Maternal Health Research Articles

Climate-fuelled disasters and perinatal health: the catch 22 when undertaking research within an under-resourced health sector

Background Climate-fuelled disasters are increasing in frequency and duration, with impacts known to disproportionately affect vulnerable populations, such as perinatal women and young families. Local healthcare workforce engagement into planning responses is required to ensure improved healthcare for these populations. One important component of perinatal care in Australia occurs through the maternal and child health nurses (MCHN). Attempted research engagement with the maternal child health nurse sector regarding the impact of disasters on the care of perinatal women during times of disaster has encountered structural barriers. Aim To understand the structural barriers that impact the research engagement of rural MCHN particularly during times of disasters. Methods A facilitated focus group with semi-structured questions was conducted with five participant-researchers. The focus group discussion underwent reflexive thematic analysis. Results Identified themes were Rationale for Research into Care of Families in the Perinatal Period, Perinatal Health and Service Provision and The Overlay of Disasters. An overarching fourth theme Implications for future Research identified elements that may improve the research engagement of primary healthcare staff, including MCHN. Conclusion There is a need to overcome structural challenges to MCHN engagement in meaningful research around the impacts of multiple disasters. Appropriate research design, including utilising co-design, adequate resourcing, and planned and considered participant communication may help to improve participant engagement for this important research. With improved sector engagement, the ongoing care of perinatal women in the current environment of multiple and compounding climate-fuelled disasters will be improved.

Analysis of Factors Influencing Pregnant Women in the Completeness of Antenatal Care Visits at UPTD Puskesmas Care Kutambaru, Lawe Bulan District, Southeast Aceh Regency

ANC or anteatal care is the care of the mother and fetus during pregnancy. Currently, the proportion of maternal mortality is approximately 305 deaths per 100 thousand live births, where the largest deaths occur in hospitals, around 77% of mothers cannot be saved, one of which is because the mothers who are referred to the hospital are already in a condition of severe complications. The purpose of this study is to analyze pregnant women in the completeness of antenatal care visits in the Working Area of the Kutambaru Care Health Center, Lawe Bulan District, Southeast Aceh Regency. This type of research uses a mixed method. The population in this study was 112 respondents, the sample in the study was 53 respondents with a slovin formula with a random sampling technique for qualitative using 9 informants. The variable results entered the multivariate test because the P value was ≤ 0.25. The results of the Multivariate analysis showed significant values and the variables of Exp(B) were, Knowledge (0.015) Exp(B) (3.572), Education (0.001) Exp(B) (0.007), Attitude (0.018) Exp(B) (1.398), Parity (0.009) Exp(B) (1,786), Income (0.000) Exp(B) (0.008), Distance (0.001) Exp(B) (1,904), Maternal Health (0.005) Exp(B) (1,556), Health Worker Support (0.001) Exp(B) (2,387). Results of Qualitative Data Analysis with Data Reduction, Data Display and Conclusion Drawing/Verification.From the results of in-depth interviews, it was found that there was an influence on the completeness of the ANC visit with factors of knowledge, education, attitude, parity, income, distance, maternal health and support of health workers. The conclusion of this study is that there is a relationship between knowledge, education, attitude, parity, income, distance, maternal health and health worker support for the completeness of ANC visits, the knowledge factor is the most dominant influencing ANC examination in pregnant women with an Exp(B) value of 3.572. It is hoped that health workers at the Kutambaru Health Center will be more routine in delivering health education to pregnant women about the importance of ANC examinations.

The relationship between the use of opioids in pregnancy and newborn’s health

ABSTRACT Objective The use of opioid substances during pregnancy, including heroin and methadone, is associated with adverse outcomes. This study aims to investigate the relationship between maternal opioid use and factors related to neonatal health at birth in Iran in 2022. Methods This was a case-control study conducted with 206 mothers (103 with opioid use disorder and 103 without). Data concerning maternal health were collected via questionnaires, while neonatal health information was obtained from maternal medical records. Data analysis was performed using Pearson correlation, independent t-tests, multiple regression, and descriptive statistics. Results The average APGAR score one minute after birth was 8.94 ± 0.23 in the group of mothers with opioid use disorder and 8.98 ± 0.19 in the group without opioid use disorder. No statistically significant difference was found between the two groups regarding APGAR scores at one minute and five minutes after birth (p > 0.05). A multiple regression analysis revealed a significant statistical relationship between maternal opioid use and neonatal weight, height, and head circumference (R = 0.71, p < 0.001). Conclusion Significant differences were observed between mothers with opioid use disorder and those without in terms of neonatal weight, head circumference, and height.

Downregulated PSME3 Contributes to Severe Preeclampsia by Promoting Trophoblast Cell Apoptosis.

Severe preeclampsia (sPE) is a serious condition posing risks to both maternal and fetal health. Based on mass spectrometry analysis, we identified a key protein, PSME3 (proteasome activator subunit 3), an 11S proteasome activator, whose protein level was significantly downregulated in sPE placentas and whose function in sPE remains unknown. PSME3 protein levels in human placental tissue were detected using Western blot, and PSME3 concentration in serum was detected by ELISA assay. The human preeclampsia-like phenotypes of Psme3-/- pregnant mice were examined. Trophoblast cell apoptosis was detected by flow cytometry. Pregnant mice were treated with 9.5% O2 to construct a preeclampsia mouse model for detecting placental Psme3 expression. The regulation of PSME3 expression by hypoxia was detected in trophoblast cell lines treated with 21% O2 or 1% O2. PSME3 protein levels were significantly downregulated in sPE placentas and serum. Pregnant mice with Psme3-/- embryos and placentas spontaneously presented human preeclampsia-like symptoms, including hypertension and proteinuria, increased serum soluble fms-like tyrosine kinase 1 concentration, fetal growth restriction, and increased cellular apoptosis. Mechanically, PSME3 knockdown promoted the apoptosis of trophoblast cells by repressing the degradation of UBE2V2 (ubiquitin conjugating enzyme E2 V2). Moreover, the placentas of hypoxia-induced preeclampsia mice presented significantly reduced Psme3 protein levels and elevated Ube2v2 protein levels. Hypoxia-inducible factor-1α functioned as a transcriptional repressor of PSME3. In sPE placentas, hypoxia of the placenta may lead to the transcriptional inhibition of PSME3. PSME3 deficiency promotes the accumulation of UBE2V2, thereby inducing trophoblast cell apoptosis. Our study provides a new perspective for elucidating the pathogenesis of sPE.

Armed violent conflict and healthcare-seeking behavior for maternal and child health in sub-Saharan Africa: A systematic review.

Over 630 million women and children worldwide have been displaced by conflict or live dangerously close to conflict zones. While the adverse effects of physical destruction on healthcare delivery are relatively well understood, the effects on healthcare-seeking behavior remain underexplored, particularly in sub-Saharan Africa. This study aims to better understand the interconnections and knowledge gaps between exposure to armed violent conflicts and healthcare-seeking behaviors for maternal and child health in sub-Saharan Africa. Five key electronic databases (PubMed, Scopus, Web of Science, PsycNET, and African Journals Online) were searched for peer-reviewed publications between 2000 and 2022. The review was designed according to PRISMA-P statement and the protocol was registered with PROSPERO database. The methodological quality and risks of bias were appraised using GRADE. A data extraction instrument was modelled along the Cochrane Handbook for Systematic Reviews and the Centre for Reviews and Dissemination of Systematic Reviews. The search results yielded 1,148 publications. Only twenty-one studies met the eligibility criteria, reporting healthcare-seeking behaviors for maternal and child health. Of the twenty-one studies, seventeen (81.0%) reported maternal health behaviors such as antenatal care, skilled birth attendance, postnatal care services, and family planning. Nine studies (42.8%) observed behaviors for child health such as vaccination uptake, case management for pneumonia, diarrhea, malnutrition, and cough. While conflict exposure is generally associated with less favorable healthcare-seeking behaviors, some of the studies found improved health outcomes. Marital status, male partner attitudes, education, income and poverty levels were associated with healthcare-seeking behavior. There is a need for multifaceted interventions to mitigate the impact of armed violent conflict on healthcare-seeking behavior, given its overall negative effects on child and maternal healthcare utilization. While armed violent conflict disproportionately affects children's health compared to maternal health, it is noteworthy that exposure to such conflicts may inadvertently also lead to positive outcomes. CRD42023484004.

Effects of maternal healthcare service utilization on modern postpartum family planning access in Bangladesh: insights from a National representative survey.

Access to modern family planning is critical for improving maternal and child health outcomes, yet it remains severely lacking in low- and middle-income countries, including Bangladesh. Maternal healthcare utilization during and after pregnancy is vital for promoting postpartum family planning. This study examined the effects of maternal healthcare service utilization on postpartum family planning uptake in Bangladesh. Reproductive calendar data from 4,081 women with recent live births were extracted from the cross-sectional 2017/18 Bangladesh Demographic and Health Survey and analyzed. The outcome variable was uptake of modern postpartum family planning methods and the exposure variables were different types of maternal healthcare services. Kaplan-Meier methods were used to calculate cumulative probabilities of modern postpartum family planning method uptake within 12 months post-delivery, and modified Poisson regression models were used to estimate the effects of utilizing maternal healthcare services on modern postpartum family planning method uptake. Modern family planning methods in the 12 month postpartum period were used by 72% of women, with over 60% starting after day 40. Less than 4% used long-acting family planning methods, while almost 40% relied on the oral contraceptive pill. Utilizing maternal healthcare services was associated with up to a 7% higher uptake of modern postpartum family planning methods compared to non-users. Three-quarters of Bangladeshi women use modern family planning within the 12 months postpartum, but often rely on less effective methods. Additionally, 25% of these women resort to traditional or no use of contraceptive methods, increasing the risks of unintended pregnancy, short birth intervals, and adverse maternal and infant health outcomes. Maternal healthcare services, including private facilities, should prioritize modern postpartum family planning provision, along with education and counseling on the benefits of long-acting contraception.

Determinations of Antenatal Care Utilization Among Reproductive Age Women in Lumbini Province, Nepal

This study examines the factors influencing Antenatal care (ANC) utilization among women aged 15–49 in Lumbini Province, Nepal, using data from the 2021 Nepal Demographic and Health Survey (NDHS). Logistic regression analysis identifies significant determinants of ANC attendance, including age, birth order, education, and wealth. This study shows that in a similar meter from the previous, women in the age group of 20-24 years are at a risk of almost 4.78 times greater for attending ANC visits than women below it. The odds continue to increase as with an all-time high validation for women aged 30-49 years (OR = 11.75, p = 0.017). Where birth order sometimes negatively affects ANC usage, women with three or more children will less likely seek ANC (OR = 0.344, p = 0.063). There is a positive association between the ANC use and education because those women with better education are 2.83 more likely to access ANC services, although it is not very significant. Indeed, differences in the economics that do exist show that poorer women attend ANC as showed to by an OR of 0.384, which denotes that they are 0.384 times less likely to attend ANC compared to the poorest (OR = 0.384, p = 0.045): with wealth, indirect influences of religion, caste/ethnicity, and location using socio-economic factors being biased toward ANC use. It shows that, it should to improve ANC for young mothers, women with higher birth orders, and income. Addressing these gaps therefore needs a multi-faceted approach in terms of strengthening education, financial support, and healthcare infrastructure. The findings provide the much needed evidence and policymakers to strategize around maternal health equity and SDG pathways that give detail in regard to addressing maternal and child health issues in Lumbini Province.

Socioeconomic Relations with the Utilization of Maternal Health Services in Marginalized Communities

This study aims to see the description of the utilization of maternal health services in marginalized communities in Makassar City and its relationship with socioeconomic characteristics. The total respondents who returned the complete questionnaire were 560 people or 79.6% of the 783 total questionnaires distributed. The study was conducted cross-sectionally. To describe socioeconomic and utilization of health services using frequency distribution. We set using cross-tabulations to see the relationship between the two variables. The results showed that socioeconomic characteristics have a significant relationship with the utilization of maternal and child health services. This study shows that the low utilization of maternal health services in vulnerable groups such as women can be caused by factors such as low levels of education, income, and accessibility of health services.

The Serbian version of the Pandemic-Related Pregnancy Stress Scale (PREPS-SRB)-A validation study.

Pregnancy is a sensitive period in a woman's life when psychological distress can have negative consequences for the mother and fetus. Prolonged and intensified symptoms of anxiety and depression caused by the COVID-19 pandemic increase the risk of maternal and fetal health complications. The Pandemic-Related Pregnancy Stress Scale (PREPS) is a thoroughly designed tool that helps determine and analyze stress among pregnant women during pandemics in three domains: Preparedness in childbirth, (2) Infection, and (3) Positive Appraisal. A cross-sectional study included 189 pregnant women attending a community health center, "Dr Simo Milošević," in Belgrade, Serbia, from January to February 2022. Pregnant women anonymously completed a questionnaire as part of the study. The mean scores for those three domains are as follows: Preparedness (2.4 ± 0.9), Infection stress (2.8 ± 1.1), and Positive Appraisal (3.7 ± 0.9). Internal consistency of the PREPS questionnaire for PREPS-Total (α = 0.867). An explanatory factor analysis of the PREPS showed that the Serbian version of the Pandemic-Related Pregnancy Stress Scale has good psychometric properties. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was found to be 0.860, indicating a high degree of sampling adequacy. Additionally, Bartlett's Test of Sphericity yielded a statistically significant result (χ2 = 1564.206, df = 105, p < 0.001). The CFA showed very good fit indices for the Serbian sample, confirming the factor structure of the original English version. The RMSEA value of 0.056 (0.036-0.075) and values for fit indices TLI (0.961) and CFI (0.974) were above the cut-off of ≥0.95, indicating an excellent fit. All standardized factor loadings were statistically significant and ranged from 0.50 to 0.85. The PREPS-SRB questionnaire serves as a valuable tool for Serbian healthcare professionals, allowing them to identify pregnant women experiencing significant stress related to the COVID-19 pandemic.

Effect of Antenatal Monthly Sulfadoxine-Pyrimethamine, Alone or with Azithromycin, on Gestational Weight Gain and Anemia during Pregnancy and One Month Postpartum in Malawi: A Randomized Controlled Trial Secondary Analysis.

Low gestational weight gain (GWG) and prenatal anemia are associated with adverse pregnancy, maternal and infant health outcomes. In a secondary analysis of a single-center, randomized, partially placebo-controlled, outcome assessor-blinded, controlled trial conducted in Malawi from 2003 to 2006, when antiretroviral treatment (ART) for HIV was not widely available, we studied whether GWG can be increased and the prevalence of maternal anemia decreased during pregnancy and at 1 month postpartum through the intermittent preventive treatment in pregnancy (IPTp) of maternal malaria and reproductive tract infections. The participants (≥15-year-old women with uncomplicated second trimester single pregnancies) received either sulfadoxine (1,500 mg) and pyrimethamine (75 mg; SP) twice (control group, n = 433), monthly SP (n = 439), or monthly SP and azithromycin (1,000 mg) twice (AZI-SP, n = 441) during pregnancy. The mean weekly GWG in the sample was 256 g/week. The participants in the monthly SP group gained, on average (95% CI), 4 g (-13 to 20; P = 0.671), and those in the AZI-SP group gained 25 g (8-41; P = 0.003) more weight per week than control group participants. Among HIV-positive participants (12%), the differences were larger and also significant between the monthly SP group and control group. Mean hemoglobin and anemia prevalence did not differ between the groups during pregnancy or postnatally. The data support a hypothesis that IPTp with monthly SP and two doses of azithromycin can increase GWG, especially among HIV-positive women who are not on ART, possibly through the reduction of infections, inflammation, and effects on the maternal gut microbiome.

Identification of genes involved in energy metabolism in preeclampsia and discovery of early biomarkers

BackgroundPreeclampsia is a complex pregnancy condition marked by hypertension and organ dysfunction, posing significant risks to maternal and fetal health. This study investigates the role of energy metabolism-associated genes in preeclampsia development and identifies potential early diagnostic biomarkers.MethodsPreeclampsia datasets from Gene Expression Omnibus were analyzed for batch correction, normalization, and differential expression. Enrichment analyses using gene ontology, Kyoto Encyclopedia of Genes and Genomes, and gene set enrichment were performed. Protein-protein interaction networks were constructed to identify key genes, and regulatory networks involving transcription factors, miRNAs, and RNA-binding proteins were established. Differential expression was validated with receiver operating characteristic curve analyses, and immune infiltration was assessed.ResultsSix energy metabolism-related genes were identified. Enrichment analyses revealed their involvement in glycolysis, gluconeogenesis, lipid transport, bone remodeling, and glucagon secretion. Key differentially expressed genes included CRH(Corticotropin-Releasing Hormone), LEP(Leptin), PDK4(Pyruvate Dehydrogenase Kinase Isozyme 4), SPP1(Secreted Phosphoprotein 1), and SST(Somatostatin). PDK4 exhibited moderate accuracy in receiver operating characteristic analysis. Immune infiltration analysis indicated significant differences between preeclampsia and control samples. qRT-PCR confirmed LEP and CRH increased, while SPP1 expression in preeclampsia samples.ConclusionDysregulated energy metabolism-related genes may contribute to preeclampsia through metabolic and immune changes. Identifying these genes aids in understanding preeclampsia’s molecular basis and early diagnosis. Future studies should validate these markers in larger cohorts and explore targeted treatments.

Factors That Influence Maternal Child Health Nurses’ Identification of Risk of Family Violence to First Nations Women in Australia

Aim: To understand the factors that influence family violence towards First Nations women, to inform practises and policies to support these women and improve their engagement in maternal child health services. Design: A qualitative study, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’, and thematic analysis of the data. Materials and Methods: Survey of 10 Maternal Child Health nurses in 2019, and interviews of 35 Aboriginal mothers in 2021. Results: The nurses identified drugs, alcohol, socio-economic issues, the history of effects of colonisation on First Nations peoples, and stress as perceived factors influencing family violence, and acceptance, fear, cultural beliefs, and mistrust, for women’s low reporting of violence. Factors that influenced nurses’ ability to identify family violence were mistrust and understanding of Aboriginal culture. Low self-esteem, lack of belonging, and not being heard were identified by the mothers as factors that influence family violence. Fear of child protective services, shame, mistrust, and poor rapport with the nurses contributed to their low reporting of violence. The most significant factor for the mothers to disclose violence is fear of losing her child, mistrust, and the questioning process. Conclusions: Nurses’ understanding of Indigenous culture is critical to develop trust and improve the engagement of First Nations women. A significant difference in the synthesis of data between the nurses and their First Nations consumers was conspicuous. Research regarding the benefit of models and interventions that recognise the social determinants of health and well-being on health outcomes as well as the value of culturally strong health services aimed to encourage an earlier identification of risk, ideally from the antenatal period to the child’s fifth birthday, is imperative. The implications of this research are of international importance for First Nations families and challenge current nursing practises to address the human rights challenge of the inequity in health outcomes between First Nation and non-First Nation children, their exposure to family violence, and their over-representation in child protection services.

Antenatal Healthcare Utilization and Maternal Health Outcomes in Rural African Setting: Evidence from Tanzania

Antenatal Healthcare Utilization and Maternal Health Outcomes in Rural African Setting: Evidence from Tanzania

Integration of transcriptomics and metabolomics data revealed role of insulin resistant SNW1 gene in the pathophysiology of gestational diabetes.

Gestational Diabetes Mellitus (GDM) is an emerging maternal health problem with increasing incidences. The lack of complete understanding of its pathophysiological mechanisms and novel regulatory biomarkers makes early diagnosis difficult. High-throughput RNA sequencing and computational bioinformatics analyses were conducted to identify novel hub genes, and their regulatory mechanisms were validated through qRT-PCR, western blot, and siRNA-mediated knockdown studies. Intermediate metabolites and circulatory levels of amino acids in the serum of GDM patients and healthy controls were measured. Transcriptomic studies identified SNW1 as the most sensitive and specific biomarker, significantly up-regulated in GDM (fold change = 1.09; p < 0.001). Metabolomic studies indicated significantly elevated gluconeogenesis in GDM, evidenced by decreased levels of alanine and increased levels of pyruvate and glucose compared to controls. siRNA-mediated knockdown of SNW1 in PANC1 cells resulted in significant down-regulation of alanine aminotransferase (ALT/GPT) and insulin receptor substrate (IRS1), while glucose transporters (GLUT2/GLUT4) and insulin (INS) were significantly up-regulated at both mRNA and protein levels. This study identified SNW1 as a novel insulin-resistant gene that induces hyperglycemia by elevating gluconeogenesis and decreasing glucose uptake. SNW1 may be considered a potential therapeutic target with clinical utility for the management of GDM.

Barriers and facilitators to maternal healthcare in East Africa: a systematic review and qualitative synthesis of perspectives from women, their families, healthcare providers, and key stakeholders

BackgroundIn East Africa, women face significant challenges accessing maternal healthcare during pregnancy, childbirth, and the postnatal period. While several studies have examined barriers and facilitators to maternal care, there is no comprehensive review reflecting the various perspectives of women, their families, healthcare providers, and key stakeholders. We systematically reviewed qualitative literature on maternal healthcare in East Africa, synthesizing insights from multiple perspectives and exploring barriers and facilitators across socioecological levels.MethodsA qualitative evidence synthesis focused on studies from East Africa published between January 2015 and June 2024. We searched electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, and used citation tracking to find additional references. Eligible studies were critically appraised using the Critical Appraisal Skills Program, and a thematic synthesis was performed to identify barriers and facilitators.ResultsOf the 3181 records identified, 81 studies (63 qualitative and 18 mixed method) met the inclusion criteria, representing 4816 individuals from six East African countries. This review identified barriers at various levels: individual barriers included a lack of awareness and knowledge, fear of being treated poorly, and financial constraints; interpersonal barriers comprised limited family support, communication challenges, and a lack of decision-making autonomy; health facility barriers included poor quality of healthcare, poor infrastructure, limited medical supplies, provider shortages, abusive behaviors from healthcare providers, lack of transportation, and high service costs; community-level barriers involved socio-cultural norms, societal stigma, and gender-based disparities; and policy-level barriers included poor focus on maternal health, a lack of male accompaniment policies, and conflicts. Key facilitators identified included improved healthcare understanding and women's self-efficacy at the individual level, family support and positive social influences at the interpersonal level, high-quality services, reliable transportation, compassionate care, and health education at the health facility level, community initiatives, gender equality, and maternity waiting homes at the community level, as well as free maternity services and health extension programs at the policy level.ConclusionThe synthesis identified key barriers and facilitators to the maternal healthcare in East African countries, ranging from individual to policy levels. We recommend that future initiatives focus on addressing these barriers while enhancing facilitators across individual, interpersonal, health facility, community, and policy levels through woman-centered, evidence-based strategies. Moreover, fostering collaboration among governments, healthcare providers, and communities is essential for improving access to the maternal continuum of care.

Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop

ABSTRACT Background Malawi has made progress in improving access to maternity care services, shifting the focus to quality of care as an essential determinant of maternal health outcomes. However, no effective mechanisms exist to use patients’ experiences of care at health facilities to inform and improve the quality of maternal healthcare. Objective To use maternal sepsis patient journeys in a workshop with maternal health stakeholders to identify and prioritise barriers in care and recommend interventions to improve maternal healthcare quality in Malawi. Methods In February 2024, in Blantyre, Malawi, using a modified nominal group technique, 28 stakeholders reviewed the patient journeys of three women hospitalised at Queen Elizabeth Central Hospital, who had sepsis after childbirth. Patient journeys narrate events experienced within a healthcare system in the patient’s words. In a multiframework approach (Four Delays, Respectful Maternity Care, and WHO Quality of Care), stakeholders identified and prioritised barriers to care and recommended interventions to improve the quality of maternal healthcare. Content analysis of the workshop data linked barriers with stakeholders’ suggested interventions. Results Nineteen barriers identified included various delays in receiving care, mistreatment by healthcare providers, and suboptimal quality of care. Stakeholders found patient journeys valuable and insightful for identifying gaps in the quality of care and promoting sepsis awareness among healthcare workers and the public. Conclusions Patient journeys are a novel tool for capturing the experience of care in Malawi. They have the potential to guide strategic improvements in maternal healthcare quality and ultimately reduce maternal morbidity and mortality.

Maternal and Child Health Following 2 Home Visiting Interventions vs Control: Five-Year Follow-Up of a Randomized Clinical Trial.

Home-based interventions targeting socially disadvantaged families may help to improve maternal and child health. Only a few studies have investigated how different staffing models affect early home visiting program outcomes. To assess the effects of 2 staffing models of an early childhood intervention on mother and child outcomes. The baseline assessment of this randomized trial was conducted between November 2006 and December 2009 in 15 municipalities in Germany. The follow-up assessment at offspring age 7 years was carried out by interviewers masked to treatment conditions from April 2015 to December 2017. Data analysis was performed from March to August 2023. Pregnant women with no previous live birth, low-income, and at least 1 additional psychosocial risk factor were eligible. A total of 1157 women were referred to the study by gynecologists, psychosocial counseling services, or employment agencies; 755 were randomized to treatment conditions (2 intervention groups and 2 control groups); and 525 completed the follow-up. Based on the Nurse-Family Partnership program, women assigned to the intervention groups received visits by either a midwife (midwife-only model) or by a team consisting of a social worker and a midwife (tandem model) until child age 2 years. Women assigned to control groups had access to the standard health and social services. Average treatment effects (ATEs) on the following primary outcomes were assessed using adjusted regression models with inverse probability weighting: developmental disorders, child behavioral problems, adverse, neglectful and abusive parenting, maternal mental health, and life satisfaction. The mean (SD) age at follow-up was 29.6 (4.36) years for mothers and 7.55 (0.75) years for children; 272 (52.2%) of the children were female. Mothers in the tandem model reported fewer internalizing child behavioral problems compared to their control group (ATE, 2.98; 95% CI, -5.49 to -0.47; absolute reduction, 13.3 percentage points). Beneficial intervention effects were found in the midwife-only group on abusive parenting (ATE, -4.00; 95% CI, -6.82 to -1.18), parenting stress (ATE, -0.13; 95% CI, -0.20 to -0.06), and maternal mental health burden (ATE, -3.63; 95% CI, -6.03 to -1.22; absolute reduction, 6.6 percentage points in depressive symptoms), but not in the tandem group. Both staffing models produced positive intervention effects, with more effects seen in the midwife-only model. These insights can guide future early childhood intervention designs and may help improve health care for socially disadvantaged families. German Clinical Trials Register Identifier: DRKS00007554.

A population-level impact assessment of the National Health Mission on maternal and child health outcomes in India.

India launched the National Health Mission (NHM) in 2005 to reduce maternal and child mortality by providing equitable, affordable, and quality healthcare services. Studies evaluating the impact of NHM primarily focused on the uptake of maternal and child health (MCH) services, revealing a dearth of evidence on related health outcomes. Using annual time-series data, we estimated the population-level (intention-to-treat effect) impact of the NHM on MCH outcomes such as infant mortality rate (IMR), stillbirth rate, neonatal mortality rate (NMR), and maternal mortality ratio (MMR). Our results exhibit strong consensus on the positive impact on IMR in the post-NHM period, with a significant reduction in its rate and regional inequity. Conversely, our estimates show a moderate impact on stillbirth rate and an insignificant impact on NMR and MMR. Our findings inform policy decisions for strengthening the public health system to amplify the positive gains in MCH outcomes.

Impact evaluation of a digital health platform empowering Kenyan women across the pregnancy-postpartum care continuum: A cluster randomized controlled trial.

Accelerating improvements in maternal and newborn health (MNH) care is a major public health priority in Kenya. While use of formal health care has increased, many pregnant and postpartum women do not receive the recommended number of maternal care visits. Even when they do, visits are often short with many providers not offering important elements of evaluation and counseling, leaving gaps in women's knowledge and preparedness. Digital health tools have been proposed as a complement to care that is provided by maternity care facilities, but there is limited evidence of the impact of digital health tools at scale on women's knowledge, preparedness, and the content of care they receive. We evaluated a digital health platform (PROMPTS (Promoting Mothers in Pregnancy and Postpartum Through SMS)) composed of informational messages, appointment reminders, and a two-way clinical helpdesk, which had enrolled over 750,000 women across Kenya at the time of our study, on 6 domains across the pregnancy-postpartum care continuum. We conducted an unmasked, 1:1 parallel arm cluster randomized controlled trial in 40 health facilities (clusters) across 8 counties in Kenya. A total of 6,139 pregnant individuals were consented at baseline and followed through pregnancy and postpartum. Individuals recruited from treatment facilities were invited to enroll in the PROMPTS platform, with roughly 85% (1,453/1,700) reporting take-up. Our outcomes were derived from phone surveys conducted with participants at 36 to 42 weeks of gestation and 7 to 8 weeks post-childbirth. Among eligible participants, 3,399/3,678 women completed antenatal follow-up and 5,509/6,128 women completed postpartum follow-up, with response rates of 92% and 90%, respectively. Outcomes were organized into 6 domains: knowledge, birth preparedness, routine care seeking, danger sign care seeking, newborn care, and postpartum care content. We generated standardized summary indices to account for multiple hypothesis testing but also analyzed individual index components. Intention-to-treat analyses were conducted for all outcomes at the individual level, with standard errors clustered by facility. Participants recruited from treatment facilities had a 0.08 standard deviation (SD) (95% CI [0.03, 0.12]; p = 0.002) higher knowledge index, a 0.08 SD (95% CI [0.02, 0.13]; p = 0.018) higher birth preparedness index, a 0.07 SD (95% CI [0.03, 0.11]; p = 0.003) higher routine care seeking index, a 0.09 SD (95% CI [0.07, 0.12]; p < 0.001) higher newborn care index, and a 0.06 SD (95% CI [0.01, 0.12]; p = 0.043) higher postpartum care content index than those recruited from control facilities. No significant effect on the danger sign care seeking index was found (95% CI [-0.01, 0.08]; p = 0.096). A limitation of our study was that outcomes were self-reported, and the study was not powered to detect effects on health outcomes. Digital health tools indicate promise in addressing shortcomings in pregnant and postpartum women's health care, amidst systems that do not reliably deliver a minimally adequate standard of care. Through providing women with critical information and empowering them to seek recommended care, such tools can improve individuals' preparation for safe childbirth and receipt of more comprehensive postpartum care. Future work is needed to ascertain the impact of at-scale digital platforms like PROMPTS on health outcomes. ClinicalTrials.gov ID: NCT05110521; AEA RCT Registry ID: R-0008449.

The Effect of Online Infant Care Education and Postpartum Counseling Based on Meleis's Transition Theory on Mothers' Self-Esteem and Infant Health: A Randomized Controlled Trial.

The aim of this research was to assess the effects of online infant care education and postnatal counseling, based on Meleis's transition theory, on maternal self-esteem and infant health. The randomized controlled trial was conducted between November 2022 and May 2023 with 102 mothers and their infants, n = 52 in the intervention and n = 50 in the control. The intervention group received training across two sessions between 32 and 38 weeks of gestation and counseling support for 3 months postbirth. The control group was shared with additional educational materials in PDF format in addition to their usual care. In the intervention group, the subdimension and total score mean of the Karitane Parental Self-Confidence Scale during pregnancy, postpartum, first, second, and third months were higher than the control group (p = 0.001). The proportion of exclusive breastfeeding in the third month was higher in the intervention group than in the control group (p = 0.001). Newborn nurses' care on Meleis' transition theory will increase the quality of care and newborn health. In our study, Meleis's transition theory provides a strong foundation for understanding mothers' psychological and physical transitions in the postpartum period. Trial Registration: NCT05812833.