Maternal Health Management Research Articles

Does PM1 exposure during pregnancy impact the gut microbiota of mothers and neonates?

BackgroundAmbient air pollutant exposure can change the composition of gut microbiota at 6-months of age, but there is no epidemiological evidence on the impacts of exposure to particulate matter with an aerodynamic diameter ≤1 μm (PM1) during pregnancy on gut microbiota in mothers and neonates. We aimed to determine if gestational PM1 exposure is associated with the gut microbiota of mothers and neonates. MethodsLeveraging a mother-infant cohort from the central region of China, we estimated the exposure concentrations of PM1 during pregnancy based on residential address records. The gut microbiota of mothers and neonates was analyzed using 16 S rRNA V3–V4 gene sequences. Functional pathway analyses of 16 S rRNA V3–V4 bacterial communities were conducted using Tax4fun. The impact of PM1 exposure on α-diversity, composition, and function of gut microbiota in mothers and neonates was evaluated using multiple linear regression, controlling for nitrogen dioxide (NO2) and ozone (O3). Permutation multivariate analysis of variance (PERMANOVA) was used to analyze the interpretation degree of PM1 on the sample differences at the OTU level using the Bray-Curtis distance algorithm. ResultsGestational PM1 exposure was positively associated with the α-diversity of gut microbiota in neonates and explained 14.8% (adj. P = 0.026) of the differences in community composition among neonatal samples. In contrast, gestational PM1 exposure had no impact on the α- and β-diversity of gut microbiota in mothers. Gestational PM1 exposure was positively associated with phylum Actinobacteria of gut microbiota in mothers, and genera Clostridium_sensu_stricto_1, Streptococcus, Faecalibacterium of gut microbiota in neonates. At Kyoto Encyclopedia of Genes and Genomes pathway level 3, the functional analysis results showed that gestational PM1 exposure significantly down-regulated Nitrogen metabolism in mothers, as well as Two-component system and Pyruvate metabolism in neonates. While Purine metabolism, Aminoacyl-tRNA biosynthesis, Pyrimidine metabolism, and Ribosome in neonates were significantly up-regulated. ConclusionsOur study provides the first evidence that exposure to PM1 has a significant impact on the gut microbiota of mothers and neonates, especially on the diversity, composition, and function of neonatal meconium microbiota, which may have important significance for maternal health management in the future.

Role of homoeopathy in the management of maternal health

Role of homoeopathy in the management of maternal health

Male Partner Involvement in Promoting Antenatal Care and Skilled Delivery Attendance in Bumula Sub-County, Kenya

Globally, male partner involvement in antenatal care and skilled delivery services remains a challenge to effective management of maternal health. Maternal morbidities and mortalities have been increasing due to the underutilization of antenatal care and skilled delivery attendance at a global level. However, developed countries have had a different story on male partner involvement in antenatal care and skilled delivery attendance – most male partners are involved in the process. But sub-Saharan Africa in the global south records the highest percentage of male partners who are never active in accompanying their female counterparts to visit antenatal care and skilled delivery. In Kenya male involvement in maternal services remains low despite it being recognized as one of the pillars of safe motherhood. Therefore, this study was conducted to investigate male partner involvement in promoting antenatal care and skilled delivery attendance in Bumula Sub-County of Bungoma County in Kenya. It focused on the level of male partners involvement in maternal health. The study adopted a cross-sectional design. The target populations were married men and community health volunteers. The study had a sample size of 427 persons. Data was collected using a pre-tested semi-structured questionnaire, key in-depth interview guides, focused group discussion guides and observation checklist. Data were analysed using descriptive statistics with the aid of the Statistical Package for Social Scientist version 25. Data were presented using tables, figures, narratives and direct quotes. The study found a low level of male involvement (18%) in promoting antenatal care and skilled delivery attendance. Most of the male partners (83.1%) did not plan with their partners for ANC and skilled delivery services, however, (54.1%) accompanied their partners to the clinics. The study concluded There was a low level of male partner involvement in ANC and skilled delivery attendance. About 18% of male partners were involvement in ANC and skilled delivery attendance. There was an improvement of male partner involvement in accompaniment and provision of support. The study recommended that the two levels of government through the Ministry of Health should create awareness campaigns and public education with a targeted massage on negative cultural practices/mindset that hinder male partner involvement in maternal health services in the Bumula sub-county.

Situation report: Maternal health management during COVID-19 pandemic at Soetomo General Hospital and Universitas Airlangga Academic Hospital, Surabaya Indonesia

The case of COVID-19 in Indonesia has shown a significantly increasing curve. This condition affected the regulation of maternal health services in Indonesia, especially in East Java Province. The health services structure was a challenge in itself, where hospitals must be adaptive during the COVID-19 pandemic. This situation also caused changes in several components of maternal health services. The report focused on maternal services in two hospitals at East Java, Indonesia (Soetomo General Hospital and Universitas Airlangga Academic Hospital) that described five main components, including patient screening, hospital visit policies, intrapartum management, postpartum management, protection and safety for health workers, and funding issues.

Participación comunitaria y salud materna en el Alto Wangky, desde la perspectiva de género

El artículo, parte de la tesis doctoral de la autora, analiza la percepción de embarazadas y puérperas en Alto Wangky sobre la participación de su familia, personal de salud y parteras para acceder a servicios de salud durante el embarazo, parto y puerperio, ampliando el mapa de facilitadores u obstaculizadores e integrando la organización y participación comunitaria al modelo de gestión local de la salud materna. El enfoque de género profundiza en dimensiones no analizadas en investigaciones clásicas positivistas, generando propuestas de acción y medidas para incidir en políticas alrededor del tema. Tipo de investigación cualitativa. Se realizó un estudio de caso, con muestra intencionada, flexible y por conveniencia. Los principales resultados muestran que la mayoría son mujeres entre 20 y 35 años, alfabetas, sin empleo o trabajan con inseguridad laboral, disponen de servicios reproductivos, pero, su acceso se dificulta por las condiciones geográficas, o sus cónyuges no les permiten usarlos. Tienen servicios prenatales y los usan, el parto es atendido a más de 1 día de viaje por río. Se concluye que las embarazadas y puérperas, con apoyo del esposo, familia y parteras acceden a servicios de salud materna disponibles pese a las dificultades socioeconómicas y de acceso en las que viven.

Effect of basic public health service project on neonatal health services and neonatal mortality in China: a longitudinal time-series study

ObjectiveTo analyse the trend change and level change of neonatal health services and neonatal mortality before and after the introduction of the Basic Public Health Service (BPHS) project in 2009.Design...

Impact of the Universal Two-Child Policy on the Workload of Community-Based Basic Public Health Services in Zhejiang Province, China

We aimed to quantitatively estimate the amount of pressure that was placed on basic public health care services (BPHS) due to the universal two-child policy issued in 2015 by comparing the workload change in maternal and child health management and the immunization of children. BPHS performance surveillance data from 2014 to 2018 in Zhejiang Province, China were analyzed to calculate the workload of the above three services using the equivalent method of BPHS cost estimation of community health services. From 2014 to 2018, the numbers of births from the Statistical Yearbook in Zhejiang Province were 578,000, 581,000, 624,000, 670,000, and 628,000, respectively, and those from the surveillance data were 416,941, 41,490, 434,163, 546,816, and 45,964, respectively. The number of births reached a peak in 2017, with the yearbook and surveillance data showing increases of 15.92% and 31.15%, respectively, over 2014. The workload of maternal and child health management and children’s immunization also peaked in 2017, increasing by 30.37%, 12.70%, and 4.33% over 2014, respectively. In 2018, the workload of maternal and child health management and children’s immunization dropped to 107.34%, 107.73%, and 98.81% over 2014, respectively. The indicators of maternal and child health management and children’s immunization services remained stable, and the related services did not decline, even in 2017. The maternal health management workload was more affected by the universal two-child policy than child health management and children’s immunization.

Role of Usual Healthcare Combined with Telemedicine in the Management of High-Risk Pregnancy in Hangzhou, China.

Background Maternal health is an important part of basic public health services in China's medical reform. Effective management is an important guarantee of maternal health. Telemedicine has been widely used in maternal health management. Objective This study explores the role of usual healthcare combined with telemedicine in the management of high-risk pregnancy. Methods The study was a retrospective. Data were obtained from Hangzhou Maternity Hospital between October 2012 and September 2016, including 93465 pregnant women who were in usual high-risk pregnancy management (usual group) and 134884 pregnant women who were in telemedicine combined with usual high-risk pregnancy management (telemedicine group). The differences in high-risk scores and pregnancy outcomes between the usual and the telemedicine groups were compared. Results The high-risk factors were analyzed, and the results showed that the first fixed high-risk factor was scar uterus and the first dynamic high-risk factor was hepatitis B. Comparing the data of two groups, the number of prenatal visits increased significantly in the telemedicine group (p value <0.05). Although the critical proportion of high-risk women was 2.13% in the usual group and 5.88% in the telemedicine group, respectively (p value <0.01), maternal mortality decreased in the telemedicine group (p value <0.05). Conclusion The combination of telemedicine and usual healthcare can urge the pregnant women to carry out antenatal visits on time, which is one of the important factors to improve the outcome of high-risk pregnancy.

Electronic Health Record Driven Prediction for Gestational Diabetes Mellitus in Early Pregnancy

Gestational diabetes mellitus (GDM) is conventionally confirmed with oral glucose tolerance test (OGTT) in 24 to 28 weeks of gestation, but it is still uncertain whether it can be predicted with secondary use of electronic health records (EHRs) in early pregnancy. To this purpose, the cost-sensitive hybrid model (CSHM) and five conventional machine learning methods are used to construct the predictive models, capturing the future risks of GDM in the temporally aggregated EHRs. The experimental data sources from a nested case-control study cohort, containing 33,935 gestational women in West China Second Hospital. After data cleaning, 4,378 cases and 50 attributes are stored and collected for the data set. Through selecting the most feasible method, the cost parameter of CSHM is adapted to deal with imbalance of the dataset. In the experiment, 3940 samples are used for training and the rest 438 samples for testing. Although the accuracy of positive samples is barely acceptable (62.16%), the results suggest that the vast majority (98.4%) of those predicted positive instances are real positives. To our knowledge, this is the first study to apply machine learning models with EHRs to predict GDM, which will facilitate personalized medicine in maternal health management in the future.

Evaluation on equalization of the essential public health services utilization based on Theil index and concentration index: evidence from Shandong province

Objective To analyze and evaluate the level of equity of essential public health services utilization in Shandong Province. Methods The main methods in use were the concentration index(CI)aided by Theil index, to assess the equity among various items of essential public health services. Results The CI of healthcare archiving, health education, elderly health management, hypertension health management, diabetes management, maternal health management, vaccination and child health management utilization between different income groups were -0.019 2, -0.011 0, 0.025 8, -0.008 0, -0.006 4, 0.037 1, 0.045 0 and 0.106 7 respectively.Theil index demonstrated the inequity in healthcare archiving and health management service utilization in Shandong resulted from regional differences.The inequity in elderly health management, hypertension health, diabetes management, vaccination and child health management utilization in Shandong resulted from urban and rural differences.The inequity in maternal health management utilization in Shandong resulted from urban and rural differences. Conclusions The utilization rate of essential public health services is different among the items, and its equity is influenced by the above-mentioned differences. Key words: Essential public health services; Utilization; Equity; Theil index; Concentration index

High Incidence of Neonatal Danger Signs and Its Implications for Postnatal Care in Ghana: A Cross-Sectional Study.

BackgroundReducing neonatal mortality is a major public health priority in sub-Saharan Africa. Numerous studies have examined the determinants of neonatal mortality, but few have explored neonatal danger signs which potentially cause morbidity. This study assessed danger signs observed in neonates at birth, determined the correlations of multiple danger signs and complications between neonates and their mothers, and identified factors associated with neonatal danger signs.MethodsA cross-sectional study was conducted in three sites across Ghana between July and September in 2013. Using two-stage random sampling, we recruited 1,500 pairs of neonates and their mothers who had given birth within the preceding two years. We collected data on their socio-demographic characteristics, utilization of maternal and neonatal health services, and experiences with neonatal danger signs and maternal complications. We calculated the correlations of multiple danger signs and complications between neonates and their mothers, and performed multiple logistic regression analysis to identify factors associated with neonatal danger signs.ResultsMore than 25% of the neonates were born with danger signs. At-birth danger signs in neonates were correlated with maternal delivery complications (r = 0.20, p < 0.001), and neonatal complications within the first six weeks of life (r = 0.19, p < 0.001). However, only 29.1% of neonates with danger signs received postnatal care in the first two days, and 52.4% at two weeks of life. In addition to maternal complications during delivery, maternal age less than 20 years, maternal education level lower than secondary school, and fewer than four antenatal care visits significantly predicted neonatal danger signs.ConclusionsOver a quarter of neonates are born with danger signs. Maternal factors can be used to predict neonatal health condition at birth. Management of maternal health and close medical attention to high-risk neonates are crucial to reduce neonatal morbidity in Ghana.

Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh.

BackgroundToll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications.MethodsIn-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted.ResultsPrior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with Solution Linked Group.ConclusionsThe use of mobile technology in this intervention took a leap from simply rendering information to providing more rapid services. Active participation of service providers along with mothers’ accessibility motivated both the service providers and mothers to communicate through mobile phone for maternal health issues. These altogether made the shift towards adoption of an innovation.

Progress on the maternal mortality ratio reduction in Wuhan, China in 2001-2012.

BackgroundMost maternal deaths occur in developing countries and most maternal deaths are avoidable. China has made a great effort to reduce MMR by three quarters to meet the fifth Millennium Development Goal (MDG5).MethodsThis retrospective study reviewed and analyzed maternal death data in Wuhan from 2001 to 2012. Joinpoint regression and multivariate Poisson regression was conducted using the log-linear model to measure the association of the number of maternal deaths with time, cause of death, where the death occurred, and cognitive factors including knowledge, attitude, resource, and management stratified.ResultsThe MMR declined from 33.41 per 100,000 live births in 2001 to 10.63 per 100,000 live births in 2012, with a total decline of 68.18% and an average annual decline of 9.89%. From 2001–2012, the four major causes of maternal death were obstetric hemorrhage (35.16%), pregnancy complications (28.57%), amniotic fluid embolism (16.48%) and gestational hypertension (8.79%). Multivariate Poisson regression showed on average the MMR decreased by.17% each year from 2001–2006 and stayed stagnant since 2007–2012.ConclusionsWith the reduction in MMR in obstetric death (e.g. obstetric hemorrhage), there had been a remarkable reduction in MMR in Wuhan in 2001–2012, which may be due to (1) the improvement in the obstetric quality of perinatal care service on prevention and treatment of obstetric hemorrhage and emergency care skills, and (2) the improvement in the maternal health management and quality of prenatal care. Interventions to further reduce the MMR include several efforts such as the following: (1) designing community-based interventions, (2) providing subsidies to rural women and/hospitals for hospital delivery, (3) screening for pregnancy complications, and (4) establishing an emergency rescue system for critically ill pregnant women.

The impact of obesity on cardiovascular structure and function: the fetal programming era

The burden of obesity is now well established as a precursor of cardiovascular disease and other disorders. Although better clinical guidelines exist to prevent and treat obesity, the prevalence of obesity among children and adolescents is increasing alarmingly. Primary prevention remains the gold standard to significantly reduce the public health concerns associated with obesity. Traditional cardiovascular disease risk factors (such as dyslipidemia, hypertension, type 2 diabetes) for cardiovascular disease among children and adolescents are known. The scope of this review is thus to discuss new and emerging obesity and associated-disease risk factors. Evaluation of the coronary plaque formation, diastolic dysfunction, carotid intima-media thickness and heart rate variability represent interesting tools with clinical relevance. Beyond these new cardiovascular disease risk factors, recent evidence suggests that a detrimental fetal environment, associated with for example, maternal obesity, insulin resistance, and physical inactivity, imprints fetal metabolic programming via epigenetic mechanisms that predisposes the newborn to obesity and cardiovascular disease later in life. This information may impact on the future management of maternal health, as well as for those high-risk children.

Analysis of maternal deaths in Shanghai from 2000 to 2009

Analysis of maternal deaths in Shanghai from 2000 to 2009

Development of a Web-Based Multimedia Health Service System for Maternal Health Management

Objective: The purpose of this study was to develop a web-based multimedia heath information system for maternal health care using principles of user-centered design. Methods: Research process includes needs assessment, needs analysis, design, development/testing, and application release. Research methods for needs assessment included literature review, interviews, focus groups, and surveys. Results: Based on the user’s needs studies, this information service system contains an introduction, pregnancy test, fetal assessment, maternal and fetal development during pregnancy, maternal self-care methods, complications of pregnancy, complications of postpartum period, information for parenting, father’s page, self-help group, FAQ, counseling and hyperlinked on Internet sites of resources pages. The web site was released using the URL: http://www.baejy.com/im. Conclusion: Through this health information system, clients can obtain information on maternal and baby care such as maternity care guidelines, daily instructions for families. This system will be a new way of nursing intervention and contribute to the maternal health promotion. (Journal of Korean Society of Medical Informatics 13-3, 285-297, 2007)

P1083 企業における母性健康管理の取り組みの現状と就労妊婦による評価(一般演題:ポスター,地方の時代の産業保健,第79回日本産業衛生学会)

P1083 企業における母性健康管理の取り組みの現状と就労妊婦による評価(一般演題:ポスター,地方の時代の産業保健,第79回日本産業衛生学会)

E114 男女雇用機会均等法改正後の母性健康管理

E114 男女雇用機会均等法改正後の母性健康管理