Maternal Health Outcomes Research Articles

Comparison of 75 mg versus 150 mg aspirin for the prevention of preterm preeclampsia in high-risk women at a tertiary level hospital: study protocol for a randomized double-blind clinical trial

BackgroundHypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health, with substantial mortality and morbidity rates globally, particularly in developing countries. Pre-eclampsia (PE) accounts for a notable portion of maternal morbidity and mortality, with varied prevalence across regions within countries like India. Despite advancements, disparities in healthcare access persist, influencing outcomes. PE not only affects maternal health during pregnancy but also predisposes women to long-term cardiovascular complications, emphasizing the need for early screening and preventive measures.MethodsThis prospective randomized double-blind clinical trial aims to compare the efficacy and safety of 75 mg versus 150 mg aspirin for preventing preterm pre-eclampsia in high-risk women. Screen-positive women aged 18–45 years with singleton pregnancies between 12 and 16 weeks of gestational age will be enrolled. They will be randomized in a 1:1 ratio to receive either 75 mg or 150 mg of aspirin nightly until 37 weeks of pregnancy or earlier if preterm pre-eclampsia develops. Feto-maternal outcomes, including preterm pre-eclampsia incidence and neonatal and maternal complications, will be assessed. The sample size calculation based on expected proportions of preterm pre-eclampsia in both groups indicates a total of 370 participants (185 per group) accounting for 20% attrition.DiscussionThis prospective randomized double-blind clinical trial aims to compare the effectiveness and safety of two doses of aspirin (75 mg vs 150 mg) in preventing preterm pre-eclampsia in high-risk women. The potential implications of this study are significant, including the optimization of aspirin prophylaxis, the development of evidence-based guidelines, and comprehensive assessment of maternal and fetal outcomes. In conclusion, the results of this study have the potential to significantly impact clinical practice by enhancing maternal and perinatal health outcomes and contributing to evidence-based obstetric care.Trial registrationClinical Trials Registry-India CTRI/2023/12/060983. Trial was registered prospectively on 29 December 2023. Acknowledgement Number REF/2023/12/076358. https://acrobat.adobe.com/id/urn:aaid:sc:AP:15870322-f1f4-4460-900c-6e056ab83a44.

Study of Some Apoptotic Protein Expration in Human Mesenchymal Stem Cells During Toxoplasma Gondii Infection

Background: Toxoplasma gondii (T. gondii) infection is a significant health concern, particularly during pregnancy, as it can lead to fetal harm and birth abnormalities. Specific Background: The role of apoptosis in managing T. gondii infection remains poorly understood, particularly regarding its molecular mechanisms. Knowledge Gap: The impact of T. gondii infection on apoptosis in mesenchymal stem cells (MSCs) derived from human umbilical cords has not been thoroughly studied in existing literature. Aims: This study aimed to investigate the activation of apoptosis and its regulatory mechanisms in human Wharton’s Jelly mesenchymal stem cells (WJ-MSCs) during T. gondii infection. Results: Using non-enzymatic techniques, we isolated T. gondii from infected and aborted phase-specific placentas. Our findings demonstrated a significant increase in the expression of apoptosis-activating genes (CASP2, CASP3, Bak1) in WJ-MSCs following infection, with a marked decrease in cell viability observed within 2 to 4 hours of exposure to the parasite (P≤0.05). Novelty: This study provides novel insights into the relationship between T. gondii infection and apoptosis in WJ-MSCs, highlighting the specific gene expression changes that occur in response to infection. Implications: Research on T. gondii's apoptotic pathways is crucial for developing therapeutic strategies to mitigate pregnancy-related adverse effects and improve maternal and fetal health outcomes. Highlights: Increased Apoptosis: T. gondii enhances apoptosis in mesenchymal stem cells. Cell Viability Impact: Significant decrease in WJ-MSC viability after infection. Clinical Relevance: Insights can inform strategies to reduce fetal infection risks. Keywords: Toxoplasma gondii, apoptosis, Wharton’s Jelly mesenchymal stem cells, pregnancy, gene expression

Spatial heterogeneity in unintended pregnancy and its determinants in India

BackgroundUnderstanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India.MethodsWe analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran’s I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts.ResultsThe national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran’s I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level.ConclusionOur analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the country.

Part II: Enhancing Breastfeeding Experience and Self-Efficacy in Opioid-Dependent Breastfeeding Mothers—Results From the PeriWell Intervention

Objective:The PeriWell project integrates the Positive Direction Model and the Tri-Core Breastfeeding Model into a virtual support program tailored to peripartum mothers in substance use recovery. PeriWell addresses the unique challenges this population faces by offering tailored, wraparound support. This manuscript, part of a two-part series, highlights the project’s outcomes, demonstrating significant implications for maternal health practices by fostering an environment of empowerment and lactation wraparound support.Methods:This longitudinal quality improvement (QI) project spanned 24 months (2019–2021) during the COVID-19 pandemic. It involved 15 peripartum mothers in substance use recovery engaging in a virtual, single-site program. The project was approved as a QI initiative by the Institutional Review Board (IRB reference 2018-19, #89), ensuring ethical adherence and participant safety. Participants provided voluntary consent and were recruited from obstetrics and gynecology offices in Upstate New York. To evaluate participants’ confidence and belief in their breastfeeding abilities, we received author permission and utilized the validated Breastfeeding Self-Efficacy Scale-Short Form (Dennis &amp; Faux, 1999; Dennis, 2010), guiding the tailored support provided.Results:Results indicated a significant increase in prenatal breastfeeding confidence correlated with the PeriWell approach (r= .782,n= 14,p&lt; .001). Participants reported improved self-confidence in latching techniques and a greater appreciation of the time commitment required for successful breastfeeding. Correlational relationships provided valuable insight to enhance and amplify breastfeeding support. The findings advocate for the inclusion of targeted specialized interventions in maternal care to better meet the needs of expecting individuals.Conclusion:Cultivating a supportive peripartum environment is fundamental to maternal-child healthcare, and the PeriWell project demonstrated the efficacy of integrating tailored, virtual peripartum and breastfeeding support for expecting and postpartum mothers in substance use recovery. This quality improvement project improved maternal and infant health outcomes, such as breastfeeding self-efficacy, and highlighted the importance and value of specialized, wraparound lactation support for vulnerable populations. These findings underscore the need for continued innovation in maternal health services, particularly through empowerment and promoting breastfeeding success in recovery settings.

Perception of Traditional Medicine During Pregnancy, Childbirth, and Postpartum in the Tacueyo Indigenous Reservation, Cauca, Colombia

Objective: The objective of this study is to investigate the perception of traditional medicine use during gestation processes in the Tacueyo Indigenous Reservation. The aim is to understand how indigenous women in the reservation perceive and utilize this resource during pregnancy, childbirth, and postpartum in the period 2021-2022. Theoretical Framework: This study is relevant in a context of high maternal and perinatal morbidity rates, focusing on ancestral practices to improve adherence to prenatal and postpartum care, contributing to the reduction of maternal mortality. Method: The study was guided by qualitative methodology and an ethnographic approach, using semi-structured interviews with 10 women. Results and Discussion: The results revealed the use of medicinal plants, interculturality as a protective factor, and barriers to accessing effective medical care. Research Implications: The implications of this research highlight the need to strengthen collaboration between traditional health practices and local health institutions within the framework of the Indigenous Own and Intercultural Health System (SISPI). Originality/Value: This study contributes to the literature by highlighting its intercultural approach and the integration of ancestral knowledge with modern public health to improve maternal health outcomes in indigenous communities.

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

ABSTRACT Background Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh. Methods A total of 2,165 children’s data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables. Results Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices. Conclusion Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.

The Involvement of Religious Leaders in Supporting Institutional Childbirth in Rural Jimma Zone, Oromia, Southwest Ethiopia: An exploratory Qualitative Study.

This exploratory qualitative study examined the involvement of religious leaders in maternal health practices with a focus on promoting institutional childbirth in the rural Jimma Zone, Oromia, Ethiopia. In-depth interviews with 24 male religious leaders revealed five key themes: awareness of childbirth practices, religious beliefs, experiences of childbirth preparedness, experiences at health institutions, and challenges with using institutional childbirth services. The findings indicate that, while religious leaders significantly influence community attitudes toward institutional childbirth, their impact is often limited by a lack of awareness and insufficient engagement with health services. This study underscores the need for culturally sensitive interventions incorporating religious beliefs into maternal health promotion. Enhanced collaboration between health care providers and religious leaders, along with targeted training, is essential for improving maternal health outcomes and increasing the use of institutional childbirth services in rural Ethiopia and other similar contexts.

Perceptions of Rural Access to Prenatal Care in the United States by Patients, Nurses, Midwives, and Physicians: An Integrative Review.

Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.

Application of time series analysis in predicting postpartum depression: integrating data from the hospitalization period and early postpartum weeks.

This study aimed to explore the dynamic changes in postpartum depressive symptoms from the hospitalization period to 4-8 weeks postpartum using time series analysis techniques. By integrating depressive scores from the hospital stay and the early postpartum weeks, we sought to develop a predictive model to enhance early identification and intervention strategies for Postpartum Depression (PPD). A longitudinal design was employed, analyzing Edinburgh Postnatal Depression Scale (EPDS) scores from 1,287 postpartum women during hospitalization and at 4, 6, and 8 weeks postpartum. Descriptive statistics summarized demographic characteristics. Time Series Analysis using the Auto-Regressive Integrated Moving Average (ARIMA) model explored temporal trends and seasonal variations in EPDS scores. Correlation analysis examined the relationships between EPDS scores and demographic characteristics. Model validation was conducted using a separate dataset. EPDS scores significantly increased from the hospitalization period to 4-8 weeks postpartum (p < .001). The ARIMA model revealed seasonal and trend variations, with higher depressive scores in the winter months. The model's fit indices (AIC = 765.47; BIC = 774.58) indicated a good fit. The Moving Average (MA) coefficient was - 0.69 (p < .001), suggesting significant negative impacts from previous periods' errors. Monitoring postpartum depressive symptoms dynamically was crucial, particularly during the 4-8 weeks postpartum. The seasonal trend of higher depressive scores in winter underscored the need for tailored interventions. Further research using longitudinal and multi-center designs was warranted to validate and extend these findings. Our predictive model aimed to enhance early identification and intervention strategies, contributing to better maternal and infant health outcomes.

EVALUATING PERINATAL OUTCOMES IN HIGH-RISK PREGNANCIES USING THE MODIFIED COOPLAND’S SCORING SYSTEM AT A TERTIARY HOSPITAL

This study aims to thoroughly assess perinatal mortality rates, Apgar scores, birth weights, and neonatal complications within the first-week post-birth among high-risk pregnancies. Methods: During a prospective cohort study at Jinnah Postgraduate Medical Centre, Karachi, from October 2023 to May 2024, we evaluated outcomes in 664 high-risk pregnant women using systematic random sampling. Participants, with singleton pregnancies of 24 weeks or more gestation, were stratified by risk level. Data included demographic details, socioeconomic status, BMI, and pregnancy history. Maternal outcomes, such as mode of delivery and postpartum haemorrhage requiring transfusion, and perinatal outcomes, including birth weight and APGAR scores, were assessed. Statistical analysis emphasized odds ratios, with p &lt; 0.05 considered significant. Ethical approval was obtained, and all participants provided informed consent. Results: This prospective cohort study at Jinnah Postgraduate Medical Centre from October 2023 to May 2024 involved 664 high-risk pregnant women categorized by standard risk scoring. Participants were predominantly low-risk (65.77%), followed by moderate-risk (19.88%) and high-risk (14.35%). Key findings included increased rates of cesarean sections, postpartum haemorrhage, premature births, low birth weight, adverse APGAR scores, NICU admissions, and perinatal mortality with escalating risk levels. Statistical analyses revealed significant associations and elevated odds ratios for adverse outcomes among higher-risk groups, underscoring the importance of risk assessment in managing maternal and perinatal health outcomes. Conclusion: Our study highlights the urgent importance of identifying and effectively managing high-risk pregnancies. We discovered that these pregnancies are associated with significantly elevated risks of complications such as Cesarean deliveries, postpartum haemorrhage, preterm births, low birth weights, low 5-minute APGAR scores, NICU admissions, and perinatal mortality. Implementing a straightforward, non-invasive risk-scoring system can facilitate early detection of high-risk cases, enabling timely and tailored interventions that can greatly improve outcomes for both mothers and infants.

Cross-Cultural Perspectives on Exercise Knowledge and Practice during Pregnancy: A Mini-Review

Background: This mini-review synthesizes current research on exercise knowledge and practices among pregnant women, with a focus on low- and middle-income countries (LMICs). Key Findings: Recent studies indicate a generally positive attitude towards exercise during pregnancy across various cultural contexts. Walking and housework emerge as the most common forms of physical activity among pregnant women in these settings. Influencing Factors: The review explores factors influencing exercise knowledge and practice, including education level, parity, socio-economic status, and cultural beliefs. It also examines the sources of information pregnant women rely on for exercise guidance. Identified Needs: Despite growing awareness, there remains a need for more specific, culturally appropriate guidance on safe and beneficial exercises during pregnancy. Recommendations: The review concludes with recommendations for healthcare providers and policymakers, emphasizing the importance of incorporating exercise counseling into routine antenatal care and tailoring interventions to local contexts. Conclusion and Future Directions: This comprehensive overview highlights the potential for improving maternal and fetal health outcomes through appropriate physical activity during pregnancy, while also identifying areas for future research.

Double burden of gestational diabetes and pregnancy-induced hypertension in Ethiopia: A systematic review and meta-analysis of observational studies.

The coexistence of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) amplifies the risk of maternal and perinatal mortality and complications, leading to more severe adverse pregnancy outcomes. This systematic review and meta-analysis aimed to assess the double burden of GDM and PIH (GDM/PIH) among pregnant women in Ethiopia. A comprehensive systematic search was conducted in the databases of PubMed, Cochrane Library, Science Direct, Embase, and Google Scholar, covering studies published up to May 14, 2023. The analysis was carried out using JBI SUMARI and STATA version 17. Subgroup analyses were computed to demonstrate heterogeneity. A sensitivity analysis was performed to examine the impact of a single study on the overall estimate. Publication bias was assessed through inspection of the funnel plot and statistically using Egger's regression test. Of 168 retrieved studies, 15 with a total of 6391 participants were deemed eligible. The pooled prevalence of GDM/PIH co-occurrence among pregnant women in Ethiopia was 3.76% (95% CI; 3.29-4.24). No publication bias was reported, and sensitivity analysis suggested that excluded studies did not significantly alter the pooled prevalence of GDM/PIH co-occurrence. A statistically significant association between GDM and PIH was observed, with pregnant women with GDM being three times more likely to develop PIH compared to those without GDM (OR = 3.44; 95% CI; 2.15-5.53). This systematic review and meta-analysis revealed a high dual burden of GDM and PIH among pregnant women in Ethiopia, with a significant association between the two morbidities. These findings emphasize the critical need for comprehensive antenatal care programs in Ethiopia to adequately address and monitor both GDM and PIH for improved maternal and perinatal health outcomes.

MIDWIFERY SERVICE MANAGERS’ READINESS FOR PREVENTION OF OBSTETRIC VIOLENCE IN NIGERIA: A COMMUNITY READINESS MODEL

Obstetric violence is a public health problem that needs to be prevented at all levels to improve maternal and newborn health outcomes. The midwifery service managers, as custodians of patient care in maternity centres are in a prime position to develop and implement effective obstetric violence prevention interventions. This study explored the midwifery service managers’ level of readiness for the prevention of Obstetric Violence in three maternity centres at three separate hospitals in Oyo State, Nigeria. Data was collected from six midwifery service managers as midwifery community leaders, using the adapted Community Readiness Model as a data collection tool. The Community Readiness Model scoring guide was used to score the six dimensions of community readiness. In addition, a thematic analysis was used to analyze the qualitative data from their views on each of the six dimensions of the Community Readiness Model. The findings revealed an overall level of readiness for the prevention of obstetric violence among midwifery service managers was at level five which is the preparatory level. This means that the community has a modest readiness for Obstetric violence prevention, and it would be easier to develop sustainable prevention interventions for obstetric violence. Understanding the midwifery service managers’ level of readiness for the prevention of obstetric violence is important for governments and other stakeholders intending to develop obstetric violence prevention interventions that are contextually appropriate and acceptable to communities.

Real-World Assessment of Psychotropic and Antiepileptic Drug Use During Pregnancy in Belgium: Trends, Predictors, and Comparative Risk of Congenital Anomalies (2010-2016).

To analyze the prescription patterns and sociodemographic factors associated with the use of antipsychotic, antidepressant, and antiepileptic drugs during pregnancy in Belgium, and to investigate their potential association with congenital anomalies. Using a nationwide linked database, we identified antidepressants, antipsychotics, and antiepileptics via the Anatomical Therapeutic and Chemical Classification (ATC) codes. For each medication group, we calculated the overall prevalence and prevalence for the three most used medications at the fifth ATC level. Sociodemographic factors influencing medication use during pregnancy were analyzed, and potential associations with congenital anomalies were investigated through logistic regression models based on generalized estimating equations. Overall, 828 016 live births pregnancies associated with 611 094 mothers were identified. We found that the use of antidepressants, antipsychotics, and antiepileptics was decreasing with the arrival of pregnancy. Mothers with a less favorable sociodemographic status were more likely to be exposed to these medications. Antiepileptics used in the first trimester were associated with an increased risk of congenital anomalies (aOR = 1.65, 95% CI 1.11-2.45) compared with unexposed women. The three most used antiepileptics were lamotrigine, valproate, and levetiracetam, among them, we found an association with congenital anomalies only for valproate (aOR = 3.92, 95% CI 2.30-6.67). Psychotropic and antiepileptic drug use decreased during pregnancy. Pregnant women with a less favorable sociodemographic status were more likely to be exposed to psychotropics and antiepileptics during pregnancy. The elevated risk of congenital anomalies associated with antiepileptics use, particularly valproate, underscores the need for targeted interventions and increased awareness to improve maternal and fetal health outcomes.

A Scoping Review of Multimodal, Dyadic Early Relational Health Interventions in NICUs in the United States.

Early relational health (ERH) interventions can buffer toxic stress and improve the developmental trajectories of neonatal intensive care unit (NICU) infants. The purpose was to examine the current state of the science related to multimodal, dyadic ERH interventions implemented in the NICU setting in the United States and identify gaps in the current literature. PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo were searched in November 2022 and November 2023 for original studies and conference proceedings from 1970 to present in the English language. Gray literature searches were performed in February 2023 and December 2023. English language, original research, with a focus on multimodal, dyadic ERH interventions that took place primarily in a NICU in the United States were included. Outcome measures could be related to implementation, relational health, or physical and/or mental health outcomes of parent and/or infant. Eighteen of 2021 reviewed articles met the inclusion criteria. Data were extracted for author, year, intervention, purpose, methods, sample, paternal inclusion, dyadic components, non-dyadic components, and major outcomes/results and distilled for study characteristics, multimodal, dyadic intervention characteristics, and outcome measures. Several multimodal dyadic interventions exist to aid ERH in the NICU, providing evidence of improved outcomes for infants and families. More research is required using higher sample sizes and replication studies. ERH interventions show promise in improving neurodevelopmental, behavioral, and maternal mental health outcomes and should be considered for implementation into NICU services.

The Maternal and Infant Health Consequences of Restricted Access to Abortion in the United States

Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference-in-differences techniques across outcomes from restricted-use microdata on the universe of US births. I find that TRAP laws lead to 11-16% increased rates of hypertensive disorders of pregnancy. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion.

Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic reviews protocol

IntroductionTeenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. More than 90% of these live births are estimated to occur in developing...

469 - Pre and postnatal imaging of thoracic aneurysm: the Case of a delicate balance between maternal and child health outcomes for a personalized care

469 - Pre and postnatal imaging of thoracic aneurysm: the Case of a delicate balance between maternal and child health outcomes for a personalized care

Screening for Pulmonary Hypertension in Pregnant Women with Sickle Cell Disease in Sub-Saharan Africa

BackgroundSickle cell disease (SCD) has evolved from a condition predominantly fatal in childhood to a chronic illness impacting many adults, including women of reproductive age. For females with SCD, pregnancy represents one of the greatest health threats, exacerbating existing health challenges and introducing new risks. Despite advancements in healthcare, routine screening for existing complications like pulmonary hypertension (PH) remains inconsistent, particularly in low- and middle-income countries (LMICs), where the prevalence of SCD is highest. Objective(s)This study aimed to assess the feasibility of screening for pulmonary hypertension (PH) in pregnant women with sickle cell disease (SCD) in LMICs, with the goal of enhancing maternal health outcomes in this vulnerable population. Study DesignA prospective multi-centre feasibility study was conducted from September 2022 to February 2023 at teaching hospitals in Ghana and Nigeria. The study included pregnant women with SCD between 28 and 34 weeks of gestation. Screening for PH utilized a tricuspid regurgitation velocity (TRV) criterion (>2.5 m/s), with adherence to American Society of Echocardiography guidelines. Statistical analysis included descriptive statistics and proportions. ResultsAmong 3091 pregnant women attending antenatal care, 88 had SCD (2.8%), and 55 were eligible for the study. We recruited 44 participants (mean age 28.9 years, SD 4.8), with 48% (21/44) SS genotype and 52% (23/44) SC genotype. Most participants (95.3%) had normal TRV (<2.5 m/s), with only one showing elevated TRV, successfully referred. Protocol adherence was 100%. Antenatal outcomes showed 95% echo uptake and 95.7% retention to term whilst postnatal echo follow-up was 43.5%. Notably, 27.1% (10/37) of deliveries required NICU admission, and 18.2% were preterm. The sole participant with PH required ICU care and experienced a preterm delivery with neonatal death on day five. Conclusion(s)Screening and referral for PH in pregnant women with SCD in LMICs are feasible but face challenges in early diagnosis, healthcare personnel availability, and postnatal follow-up. Strategic planning is crucial to address these challenges and improve outcomes in this high-risk population

Health Workers Perception On The Key Drivers Of Maternal Mortality

Maternal mortality remains a critical public health issue, particularly in low- and middle-income countries. Health workers play a pivotal role in addressing this challenge, offering insights into the key drivers of maternal deaths. This study explores the perceptions of healthcare workers on the systemic, socioeconomic, cultural, and healthcare-related factors contributing to maternal mortality. Health workers identify systemic barriers, including understaffing, lack of resources, inadequate training, and inefficient referral systems, as significant contributors. Cultural and religious influences also impact maternal care, with societal norms often discouraging women from seeking professional healthcare. Additionally, socioeconomic factors like poverty, illiteracy, and unemployment further exacerbate the problem, limiting access to quality maternal care. Health workers’ insights are crucial in designing effective interventions, emphasizing the need for improved training, better healthcare infrastructure, and community engagement to address cultural barriers. This study highlights the importance of empowering healthcare professionals to deliver high-quality maternal care, suggesting that systemic reforms, including enhanced emergency obstetric care and better access to medical supplies, are essential for reducing maternal mortality rates. Understanding these perspectives can inform policies and programs aimed at improving maternal health outcomes, particularly in resource-limited settings