Maternal Illness Research Articles

Parental Mental Illness and the Likelihood of Child Out-of-Home Care: A Cohort Study.

To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship. Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes. After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54). Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families.

Breastfeeding Rates During the COVID-19 Pandemic in Germany: Data from the CRONOS Registry.

SARS-CoV-2 infection and COVID-19 disease are thought to have an impact on breastfeeding rate - besides other known peripartal issues. Data of the national CRONOS registry regarding breastfeeding behavior in 6,746 women was analyzed regarding the time window between maternal SARS-CoV-2 infection and time of delivery. In addition, other influencing factors like the predominant viral variant, maternal disease severity, and gestational age at delivery were taken into account. Our data suggest that within the variables analyzed, in the case of acute maternal infection (<14 days before birth), breastfeeding behavior improved with increasing gestational age at birth (p<0.0001), with less severe maternal illness (p<0.0001) and as the pandemic progressed with less virulent viral variants (p=0.01). When adjusting for COVID-19-associated and non-associated factors, rooming-in remains the most important factor positively influencing breastfeeding behavior. With regards to the benefits for mother and infants from breastfeeding, a separation of mother and child even in case of infectious settings should be avoided.

Tachycardia Unresponsive to Crystalloid Bolus

Dehydration is a common complaint in the pediatric emergency department. The treatment is typically focused on oral or intravenous rehydration with the goal of normalization of vital signs, primarily the heart rate but potentially also the blood pressure. The failure of routine therapy may lead to the consideration of other etiologies, including potential chronic conditions. We present a unique case of a twenty-three-month-old female who initially presented to the pediatric emergency department with signs of dehydration secondary to vomiting and diarrhea as well as tachycardia that did not improve with fluid resuscitation. Although physical examination findings were subtle, laboratory testing later confirmed the diagnosis of thyrotoxicosis. She was started on treatment with atenolol and methimazole. This case describes thyroid disease in a young child without a history of maternal autoimmune illness, which is rarely diagnosed in the emergent department. Healthcare providers should be cognizant of the spectrum of clinical findings in pediatric hyperthyroidism, since the early recognition and treatment is crucial for improved outcomes with this life-threatening pediatric condition. We discuss the consequences of undiagnosed Grave’s disease and review common findings that can assist with early diagnosis in the emergency department.

AYURVEDIC MANAGEMENT OF STANYAKSHAYA WITH DARUHARIDRADIGANA KASHAYA W.S.R TO HYPO GALACTORRHEA - A CASE STUDY.

Stanyakshaya is a common threat, with primiparous women. Incidence has been estimated to range from 23% to 63% during the 1st 4 months after delivery. Emotional stress, anxiety and maternal illness are the various psychosomatic factors that influence lactation insufficiency. Due to which many lactating mothers use alternative food/milk instead of breastmilk which is harmful for baby’s health. Case report: A 25-year-old female, came with complaint of less amount of breast milk, is housewife by occupation was treated with Daruhradigana kashaya according to treatment regimen. Result &amp; Discussion: It has promising result in the management of all the parameters which improved gradually and at the end of day forty all parameter in mother found within normal limits of Stanyakshaya. Drugs used in the treatment of Mandagni serving as Nidana of all diseases is corrected, which are having Deepaniya Pachana Guna and Madhur rasa vipak. The correction of Atisantarpana leads to normalization of Vat dosh. So, the Preenan from the diet is assimilated properly by which Jeevan was achieved with respect to Jataragni. Conclusion: It works in Rasa dhatwagni Vardhan which in turn helps in Rasa dhatu &amp; its Upadhatu nirman and same should be corrected as Stanya is Upadhatu of Rasa dhatu. Same treatment plan may not be helpful in each and every patient of Stanyakshaya. The present study reporting a case of hypo-galactorrhea diagnosed and observed marked improvement. We hope further extended research on this problem.

Maternal Thyroid Dysfunction During Pregnancy as an Etiologic Factor in Autism Spectrum Disorder: Challenges and Opportunities for Research.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition with unknown etiology. Both genetic and environmental factors have been associated with ASD. Environmental exposures during the prenatal period may play an important role in ASD development. This narrative review critically examines the evidence for a relationship between maternal thyroid dysfunction during pregnancy and ASD in the child. Summary: Studies that assessed the associations of hypothyroidism, hyperthyroidism, hypothyroxinemia, thyroid hormone concentrations, or autoimmune thyroid disease with ASD outcomes were included. Most research focused on the relationship between hypothyroidism and ASD. Multiple population-based studies found that maternal hypothyroidism was associated with higher likelihood of an ASD diagnosis in offspring. Associations with other forms of maternal thyroid dysfunction were less consistent. Findings may have been affected by misclassification bias, survival bias, or publication bias. Studies using medical records may have misclassified subclinical thyroid dysfunction as euthyroidism. Two studies that assessed children at early ages may have misclassified those with ASD as typically developing. Most studies adjusted for maternal body mass index (BMI) and/or mental illness, but not interpregnancy interval or pesticide exposure, all factors associated with fetal survival and ASD. Most studies reported a combination of null and statistically significant findings, although publication bias is still possible. Conclusions: Overall, evidence supported a positive association between maternal thyroid dysfunction during pregnancy and ASD outcomes in the child, especially for hypothyroidism. Future studies could reduce misclassification bias by using laboratory measures instead of medical records to ascertain thyroid dysfunction and evaluating children for ASD at an age when it can be reliably detected. Survival bias could be further mitigated by adjusting models for more factors associated with fetal survival and ASD. Additional research is needed to comprehensively understand the roles of maternal levothyroxine treatment, iodine deficiency, or exposure to thyroid-disrupting compounds in the relationship between maternal thyroid dysfunction and child ASD outcomes.

Supplemental Material for Disinhibited Attachment Behavior Among Infants Reared at Home: Relations to Maternal Severe Mental Illness and Personality Disorder Symptoms

Supplemental Material for Disinhibited Attachment Behavior Among Infants Reared at Home: Relations to Maternal Severe Mental Illness and Personality Disorder Symptoms

Health Risks of Climate Change and Variability to Maternal Health

Climate change has emerged as a significant global challenge with far-reaching implications to human health. Through a comprehensive review of scholarly articles, the study examines the complex interplay between climate change and maternal health and highlights the role of religion in climate change mitigation. Mothers play an integral role in creating and sustaining healthy households. Furthermore, improving maternal health is essential to achieving global sustainable development goals, particularly goal 3 (Good Health and Well-being). The paper sought to examine the physical and psychosocial effects of climate change on expectant mothers. The study explored the following objectives: the direct impacts of climate change on maternal health; Indirect impacts of climate change on maternal; and mitigation strategies. The study revealed that, rising temperatures and heatwaves increase maternal heat-related illnesses, potentially affecting birth outcomes. Vector-borne diseases, influenced by climate shifts, pose additional threats to maternal well-being. Environmental stressors, including natural disasters and climate-related migration, contribute to maternal stress, anxiety and depression affecting maternal care. Christian teachings acknowledge human life as precious and sacred. It should be protected and valued from conception until death. Religious beliefs and values lay emphasis on stewardship of the environment, social justice, compassion, and community support. Religious institutions and leaders can play pivotal roles in advocating for climate action, promoting sustainable practices, and providing psychosocial support to individuals and families affected by climate-related health issues. To effectively combat climate change effects, the study recommends that it is imperative to embrace integrated approaches that prioritize healthcare access, environmental resilience, mental health support, and community-based initiatives that integrate religious perspectives with scientific knowledge and best practices.

Exposure to prenatal infection and the development of internalizing and externalizing problems in children: a longitudinal population-based study.

A large body of work has reported a link between prenatal exposure to infection and increased psychiatric risk in offspring. However, studies to date have focused primarily on exposure to severe prenatal infections and/or individual psychiatric diagnoses in clinical samples, typically measured at single time points, and without accounting for important genetic and environmental confounders. In this study, we investigated whether exposure to common infections during pregnancy is prospectively associated with repeatedly assessed child psychiatric symptoms in a large population-based study. Our study was embedded in a prospective pregnancy cohort (Generation R; n = 3,598 mother-child dyads). We constructed a comprehensive prenatal infection score comprising common infections for each trimester of pregnancy. Child total, internalizing, and externalizing problems were assessed repeatedly using the parent-rated Child Behavioral Checklist (average age: 1.5, 3, 6, 10, and 14 years). Linear mixed-effects models were run adjusting for a range of confounders, including child polygenic scores for psychopathology, maternal chronic illness, birth complications, and infections during childhood. We also investigated trimester-specific effects and child sex as a potential moderator. Prenatal exposure to infections was associated with higher child total, internalizing, and externalizing problems, showing temporally persistent effects, even after adjusting for important genetic and environmental confounders. We found no evidence that prenatal infections were associated with changes in child psychiatric symptoms over time. Moreover, in our trimester-specific analysis, we did not find evidence of significant timing effects of prenatal infection on child psychiatric symptoms. No interactions with child sex were identified. Our research adds to evidence that common prenatal infections may be a risk factor for psychiatric symptoms in children. We also extend previous findings by showing that these associations are present early on, and that rather than changing over time, they persist into adolescence. However, unmeasured confounding may still explain in part these associations. In the future, employing more advanced causal inference designs will be crucial to establishing the degree to which these effects are causal.

Assessment of non-syndromic orofacial cleft severity and associated environmental factors in Saudi Arabia: A cross-sectional study

ObjectiveTo evaluate the relationship between different environmental risk factors and the severity of cleft lip with/without palate (CL ± P) and cleft palate (CP) in Saudi Arabia. MethodsThis was a cross-sectional national study, of government hospitals in 10 cities distributed across major regions of Saudi Arabia, from June 2020 to June 2021. All newborns with CL ± P or CP were clinically examined and evaluated for cleft phenotype severity using the LAHSHAL classification system. Various environmental factors were evaluated by interviewing parents using a validated questionnaire. The severity of CL ± P and CP was evaluated in relation to environmental factors. ResultsWe recruited 174 patients with non-syndromic orofacial cleft (NSOFC); 122 (70.1 %) had CL ± P and 52 (29.9 %) had CP. After adjusting the odds ratios by ordinal regression for CL ± P and logistic regression analysis for CP, environmental factors that significantly increased the severity of CL ± P were family history of NSOFC, maternal illnesses, and maternal medication use (P = 0.02, adjusted odds ratio [AOR]:2.70; P = 0.002, AOR:3.70; and P = 0.03, AOR:2.14, respectively). Folic acid supplementation in the first trimester significantly reduced the severity of CL ± P and CP (P = 0.001, AOR:0.18 and P = 0.001, AOR:0.012, respectively). ConclusionThe severity of CL ± P was affected by some maternal exposures during the 3-month pre-gestation period. Therefore, our results suggest the possibility of controlling the severity of NSOFC.

Improving Data Collection in Pregnancy Safety Studies: Towards Standardisation of Data Elements in Pregnancy Reports from Public and Private Partners, A Contribution from the ConcePTION Project.

The ConcePTION project aims to improve the way medication use during pregnancy is studied. This includes exploring the possibility of developing a distributed data processing and analysis infrastructure using a common data model that could form a foundational platform for future surveillance and research. A prerequisite would be that data from various data access providers (DAPs) can be harmonised according to an agreed set of standard rules concerning the structure and content of the data. To do so, a reference framework of core data elements (CDEs) recommended for primary data studies on drug safety during pregnancy was previously developed. The aim of this study was to assess the ability of several public and private DAPs using different primary data sources focusing on multiple sclerosis, as a pilot, to map their respective data variables and definitions with the CDE recommendations framework. Four pregnancy registries (Gilenya, Novartis; Aubagio, Sanofi; the Organization of Teratology Information Specialists [OTIS]; Aubagio, Sanofi; the Dutch Pregnancy Drug Register, Lareb), two enhanced pharmacovigilance programmes (Gilenya PRIM, Novartis; MAPLE-MS, Merck Healthcare KGaA) and four Teratology Information Services (UK TIS, Jerusalem TIS, Zerifin TIS, Swiss TIS) participated in the study. The ConcePTION primary data source CDE includes 51 items covering administrative functions, the description of pregnancy, maternal medical history, maternal illnesses arising in pregnancy, delivery details, and pregnancy and infant outcomes. For each variable in the CDE, the DAPs identified whether their variables were: identical to the one mentioned in the CDE; derived; similar but with a divergent definition; or not available. The majority of the DAP data variables were either directly taken (85%, n = 305/357, range 73-94% between DAPs) or derived by combining different variables (12%, n = 42/357, range 0-24% between DAPs) to conform to the CDE variables and definitions. For very few of the DAP variables, alignment with the CDE items was not possible, either because of divergent definitions (1%, n = 3/357, range 0-2% between DAPs) or because the variables were not available (2%, n = 7/357, range 0-4% between DAPs). Data access providers participating in this study presented a very high proportion of variables matching the CDE items, indicating that alignment of definitions and harmonisation of data analysis by different stakeholders to accelerate and strengthen pregnancy pharmacovigilance safety data analyses could be feasible.

Evaluation of Calretinin and enumeration of mast cells in rectum tissue biopsies of Hirschsprung and non-Hirschsprung disease in neonate and infant

The Hirschsprung disease (HD) is a complex genetic congenital condition characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the colon and rectum, leading to functional intestinal obstruction. A study was conducted from July 2022 to December 2022. The Toluidine blue stain and calretinin immunohistochemistry were applied to 36 cases of neonates and infants who clinically presented with symptoms suspicious of having HD, And the hematological study of cell blood counts test and compared the result of the HD group with the non-HD group and control group. The study showed an increase in mast cell numbers in the rectal biopsy tissue of HD patients compared with non-HD patients using Toluidine blue stain. The Immunohistochemistry for calretinin result displayed 27 (75%) cases as HD, while the remaining 9 (25%) cases were confirmed as non-HD and showed hypertrophied nerve fiber in HD cases. at the same time, the complete blood count result was unrelated to HD. Some worrying maternal risk factors were highlighted during pregnancy were the age of the mother at conception, maternal illness, intake of drugs, type of Childbirth, and number of previous maternal abortions; all of them show a non-significant difference between the HD group and non-HD group, also consanguineous marriage was detected and shows a significant difference between the HD group and non-HD group. Keywords: Hirschsprung, Calretinin, Toluidine blue, CBC count

Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review

IntroductionMore than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal...

Prevalence and associated factors of structural congenital anomalies in resource limited setting, 2023: a systematic review and meta-analysis.

Several studies have been conducted on structural congenital anomalies (CA). However, there is a paucity of studies that provide a comprehensive review of structural anomalies. We aimed to verify the available research articles to pool the possible risk factors of structural CA in resource-limited settings. The research articles were genuinely searched using PubMed, Scopus, Cochrane Library, Web of Science, free Google database search engines, Google Scholar, and ScienceDirect databases. Published studies were searched and screened for inclusion in the final analysis, and studies without sound methodologies and review and meta-analysis were not included in the analysis. This review analyzed data from 95,755 women who gave birth as reported by primary studies. Ten articles were included in this systematic review and meta-analysis. The articles that had incomplete information and case reports were excluded from the study. The overall pooled effect estimate (EI) of structural CA was 5.50 (4.88-6.12) per 100 births. In this systematic review and meta-analysis, maternal illness EI with odds ratio (OR) = 4.93 (95% CI: 1.02-8.85), unidentified drug use with OR = 2.83 (95% CI: 1.19-4.46), birth weight with OR = 4.20 (95% CI: 2.12-6.28), chewing chat with OR = 3.73 (95% CI: 1.20-6.30), chemical exposure with OR = 4.27 (95% CI: 1.19-8.44), and taking folic acid tablet during pregnancy with OR = 6.01 (95% CI: 2.87-14.89) were statistically significant in this meta-regression. The overall pooled effect estimate of structural CA in a resource-limited setting was high compared to that in countries with better resources. Maternal illness, unidentified drug use, birth weight, chewing chat, chemical exposure, and never using folic acid were found to be statistically significant variables in the meta-regression. Preconception care and adequate intake of folic acid before and during early pregnancy should be advised. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384838.

Stigma perceived by mothers of children with congenital Zika virus syndrome

Objective: to understand the experiences of stigma perceived by mothers of children with congenital Zika virus syndrome and its repercussions. Methods: a qualitative study was carried out with 12 mothers who responded to semi-structured interviews. Correspondence Factor Analysis and Descending Hierarchical Classification were carried out using the IRaMuTeQ software. Results: four classes emerged that deal with the experience of perceiving stigma: Perceiving public discrimination; Stigmatizing behaviors and their repercussions; Feeling guilty and adopting coping strategies; Experiencing rejection from the father, others and feeling lonely. Conclusion: stigma is perceived by mothers of children with congenital Zika virus syndrome in affective, family, and social interactions, expressed through rejection, withdrawal and exclusion resulting in suffering for the mothers, who adopt hiding the child and self-isolation as coping strategies. Contributions to practice: nursing should identify signs of social isolation, deep sadness and stress related to the stigma of being the mother of a child with congenital Zika virus syndrome and draw up care plans to prevent maternal illness.

Barriers in exclusive breastfeeding encountered by mothers in urban slum area of a metropolitan city.

Breastfeeding is considered the most important source of nutrients for the baby. But owing to ignorance, lack of education, and cultural norms, exclusive breastfeeding (EBF) is not done by majority of the mothers. Hence, this study is carried out to determine various barriers faced by the mothers that influenced their decision on EBF. A descriptive qualitative study was conducted among the mothers whose children were less than 1 year of age visiting a well-baby clinic and Immunisation OPD of Urban Health Centre catering to the Urban Slum of Malvani in the Metropolitan city of Mumbai. In-depth interviews (IDIs) were done with 17 participants from August to November 2022. Thematic analysis was conducted on the qualitative data obtained. Four major themes were generated from the transcripts. They are -barriers and concerns faced by mothers to exclusively breastfeed, enablers/motivators, sources of knowledge regarding EBF, and breastfeeding practices. Various barriers faced by mothers were gaps in knowledge, maternal Illness, religious reasons, inadequate milk production, bias toward top feeds, lack of autonomy to take decisions, and cultural norms, while positive family support, good knowledge about breastfeeding, and a supportive home environment motivated mothers to exclusively breastfeed their infants. Sources of knowledge were identified to be doctors and health care workers, mothers/mothers-in-law, sisters, friends, and social media. There are various challenges as well as motivators identified for EBF. Barriers, such as gaps in knowledge, and the negative influence of social media can be improved upon by health education. Therefore, it is crucial to teach expectant mothers as well as families about breastfeeding. Additionally, we advise stepping up public health education initiatives to support breastfeeding.

Cardiovascular disease in pregnancy and its outcome: A prospective study.

Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases.

Psychiatric illness and pregnancy: A literature review

BackgroundWomen of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. ObjectivesThis article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. MethodsA thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. ResultsThe presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. ConclusionsPregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.

Maternal psychiatric and somatic illness, and the risk of unintentional injuries in children: variation by type of maternal illness, type of injury and child age

BackgroundMaternal mental illness appears to increase the risk of unintentional childhood injuries, which are a common cause of morbidity and mortality in early childhood. However, little is known about the...

Current preconception care practice in the Netherlands — An evaluation study among birth care professionals

ObjectiveTo evaluate the current practice of preconception care in the Netherlands and the perceptions of birth care professionals concerning preconception care. MethodsWe have developed a digital questionnaire and conducted a cross-sectional study by distributing the questionnaire among 102 organisations: 90 primary care midwifery practices and obstetric departments of 12 hospitals in the Southwest region of the Netherlands between December 2020 and March 2021. One birth care professional per organization was asked to complete the questionnaire. Descriptive statistics were used to present the results. FindingsRespondents of eighty-three organisations (81.4 %) filled in the questionnaire, of whom 74 respondents were independent primary care midwives and 9 respondents were obstetricians. Preconception care mostly consisted of an individual consultation in which personalized health and lifestyle advice was given. Among the respondents, 44.4 % reported that the organization had a preconception care protocol. The way in which the consultation was carried out, as well as the health and lifestyle related questions asked, differed between respondents. More than 85 % of the respondents inquire about the following possible risk factors for complications: maternal illnesses, obstetric history, folic acid supplement intake, alcohol intake, smoking, substance abuse, hereditary disease, prescription medication, dietary habits, overweight, and birth defects in the family. The respondents acknowledged that preconception care should be offered to all couples who wish to become pregnant, as opposed to offering preconception care only to those with an increased risk of complications. Still, respondents do not receive many questions regarding the preconception period or requests for preconception care consultations. Key conclusionBirth care professionals acknowledge the need for preconception care for all couples. In the Netherlands, preconception care consists mostly of an individual consultation with recommendations for health and lifestyle advice. However, the identification of risk factors varies between birth care professionals and less than half of the respondents indicate that they have a protocol available in their practice. Furthermore, the demand of parents-to-be for preconception care is low. More research, that includes more obstetricians, is necessary to investigate if there is a difference between the care provided by primary care midwives and obstetricians. Implications for practice: To increase the awareness and uptake of preconception care, it would be prudent to emphasize its importance to parents-to-be and professionals, and actively promote the use of widespread, standardized protocols for birth care professionals.

Pathophysiology and management of iron deficiency anaemia in pregnancy: a review.

According to World Health Organization (WHO), iron deficiency anaemia (IDA) is considered the most prevalent nutritional deficiency worldwide, affecting approximately 30% of the global population. While gastrointestinal bleeding and menstruation in women are the primary causes of IDA, insufficient dietary iron intake and reduced iron absorption contribute to the condition. The aim of IDA treatment is to restore iron stores and normalise haemoglobin levels in affected patients. Iron plays a critical role in various cellular mechanisms, including oxygen delivery, electron transport, and enzymatic activity. During pregnancy, the mother's blood volume increases, and the growing foetus requires a significant increase in iron. Iron deficiency during pregnancy is associated with adverse outcomes such as maternal illness, low birth weight, preterm birth, and intrauterine growth restriction. Iron supplementation is commonly used to treat IDA; however, not all patients benefit from this therapy due to factors such as low compliance and ineffectiveness. In the past, IV iron therapy was underutilised due to its unfavourable and occasionally unsafe side effects. Nevertheless, the development of new type II and III iron complexes has improved compliance, tolerability, efficacy, and safety profiles. This article aims to provide an updated overview of the diagnosis and management of IDA during pregnancy. It will discuss the advantages and limitations of oral versus intravenous iron and the pathophysiology, diagnosis, treatment, and overall management of IDA in pregnancy.