Maternal Programs Research Articles

Provider perspectives on maternal care challenges for Black and Latine Women in Indiana: a qualitative interview study

Indiana consistently ranks among the states with the highest maternal and infant mortality in the United States, particularly affecting Black and Latine communities, endangering their right to safe and respectful maternal care. Providers working with these communities are crucial in identifying challenges faced by their clients, and to inform programmes and policies. We interviewed 32 clinical and community-based providers to understand their perspectives on the challenges faced by their Black and Latine clients from February to April 2021. Participants were identified through online sources and referrals. Interviews, conducted over online video, were recorded, transcribed, and analysed following a six-step thematic approach. Six areas of challenges emerged: non-medical infrastructure and policy problems, effects of systemic racism and bias, insecurity of the Latine community, dissatisfaction with maternal care delivery, issues in navigating maternal healthcare, and limitations to holistic models of care. The results demonstrate the interconnected structural, organisational, and interpersonal nature of the challenges. Though challenges were described at structural and organisational levels, the focus of state maternal care programs is largely at personal and interpersonal levels. Obstetric racism, citizenship restrictions, shortage of Black and Latine providers, and transportation issues are complex problems, requiring multilevel interventions and policies to ensure Black and Latine women can exercise their right to safe and respectful maternal care. A rights-based approach centring the needs of Black, Latine and other minoritised communities should be implemented to make effective changes with an equity focus.

Reverse epidemiology of obesity paradox: Fact or fiction?

Obesity paradox refers to the clinical observation that when acute cardiovascular decompensation occurs, patients with obesity may have a survival benefit. This apparently runs counter to the epidemiology of obesity, which may increase the risk for non-communicable diseases (NCDs). The scientific community is split on obesity paradox, with some supporting it, while others call it BMI paradox. This review: (a) defines the obesity paradox, and its proposed role in overall mortality in NCDs; (b) delineates evidence for and against obesity paradox; (c) presents the importance of using different indices of body mass to assess the risk in NCDs; (d) examines the role of metabolically healthy obesity in obesity paradox, and emerging importance of cardio-respiratory fitness (CRF) as an independent predictor of CVD risk and all-cause mortality in patients with/without obesity. Evidence suggests that the development of obesity and insulin resistance are influenced by genetic (or ethnic) make up and dietary habits (culture) of the individuals. Hence, this review presents lean diabetes, which has higher total CVD and non-CVD mortality as compared to diabetics with obesity and the possibility of maternal factors programming cardiometabolic risk during fetal development, which may lead to a paradigm shift in our understanding of obesity.

Knowledge, attitudes, and support needs of obstetric and gynecological nurses and midwives toward perinatal mental health disorders screening in Central China: a multicenter cross-sectional survey.

The perinatal period is a time of increased vulnerability regarding maternal mental health status. Although guidelines and policies have been published for perinatal mental health disorders (PMHDs) screening in China, the knowledge, attitudes, and support needs of nurses and midwives toward implementing mental health screening programs during pregnancy remain unclear. Thus, this study aimed to investigate the knowledge of PMHDs, attitudes and support needs related to implementing mental health screening during pregnancy among obstetrics and gynecology (OB/GYN) nurses and midwives in the central region of China while identifying the related influencing factors. A cross-sectional survey was conducted in 14 cities in Hubei, China, using convenience sampling from July to October 2023. The Chinese version of the Perinatal Mental Health Knowledge Questionnaire, the Chinese version of the Perinatal Mental Health Attitudes Scale, and the Health Care Facilities Support Needs Scale were used to investigate the PMHDs knowledge, attitudes, and support needs of OB/GYN nurses and midwives, respectively. Data were analyzed using SPSS version 27.0. Descriptive and inferential statistics were performed, with a p-value of <0.05 considered statistically significant. The average scores for knowledge, attitudes, and support needs were 6.09 ± 1.99 (total score: 13), 47.67 ± 8.80 (total score: 80), and 29.35 ± 4.66 (total score: 35), respectively. After adjusting for years of nursing experience and years of obstetrics and gynecology nursing experience, the multivariate logistic regression analysis indicated that having mental health-related education or work experience [adjusted OR (aOR) = 1.43, p = 0.01], being midwives (aOR = 1.78, p < 0.001), and working in specialist maternity hospitals (aOR = 1.55, p < 0.001) were significantly associated with higher knowledge scores; having mental health related education or work experience (aOR = 1.59, p = 0.014) and working in specialist maternity hospitals (aOR = 1.42, p < 0.01) were significantly associated with higher support needs scores. OB/GYN nurses and midwives demonstrated insufficient knowledge and moderate attitudes toward PMHDs screening, and have great support need for PMHDs screening. To address these issues, medical organizations and relevant government sectors should enhance training for nurses and midwives on PMHDs and provide professional support to promote routine maternal mental health screening programs and improve perinatal mental health outcomes.

Strengthening nutrition policy and service delivery: Lessons learned from a six-country assessment of Alive and Thrive's technical assistance.

Alive & Thrive (A&T) provides strategic technical assistance (TA) to develop effective policies; improve maternal, infant, and young child nutrition (MIYCN) programme design and implementationand enhance system capacity to sustain quality MIYCN service delivery at scale. A qualitative assessment was conducted using document review and stakeholder interviews (n = 79) to describe a selection of A&T's TA in six countries and systematically assess the contextual and TA process-related factors that influenced the results achieved and document the lessons learned about MIYCN TA design and implementation. To facilitate the selection of different types of TA, we classified TA into two levels of stakeholder engagement and intensity. Under the Technical Advisor TA category, we assessed A&T's support to strengthen national policy formulation, monitoring, and implementation of the International Code of Marketing of Breast-milk Substitutes. For Capacity Development TA, we assessed A&T support to scale-up maternal nutrition services and to increase strategic use of data. Factors important for TA provision included identifying and engaging with the right people, using evidence to support advocacy and decision-making, using multiple ways to strengthen capacity, developing packages of tools to support programme scale-up, and reinforcing feedback mechanisms to improve service provision and data quality. Challenges included shifts in the political context, poorly functioning health systems, and limited resources to replicate or sustain the progress made. Continued investment in evidence-based and practical TA that strengthens the institutionalization of nutrition across all stakeholders-including government, medical associations, civil societyand development partners-is essential. Future TA must support governments to strengthen system capacity for nutrition, including financial and human resource gaps that hamper full scale-up.

Maternal Perspectives on and Preferences for an Enhanced Neonatal Jaundice Education Program: An Evaluation Using the Consolidated Framework for Implementation Research.

Neonatal mortality is a major contributor to under-five deaths yet the main causes of these deaths are preventable. Postnatal health education programs can improve timely detection and care seeking for newborn morbidities such as neonatal jaundice (NNJ). Being a common occurrence in low-income countries, it is surprising that women do not have sufficient knowledge about NNJ. Although the knowledge can be improved through routine education programs, healthcare providers rarely engage women in evaluating such programs, which limits their uptake and sustainability. This was a qualitative study evaluating a postnatal neonatal jaundice health education program conducted at Jinja Regional Referral Hospital (JRRH). Narrative data on the structure, design, and delivery of the program was recorded from 12 postnatal women through unstructured interviews. The participants were those who had taken part in an enhanced NNJ education program. Qualitative content analysis, guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Using the CFIR, two themes were identified; the intervention characteristics domain and the individual domains. The constructs under these domains were intervention design quality and packaging, relative advantage, and maternal knowledge needs. The augmented nature of the intervention, sorting individual needs, ability to promote continuity of care, and care-seeking were identified as key facilitators. Lack of group interaction was identified by some women as a possible barrier. Overall, the education program was positively perceived by women and preferred compared to the conventional method of health education. In low-resource settings where maternal health education can contribute to a reduction in newborn mortality, the design, implementation, and evaluation of maternal education programs should be informed by women's preferences. Healthcare providers should utilize multiple sources of information and routinely practice patient-centered evaluation to meet the changing knowledge demands of postnatal women.

Camp-style lifestyle modification program (CAMP) for diabetes prevention among rural women with prior GDM: study protocol for a three-arm cluster hybrid type 2 randomized controlled trial

BackgroundIntensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes.MethodsA three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions.DiscussionThe CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings.Trial registrationRegistered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.

Determinants of quality antenatal care use in Kenya: Insights from the 2022 Kenya Demographic and Health Survey

Provision of quality antenatal care (ANC) is important to reduce maternal and newborn fatalities worldwide. However, the use of quality ANC by women of reproductive age and associated factors remain unclear in many developing countries. Therefore, this study aimed to determine factors associated with receiving quality ANC in Kenya among women of reproductive age. We analyzed secondary data from the 2022 Kenya Demographic Health Survey, which included 11,863 women. Participants were selected using two-stage stratified sampling. Univariate and multivariable logistic regression analyses were used to analyze the data. Of the 11,863 participating women, 61.2% (95% confidence interval (CI): 59.7%–62.6%) received quality ANC. Participants aged 20–34 years had a 1.82 (95%CI: 1.15–2.87) times higher likelihood of receiving quality ANC compared with those aged 15–19 years. Those who had attended four or more ANC visits were 1.42 (95%CI: 1.14–1.79) times more likely to receive quality ANC than those who attended three or fewer visits. Participants with media access were 1.47 (95%CI: 1.06–2.03) times more likely to receive quality ANC than those without media access. Compared with participants in the “poorest” quintile, the likelihood of receiving quality ANC was 1.93 (95%CI: 1.21–3.08) and 1.44 (95%CI: 1.01–2.06) times higher for participants in the “richest” and “richer” quintiles, respectively. Furthermore, compared with participants from the Coastal region, the odds of receiving quality ANC were 0.25 (95%CI: 0.15–0.31) to 0.64 (95%CI: 0.44–0.92) times lower for those from all other Kenyan regions. Participants whose partners made their healthcare decisions were 0.74 (95%CI: 0.58–0.95) times less likely to receive quality ANC than those who made decisions independently. We found that just over 60% of participating mothers had received quality ANC. Factors associated with receiving quality ANC were: age, region, maternal education, healthcare-seeking decision-making, access to media, time to the health facility, ANC visits, and ANC provider type (doctor, nurse/midwife/clinical officer). Maternal health improvement programs should prioritize promoting access to education for girls. Furthermore, interventions should focus on promoting shared decision-making and autonomy in healthcare-seeking behaviors among pregnant women and their partners, increasing access to care provided by skilled healthcare workers, and addressing regional disparities in healthcare delivery.

COVID-19 Vaccine Safety in Pregnancy, A Nested Case-Control Study in Births From April 2021 to March 2022, England.

Assessment of COVID-19 vaccine safety in pregnancy using population-based data. Matched case-control study nested in a retrospective cohort. April 2021-March 2022, England. All pregnant individuals aged between 18 and 50 years with valid health records. Individuals identified from the national Maternity Services Data Set (MSDS) had their records linked to hospital admission, national COVID-19 vaccine and COVID-19 testing databases. Matching included participant's age and estimated week of conception. We compared outcomes across multiple COVID-19 vaccine exposures using conditional multivariable logistic regression, adjusting for demographic and health characteristics. Adverse pregnancy, maternal and neonatal outcomes. 514 013 individuals were included. We found lower odds of giving birth to a baby who was low birthweight (aOR = 0.86, 95% CI: 0.79-0.93), preterm (aOR = 0.89, 95% CI: 0.85-0.92) or who had an Apgar score < 7 at 5 min of age (aOR = 0.89, 95% CI: 0.80-0.98) for individuals who received at least one dose of COVID-19 vaccine during pregnancy. The odds of admission to intensive care unit during pregnancy were lower in those vaccinated (aOR = 0.85, 95% CI: 0.76-0.95). There was no association between vaccination in pregnancy and stillbirth, neonatal death, perinatal death and maternal venous thromboembolism in pregnancy. COVID-19 vaccines are safe to use in pregnancy. Our findings generated important information to communicate to pregnant individuals and health professionals to support COVID-19 maternal vaccination programmes.

Acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in low- and middle-income countries: a systematic review and meta-analysis protocol

BackgroundPregnant women, fetuses, and neonates are particularly vulnerable to vaccine-preventable diseases (VPDs). These VPDs are associated with high morbidity and mortality among expectant mothers and their fetuses and neonates. Vaccination during pregnancy can protect the expectant mother from VPDs to which she may be especially vulnerable while pregnant. In addition, the passive transfer of maternal neutralizing immunoglobulin G (IgG) and secretory immunoglobulin A (IgA) also protects the fetus against congenital infections and may further protect the neonate from infection during the first few months of life. Despite this, coverage of recommended maternal vaccines remains suboptimal globally, especially in resource-constrained settings. Determinants of vaccine acceptance and uptake are frequently understudied in low- and middle-income countries (LMICs) and among specific groups such as pregnant and postpartum women. This proposed systematic review will assess the acceptance and uptake of vaccines against tetanus, influenza, pertussis, and COVID-19 among pregnant and postpartum women in LMICs.MethodsA Boolean search strategy employing common and medical subject heading (MeSH) terms for tetanus, influenza, pertussis, and COVID-19 vaccines, as well as vaccine acceptance, hesitancy, together with uptake, pregnancy, and postpartum, will be used to search electronic databases for relevant literature published between 2009 and 2024. Only studies conducted in LMICs that investigated determinants of acceptance, hesitancy, and uptake of tetanus, influenza, pertussis, and COVID-19 vaccines among pregnant and postpartum women will be eligible for inclusion in the review. The quality and the risk of bias of all eligible full-text articles will be assessed using the Joanna Briggs Institute’s (JBI) critical appraisal tools.DiscussionThis protocol proposes a systematic review and meta-analysis that aims to assess the uptake of maternal vaccines and to systematically appraise and quantify determinants of the acceptance and uptake of recommended vaccines during pregnancy and postpartum in LMICs. A better understanding of these factors and how they influence maternal vaccine decision-making will enable public health practitioners as well as global and national policymakers to design more effective interventions as we look towards expanding the scope and reach of maternal immunization programs.

A combination analysis based on bioinformatics tools reveals new signature genes related to maternal obesity and fetal programming.

Maternal obesity significantly influences fetal development and health later in life; however, the molecular mechanisms behind it remain unclear. This study aims to investigate signature genes related to maternal obesity and fetal programming based on a genomic-wide transcriptional placental study using a combination of different bioinformatics tools. The dataset (GSE128381) was obtained from Gene Expression Omnibus (GEO). The data of 100 normal body mass index (BMI) and 27 obese mothers were included in the analysis. Differentially expressed genes (DEGs) were evaluated by limma package. Thereafter, functional enrichment analysis was implemented. Then, weighted gene co-expression network analysis (WGCNA) and the least absolute shrinkage and selection operator (LASSO) analysis were used to further screening of signature genes. Simple linear regression analysis was used to assess the correlation between signature genes and newborn birth weight. Gene set enrichment analysis (GSEA) was implemented to study signaling pathways related to signature genes. The expression of the signature genes was also explored in 48 overweight mothers in the same dataset. A total of 167 DEGs were obtained, of which 122 were up-regulated while 45 were down-regulated. The dataset was then clustered into 11 modules by WGCNA, and the MEbrown was found as the most significant module related to maternal obesity and fetal programming (cor = 0.2, p = 0.03). The LASSO analysis showed that PTX3, NCF2, HOXB5, ABCA6, and C1orf162 are signature genes related to maternal obesity and fetal programming, which were increased in the placenta of obese mothers compared to those with normal BMI. The area under the curve (AUC) of the signature genes in the receiver operating characteristic curve (ROC) was 0.709, 0.660, 0.674, 0.667, and 0.717, respectively. Simple linear regression analysis showed that HOXB5 was associated with newborn birth weight. GSEA analysis revealed that these signature genes positively participate in various signaling pathways/functions in the placenta. PTX3, NCF2, HOXB5, ABCA6, and C1orf162 are novel signature genes related to maternal obesity and fetal programming, of which HOXB5 is implicated in newborn birth weight.

Effects of dietary restriction and one-carbon metabolite supplementation during the first 63 days of gestation on the maternal gut, vaginal, and blood microbiota in cattle

BackgroundMaternal diet quality and quantity have significant impacts on both maternal and fetal health and development. The composition and function of the maternal gut microbiome is also significantly influenced by diet; however, little is known about the impact of gestational nutrient restriction on the bovine maternal microbiome during early gestation, which is a critical stage for maternal microbiome-mediated fetal programming to take place. The objective of the present study was to evaluate the impacts of diet restriction and one-carbon metabolite (OCM) supplementation during early gestation on maternal ruminal, vaginal, and blood microbiota in cattle. Thirty-three beef heifers (approx. 14 months old) were used in a 2 × 2 factorial experiment with main factors of target gain (control [CON]; targeted 0.45 kg/d gain vs restricted [RES]; targeted − 0.23 kg/d gain), and OCM supplementation (+ OCM vs − OCM; n = 8/treatment; except n = 9 for RES–OCM). Heifers were individually fed, starting treatment at breeding (d 0) and concluding at d 63 of gestation. Ruminal fluid and vaginal swabs were collected on d − 2, d 35, and d 63 (at necropsy) and whole blood was collected on d 63 (necropsy). Bacterial microbiota was assessed using 16S rRNA gene (V3–V4) sequencing.ResultsOverall ruminal microbiota structure was affected by gain, OCM, time, and their interactions. The RES heifers had greater microbial richness (observed ASVs) but neither Shannon nor Inverse Simpson diversity was significantly influenced by gain or OCM supplementation; however, on d 63, 34 bacterial genera showed differential abundance in the ruminal fluid, with 25 genera enriched in RES heifers as compared to CON heifers. In addition, the overall interaction network structure of the ruminal microbiota changed due to diet restriction. The vaginal microbiota community structure was influenced by gain and time. Overall microbial richness and diversity of the vaginal microbiota steadily increased as pregnancy progressed. The vaginal ecological network structure was distinctive between RES and CON heifers with genera-genera interactions being intensified in RES heifers. A relatively diverse bacterial community was detected in blood samples, and the composition of the blood microbiota differed from that of ruminal and vaginal microbiota.ConclusionRestricted dietary intake during early gestation induced significant alterations in the ruminal microbiota which also extended to the vaginal microbiota. The composition of these two microbial communities was largely unaffected by OCM supplementation. Blood associated microbiota was largely distinctive from the ruminal and vaginal microbiota.

Burden of Congenital CMV Infection: A Narrative Review and Implications for Public Health Interventions.

Cytomegalovirus causes the most common congenital infection worldwide. With most infants asymptomatic at birth, the few affected may present with variable clinical scenarios, from isolated hearing loss to severe neurologic impairment. Public health interventions include all actions at the health system, community, and individual levels that aim at reducing the burden of congenital Cytomegalovirus. This review examines the literature on maternal and neonatal screening programs in light of current evidence for treatment and the development of vaccines against Cytomegalovirus. Potential biases and benefits of these interventions are outlined, with the objective of increasing awareness about the problem and providing readers with data and critical tools to participate in this ongoing debate.

Supporting Timor-Leste midwives and nurses through an educational program: An evaluative study

Little is currently known about the impacts of participation in a five-week Australian maternal and newborn health training program for Timorese midwives and nurses. BackgroundThe maternal mortality rate in Timor-Leste is estimated to be around 204 per 100,000 live births, and there is a correlation between safe and quality maternal and newborn health services. Hence, there is a need to develop the nation’s maternity workforce. Whilst numerous training programs have been geared towards improving the knowledge and skills of Timorese midwives and nurses, to date, no published study has evaluated their impact on participants. AimTo describe satisfaction of an Australian maternal and newborn health training program for Timorese midwives and nurses and its impact based upon the participants survey and qualitative evaluations. MethodsAn evaluative study was conducted using a survey to explore the impacts of a five-week Australian residential training program on 12 Timorese midwives and one nurse. FindingsThe survey data demonstrated an increase in the participants knowledge and skills required to provide enhanced maternal and newborn care; post-training, most participants demonstrated increased knowledge of obstetric emergencies. The participants showed the most pronounced increase in Advanced Clinical Skills in the subjects of fetal assessment, neonatal resuscitation and obstetric emergencies.The qualitative data identified two main themes and six subthemes related to professionalism, communication, and connections. ConclusionAn Australian residential training program, provided in collaboration with local Rotary clubs can enhance the development of maternal and newborn healthcare skills for midwives and nurses from Timor-Leste.

Maternal cafeteria diet programs fecal microbiota and modulates serum fatty acid and amino acid levels in adulthood rats

Maternal food environment can program fecal microbiota in offspring mediated by the imprint of intrauterine conditions. Gut bacteria play a role in host fatty acid and amino acid metabolism. This study aimed to determine the effects of maternal diet on fecal microbiota, and the impact on fatty acid and amino acid metabolism in male offspring rats. Ten male pups from dams fed standard diet (C-C, n = 5) and cafeteria diet (Caf-C, n = 5) were fed standard chow diet for twenty-three weeks. Fresh fecal samples were collected at three and twenty-six weeks of age for fecal microbiota analysis by metagenomic sequencing of the V3-V4 region of the 16S rRNA gene. At the end of the study, serum samples were collected to analyse fatty acids from phospholipid and cholesterol ester fractions by gas chromatography and free amino acids by liquid chromatography. The bacterial abundance from the Actinobacteria and Proteobacteria phyla significantly decreased over time for both groups. Additionally, significant differences were found between C-C and Caf-C groups in these bacterial phyla. In the Caf-C group, Firmicutes and Elusimicrobia phyla increased, while Bacteroidetes decreases in adulthood samples. At the genus level, the abundance of Bacteroides decreased, while Elusimicrobium, Lactobacillus, Turicibacter, Blautia, and Veillonella increased in the Caf-C group. Several metabolites including PL-MCFAs (caprylic acid and capric acid), CE-MUFAs (palmitoleic acid and heptadecenoic acid), and free amino acids aspartate, glutamic acid, and cysteine were significantly higher in Caf-C group. This study underscores the putative programming of offspring fecal microbiota by maternal diet impact. These changes led to alterations fatty acids and amino acids metabolism in adult male offspring rats.

Effectiveness of Communication Channels for Maternal Healthcare in Delta State

This study on the effectiveness of communication channels for maternal healthcare is one of great concern with the increased health risks for women in their reproductive years of pregnancy and childbirth. This is especially true in developing countries such as Nigeria where thousands of women die yearly in pregnancy or childbirth. The qualitative and quantitative design method was applied in the study and the questionnaire was used for data collection from 399 respondents. The study found that the level of awareness of the programmes was encouraging for FMHCP and HeFAD; that the communication channels were adequate, and more than half thought they were effective in influencing participation in the maternal healthcare programmes. The findings provide healthcare professionals with an important insight into issues of effective communication therefore, recommend the continuous usage of communication channels to spread awareness of maternal healthcare programmes to enhance the provision of appropriate health information and maternity care to women

A Study on the Construction of a Core Midwife-Led Total Maternal Care Program for High-Risk Pregnancies

Objective: To analyze the care needs of high-risk pregnant women during pregnancy, delivery, and postpartum hospitalization. Additionally, to gather obstetrics staff’s suggestions for improving a total care program with core midwives leading. Methods: The study conducted semi-structured interviews with 20 high-risk pregnant women and 10 obstetricians at a tertiary hospital from August 2021 to October 2022. A descriptive qualitative study assessed their care needs and current care models. An evidence-based approach was used to evaluate guidelines and develop a draft care plan. Finally, the Delphi method refined the core midwife-led total care program. Results: The study formulated a draft for a core midwife-led care program, integrating literature and expert feedback. This program defined midwife roles with 7 service standards and 6 qualification standards. The care practice included 3 level 1, 19 level 2, and 58 level 3 entries. Management of common risk factors had detailed entries for conditions like gestational diabetes, advanced maternal age, abnormal early pregnancy weight, hypertensive disorders, and scarred uterus. Conclusion: The study offers a qualitative exploration of high-risk pregnant women’s care needs and suggests improvements based on healthcare professionals’ experiences. It provides a foundation for a midwife-led care program and proposes new research directions. The methodology combines the Ottawa research application model, evidence-based approaches, and theoretical analysis to support this program’s development.

Potential impact of nirsevimab and bivalent maternal vaccine against RSV bronchiolitis in infants: A population-based modelling study

BackgroundA new monoclonal antibody (nirsevimab; Beyfortus®) and a bivalent prefusion RSV vaccine (Abrysvo®) for maternal immunization have been approved recently. This is a modelling study to estimate the potential impact of different immunization programs with these products on RSV-bronchiolitis. MethodsPopulation-based real-world data from primary care and hospitalizations were considered. RSV bronchiolitis dynamics in absence of these immunization scenarios were explained by a multivariate age-structured Bayesian model. Then, the potential impact was simulated under different assumptions including the most recent clinical trial data. Differences in endpoints, populations, and timeframes between trials make the two products’ efficacy difficult to compare. ResultsA seasonal with catch-up program, assuming a constant effectiveness of 79.5 % during the first 5 months followed by a linear decay to 0 by month 10 with nirsevimab, would prevent between 5121 and 8846 RSV bronchiolitis per 100,000 infants-years. Assuming 77.3 % effectiveness with the same decay, between 976 and 1686 RSV-hospitalizations per 100,000 infants-years could be prevented depending on the uptake. A year-round maternal immunization program, with 51 % of effectiveness during the first 6 months followed by a linear decay to 0 by month 10 would prevent between 3246 and 5606 RSV bronchiolitis cases per 100,000 infants-years. Assuming 56.9 % effectiveness with the same decay, between 713 and 1231 RSV-hospitalizations per 100,000 infants-years could be prevented. ConclusionsOur results suggest that each strategy would effectively reduce RSV-bronchiolitis.

A comparison between different models of delivering maternal cash transfers in Myanmar.

As part of a randomized controlled trial conducted in Myanmar between 2016 and 2019, we explore the performance of a maternal cash transfer program across villages assigned to different models of delivery (by government health workers vs loan agents of a non-governmental organization) and identify key factors of success. Measures include enrolment inclusion and exclusion errors, failures in payment delivery to enrolled beneficiaries (whether beneficiaries received any transfer, fraction of benefits received and whether there were delays and underpayment of benefit amounts) and whether beneficiaries remained in the program beyond eligibility. We find that women in villages where government health workers delivered cash transfers received on average two additional monthly transfers, were 19.7% more likely to receive payments on time and in-full and were 14.6% less likely to stay in the program beyond eligibility. With respect to the primary health objective of the program-child nutrition-we find that children whose mother received cash by government health workers were less likely to be chronically malnourished compared to those whose mother received cash by loan agents. Overall, the delivery of cash transfers to mothers of young children by government health workers outperforms the delivery by loan agents in rural Myanmar. Qualitative evidence suggests two key factors of success: (1) trusted presence and past interactions with targeted beneficiaries and complementarities between government health workers' expertise and the program; and (2) performance incentives based on specific health objectives along with top-down monitoring. We cannot exclude that other incentives or intrinsic motivation also played a role.

1223-P: Assessing the Impact of the "Management of Maternal (MOMs) Diabetes Program" in South Carolina

1223-P: Assessing the Impact of the "Management of Maternal (MOMs) Diabetes Program" in South Carolina

Educating Families on Urgent Maternal Warning Signs: Learning From a Pilot to Improve Training and Tools for Maternal and Child Home Visiting Programs.

Early recognition of the warning signs of pregnancy-related complications and provision of timely, quality care could prevent many maternal deaths. We piloted a maternal warning signs education intervention with five Maryland-based maternal, infant, and early childhood home visiting programs serving populations disproportionately affected by adverse maternal outcomes. The intervention included a 1.5-hr online training for home visitors, monthly collaborative calls with program managers, and a client education toolkit with a 3-min video, illustrated handout of 15 urgent maternal warning signs, magnet with the same, and discussion guide for home visitor-client interactions. A mixed-methods formative evaluation assessed the acceptability, feasibility, and utilization of different components of the intervention. Home visiting program staff reported that the materials were highly acceptable and easily understood by diverse client populations. They valued the illustrations, simple language, and translation of materials in multiple languages. Program managers found implementation a relatively simple process, feasible for in-person and remote visits. Despite positive reception, not all components of the toolkit were used consistently. Program managers and staff also identified the need for more guidance and tools to help clients communicate with health care providers and advocate for their health care needs. Feedback from pilot sites was used to adapt the training and tools, including adding content on patient self-advocacy. Home visiting programs have a unique ability to engage families during pregnancy and the postpartum period. This pilot offers lessons learned on strategies and tools that home visiting programs can use to improve early recognition and care-seeking for urgent maternal warning signs.