Maternity Providers Research Articles

Diet and size at birth affect larval rockfish condition and survival

Feeding success and maternal effects on larval size have long been hypothesized to be important contributors to interannual recruitment variability in marine fishes. This study examined the feeding ecology and influences of diet and size at birth on length and growth of larval rockfishes (Sebastes spp.). Prey carbon biomass and selection were calculated from gut contents, size at birth was estimated using otolith core size, and recent growth was derived from outer otolith increment widths. Biomass contributions of preferred prey and otolith data were integrated into Bayesian hierarchical models predicting length and growth. Larvae primarily fed on and selected for copepod nauplii and calanoid copepodites, modulating feeding with ontogeny and in response to prey availability. Based on carbon weight, the relative contribution of calanoid copepodites to the diet was more strongly and positively correlated with length and growth than that of nauplii. Younger larvae experienced faster growth in association with calanoid copepodite consumption than older larvae. Positive effects of core radius suggest that initial larval size, believed to be mediated by maternal provisioning, increases the likelihood of survival, larger size, and faster growth. These findings ultimately provide evidence that selective feeding and size at birth mediate rockfish survival in early life stages.

“It's a big conversation”: Views of service personnel on systemic barriers to preventing smoking relapse among pregnant and postpartum Aboriginal and Torres Strait Islander women – A qualitative study

BackgroundProviding smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers. AimThis paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal). MethodsTwenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed. FindingsThemes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation. ConclusionTo drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals’ capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

Markers for egg quality in European eel derived from offspring of females subjected to different gonadotropic treatments

Broodstock management techniques in general, and gonadotropic treatments for vitellogenesis induction in particular, can influence the maternal provisioning of different compounds to the eggs, thus affecting embryo and larval competence. Among these, the abundance of certain transcripts as well as lipid content and fatty acid composition have been used as egg quality markers alongside other egg morphological parameters, such as egg size and the occurrence of abnormal cleavages during the first stages of embryonic development. Here, we evaluated the use of different markers of egg quality from farmed-raised European eel, Anguilla anguilla, broodstock reared on the same formulated diet but subjected to different pituitary extract administration schemes: weekly injections of salmon pituitary extract (SPE) in a constant dose or weekly injections of carp pituitary extract (CPE) at a stepwise increasing dose. Egg batches were categorized in two quality groups (high and low) according to their survival to the first feeding larval stage. In agreement with previous studies, unfertilized eggs and 4-h post fertilization embryos (16-cell stage) from SPE treated females had higher epcam expression levels than CPE ones, which is a molecule involved in cell-cell adhesion. When comparing treatments, batches from the SPE treatment had a lower incidence of cleavage abnormalities which could originate from compromised cell adhesion. On the other hand, this difference was not observed when comparing high-quality batches (i.e. those surviving up to the first-feeding stage) and low-quality ones. From the five genes analysed: epcam, dcbld1, plec, cenpf, and cenpk, only the latter had a differential expression between high- and low-quality groups both in unfertilized eggs and 4 h-post-fertilization embryos. This gene, cenpk, is involved in kinetochore assemblage during cell division and appears to be promising as egg quality marker in European eel in combination with epcam and dcbld1. Common biomarkers, such as egg size, total protein and lipid content, were similar between groups. However, although fatty acid composition was similar between quality groups, DHA and EPA content in unfertilized eggs was affected by the gonadotropic treatment applied to the female broodstock, and higher for the CPE treated females than the SPE ones. This entails that the hormonal treatments applied for vitellogenesis induction can influence the amount of specific fatty acids being transferred to the eggs, even for female broodstock that were fed the same high-quality diet.

Standardizing feeding strategies for preterm infants born greater than 1500 grams.

Use of standardized feeding protocols and donor breast milk (DBM) have been studied primarily in infants born <1500 g and not examined exclusively in infants born >1500 g. In this retrospective pre-post-implementation cohort study, we evaluated a protocol for preterm infants born >1500 g that was implemented clinically to standardize feeding advancements at 30 mL/kg/day, with infants born <33 weeks eligible to receive DBM. We compared placement of peripherally inserted central catheters for parenteral nutrition, feeding tolerance, growth, and maternal milk provision in the 18 months before/after implementation. The association between DBM intake and growth was evaluated using multivariable linear regression. We identified 133 and 148 eligible infants pre/post-implementation. Frequency of peripherally inserted central catheters and rate of maternal milk provision was not statistically different. While there was no difference in median days to full enteral volume, there was a narrower distribution post-implementation (p < 0.001). Growth was similar between eras, but each 10% increase in DBM was associated with 1.0 g/d decrease in weight velocity (p < 0.001). A feeding protocol for preterm infants >1500 g is associated with more consistent time to full enteral volume. Further investigation is needed to clarify DBM's impact on growth in this population. Despite practice creep, no study has examined the use of standardized feeding protocols or pasteurized donor breast milk exclusively in infants >1500 g. A feeding protocol in this population may achieve full enteral feedings more consistently. With appropriate fortification, donor breast milk can support adequate growth in infants born >1500 gbut warrants furtherstudy.

Does maternity care in Australia align with the national maternity Strategy? Findings from a national survey of women’s experiences

BackgroundWomen Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles. AimTo explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy’s values and principles. MethodsWomen who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women’s experiences according to the Strategy’s values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported. FindingsThe survey was completed by 1750 women. A proportion of women perceived the Strategy’s values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period. ConclusionDespite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women’s access to and experiences of care across the entire maternity episode.

The Integrative Life history of Maternal Effects.

Context-dependent allocation of resources drives trade-offs among fitness-related traits and other phenotypes to which those traits are linked. In addition, the amount and type of acquired resources can also affect the phenotypes of other organisms through indirect genetic effects, as exemplified by the maternal provisioning of offspring. Despite a large literature on maternal effects, we lack a comprehensive understanding of the extent to which mothers might affect the phenotypes of their offspring, as well as the various mechanisms by which they do so, particularly with regard to many functional traits that are key determinants of survival and reproduction. Our goals in this paper are to review the various approaches to measuring and understanding maternal effects, and to highlight some promising avenues for integration of maternal effects with some other key areas of evolutionary ecology. We focus especially on nutritional geometry; maternal age; and traits proximate to fitness such as whole-organism performance. Finally, we discuss the logistic and practical limits of quantifying these effects in many animal systems, and emphasize the value of integrative approaches in understanding the mechanisms underlying maternal influence on offspring phenotypes.

Using interpretive description to facilitate women's contributions to maternity care: experiences and views of obstetric fistula prevention

Background/Aims Interpretive description is a qualitative methodology that combines detailed descriptions with thoughtful interpretation. This approach is especially effective for producing practical insights and deepening the understanding of phenomena in clinical or practice-based settings. The aims of this study were to explore how interpretive description could be used to research the experiences and views of women with obstetric fistula. Methods Interpretive description was used to explore the experiences and views of 15 purposively selected women affected by obstetric fistula. Participants were recruited via the Evangel Vesico Vaginal Fistula Centre of Bingham University Teaching Hospital. Data were collected via in-depth interviews and concurrently analysed thematically. Results Interpretive description provided women with a unique opportunity to share their experiences of the causes and avoidable risk factors of obstetric fistula. The approach yielded qualitative findings and allowed for the representation of different views, leading to an understanding of how to mitigate obstetric fistula in the community. Conclusions Interpretive description was used to listen to the voices of women affected by obstetric fistula, learn from their experiences and highlight the interventions that may alter risk factors for the condition in the community. This is the first study to use interpretive description to facilitate under-represented women's contributions to maternity care by listening to their experiences and views. This enabled identification of gaps in maternity care provision, which would be of interest to the community and health service leaders as well as policymakers in sub-Saharan Africa. Implications for practice Interpretive description allows for deep capture of women's perspectives, allowing implementation of interventions designed to target issues as perceived by those most affected. This also ensures that under-represented groups are included in the research process.

Care bundles for women during pregnancy, labour/birth, and postpartum: a scoping review

Background Care bundles, introduced in 2001, are described as a set of at least three evidence-based healthcare interventions delivered together in a clinical care episode by all healthcare providers. Although widely implemented in some healthcare areas, care bundle use in maternity care appears relatively recent. To identify the types of care bundles that have been developed, evaluated, or implemented for women during the perinatal period, we undertook a scoping review. Methods Joanna Briggs Institute methodological guidance for scoping reviews was used. MEDLINE, CINAHL, Embase, Maternity and Infant Care, and Epistemonikos were searched from January 2000 to October 2023. Records that reported on women during pregnancy and up to six-weeks postpartum as the intended or actual recipients of a care bundle, were included. The concept of interest was development, evaluation, or implementation of a care bundle. The context was maternity care provision, in any setting or geographical location. Results The search yielded 147 eligible records of which 69 originated in the USA. Most records were concerned with care bundle evaluation (n=74), and most were published in the last five-years (n=95). Eleven categories of clinical conditions were identified. These were surgical site infection, obstetric haemorrhage, perineal trauma, sepsis, stillbirth, hypertension, safe reduction of caesarean section, enhanced recovery after caesarean, placenta accrete, perinatal anxiety/depression, and ‘other’ which contained 21 records reporting on care bundles for one clinical condition. Few clinical conditions had good overlap of care bundle elements. Systematic reviews based on data from non-randomised studies may be feasible for some clinical conditions. Conclusions This scoping review provides comprehensive insight on care bundles in maternity care. Few studies were found that evaluated the effectiveness of these bundles, and many bundles for similar clinical conditions contained diverse elements. A more global approach to care bundle development, evaluation, and implementation in maternity care is recommended.

Postnatal maternal care moderates the effects of prenatal bisphenol exposure on offspring neurodevelopmental, behavioral, and transcriptomic outcomes.

Bisphenols (BP), including BPA and "BPA-free" structural analogs, are commonly used plasticizers that are present in many plastics and are known endocrine disrupting chemicals. Prenatal exposure to BPA has been associated with negative neurodevelopmental and behavioral outcomes in children and in rodent models. Prenatal BPA exposure has also been shown to impair postnatal maternal care provisioning, which can also affect offspring neurodevelopment and behavior. However, there is limited knowledge regarding the biological effects of prenatal exposure to bisphenols other than BPA and the interplay between prenatal bisphenol exposure and postnatal maternal care on adult behavior. The purpose of the current study was to determine the interactive impact of prenatal bisphenol exposure and postnatal maternal care on neurodevelopment and behavior in rats. Our findings suggest that the effects of prenatal bisphenol exposure on eye-opening, adult attentional set shifting and anxiety-like behavior in the open field are dependent on maternal care in the first five days of life. Interestingly, maternal care might also attenuate the effects of prenatal bisphenol exposure on eye opening and adult attentional set shifting. Finally, transcriptomic profiles in male and female medial prefrontal cortex and amygdala suggest that the interactive effects of prenatal bisphenol exposure and postnatal maternal care converge on estrogen receptor signaling and are involved in biological processes related to gene expression and protein translation and synthesis. Overall, these findings indicate that postnatal maternal care plays a critical role in the expression of the effects of prenatal bisphenol exposure on neurodevelopment and adult behavior. Understanding the underlying biological mechanisms involved might allow us to identify potential avenues to mitigate the adverse effects of prenatal bisphenol exposure and improve health and well-being in human populations.

Do maternal allocations towards offspring quality and quantity ameliorate the effects of predators on offspring survival?

AbstractReproductive allocation is often balanced between the quantity and quality of offspring. Ecological stresses, like exposure to predators, can cause organisms to shift their allocations along this continuum. While the consequences of such plastic shifts for offspring performance are often untested, they are critical to understanding the potential long‐term benefits of manipulating predation risk as an agricultural pest management technique. Predation risk induces reductions in egg production and increases in nutritional condition due to maternal provisioning in Colorado potato beetles (Leptinotarsa decemlineata, CPB). Here, we tested whether reductions in density or increases in offspring condition, which may increase per‐capita larval survival, can compensate for the reduction in total egg production, especially when offspring are exposed to predators. In two field trials, we manipulated density and condition of larval CPB and measured survival through development to adulthood in field cages with and without predaceous stink bugs (Podisus maculiventris). As expected, cages with the higher initial larval densities had more larvae and adults surviving in the treatments without predators – about 30%–50% survival across densities. When predators were present, this relationship did not hold because of density‐dependent predation. Larval condition interacted with density and impacted larval survival in both trials albeit in different ways. In trial 1, unprovisioned beetles had higher survival at the higher densities; in trial 2, provisioned beetles had higher survival across densities. Synthesis and Applications: Overall, our test of the effects of predation risk via manipulations of larval density and condition revealed few net compensatory benefits to the prey of reduced density and higher condition. Benefits to the prey of shifts in allocation from the quantity to quality of offspring may depend on factors that influence the strength of density dependence, including predation intensity. Our results suggest a new strategy of taking advantage of the reductions in prey density due to non‐consumptive effects of predators as a pest management approach to protect plants.

Family physicians provide maternity care in and around the maternity care shortage areas, particularly rural.

This study examined demographic, practice, and area-level characteristics associated with family physicians' (FP) provision of maternity care. Using the American Board of Family Medicine Certification examination application survey data, we investigated the relationship between FPs' maternity care service provision and (1) demographic (gender, years in practice, race/ethnicity), (2) practice characteristics (size, ownership, rurality), and (3) county-level factors (percentage of reproductive-age women, the number of obstetrician-gynecologists (OBGYNs) and certified nurse midwives (CNMs) per 100,000 reproductive-age women). We performed summary statistics and multivariate logistic regression analyses. Of the 59,903 FPs in the sample, 7.5% provided maternity care. FPs practicing in rural were 2.5 times more likely to provide maternity care than those practicing in urban areas. FPs in academic (odds ratio [OR] 4.6, 95% confidence interval [CI] 4.1-5.1) and safety-net settings (OR 1.9, 1.7-2.1) had greater odds of providing maternity care. FPs in the bottom quintile with no or fewer OBGYNs and CNMs had a higher likelihood of maternity care provision (OR 2.1, 1.8-2.3) than those in the top quintile, with more OBGYNs and CNMs. FPs in high-needs areas, such as rural and safety net settings, and areas with fewer CNMs or OBGYNs are more likely to provide maternity care, demonstrating the importance of FPs in meeting the needs of women with limited maternity care access. Our study findings highlight the importance of considering the contributions of FPs to maternity care as the organizations prioritize resource allocation to areas of highest need.

Evolution of Maternal Provisioning and Development in the Ophiuroidea: Egg Size, Larval Form and Parental Care.

The Ophiuroidea is the most speciose class of echinoderms and has the greatest diversity of larval forms, but we know less about the evolution of development (evo-devo) in this group than for the other echinoderm classes. As is typical of echinoderms, evo-devo in the Ophiuroidea resulted in the switch from production of small eggs and feeding (planktotrophic) larvae to large eggs and non-feeding (lecithotrophic) larvae. Parental care (ovoviviparity or viviparity/matrotrophy) is the most derived life history. Analysis of egg data for 140 species (excluding viviparity and facultative planktotrophy) indicated a bimodal distribution in egg volume corresponding to planktotrophy and lecithotrophy+ovoviviparity, with three significant egg size groups due to the very large eggs of the ovoviviparous species. The marked reduction in fecundity in species with extremely large eggs is exemplified by the ovoviviparous species. Egg size in the two species with facultative planktotrophy were intermediate with respect to the two modes. Identifying the ancestral larval life history pattern and the pathways in the switch from feeding to non-feeding larvae is complicated by the two patterns of metamorphosis seen in species with planktotrophic development: Type I (ophiopluteus only) and Type II (ophiopluteus+vitellaria larva). The variability in arm resorption at metamorphosis across ophiuroid families indicates that the Type I and II patterns may be two ends of a morphological continuum. This variability indicates ancestral morphological plasticity at metamorphosis followed by canalization in some taxa to the vitellaria as the metamorphic larva. Vestigial ophiopluteal traits in lecithotrophic ophioplutei and vitellaria indicate evolution from the ancestral (feeding larva) state. Parental care has evolved many times from an ancestor that had a planktonic ophiopluteus or vitellaria and is often associated with hermaphroditism and paedomorphosis. A secondary reduction in egg size occurred in the viviparous species.

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

Model of perinatal care but not prenatal stress exposure is associated with birthweight and gestational age at Birth: The Australian birth in the time of COVID (BITTOC) study

ObjectiveThe present study aimed to understand, relative to standard care, whether continuity of care models (private midwifery, continuity of care with a private doctor, continuity of care with a public midwife), and women’s experience of maternity care provision, during the perinatal period buffered the association between prenatal maternal stress (PNMS) and infant birth outcomes (gestational age [GA], birth weight [BW] and birth weight for gestational age [BW for GA]). Methods2207 women who were pregnant in Australia while COVID-19 restrictions were in place reported on their COVID-19 related objective hardship and subjective distress during pregnancy and provided information on their model of maternity care. Infant birth outcomes (BW, GA) were reported on at 2-months postpartum. ResultsMultiple linear regressions showed no relationship between PNMS and infant BW, GA or BW for GA, and neither experienced continuity of care, nor model of maternity care moderated this relationship. However, compared with all other models of care, women enrolled in private midwifery care reported the highest levels of experienced continuity of care and birthed infants at higher GA. BW and BW for GA were higher in private midwifery care, relative to standard care. ConclusionEnrollment in continuous models of perinatal care may be a better predictor of infant birth outcomes than degree of PNMS exposure. These results highlight the possibility that increased, continuous support to women during pregnancy may play an important role in ensuring positive infant birth outcomes during future pandemics.

Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South.

The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

The nexus between maternity care and bordering practices: A qualitative study of provider perspectives on maternal healthcare provision for Afghan women migrating through Serbia to Western Europe

Serbia is a well-established transit country for Afghans travelling overland to seek protection in Western Europe, and Afghan women continue to experience pregnancy and birth during migration. This qualitative study aimed to explore the perspectives and experiences and of clinical and non-clinical perinatal care and support providers to Afghan women during migration through Serbia, using a critical border studies lens. Semi-structured interviews with 21 Serbia-based providers (conducted August 2021–October 2022 and analysed thematically) provided five inductive themes: (1) contours of life in Serbia for Afghan women; (2) providing maternity care and support to a highly mobile group; (3) enablers and barriers to accessing and using maternity care; (4) risks of onward migration; and (5) supporting women in a landscape of constant change. We identified ways in which regional geopolitics translated to bordering practices that interfered with maternity support provision to Afghan women in Serbia. We argue that non-exclusionary systems of care are needed to ensure women on the move receive adequate maternity support.

Implementing Guidelines to Manage Perinatal Depression: Exploration of the Healthcare Provider’s Perceptions

Perinatal mental health guidelines are still lacking in more than 80% of low- and middle-income countries. World Health Organization has outlined the importance of an evidence-informed approach for developing and sustaining high-quality integrated mental health services for women during the perinatal period. Method: The study explored healthcare providers' perceptions of implementing guidelines to manage perinatal depression in primary healthcare settings in Namibia. A qualitative, explorative, descriptive, and contextual design was applied to collect data from a purposively selected sample of 12 healthcare providers. This involved two focus groups with healthcare providers. Thematic analysis of the interview transcripts was conducted simultaneously with data collection. Findings: The study highlighted three major themes for successfully implementing the guidelines to manage perinatal depression: the significance of implementing the guidelines, integration of the guidelines into perinatal care settings, and barriers to implementing the guidelines. Conclusion: Healthcare providers were aware of poor maternal mental health provision within perinatal care settings and were ready to implement the guidelines to manage perinatal depression. Professional training and continuous education on perinatal depression are fundamental components in fostering quality of care and community awareness, as well as improving stigma within the community and healthcare providers.

Effect of Maternal Flavour Conditioning Combined with Organic and Inorganic Iron-Supplemented Creep Feed on Piglet Performance and Haemoglobin Status.

Iron injections are vital but imperfect against iron deficiency anaemia (IDA). This experiment explored the effects on piglets of maternal flavour conditioning and the voluntary intake of anise flavoured, iron-supplemented creep feed compared with iron injections. The experiment was a 2 × 2 factorial arrangement: ±maternal exposure to dietary anise flavour and ±intramuscular injections of piglets. Twenty-three sows and their litters (242 piglets) were randomly allocated to one of four treatments (n = 5 or 6 per treatment): no flavour plus no injection (NF + NI); no flavour plus iron injection (NF + I); flavour plus no injection (F + NI); and flavour plus iron injection (F + I). All piglets could access anise flavoured, iron-supplemented creep feed (organic and inorganic forms) from D2 of birth. Sow feed intake and milk anethole concentration, piglet body weight (BW) and average daily gain (ADG), creep feed disappearance, piglet behavioural time budgets, and piglet blood glucose and haemoglobin concentrations were determined. Over the four-week study, the only significant differences found were that iron-injected piglets had reduced blood glucose (p = 0.036) on D14 and that maternal flavour provision increased the frequency of piglet creep feed interaction (p = 0.023) and decreased the frequency of suckling events (p = 0.009). In summary, maternal flavour conditioning reduced piglet creep feed neophobia without influencing consumption. The supplementation of creep feed with iron and anise flavour to piglets under the conditions of this trial was effective in preventing IDA, regardless of exposure to maternal flavouring conditioning.

Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam.

The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.

Phylogenetic analysis of viviparity, matrotrophy, and other reproductive patterns in chondrichthyan fishes.

The reproductive diversity of extant cartilaginous fishes (class Chondrichthyes) is extraordinarily broad, reflecting more than 400 million years of evolutionary history. Among their many notable reproductive specialisations are viviparity (live-bearing reproduction) and matrotrophy (maternal provision of nutrients during gestation). However, attempts to understand the evolution of these traits have yielded highly discrepant conclusions. Here, we compile and analyse the current knowledge on the evolution of reproductive diversity in Chondrichthyes with particular foci on the frequency, phylogenetic distribution, and directionality of evolutionary changes in their modes of reproduction. To characterise the evolutionary transformations, we amassed the largest empirical data set of reproductive parameters to date covering nearly 800 extant species and analysed it via a comprehensive molecular-based phylogeny. Our phylogenetic reconstructions indicated that the ancestral pattern for Chondrichthyes is 'short single oviparity' (as found in extant holocephalans) in which females lay successive clutches (broods) of one or two eggs. Viviparity has originated at least 12 times, with 10 origins among sharks, one in batoids, and (based on published evidence) another potential origin in a fossil holocephalan. Substantial matrotrophy has evolved at least six times, including one origin of placentotrophy, three separate origins of oophagy (egg ingestion), and two origins of histotrophy (uptake of uterine secretions). In two clades, placentation was replaced by histotrophy. Unlike past reconstructions, our analysis reveals no evidence that viviparity has ever reverted to oviparity in this group. Both viviparity and matrotrophy have arisen by a variety of evolutionary sequences. In addition, the ancestral pattern of oviparity has given rise to three distinct egg-laying patterns that increased clutch (brood) size and/or involved deposition of eggs at advanced stages of development. Geologically, the ancestral oviparous pattern arose in the Paleozoic. Most origins of viviparity and matrotrophy date to the Mesozoic, while a few that are represented at low taxonomic levels are of Cenozoic origin. Coupled with other recent work, this review points the way towards an emerging consensus on reproductive evolution in chondrichthyans while offering a basis for future functional and evolutionary analyses. This review also contributes to conservation efforts by highlighting taxa whose reproductive specialisations reflect distinctive evolutionary trajectories and that deserve special protection and further investigation.