Black women face a disproportionate risk of perinatal mental mood disorders with significant implications for maternal and infant health outcomes. Identifying the determinants of Black maternal mental health is needed to inform the development of culturally concordant programs and policy interventions. This scoping review aims to identify and explore the sociocultural and structural determinants of Black maternal mental health. Following the methodological frameworks proposed by Arksey and O'Malley and reworked by Levac etal., searches were conducted in four databases: CINAHL, MEDLINE, PsycINFO, and Google Scholar. Studies published in English between January 2010 and December 2024 were included. A total of 4280 studies were retrieved. Two team members independently screened the articles, and conflicts were resolved by a third member. The data were extracted and analyzed thematically to identify the socio-cultural and structural determinants of Black maternal mental health. Twenty-two studies were included in the final review. The review identified gendered racial stress, sociocultural expectations about strength, mental health-related stigma, racism in healthcare, health insurance coverage, socioeconomic status, relationship status, neighborhood conditions, level of educational attainment, and availability of social support as determinants of Black maternal mental health. These determinants are not mutually exclusive but intersect in complex ways to influence Black maternal mental health outcomes. Findings from this review underscore the need for designing community and equity-informed interventions and programs to address health inequities and promote maternal mental health. Future research should focus on culturally and contextually grounded approaches to guide the development of innovative maternal mental health interventions.

Uganda hosts the largest refugee population in Africa, which exerts much pressure on the district health systems. While refugee-hosting districts (RH) receive targeted investments, the extent to which these influence maternal and child health (MCH) service coverage remains unclear. Using routine facility data, we examined differences in MCH coverage and trends between RH and non-refugee-hosting (non-RH) districts and also explored the effects of government health financing and health system performance on MCH coverage. We conducted a retrospective analysis utilizing routine health facility MCH data from the Uganda District Health Information System and district-level government Primary Healthcare (PHC) expenditure data from 2020 to 2023. MCH indicators were ANC1st trimester, ANC4, Institutional deliveries, mothers' Post-natal care (PNC), Measles1 and DPT3 vaccination. We computed a composite coverage index (CCI), health systems performance z-score and compared trends across RH and non-RH districts. Mixed Effects Models assessed the association between government expenditure, RH-status, health system performance over the years. RH districts consistently had modestly higher coverage of ANC1st trimester, ANC4, Institutional deliveries, PNC, Measles vaccination and CCI trends. Government expenditure was significantly higher in RH districts and refugee-dominant (RD) districts (p < 0.001 vs. p = 0.007). Refugee-dominant districts had higher but non-significant MCH coverage. Unadjusted models of MCH indicators and CCI were positively influenced by government financing and health systems performance z-score except for DPT3 and Measles, respectively. Adjusted models revealed that ANC4 coverage was 7.4% points higher in RH districts (7.42; 95% CI:0.753, 14.090; p = 0.029) and increased by 3.6% points for every unit increase in z-score (3.60; 95% CI: 0.729, 6.462; p = 0.014). CCI increased by 1.6% points and 2.3% points for every unit increased in the government expenditure and z-score respectively (1.55; 95% CI: 0.310, 2.788; p = 0.014) vs. (2.31; 95% CI: 0.642, 3.975; p = 0.007). Novel approach - leveraging routine facility data, revealed MCH coverage was modestly consistently higher in RH districts over the years and RH status influenced ANC4 coverage. Overall district-CCI depended on Government investment and health systems performance implying increase in PHC financing could be a key driver to universal district-level improvement.

In many countries, the consent for caesarean section (CS), when indicated, is made by the woman herself. However, in Somaliland, the family (husband, father, or other close male family member) are required to make the consent for CS to be performed, a process that can be time-consuming and result in adverse outcomes. This study aimed to investigate the barriers to and facilitators of timely family consent in caesarean sections at the national referral hospital in Somaliland. A convergent mixed-methods study with a parallel sampling method was conducted at the national referral hospital in Somaliland. Quantitative data was collected on timely vs. late family consent for CS, as well as sociodemographic and obstetric characteristics. Data were analysed using binary and multivariable logistic regression. In addition, in-depth interviews were conducted and analysed using thematic analysis. Of the 516 women included in the quantitative phase of the study, 16 participated in the in-depth interviews. The quantitative results showed that women with hypertensive disorders (aOR 8.491; 95% 1.076-66.991) and obstetric haemorrhage (aOR 3.209; 95% CI 1.159-8.887) had higher odds of late family consent compared to women without hypertensive disorders and obstetric haemorrhage respectively. The themes that emerged on barriers to timely family consent for CS were poor communication and understanding, delayed informed choice for CS, differences in understanding between family members on the indication for CS, and absence of the person providing formal consent. The themes that emerged on facilitators of timely family consent were the husband's autonomous decision making for CS and adequate disclosure of all relevant information about CS. A standard counselling package can be designed on educating family members on the importance of timely CS consent during the antenatal period with male involvement. A policy should be developed that gives women the autonomy to make health decisions and give consent in maternal health emergencies. Healthcare providers need training on effective communication when requesting CS consent, with a focus on the elements of informed consent.

Lipid nanoparticles (LNPs) have garnered tremendous enthusiasm in preclinical and clinical settings for the delivery of nucleic acids such as mRNA. With applications in protein replacement therapies, vaccines and gene editing, mRNA LNPs have only recently been explored in the context of pregnancy disorders. There is a significant need for the design of novel therapeutic technologies such as mRNA LNPs to treat obstetric disorders like pre-eclampsia that are associated with placental pathology and detrimental effects on maternal and fetal health. Here, we present a step-by-step procedure for the preparation and evaluation of placenta-tropic mRNA LNPs for researchers from varied disciplines to explore their application in treating pregnancy disorders. In this Protocol, we describe steps for synthesizing and purifying the key ionizable lipid excipient of the placenta-tropic LNP formulation (4 d) before preparing mRNA LNPs using microfluidic mixing (1 d). Then, we detail in vitro mechanistic evaluations of the effect of protein adsorption on LNP-mediated mRNA transfection to placental trophoblasts (3 d). Finally, we outline methods for isolating reproductive tissues from time-dated pregnant mice to assess in vivo LNP biodistribution and mRNA transfection to the murine placenta (16 d). Compared to alternative LNP formulation procedures, this Protocol focuses on delivering mRNA LNPs to the placenta with a workflow that can be applied for a range of obstetric disorders. This Protocol seeks to increase interdisciplinary work at the interface of nanomedicine, gene modulation and reproductive health.

The enhancement of women’s well-being through pregnancy, childbirth and following delivery is known as maternal health. However, lack of access to clean drinking water in households leads to a lot of time spent for collection of water by women and girls, resulting in an inability to avail of maternal healthcare services. As evidence on this topic for India is scant, we analyse the relationship between water carriage and continued use of skilled maternal healthcare services, namely antenatal care (ANC), delivery and postnatal care (PNC). Using data on 31,054 women from the National Family Health Survey-4 (NFHS-4), 2015–2016, we find that women who have to fetch drinking water for their households are significantly less likely to avail all three services from skilled personnel as compared to their counterparts who have it available on premises or get it delivered to their homes. Hence, providing safe indoor water is critical for the reduction of maternal deaths in India.

This study investigates the impact of government health expenditure on health outcomes in African OPEC member countries (Nigeria, Algeria, Angola, Gabon, and the Republic of Congo) using panel data from 2000 to 2024. Employing econometric models, including unit root tests, co-integration analysis and the Pooled Mean Group (PMG) estimator. Results revealed that long-term, both out-of-pocket and government health expenditures positively influence life expectancy, while short-term effects are insignificant. For maternal mortality, short-term analysis shows significant reductions with increased government spending and out-of-pocket payments, though long-term effects are insignificant. The findings underscore that effective health expenditure, coupled with responsible management of external debt and systemic reforms, is vital for improving health outcomes. The study concludes that policymakers should focus on increasing healthcare funding, reducing out-of-pocket costs, enhancing health system efficiency. Recommendations include increasing healthcare funding, reducing out-of-pocket costs, responsible management of external debt(EXD) and strengthening healthcare infrastructure. Emphasizing sustainable economic growth and targeted maternal health interventions are essential. Future research at the regional level within Nigeria could provide deeper insights for tailored health strategies to enhance outcomes across different areas.

Background The gut microbiota is regarded as one of the key factors regulating host health. The gut microbiota and its connection to fecal metabolites are crucial for supporting fetal development and ensuring maternal health during reproductive stages. Although studies have examined Asian elephants, the composition and function of the gut microbiota in pregnant and non-pregnant captive Asian elephants have not been reported. Methods We compared the fecal microbiota and fecal metabolites of pregnant (G1), non-pregnant (never gotten pregnant after reaching sexual maturity, G2), and subadult (G3) captive Asian elephants using metagenomic sequencing and untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics. Results We found significant differences in the gut microbiota among the G1, G2, and G3 groups. The phylum Bacteroidetes showed notable differences between G1 and G2. The analysis of fecal metabolomics revealed significant differences in 49 metabolites between G1 and G2, of which 25 were upregulated and 24 were downregulated. These results suggested significant differences in the composition of gut microbiota and fecal metabolites during reproductive stages, while gut microbial diversity remained stable. These findings inform our ongoing research on the potential health conditions of captive Asian elephants, with the aim of better understanding the role of the gut microbiota in reproductive regulation.

Prevalence and determinants of full immunization among children under five in sub-Saharan Africa: A systematic review and meta-analysis (2013-2025).

Development and evaluation of an evidence-based training and supervision program to enhance clinical competence management in perinatal depression management among rural maternal and child health workers: A pre-post study.

Over the years, the impact of music on the prenatal and neonatal stages of human life has gained significant scientific attention. This study provides a comprehensive bibliometric review of research investigating how music influences fetal and newborn development. Using the Scopus and Web of Science databases, a search of relevant studies published in English between January 2006 and July 2025 was conducted, whose basic criterion was the use of the following keywords: “music” and “fetus” or “fetal”. Additional terms such as “fetus development”, “fetus heart rate”, “fetus movement”, “mother–fetus relationship”, “newborn”, etc., were also utilized. In result, 75 publications were selected, and their bibliographic data and full sources were retrieved. The included studies were grouped according to two perspectives that consider the impact of music (1) on the development of the fetus and the newborn, and (2) on maternal health and mother–fetus bonding. Using VOSviewer, bibliometric mapping was performed, which allowed to obtain keyword co-occurrence network and co-authorship network. The chosen literature was then quantitatively and qualitatively analyzed. The analysis revealed a sharp upward trend in publications starting in 2015, with a temporary decline in 2020 due to the COVID-19 pandemic. The highest number of publications were from Iran. The most investigated topics were related to the fetus heart and maternal health. The most common publication type and research methodology were, respectively, article and experiment. While the key authors Lordier, L., Filippa, M., Grandjean, D., and Monaci, M.G. lead the field, the co-authorship network remains fragmented into isolated and relatively small research groups. The Journal of Maternal–Fetal and Neonatal Medicine emerged as the leading publication outlet, while the study by Graven et al. entitled “Auditory Development in the Fetus and Infant” remains the most cited work. The keyword co-occurrence network allowed the identification of three main thematic clusters indicating the physiological, clinical, and therapeutic aspects of the impact of music on fetal and neonatal development. A qualitative analysis revealed that music plays a vital role in early human development and maternal well-being, demonstrating positive effects of auditory stimuli on fetal and newborn physiology, as well as on the mother–fetus relationship, while being a non-invasive and non-pharmacological method of intervention. However, the lack of a fully connected global research community and standardized protocols for, e.g., choosing the musical repertoire, sound administration, and the duration of exposure suggests the need for increased international collaboration to further integrate music therapy into standard clinical practices for prenatal and neonatal care.

This study was conducted to examine the effect of mothers' perception of birth on separation anxiety, a rarely studied but clinically important topic in perinatal mental health. A descriptive and correlational design was used to identify relationships without intervention. The sample consisted of 305 postpartum women between the seventh day and sixth week, recruited from a private hospital. Data were collected using the Introductory Information Form, the Perception of Birth Scale, and the Adult Separation Anxiety Questionnaire. Statistical analyses included independent t-tests, ANOVA, Pearson correlation, and multiple regression. The mean age of participants was 29.09 ± 6.48 years. Separation anxiety was found to be significantly negatively correlated with the total score of the Perception of Birth Scale (r = -0.43, p ⩽ 0.001). Regression analysis showed that experiences during the pain period (β = -0.32, p < 0.001) and spousal involvement (β = -0.12, p < 0.05) negatively predicted separation anxiety. These two factors explained 21% of the variance. The findings suggest that positive childbirth perceptions, particularly effective pain management and partner support, may reduce maternal separation anxiety. This study contributes an innovative perspective by linking birth perception with separation anxiety, highlighting the need for interventions that promote positive childbirth experiences in order to protect maternal mental health.

Cesarean scar ectopic pregnancy is a rare but increasingly recognized form of ectopic pregnancy in which a pregnancy is implanted into a myometrial defect caused by a cesarean scar. If not promptly identified, it can lead to life-threatening complications, underscoring the need for heightened clinical suspicion, timely diagnosis, and context-appropriate management. Reports from resource-limited settings remain scarce, making this case series from Ethiopia important for raising clinical awareness and highlighting the challenges of timely recognition and management. We reported two consecutive cases of maternal near misses that met the WHO criteria, both resulting from cesarean scar ectopic pregnancy, along with a third case involving delayed diagnosis. All were Ethiopian (East Africa), managed at a teaching hospital in Ethiopia between January 2023 and May 2025. Patient 1: a 28year-old (gravida 4, two prior cesareans) who was initially misdiagnosed with threatened miscarriage at a gestational age of 10weeks, was managed expectantly for 2weeks and was later misdiagnosed with incomplete miscarriage, underwent manual vacuum aspiration, and experienced severe hemorrhage; cesarean scar ectopic pregnancy was subsequently diagnosed, ultimately requiring emergency hysterectomy and transfusion of five units of whole blood. Patient 2: a 25year-old woman with one prior cesarean section presented with recurrent vaginal bleeding following an induced medical abortion, resulting in severe anemia with a hemoglobin level of 4.7g/dL. Ultrasound revealed a 3.5cm × 4cm mass at the anterior isthmus consistent with cesarean scar ectopic pregnancy, which was managed by laparotomic wedge resection of the scar‑site lesion, bilateral uterine artery ligation, and transfusion of six units of whole blood. Patient 3: a 30year-old woman (gravida 3, one prior cesarean delivery) had cesarean scar ectopic pregnancy missed during antenatal care; her diagnosis at 10weeks followed the onset of pain and bleeding, and she underwent laparotomic resection of the scar‑site lesion. Histopathology confirmed cesarean scar ectopic pregnancy in all patients. Cesarean scar ectopic pregnancy is an emerging, potentially life-threatening complication in low-resource settings, where limited diagnostic capacity and low clinical suspicion often impede timely diagnosis and management. The avoidance of blind uterine evacuation until cesarean scar ectopic pregnancy is excluded, the adoption of lesion-tailored treatment strategies, and the strengthening of targeted clinical training and diagnostic access are critical to improve maternal health outcomes and reduce morbidity in these settings.

Continuum of care in maternal and child health (MCH) services is a key strategy for improving MCH outcomes. This study examines the effect of conditional cash incentives and community health worker support on the uptake of the continuum of MCH care, defined as the sequential utilization of antenatal, skilled delivery, and postnatal services. Using nationally representative cross-sectional datasets and a difference-in-difference framework, we find that both interventions significantly improved the continuum of MCH care. The intent-to-treat estimates showed a 5-percentage-point increase in the proportion of women completing the full continuum of care. Heterogeneity analysis revealed more substantial effects among educated women, those in urban areas, and those in higher wealth quintiles. Insights from qualitative interviews with mothers and community health workers suggested that awareness of antenatal care and institutional delivery increased; however, postnatal care was typically sought only in response to complications, and the uptake of all recommended MCH services as a full continuum was often hindered by intersecting demand- and supply-side barriers. Notably, participants emphasized that sustained community health worker engagement had a more significant impact on ensuring care continuity than cash incentives alone. These findings highlight the need for policy strategies that enhance community health worker-led support mechanisms, combined with financial incentives, to promote the comprehensive and sustained use of maternal health services among disadvantaged population groups.

Background: Gestational diabetes mellitus (GDM) and periodontitis (PD) are chronic inflammatory conditions that may share metabolic and immune pathways. Evidence suggests an association between them, although results across studies remain inconsistent. This systematic review and meta-analysis evaluated the relationship between GDM and PD and examined whether GDM influences key periodontal parameters. Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and Embase was conducted up to August 2025 following PRISMA guidelines. Observational studies comparing periodontal status in pregnant women with and without GDM were included. Periodontal status was assessed using probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). Study quality was evaluated with the Newcastle–Ottawa Scale, and random-effects models were applied to estimate pooled associations. Results: Fifteen studies involving about 3800 pregnant women met the criteria. A significant association was found between GDM and PD (Odds Ratio [OR] 2.10; 95% Confidence Interval [CI] 1.64–2.69). No significant association emerged between GDM and gingivitis. Women with GDM showed increased BOP and higher PPD, indicating greater periodontal inflammation, while CAL did not significantly differ between groups. Conclusions: The findings support a significant association between GDM and periodontitis, suggesting that gestational hyperglycemia may enhance periodontal inflammation and early tissue changes. Incorporating periodontal screening into prenatal care may benefit maternal oral and metabolic health. Further longitudinal and interventional studies are needed to clarify causality and to explore whether periodontal therapy may help reduce risks linked to GDM.

Placental schistosomiasis (PS) is underdiagnosed and may compromise maternal and neonatal health. This study estimated the prevalence of PS in a rural Gabonese population of pregnant women with confirmed S. haematobium infection using light microscopy of macerated placental tissue. This is a cross-sectional, diagnostic proof-of-concept study which applied an improved placenta maceration technique in real-world conditions to diagnose PS. Performing light microscopic assessment of a single sample of 10 mL urine, we screened pregnant women for S. haematobium infection who sought antenatal care in Lambaréné (Gabon) between January 2022 and January 2023. Women positive for S. haematobium infection were followed up until delivery. Additionally, a subsample of women with negative urine samples was recruited as a non-infected control group (1:1 ratio infected and non-infected groups) and followed up until delivery. Only participants with available macerated placental samples were considered for final analysis. Placental samples were subjected to light-microscopy-based screening for S. haematobium eggs and PS was considered present if a least one S. haematobium egg was detected. Positive light microscopic placental samples were confirmed by qPCR. Among 318 women screened for S. haematobium in urine, we found 40 (12.6%; 95% CI: 9.1-16.7%) to be positive. Together with 40 women in the non-infected control group all women were followed up until delivery. After loss-to-follow-up, 28 (70%; 28/40) women with S. haematobium infection and 20 (50%; 20/40) without infection provided placenta samples at delivery. In the group with S. haematobium infection, 14% (4/28; 95% CI: 4.0-32.7%) of women were positive for S. haematobium eggs in macerated placenta tissue. In the non-infected control group, one woman (5%; 1/20; 95% CI: 0.1-24.9%) had a positive microscopy result for PS. All five women with positive S. haematobium egg microscopy in placental tissue received a concordant qPCR result. 14% of women with S. haematobium infection also had PS. Notably, PS was also observed in 5% of women without detectable S. haematobium eggs in urine. This suggests that PS could be an underestimated phenomenon in highly endemic regions and warrants further investigations of its implications for mother-and-child health.

Abortion is a deeply controversial public health issue, evoking diverse opinions regardless of legal context. Yet policymaking often relies on generalised opinion surveys that lack contextual nuance. We examined public opinions of abortion in Kenya in relation to circumstances of rape, foetal anomaly, and maternal health risk. We used a nationally representative sample of 8,942 adults in Kenya, drawn from a database of 12 million phone users. Using a two-stage sampling approach with random-digit dialling, the sample was stratified by location, sex, and age to ensure proportional representation. A vignette-based questionnaire described three scenarios involving foetal anomaly, threats to the woman's life or health, and rape. It included 14 opinion statements per vignette, each with six response options indicating degrees of agreement or disagreement, and three questions to ascertain levels of support for abortion rights in these circumstances. Trained interviewers administered the questionnaire via telephone between October and November 2022. Multivariable-adjusted linear regression was used to assess factors influencing abortion opinions. Most respondents (> 61%) favoured abortion when pregnancies threaten women's life or health, while only 29% and 44%, respectively, supported it in cases of rape or foetal anomaly. There was significant support for abortion to be performed by the public health system, yet lower support for the idea of abortion as a woman's right. Liberal constructs had higher mean scores than conservative ones, with women's reproductive autonomy scoring highest (3.44 ± 1.07), indicating widespread agreement that abortion decisions should rest solely with the pregnant woman. Among conservative constructs, the sanctity of life had the highest mean score (2.40 ± 0.89), reflecting a strong belief in the value of life among abortion opponents. Abortion opinions varied depending on circumstance, with notable support for legal abortion across contexts. It is recommended that public policy reflect these nuanced views and address key barriers to support, particularly in framing abortion as a matter of public health, gender equality, and human rights.

Maternal nutrition during gestation is fundamental to metabolic homeostasis. This study investigates the impact of sugar-sweetened beverages (SSBs, 20% sucrose water) on maternal physiology through the gut microbiota-oxidative stress-inflammation network and delineates the underlying mechanisms. Using a C57BL/6J mouse model, we implemented a maternal SSB dietary regimen sustained until late gestation. SSB exposure significantly increased maternal body weight, intestinal weight, blood glucose levels, and serum lipopolysaccharide (LPS) and LPS-binding protein (LBP) concentrations. Concurrently, SSBs compromised the intestinal barrier, elevated pro-inflammatory cytokine levels and gene expression, and suppressed intestinal antioxidant capacity. We further identified that pregnancy-induced nutritional demand triggered compensatory intestinal responses, including upregulation of glucose transporters. However, in the context of SSBs, this adaptation escalated into maladaptive metabolic stress, aggravating intestinal injury, oxidative-inflammatory imbalance, and systemic metabolic disruption. Gut microbiota analysis revealed SSB-induced enrichment of Akkermansia, Prevotella, Bacteroides, Alistipes, and Bifidobacterium, with functional enrichment in carbohydrate metabolism and the TCA cycle. These microbial shifts were accompanied by altered short chain fatty acid (SCFA) profiles, characterized by elevated acetate and propionate but reduced butyrate, further disrupting gut homeostasis and maternal metabolism. By constructing an integrated "SSBs-microbiota-metabolites-maternal health" network, we elucidate how excessive Akkermansia muciniphila (A. muciniphila) colonization under gestational high sugar conditions contributes to mucosal breakdown and systemic inflammation. This study provides mechanistic evidence supporting sugar restriction during pregnancy, with important implications for preventing gestational metabolic diseases and improving maternal health outcomes.

Remodeling maternal health care: evaluating the impact of implementing the midwifery model of care on maternal and neonatal health outcomes in Ethiopia: The MiMoC project.

Different patterns of association between maternal mental health and infant negative affect subdomains: Findings from the Germina cohort.

This retrospective observational study assessed the US Agency for International Development-health quality accelerator activity data from 2022 to mid-2024 to examine the impact of the point of care quality improvement (POCQI) model on maternal, neonatal, and child health in Jordan. Significant improvements were made to 356 different POCQI initiatives enrolled in various healthcare facilities. In maternal health, antenatal care improved from 23.8% to 71.4%; anemia screening and treatment increased from 50.6% to 79.1%; and family planning services increased from 40.6% to 74.4%. Neonatal health outcomes improved, with delayed cord clamping rates increasing from 12.3% to 77.8% and immediate drying rate increasing from 35.3% to 82.9%. Child health outcomes also improved, with growth and development screening rates increasing from 27.4% to 63.3%. All improvements in outcomes results were statistically significant (p &amp;lt; 0.05). In conclusion, the POCQI model has significantly improved health outcomes and reduced preventable health challenges with more research needed for sustainability and integration long-term.