Maternal Health Outcomes Research Articles

Supportive supervision of village, health, sanitation and nutrition day (VHSND) during post-pandemic period in Assam

Background: VHSND, a community platform bringing health, early childhood development, nutrition, and sanitation services by community engagement was affected by COVID-19 pandemic. Aims & Objectives: To assess the process of VHSND implementation during post-pandemic period in Assam. Methodology: This cross-sectional study was conducted as operational research in five districts of Assam, selected based on zonal representation; between Sept’2021- Aug’2022. Standard format (GOI) was used for VHSND monitoring. Descriptive analysis was done along with quarter-wise comparison of observations and knowledge of Auxiliary Nurse and Midwife (ANM). Results: A total of 370 VHSND sessions were observed. VHSND micro plan availability increased from 87.5% to 98.4% over four quarters. Displaying banners varied between 56.3% and 79.5%, and functional toilets increased from 41.3% to 77%. Height measurement improved from 58.8% to 88.5%. Haemoglobin estimation varied between 46.3% and 75.4%. Recognition of high-risk pregnancies due to severe anaemia increased from 60% to 91.8%. Regarding danger signs like bleeding from vagina increased from 50.0% to 95.1%. Conclusion: Notable progress could be documented in logistical readiness and ANM knowledge in different quarters in post-pandemic period. While service delivery and ANM counselling efforts have seen improvement, targeted interventions remain crucial for optimizing maternal and child health outcomes in the region.

Understanding the Factors Promoting Mother to Child Transmission of HIV/AIDS in Nigeria

Mother-to-child transmission (MTCT) of HIV/AIDS remains a significant public health challenge in Nigeria. This review aimed to identify and understand key factors promoting MTCT and assess the effectiveness of current prevention interventions. A systematic literature search was conducted across multiple databases using relevant keywords and approximately 57 individual literatures was reviewed. Studies focusing on MTCT in Nigeria published after 2015 were included. Eligible studies were critically appraised for quality and relevance. Findings indicate significant knowledge gap (such as misconceptions about transmission routes, limited understanding of prevention methods, delay in seeking testing and care and inconsistent adherence to Antiretroviral therapy) among pregnant women regarding HIV transmission, persistent stigma and discrimination hindering access to PMTCT services, and challenges within the healthcare system such as geographical disparities and inadequate provider training. Cultural practices, including breastfeeding and postnatal rituals, further exacerbate MTCT risk. Male partner involvement emerges as a crucial yet often overlooked aspect of PMTCT. Existing interventions showed moderate effectiveness, highlighting the need for tailored approaches. Strengthening multi-level interventions addressing social, economic, and cultural determinants, alongside culturally sensitive approaches and increased male engagement, are crucial to address MTCT and improve maternal and child health outcomes in Nigeria. Future research should focus on developing and evaluating interventions tailored to specific contexts and populations.

The Equity Impact of Universal Home Visits to Pregnant Women and Their Spouses in Bauchi State, Nigeria: Secondary Analysis From a Cluster Randomised Controlled Trial.

Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits. To examine equity of the intervention implementation and its pro-equity impact. The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women. We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels. Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors. The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.

Improving Maternal Health and Birth Outcomes Through FreshRx: A Food-Is-Medicine Intervention.

Food insecurity has far-reaching consequences for health and well-being, especially during pregnancy and postpartum periods. This study examines a food-is-medicine approach that aimed to reduce food insecurity, maternal stress, depression, anxiety, preterm labor, and low birthweight. Pre-post interventional study of FreshRx: Nourishing Healthy Starts, a pregnancy focused food-is-medicine program led by a local hunger relief organization and obstetrics department. St. Louis, Missouri, a Midwestern U.S. city with higher-than-average infant mortality, low birthweight, and preterm birth rates. Participants (N = 125) recruited from a local obstetrics clinic had pregnancies earlier than 24weeks gestation; spoke English; and were enrolled in Medicaid. At baseline, 67.0% reported very low food security and none reported high food security, while 34.7% indicated depressive symptoms. FreshRx included weekly deliveries of fresh food meal kits, nutrition counseling and education, care coordination, and supportive services. 18-Question U.S. Household Food Security Survey, Edinburgh Postnatal Depression Scale, birthweight, gestational age. Single arm pre-post analysis. Average gestational age of 38.2weeks (n = 84) and birthweight of 6.7 pounds (n = 81) were higher than rates for the general population in the area. For study participants who completed a sixty-day post-partum assessment, 13% (n = 45) indicated maternal depression (P < .01). Food-is-medicine interventions may be an efficient, effective, and equitable tool for improving birth and maternal health outcomes.

Quantifying the Occurrence of High-Risk Pregnancy: A Comprehensive Survey.

Background High-risk pregnancies are characterized by various factors that pose potential risks to maternal and newborn health outcomes. Early detection of these high-risk pregnancies serves as a crucial initial step in preventing maternal mortality and morbidity, thereby promoting the overall health of both mother and baby. This study sought to assess the occurrence of high-risk pregnancy and investigate the factors associated with it among pregnant women. Methods A descriptive survey was undertaken at the Obstetrics and Gynaecology outpatient department of a District Government Hospital in Tamil Nadu, involving 1889 pregnant women in their second and third trimesters. A structured questionnaire, constructed following the Indian standard criteria outlined by the National Health Portal of India, served as the data collection tool. The survey was conducted in February and March 2022, during which pregnant women were interviewed. Subsequently, the collected data underwent descriptive and inferential statistical analysis. Results Among the 1889 pregnant women surveyed, 29% (n=530) were classified as high-risk pregnancies. Within this group, 34.3% (n=182) were diagnosed with hypothyroidism, while 23.2% (n=123) experienced pregnancy-induced hypertension. Significant associations with high-risk pregnancy were observed for factors such as age, education status, occupation, family income, socioeconomic status, and gravida among the pregnant women. Conclusion Policymakers must urgently implement evidence-based interventions aimed at early detection and treatment of high-risk pregnancies. This proactive approach is essential in preventing maternal mortality and morbidity.

Are pelvic-abdominal mechanics exercises effective for cesarean delivery rate and postpartum pelvic floor function: A randomized controlled trial

ObjectivesTo examine the effectiveness of pelvic-abdominal mechanics exercise in reducing cesarean section rates and preventing pelvic floor dysfunction in primiparous women. DesignRandomized controlled trial. MethodsA single-center prospective study was conducted among 200 primiparous participants (aged 18–38 years) who undertook formal card-issuing maternity tests between June 1, 2022, and June 30, 2023. Participants were divided into two groups: exercise (intervention) and control using the random number table method. Participants of the intervention group performed pelvic-abdominal mechanics exercise at least 1 h each time per week for three months. Participants of the control group did not perform any pelvic-abdominal mechanics exercise during pregnancy. This study conducted a comprehensive evaluation from three perspectives, including maternal and neonatal health outcomes during delivery, the recovery status of pelvic floor muscles at 42 days postpartum, and the quality of life during late pregnancy (36–38 weeks) and 42 days postpartum. ResultsA significant difference was found in delivery outcomes. The cesarean section rates are significantly higher (p < 0.05) in the control group (36 %) than in the exercise group (19 %). At 42 days postpartum, pelvic floor assessment showed that the exercise group had significantly better results in pelvic floor muscle strength compared to the control group, with statistical significance (p < 0.05). ConclusionsPelvic-abdominal mechanics exercise lowers the rate of cesarean section and improves postpartum pelvic floor function.

Assessing the acceptability and usability of digital interventions for pregnancy health

Background: Despite the promising potential of digital interventions to enhance maternal health outcomes, there is a lack of comprehensive exploration into their real-world acceptability, usability, and effectiveness among pregnant women. This study was conducted to evaluate the acceptance and usability of digital interventions among pregnant women to gain insights into real-world applications. Methods: The study enrolled fifteen pregnant women (ages 20 to 40 years) using an online application between November 2022 and May 2023. Data collection comprised a usability survey, and statistical analysis employed descriptive statistics and Chi-square tests. Results: Significant variations in age (mean 29.33 years) and gestational age (mean 13.80 weeks) were observed (p&lt;0.001). Ease of use received positive ratings (73.3% found it easy; p=0.071), with no participants finding it difficult (p&lt;0.001). The introduction to the application was well-received (p=0.004). Monitoring utilities were deemed helpful by 73.3% (p=0.071), with strong agreement from 26.7%. App engagement was high, with 86.7% disagreeing it was boring and 13.3% strongly disagreeing with the same (p=0.020). Motivational impact for a healthy diet was endorsed by 80% (p=0.091), and medication adherence support by 93.3% (p=0.015). Recordkeeping ease was significant (80% agreement; p=0.247). Notably, 86.7% remained active users after 30 days, with no dropouts (p&lt;0.001). Conclusions: This pilot study suggests that digital interventions can positively influence maternal health, offering valuable insights for their integration into healthcare strategies.

A Comparative Analysis of Healthcare Facilities: With and Without 24/7 Interventions.

Background: Maternal and neonatal mortality remains disproportionately high in low and middle-income countries, particularly in remote areas with limited healthcare accessibility. The Tharparkar district of Sindh, Pakistan, exemplifies such challenges, with basic utilities and healthcare services notably lacking. Objective: This study aimed to assess the impact of 24/7 availability of Maternal, Newborn, and Child Health (MNCH) services on healthcare delivery and patient outcomes in government healthcare facilities in the Tharparkar district. Methods: This action research followed a cross-sectional study design. Data collection commenced after receiving ethical approval and written consent from the Government District Health Officer of Tharparkar. Longitudinal data were collected using District Health Information tools from six healthcare facilities, three of which operated 24/7 and the remaining three for six hours daily. Data included indicators such as general outpatient department (OPD) visits, non-vaginal deliveries (NVD), antenatal, postnatal care, family planning, immunization, neonatal deaths, stillbirths, and live births. Statistical analysis was conducted using SPSS version 25, and results were visualized using Tableau 2024. Results: Facilities operating 24/7 reported a significant increase in healthcare utilization: general OPD attendance increased by 118.5% at THQ Kheeme Jo Par, 168.2% at GD Jese Jo Par, and 150.5% at GD Mehrna Vero. There were also notable improvements in NVD, antenatal, postnatal care, and family planning services. Immunization rates improved, stillbirths decreased, and there were zero neonatal deaths reported in these facilities following the intervention. Conclusion: The implementation of 24/7 MNCH services in Tharparkar significantly enhanced healthcare service delivery and improved maternal and child health outcomes. Continuous healthcare availability is crucial for improving health indicators and achieving global health targets in underserved populations.

Medical Implications of Restricting Abortions on Women Diagnosed With Fetal Anomalies Following the Overturn of Roe v. Wade: A Scoping Review.

This scoping review addresses the potential maternal health outcomes of abortion restrictions in the U.S. by studying and analyzing the reported effects of abortion bans or limitations globally. The goal was to examine the medical implications for pregnant women who are unable to abort fetuses that have severe medical anomalies due to imposed restrictions. EMBASE, Medline, and CINAHL databases were searched for studies published in English concerning the medical implications of abortion restrictions in any country prior to the overturn of Roe v. Wade in 2022. For the search criteria using Boolean operators, keywords included the terms "fetal anomaly," "abortion ban," and "implications." Inclusion criteria incorporated studies published between 1980 and 2021, and controlled experimental research studies aimed to evaluate interventions were excluded. This resulted in 469 records initially found. Duplicate records were removed, and two separate tier reviews were conducted. Eleven reviewers independently screened abstracts and titles of 332 records to ascertain eligibility. Eligibility included pregnant women diagnosed with fetal anomalies, women denied access to safe abortions, and the maternal and fetal medical impacts of this. Three reviewers in the second screening independently read 36 full articles to further assess eligibility, resulting in 14 articles in the final review. Findings from this study showed that abortion bans in countries around the world have led to health complications in women seeking illegal abortion services, a decline in maternal mental health, including stress and depression, various medical complications such as obstructed labor, and an increase in high-risk fetuses born with severe deficits. The findings of this review portend similar negative consequences to be experienced by women who are subject to stricter abortion laws in the U.S.

Pre-Pregnancy Obesity and Infants' Motor Development within the First Twelve Months of Life: Who Is Expected to Be the Ultimate Carrier of the Obesity Burden?

Pre-pregnancy obesity is a significant public health concern with profound implications for maternal and child health. The burgeoning evidence suggests that maternal obesity prior to conception is intricately linked with an increased risk of gestational complications, as well as with adverse neonatal outcomes. Furthermore, the long and short-term health of offspring, including the risk of early motor development impairment, obesity, and metabolic syndrome in childhood and adulthood, may be adversely affected as well. Addressing pre-pregnancy obesity is critical for improving overall maternal and child health outcomes, and therefore, the aim of this study was to evaluate the connections linking pre-pregnancy obesity with infants' motor development within the first twelve months of infants' lives. This study included 200 mother-infant pairs divided into two groups based on their pre-pregnancy body mass index values. To assess infants' early motor development, we used the Alberta Infant Motor Scale (AIMS) and evaluated the parameters of infants' early motor development at the ages of three, six, nine, and twelve months. Pre-pregnancy overweight/obesity was significantly associated with excessive gestational weight gain (p < 0.001), fetal macrosomia (p = 0.022), and a family history of diabetes and cardiovascular diseases (p = 0.048 and p = 0.041, respectively), as well as with all observed parameters of early motor development at the ages of three, six, nine, and twelve months: AIMS 3 months total (p < 0.001), AIMS 6 months total (p < 0.001), AIMS 9 months total (p < 0.001), and AIMS 12 months total (p < 0.001). Furthermore, pre-pregnancy overweight/obesity was a significant predictor for AIMS 6 months total (p = 0.043) and AIMS 6 months supination (p = 0.017). Pre-pregnancy obesity is a critical determinant of pregnancy outcomes and offspring early motor development, with possible far-reaching implications for children's long-term well-being. Addressing this issue requires a comprehensive approach that includes preconception weight management, targeted interventions during the pregnancy and postpartum periods, and ongoing research to better understand the underlying mechanisms and develop effective strategies for prevention and management.

A network of care to improve the continuity and quality of maternal and perinatal services in Makueni County, Kenya: study protocol

Background Kenya’s high maternal and perinatal mortality rates exceeds its recommended 2030 targets. The lack of effective collaboration between health facilities and workers contributes to delays and uncoordinated provision of care, leading to negative maternal and neonatal health (MNH) outcomes. Network of Care (NOC) is an effective strategy to improve health facility network efficiencies and MNH outcomes. Utilizing NOC to improve health system coordination and MNH outcomes in Kenya has not been studied. We present a study protocol for implementation research to investigate the feasibility and acceptability of establishing a county-level NOC on relationships among health facilities and workers, the feasibility of NOC for the Makueni county health system, and the impact of NOC on the quality of MNH services and emergency referrals within the county health system. Levels of communication, collaboration, and trust between NOC health facilities and levels of preparedness for management of MNH complications are also evaluated. Methods The study employed a mixed methods design with quantitative data from health worker self-administered phone surveys, health facility referral forms, and facility registers collected at baseline, then every three months from September 2021 to July 2023. Health worker focus group discussions and county management key informant interviews were conducted at baseline, midline, and endline. The study purposively selected 60 public and private health facilities in Makueni. These facilities were a sub-sample of 344 facilities with the highest maternity caseloads. A descriptive and thematic analysis of communication, collaboration, and trust between NOC health facilities and workers, and referral system changes will take place. Trend analysis of MNH indicators for Makueni from the Kenya Health Information System will be done. Conclusion This study aims at informing decision-makers locally and globally on whether NOC is feasible and acceptable as a county-level model of care in Kenya with application to similar LMIC settings.

Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.

To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

Dietary diversity and preferences among pregnant women and its association with anaemia

Purpose This study aims to assess dietary choices of pregnant women and its relationship with their anaemia status. Design/methodology/approach A mixed-method study comprising a survey and three focus group discussions (FGDs). The survey included 380 adult pregnant women with data collected on food choices, preferences and haemoglobin (Hb) status. Findings More than 50% of women in the study had Hb concentration &lt; 11.0 g/dl; mean Hb was 10.24 g/dl (SD = 1.59). Univariate analysis was used to generate descriptive tabulations for socio-demographic characteristics of respondents, dietary choices for women and anaemia status. T-test and bivariate analysis between dietary diversity score of the women among the food groups consumed as well as their anaemia (Hb) status. This showed that women with high dietary diversity score had improved Hb status (P = 0.003), and those who consumed meat and fish as well as dark leafy vegetables had significantly high diversity scores (P = 0.031 and P = 0.049). Thematic analysis was used for analysing qualitative data. Research limitations/implications The sample used in the study is unlikely to be fully representative of pregnant women in the Accra Metropolis. In addition, this study used a cross-sectional study design, making it difficult to establish causal associations between nutritional status and food choice of pregnant women. It does not also show variation in dietary practices by seasons of the year. The scope of the study did not allow for a detailed analysis, and this should be considered in future studies. Also, the study did not explore an obstetric factor like past bleeding history as well as the menstrual cycle of these pregnant women, as these factors are likely to interfere with the anaemia status of the pregnant women. Originality/value This paper contributes significant value by specifically focusing on and clarifying the complex relationship between dietary choices and aneamia among pregnant women. It also provides insights into the distinct dietary patterns and preferences of pregnant women, which may be contributing to the high prevalence of aneamia. The results of the study can inform the development of localized, evidence-based interventions to address this critical public health concern, ultimately leading to improved maternal and foetal health outcomes.

The Role of Helicobacter pylori and Metabolic Syndrome-Related Mast Cell Activation Pathologies and Their Potential Impact on Pregnancy and Neonatal Outcomes.

Helicobacter pylori infection, a significant global burden beyond the gastrointestinal tract, has long been implicated in various systemic pathologies. Rising evidence suggests that the bacterium's intricate relationship with the immune system and its potential to induce chronic inflammation impact diverse pathophysiological processes in pregnant women that may in turn affect the incidence of several adverse pregnancy and neonate outcomes. Helicobacter pylori infection, which has been linked to metabolic syndrome and other disorders by provoking pericyte dysfunction, hyperhomocysteinemia, galectin-3, atrial fibrillation, gut dysbiosis, and mast cell activation pathologies, may also contribute to adverse pregnancy and neonatal outcomes. Together with increasing our biological understanding of the individual and collective involvement of Helicobacter pylori infection-related metabolic syndrome and concurrent activation of mast cells in maternal, fetus, and neonatal health outcomes, the present narrative review may foster related research endeavors to offer novel therapeutic approaches and informed clinical practice interventions to mitigate relevant risks of this critical topic among pregnant women and their offspring.

Social context of contraceptive use transition among sexually active women in Zambia (1992-2018): A decomposition analysis.

Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15-49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992-1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia.

Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia.

Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), 'Structural inequities and the toll of the pandemic'; theme (2), 'Supportive infrastructure'; and theme (3), 'Cultural safety during the pandemic'. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies.

Maternal Sleep Health, Social Support, and Distress: A Mixed–Methods Analysis of Mothers of Infants and Young Children in Rural US

ABSTRACT Objectives The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. Methods 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. Results Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. Conclusions Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence.

Ascertaining the utility of continuous glucose monitoring (CGM) in pregnancy complicated by diabetes is a rapidly evolving area, as the prevalence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) escalates. The seminal randomized controlled trial (RCT) evaluating CGM use added to standard care in pregnancy in T1D demonstrated significant improvements in maternal glycemia and neonatal health outcomes. Current clinical guidance recommends targets for percentage time in range (TIR), time above range (TAR), and time below range (TBR) during pregnancy complicated by T1D that are widely used in clinical practice. However, the superiority of CGM over blood glucose monitoring (BGM) is still questioned in both T2D and GDM, and whether glucose targets should be different than in T1D is unknown. Questions requiring additional research include which CGM metrics are superior in predicting clinical outcomes, how should pregnancy-specific CGM targets be defined, whether CGM targets should differ according to gestational age, and if CGM metrics during pregnancy should be similar across all types of diabetes. Limiting the potential for CGM to improve pregnancy outcomes may be our inability to maintain TIR > 70% throughout gestation, a goal achieved in the minority of patients studied. Adverse pregnancy outcomes remain high in women with T1D and T2D in pregnancy despite CGM technology, and this review explores the potential reasons and questions yet to be investigated.

Beyond Birth Work: Addressing Social Determinants of Health With Community Perinatal Support Doulas.

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017-2018, 2020-2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work-whether because of transportation challenges or pregnancy-related health complications-led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women.

The Importance of Therapeutic Nutrition in Pregnancy: A Comprehensive Review

Pregnancy is a critical period in a woman's life where proper nutrition plays a pivotal role in maternal and foetal health. Therapeutic nutrition interventions during pregnancy have gained increasing attention due to their potential to prevent complications and promote optimal outcomes for both the mother and the developing foetus. This review aims to explore the importance of therapeutic nutrition in pregnancy by examining its impact on maternal health, foetal development, and long-term outcomes. Key aspects such as macronutrient and micronutrient requirements, dietary interventions, and their effects on pregnancy outcomes will be discussed. Additionally, the review will address the significance of nutritional counselling and education in prenatal care. Understanding the role of therapeutic nutrition in pregnancy is essential for healthcare providers to optimize maternal and foetal health outcomes.