. Findings show that most girls rely on maternal health-related information from unverified sources, including family members, traditional birth attendants, and drug sellers, which increases health risks. The majority reported that adolescent girls need professional healthcare providers in their area who would work according to their work schedule as most of the girls are engaged in income-generating work for about 9-11 hours, and the scope of work (daily wagers) hardly supports 'leave with pay'. Therefore, there is a critical need for professional healthcare services tailored to the girls' work schedules. Social norms and stigma further restrict access to reliable health information, especially for unmarried girls. Socioeconomic disparities also shape health-seeking behaviors, with wealthier adolescents having greater access to formal healthcare services. Addressing these barriers is crucial for improving maternal health outcomes. The results might be useful for informed policy formulation and program design to ensure better health outcomes for marginalized adolescents.

Good practice in lactation counseling for Ukrainian refugee mothers to ensure the health and mental benefits of breastfeeding - an observational study.

The study presents a cross-sectional analysis of the population of Ukrainian women who received maternity care in 11 Polish hospitals. Multidirectional lactation counseling was implemented from March to November 2023 by the Human Milk Bank Foundation in cooperation with UNICEF Refugee Response Office in Poland. Medical data were collected using questionnaires prepared for the study. When the mother indicated that she had mental problems or the health care personnel spotted problems, she was she referred to a psychologist for diagnostics, who used questionnaires appropriate to the patient's situation such as: Patient Health Questionnaire-9 for depression assessment and Generalized Anxiety Disorder Questionnaire-7 for anxiety assessment. In total, 1203 consultations were carried out, of which 542 were lactation counseling, 305 - were physiotherapy, 227 - were psychological, and 129 - were with speech-language pathologists. Two hours of skin-to-skin contact (SSC) and latching on the breast within the 1st hour postpartum occurred in more than half of the participants. In the rest of the population, shortened or lack of SSC was associated with breastfeeding delayed by at least one day. 53% of the population required lactation counseling, of which 242 were one-time visits. Continued support was 98% effective in achieving breastfeeding goals. 167 mothers required psychological support, of which only 53 women continued treatment beyond one-time counseling. Only about 1% of women experienced mental disorders based on a psychological interview. The use of lactation counseling more often than psychological counseling by refugee mothers could be related to the beneficial effects of breastfeeding on maternal well-being through hormonal self-regulation and empowerment as a mother. However, focused research is needed on the impact of breastfeeding on the mental health of refugee women.

The moderating effect of maternal modeling on age-related decline in children's physical activity.

Maintaining adequate levels of physical activity is challenging for many children. Parents, particularly mothers, play a pivotal role in children's engagement in health behaviors. This longitudinal study investigated the moderating role of maternal physical activity-related modeling behaviors on the typical age-related decline in children's physical activity. A total of six waves of 1-week ecological momentary assessments were conducted with mother-child dyads (N = 202) of 8- to 12-year-old children. The results indicated that both maternal physical activity and physical activity in the presence of their child attenuated the typical decline in the children's physical activity over time. These findings underscore the importance of maternal physical activity-related behaviors in shaping children's physical activity habits over time. The discussion centers on the need to further explore the mechanisms underlying these moderation effects and outlines implications for interventions targeting children's physical activity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

New health programs to address the demographic problem

Healthcare plays an important role in solving the demographic problem. In order to raise the birth rate, a new standard of obstetric and gynecological care has been introduced. A key element of the new standard is the creation of women’s health centers. It is planned to create women’s health centers on the basis of a multidisciplinary hospital. This will make it possible to use additional hospital resources for examination, pregnancy management, maternity care, and treatment, if necessary, of the mother and newborn. As part of the medical examination, an assessment of the reproductive health of working men and women is being introduced, including screening of anti-muller hormone in women, the possibility of carrying out a genetic test of embryos, IVF, cryopreservation. All services will be provided to women through compulsory health insurance.

Going Back in Time: Prenatal Presentations of Postnatal Genetic Diagnoses Made in a Neonatal Intensive Care Unit.

Prenatal genetic diagnosis can impact care across the perinatal continuum; however, prenatal suspicion for genetic disorders may be complicated by incomplete knowledge of fetal rare-disease phenotypes. Here, we describe the prenatal presentations of a cohort of infants with rare genetic conditions who were diagnosed postnatally in a neonatal intensive care unit (NICU), to characterize prenatal presenting features and evaluate why the diagnosis was not identified prenatally. Retrospective cohort study of infants born over a 7year period (2017-2023) who were admitted to a Level IV NICU and received a postnatal genetic diagnosis prior to 1year of age. We identified which of these infants had been imaged prenatally at our Maternal Fetal Care Center (MFCC) as an opportunity for prenatal genetic diagnosis. Clinical data were abstracted from the medical records. 51 cases met the inclusion criteria. Nine of the 51 infants were not strongly suspected to have a genetic syndrome prenatally when seen at the MFCC, as evidenced by lack of prenatal genetic consultation and lack of documented suspicion for a genetic etiology. These cases largely had absent or uncertain prenatal phenotypes. In most cases (42/51, 82.4%), prenatal diagnostic testing was not pursued even if offered. Overall, postnatal diagnoses, of which there was one dual diagnosis, were made by karyotype/FISH (11/52, 21.1%), microarray (8/52, 15.4%), gene panel/targeted testing (17/52, 32.7%), or exome sequencing (16/52, 30.8%). Our data illustrate the challenges in fetal phenotyping and support a broad approach to prenatal testing to facilitate early genetic diagnosis, which may meaningfully impact postnatal care.

Geographic disparities and determinants of full utilization of the continuum of maternal and newborn healthcare services in rural India

BackgroundTo further reduce maternal and neonatal mortality, it is essential for mothers and newborns to fully utilize all essential services within the continuum of maternal and newborn care. However, research on maternal and child health services in India has not sufficiently examined geographical disparities in the full utilization of these services and the factors influencing the full utilization, particularly in rural areas. This study aims to address this critical gap.MethodsUtilizing data from 130,312 mothers collected in the National Family Health Survey-5 (2019–21), this study employed spatial analysis to uncover geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services in rural India. Additionally, binary logistic regression was used to identify the factors associated with this utilization.ResultsIn rural India, 54.3% mothers recieved four or more antenatal care visits, 88.6% received skilled birth attendance, and 75.5% of mothers and 79.8% of newborns received postnatal care within 48 hours of birth. However, only 43.5% mothers-newborn dyads in rural India utilized all four services of the continuum of maternal and newborn healthcare. There were significant geographical disparities in the full utilization of the continuum of maternal and newborn healthcare services. Hotspots were primarily identified in districts of southern states, western Maharashtra, and central Odisha, while cold spots were evident in the northeastern states of Arunachal Pradesh, Meghalaya, Assam, and Nagaland, as well as in the Empowered Action Group states of Bihar, Uttar Pradesh, and Jharkhand. Key determinants influencing the full utilization of the continuum of care in rural India included maternal education, household wealth, parity, health insurance coverage, and exposure to mass media. Specifically, the odds of fully utilizing the continuum of care were significantly lower among women without formal education (adjusted odds ratio = 0.60, 95% CI = 0.56–0.65), those from the poorest wealth quintile (0.65, 0.61–0.69), and mothers with six or more children (0.42, 0.37–0.47), compared to mothers with higher education, those in the richest wealth quintile, and mothers with a single child, respectively. Additionally, mothers from the southern region were more than twice as likely (2.11, 1.99–2.20) to fully utilize the continuum of healthcare services compared to mothers from the northern region.ConclusionThe significant geographical disparities in the full utilization of maternal and newborn healthcare services in rural India highlight the necessity for tailored, region-specific interventions. Future programs should focus on addressing the barriers to care by prioritizing vulnerable groups, including those who are poor, uninsured, less educated, adolescents, and women with high parity.

Health Education, Breastfeeding and Postpartum Depression

During the period of postpartum happiness, 10-15% of mothers in the world face a mental difficulty, postpartum depression (PPD). The literature shows an association between breastfeeding and PPD. Preventing breastfeeding is connected to an increase in the tendency to PPD, and on the other hand PPD is found to be more severe among mothers who wanted to breastfeed and failed. What is the connection between breastfeeding and PPD? What is the effect of health education on breastfeeding among postpartum women? Does breastfeeding protect or aggravate? Currently, there are no studies that clearly confirm this relationship. The World Health Organization, 2023 emphasizes the importance of policies to promote breastfeeding. Breastfeeding has health and emotional benefits that affect society, the economy, the environment and the mental health of the public. Studies show that breastfeeding is associated with sociocultural affiliation, religious, cultural, social support, self-efficacy, and PPD. Factors influencing maternal behaviors. I am a public health nurse and lactation consultant. The article is a theoretical component of a doctoral thesis aimed at early identification of mothers in risk groups for unhealthy behaviors, providing a response to improve the quality of life and public health and saving future expenses for the health care system. In the article I will present literature, opinions that exist today on the subject and examine the meeting between breastfeeding and PPD. I will focus on the consequences of health education on the health of the mother and the baby in the world and in Israel.

THE RELATIONSHIP BETWEEN MATERNAL BEHAVIOR (KNOWLEDGE, ATTITUDE, ACTIONS) ON THE CARE OF BABY BOTTLES AND INCIDENCE OF DIARRHEA IN TODDLERS AT BALOI PERMAI PUBLIC HEALTH CENTER, BATAM CITY, IN 2024

Diarrhea is the disease with the second highest mortality rate in the world, especially in children under five, more than 1,200 children under five die every day or around 444,000 children per year. Based on the results of the Batam City Health Office presurvey, the Baloi Permai Health Center has the most diarrhea among children under five with a total of 389 in 2023. This study aims to determine the relationship between maternal behavior (knowledge, attitude, action) about how to care for milk bottles and the incidence of diarrhea in toddlers at the Baloi Permai Health Center, Batam City. The design of this study uses a quantitative approach with a cross sectional approach. The research sample includes mothers who have toddlers. The number of samples in this study was 79 mothers with purposive sampling techniques. The location of the research was carried out at the Baloi Permai Health Center which was carried out in July 2024. The data collection tool used a questionnaire (knowledge, attitudes, actions) about how to care for milk bottles with the incidence of diarrhea in toddlers. Data analysis using the chi-square statistical test. The results of the study were that most mothers had behaviors about bottle care in the poor category (60.8% knowledge, 57.0% attitude, and 64.6% action). The results of the study showed that there was a significant relationship between the knowledge, attitude, and actions of mothers who calmed down how to care for milk bottles with the incidence of diarrhea in toddlers with a p-value of 0.000, so it can be concluded that maternal behavior (knowledge, attitude, action) about how to care for milk bottles has a significant influence on the incidence of diarrhea in toddlers at the Baloi Permai Health Center, Batam City.

“Increasing body mass index is associated with intensive care unit admission and severe maternal morbidity”

Objective This study aimed to assess the relationship between increased body mass index (BMI) with severe maternal morbidity (SMM). Study Design We obtained data for a retrospective cohort of singleton live births using an electronic birth certificate database from 2010 to 2022 in Central New York. Institutional review board exemption was obtained. Pre-pregnancy BMI was assessed as a continuous variable and a categorical variable with groups of BMI <18.5 kg/m2, 30–39.9 kg/m2, 40–49.9 kg/m2, and ≥50 kg/m2 compared to patients with BMI 18.5–29.9 kg/m2. Primary outcomes were maternal intensive care unit (ICU) admission and composite SMM defined as ICU admission, unplanned hysterectomy, reoperation, eclampsia, and blood transfusion. Secondary outcomes were the individual SMM components, 5-minute APGAR score <7, and neonatal intensive care unit (NICU) admission. ANOVA and χ2 were used to compare continuous and categorical variables respectively, and logistic regression was used to obtain adjusted odds ratios for primary and secondary outcomes. Results There were 223,837 patients with singleton live births with mean BMI 27.86 kg/m2. 54,385 (24.3%) had BMI 30–39.9 kg/m2, 13,299 (5.9%) had BMI 40–49.9 kg/m2, and 1,958 (0.87%) had BMI ≥50 kg/m2. 3,203 (1.4%) patients experienced SMM, and 423 (0.2%) patients were admitted to ICU. For each 1-point increase in BMI the adjusted odds ratio (aOR) of SMM increased by 0.8% (aOR 1.008, 95% CI 1.002–1.013) and ICU admission increased by 2.0% (aOR 1.02, 95% CI 1.005–1.034). Odds of ICU admission for those with BMI 40-49.9 kg/m2 increased by 69% (aOR 1.69, 95% CI 1.16–2.47); BMI ≥50 kg/m2 increased by 300% (aOR 3.01, 95% CI 1.53–5.91), but those with BMI 30-39.9 kg/m2 did not have significantly higher odds of ICU admission (aOR 1.09, 95% CI 0.84–1.42). Conclusion Increasing BMI was significantly associated with increased SMM and maternal ICU admission.