Asynchronous online versus face-to-face mindfulness training for maternal mental health: A randomised controlled trial.

This study aimed to analyze metabolic characteristics of the umbilical cord blood associated with brain injury in neonates with selective fetal growth restriction (sFGR). A prospective cohort of 30 sFGR twin pairs delivered at Peking University Third Hospital between September 2017 and December 2019 was enrolled. Maternal-fetal clinical data and information on neonatal complications, including brain injury, were collected for both the growth-restricted (sFGR-S) and larger (sFGR-L) fetuses. The mean maternal age at delivery was (30.7±3.9) years, and the mean gestational age at delivery was (32.7±2.2) weeks. Among the 30 sFGR cases, there were 12 cases of type Ⅰ, 11 type Ⅱ, and 7 type Ⅲ. The cohort comprised 30 male and 30 female neonates (50% each). Brain injury occurred in 12 (40%) of the sFGR-S group, including 7 cases of intracranial hemorrhage (IVH), 3 cases of periventricular leukomalacia (PVL), and 2 case with both. In the sFGR-L group, brain injury occurred in 9 (30%) neonates, including 6 cases of IVH, 2 cases of PVL, and 1 case with both. Receiver operating characteristic (ROC) curve analysis for the sFGR-S group yielded an area under the curve (AUC) of 0.853 (95%CI: 0.698-1.000) for tyrosine alone, and an AUC of 0.944 (95%CI: 0.859-1.000) for the combination of tyrosine and myristic acid. For the sFGR-L group, the AUC was 0.880 (95%CI: 0.708-1.000) for S-adenosyl methionine (SAM) alone, and 0.917 (95%CI: 0.749-1.000) for the combination of SAM and trans-vaccenic acid. In conclusion, neonates in the sFGR-S and sFGR-L groups exhibit distinct metabolic profiles, and differential metabolites with their related pathways hold potential predictive value for neonatal brain injury.

To investigate the knowledge, attitudes and practices (KAP) of parents of children born moderate to late preterm (32 to <37 weeks' gestation) regarding their children's neurodevelopment. A cross-sectional study. This study was conducted from March to June 2025 at the Second People's Hospital of Changzhou. Parents of children born moderate to late preterm were surveyed in the outpatient clinic when their children were at preschool age. No. KAP scores were assessed using a questionnaire, and differences among parents were compared across different demographic characteristics. KAP scores were converted to percentages and interpreted using a 70% descriptive cut-off. Structural equation modelling was employed to investigate the inter-relationships among the KAP dimensions. This study included 499 participants, with a mean maternal age of 34.03±5.42 years; the majority were women (92.79%). The mean knowledge score was 7.22±3.53 (out of a possible maximum of 18), the mean attitude score was 23.91±5.16 (out of a possible maximum of 35) and the mean practice score was 25.84±5.08 (out of a possible maximum of 40). The knowledge scores correlated with the attitude (r=0.193, p<0.001) and practice (r=0.558, p<0.001) scores, while the attitude scores correlated with the practice scores (r=0.312, p<0.001). The path analysis revealed that knowledge had a direct influence on attitude (β=0.290, p=0.011) and practice (β=0.582, p=0.006). Attitude had a direct influence on practice (β=0.228, p=0.012). Knowledge also had an indirect influence on practice through its impact on attitude (β=0.066, p=0.005). Parents' KAP scores were below the descriptive 70% sufficiency threshold, particularly for knowledge, suggesting unmet needs for clearer follow-up communication and family-centred neurodevelopmental education. Interventions should focus on strengthening family-centred education, clearer follow-up communication and parental engagement in neurodevelopmental monitoring and early intervention.

To evaluate the feasibility and accuracy of remote, clinician-guided biophysical profile (BPP) assessment using a handheld ultrasound device operated by lay users. This prospective, non-randomized, quasi-blinded study compared clinician-guided ultrasound-based BPP scans performed remotely by lay users using the Pulsenmore ES device with concomitant standard in-clinic ultrasound examinations performed by healthcare professionals, with both assessments conducted consecutively and immediately one after the other. Agreement between modalities was assessed for individual BPP components and overall BPP scores. A total of 30 pregnant women were enrolled at a mean gestational age of 33.0 ± 2.6 weeks. The mean maternal age was 31.4 ± 4.5 years, and mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 27.4 ± 5.2. Overall agreement between remote and in-clinic BPP scores was 90%. Agreement was 100% for cardiac activity, fetal movements, fetal presentation, placental location, and subjective amniotic fluid volume assessment. Agreement for fetal tone and breathing movements was 96.7 and 93.3%, respectively. Sensitivity and specificity of remote BPP assessment for detecting abnormal overall BPP findings, using the standard in-clinical ultrasound examination as the reference standard, were 92.6 and 66.7%. The mean difference in total BPP score was 0.07 ± 0.64 points. Mean fetal heart rate and maximal vertical pocket measurements were comparable between modalities. Remote examinations required more time than in-clinic scans (8.0 ± 3.9 vs. 4.6 ± 3.3 min) but remained within recommended limits. Clinician-guided remote BPP assessment using a handheld ultrasound device operated by lay users demonstrates high agreement with standard in-clinic ultrasound under supervised conditions and may represent a reliable alternative for prenatal surveillance in selected populations.

Lebanese Americans, the largest Arabethnic group in the United States, remain underrepresented in mental health research despite collective exposure to conflict, displacement, and immigration. This study examined intergenerational associations of parental childhood war exposure (CWE) during the Lebanese Civil War (1975-1990) on the mental health of second-generation Lebanese American young adults (G1) and characterized G1 clinical symptoms and service use. Using community-partnered recruitment, 92 G1 (mean age 28.1 years, SD 4.5) participants reported on their own adverse childhood experiences (ACEs), psychiatric symptoms, past mental health service use, and duration of CWE in their 184 immigrant parents (G0; mean maternal and paternal ages 54.6 and 58.7 years, respectively). G1s showed high levels of clinical range psychopathology: 48.9% for depression, 44.6% for anxiety, and 22.5% for PTSD, with 58.7% meeting criteria for at least one internalizing disorder. Females had significantly higher anxiety (mean GAD-7 = 9.7 vs. 7.5; p = 0.04) and PTSD symptoms (mean PCL-5 = 26.3 vs. 15.5; p < 0.01), while males reported greater nicotine use symptoms (mean 1.2 vs. 0.5; p = 0.01). Maternal CWE duration was associated with G1 depression (ρ = 0.24; p = 0.023) and PTSD (ρ = 0.22; p = 0.037); Paternal CWE was associated with G1 nicotine use (ρ = 0.21; p = 0.047). These results remained largely consistent after controlling for G1 ACEs. Only 25.9% of G1s with clinical threshold symptoms accessed care in the past year. Findings highlight distinct maternal and paternal intergenerational patterns and major gaps in service use.

BackgroundEpisiotomy remains the primary surgical intervention during childbirth to prevent severe maternal complications, particularly in resource-constrained settings like Uganda, where alternatives are scarce. Despite WHO’s recommendation to limit episiotomy rates to <10%, its use remains high, with risks of severe perineal tears. This study assessed prevalence and predictors of severe perineal tears following episiotomy: A cross-sectional study in Uganda.MethodsA hospital-based descriptive cross-sectional study enrolled 249 women who underwent episiotomy at MRRH from September–December 2024. Data were collected using structured questionnaires, and tears were confirmed via digital rectal examination. Data were analyzed at univariate, bivariate levels, followed by Modified Poisson regression to determine the factors associated with episiotomy extensions.ResultsThe mean maternal age was 22.9 (±4.2) years. Of 249 women, 34 (13.7%, 95% CI: 9.9–18.5%) experienced extensions, primarily third-degree tears (n = 31). Multivariate analysis identified two significant factors associated with episiotomy extension into third- or fourth-degree perineal tears: Fetal distress in the second stage of labour (aPR: 3.05 (1.66–5.60) p < 0.001) and delivery conducted by a medical intern doctor (aPR: 2.62 (1.10–6.21), p = 0.029).ConclusionApproximately 1 in 8 women with episiotomy at MRRH sustained severe perineal tears and were associated with fetal distress and intern-assisted deliveries. To mitigate these outcomes, we recommend: enhanced mentorship and supervision for junior birth attendants and strict adherence to evidence-based practices to reduce procedural errors and we suggest reviewing the indications for episiotomy to lower the baseline rate. These measures could improve maternal safety and quality of care in similar low-resource settings.

To evaluate cesarean scar morphology following vaginal birth after cesarean section (VBAC) and to examine associations of scar parameters with labor and clinical parameters. In a prospective cohort study at a single tertiary center, women who had undergone one prior low-transverse cesarean section and delivered vaginally underwent two transvaginal ultrasound examinations: one immediately after delivery and one 24-48 hours postpartum. Scar depth and width, adjacent myometrial thickness (AMT), and residual myometrial thickness (RMT) were measured. Correlations with clinical and labor variables were analyzed. 50 women were included. The mean maternal age was 30.7 ± 4.8 years and the mean BMI was 30.3 ± 4.4 kg/m². 41 women completed both examinations. Between the two ultrasound examinations, the mean scar depth and width decreased (15.8 ± 6.7 mm vs. 13.1 ± 4.1 mm; p = 0.009 and 16.8 ± 9.6 mm vs. 12.2 ± 5.8 mm; p = 0.007, respectively), while the AMT and RMT remained unchanged (p > 0.7). Non-spontaneous labor onset was associated with deeper scars (p = 0.027), and spontaneous rupture of membranes correlated with a greater RMT (p = 0.041). Women with a BMI ≥30 kg/m² had a thinner AMT and RMT (p = 0.022 and 0.025, respectively) and more frequent labor augmentation (p = 0.006). No uterine ruptures or major maternal and neonatal complications occurred. Immediate postpartum ultrasound after VBAC elucidated early remodeling of the previous cesarean scar. Non-spontaneous labor onset and a higher BMI were associated with a less favorable scar morphology, though without adverse short-term maternal or neonatal outcomes.

Adverse pregnancy outcomes (APOs) are increasingly recognized as early indicators of maternal cardiovascular risk. However, their associations with nontraumatic subarachnoid hemorrhage (SAH) remain poorly understood. We conducted a nationwide cohort study of 1 785 088 primiparous women in the Swedish Medical Birth Register between 1973 and 2014, followed from first birth through December 31, 2023. APOs included hypertensive disorders of pregnancy, gestational diabetes, placental abruption, preterm birth, abnormal fetal growth, and stillbirth. SAH was the primary outcome, with aortic aneurysm rupture or dissection and spontaneous coronary artery dissection as secondary outcomes. Hazard ratios (HRs) and 95% CIs were estimated using Cox regression, adjusting for calendar year, parity, maternal sociodemographic characteristics, and psychiatric disorders, with sibling analyses to account for shared familial and genetic factors. Mean maternal age was 28.2 years, and abnormal fetal growth was the most common APO category. Over up to 50 years, 759 722 (42.6%) women experienced at least 1 APO; there were 5751 (0.32%) events of SAH. Women with APOs had increased risks of SAH compared with those without, particularly after placental abruption (HR, 1.62 [95% CI, 1.29-2.04]), hypertensive disorders of pregnancy (HR, 1.58 [95% CI, 1.41-1.77]), gestational diabetes (HR, 1.40 [95% CI, 1.04-1.90]), preterm birth (HR, 1.35 [95% CI, 1.24-1.47]), and small for gestational age (HR, 1.34 [95% CI, 1.26-1.43]). The associations were consistent in sibship analyses. The excess SAH risk was greatest in the first years after delivery and attenuated over time. Increased risks of aortic aneurysm rupture or dissection were observed after hypertensive disorders of pregnancy, preterm birth, and severely large for gestational age (HRs ranged from 1.43 to 1.66), whereas associations with spontaneous coronary artery dissection differed in direction. APOs were associated with increased maternal risk of SAH, with variation by the timing, severity, and accumulation of pregnancy complications, suggesting underlying vascular vulnerability.

Cytomegalovirus (CMV) is the most common congenital infection globally, and the leading cause of non-genetic hearing loss and neurodevelopmental disability. The burden is highest in low- and middle-income countries where HIV is also highly prevalent. Women living with HIV have a higher prevalence of CMV and are more likely to transmit CMV to their infants. Despite this, congenital CMV (cCMV) and newborn hearing screening are not routinely available in sub-Saharan Africa (sSA) resulting in missed diagnoses and delayed treatment. Additionally, data comparing cCMV prevalence in HIV-exposed and non-exposed infants is limited. We aimed to determine cCMV prevalence among HIV-exposed and -unexposed neonates in Uganda, describe associated clinical characteristics, and assess infant hearing outcomes. This study was nested within a prospective cohort of pregnant women with and without HIV, followed with their infants through early childhood. Eligible participants were 18 years or older, pregnant, and planned to deliver at one of two clinics. We tested newborn saliva for CMV using a real-time PCR. Hearing screening was performed using a pre-approved screening algorithm. Maternal and neonatal medical characteristics and diagnoses were abstracted from clinical records. A total of 793 women and their newborns were enrolled. Mean maternal age was 28 (standard deviation [SD] 6) years, and parity was 3 (SD, 2.0). The mean birth weight was 3.0 (SD, 0.5) kilograms and gestational age was 37 (SD, 2.0) weeks. Overall, 677 out of 793 (84.7%) neonatal saliva samples were tested for cCMV, 23 out of 677 (3.4%) were positive with no difference by maternal HIV status. cCMV was not associated with failed hearing screen. However, lower one-minute Apgar and jaundice were associated with cCMV. cCMV prevalence was high in this Ugandan cohort and did not differ by HIV exposure. Hearing outcomes were similar by cCMV status. Future studies should include a comprehensive clinical and audiological assessment for both HIV-exposed and -unexposed neonates, and longitudinal follow-up to detect hearing loss and other cCMV-associated sequelae.

Peer support is a promising strategy to improve breastfeeding outcomes, but evidence for online formats is limited. To evaluate whether structured peer support delivered via video calls improves exclusive breastfeeding rates and maternal breastfeeding self-efficacy. This multicenter, randomized clinical trial enrolled first-time mothers with low breastfeeding confidence from 4 public postnatal wards in Hong Kong from January 31, 2021, to June 30, 2024. Participants were randomly assigned (1:1) to intervention or control. The primary analysis was conducted from July 1 to 31, 2024, with final data analysis completed by December 31, 2025. The intervention included usual postnatal care, consisting of access to lactation consultants and standard breastfeeding information from the Department of Health, plus at least 2 video call sessions with trained peer support volunteers at 10 days and 1 month post partum. The primary outcome was the proportion of infants who were exclusively breastfed at 6 months post partum. Secondary outcomes included exclusive breastfeeding at 1, 2, and 4 months post partum and maternal self-efficacy (measured using the Breastfeeding Self-Efficacy Scale-Short Form) at 2 and 4 months. All outcomes were analyzed on an intention-to-treat basis. Among 442 participants, 224 were allocated to the intervention group and 218 were allocated to the control group. The mean (SD) maternal age was 32.4 (4.0) years (32.4 [4.2] years in the intervention group and 32.3 [3.9] years in the control group). The primary 6-month outcome did not differ significantly between groups (37 of 184 [20.1%] vs 29 of 186 [15.6%]; adjusted odds ratio [AOR], 1.57 [95% CI, 0.85-2.89]; P = .15); however, exclusive breastfeeding at 2 months (a secondary outcome) was significantly higher in the intervention group (54 of 199 [27.1%] vs 38 of 200 [19.0%]; AOR, 1.80 [95% CI, 1.08-3.01]; P = .02). Longitudinal analysis confirmed higher odds of exclusive breastfeeding in the intervention group over time, with the largest difference at 2 months. Breastfeeding self-efficacy showed significantly greater improvement in the intervention group (time × intervention interaction: β = 1.01 [95% CI, 0.21-1.81]; P = .01), with a higher score at 4 months (adjusted β, 4.65 [95% CI, 1.60-7.70]; P = .01). In this randomized clinical trial, video call-based peer support did not increase exclusive breastfeeding at 6 months; however, it significantly increased exclusive breastfeeding at 2 months and improved maternal breastfeeding self-efficacy, offering a scalable model for postnatal care integration. ClinicalTrials.gov Identifier: NCT04621266.

BackgroundExposure to heat and cold are associated with adverse birth outcomes, but whether ambient temperature affects embryonic and early fetal development remains unclear. We aimed to examine the association between ambient temperature exposure during early pregnancy and crown–rump length (CRL).MethodsData from the Generation R Next Study (2017–2021) were analysed, with findings replicated in the Generation R Study (2002–2006), both population-based cohorts based in Rotterdam, The Netherlands. Weekly mean temperatures were modeled from the last menstrual period onward at a spatial resolution of 100 × 100 m by using the UrbClim™ model. The CRL was measured via 2D ultrasound at approximately 8, 10, and 12 weeks’ gestation in pregnancies with regular menstrual cycles. Distributed lag nonlinear models were applied.ResultsIn Generation R Next (N = 1378; mean maternal age 31.9 years), higher temperatures during the first 9 weeks were associated with a smaller CRL at 12 weeks {e.g. −7.2 mm [95% confidence interval (CI) −12.0, −2.3] at 19.2 vs 9.0°C during weeks 1–6}. Colder exposures during the first 11 weeks were also associated with a smaller CRL [−7.6 mm (95% CI −11.9, −3.3) at 3.6 vs 9.0°C during weeks 1–11]. No associations were observed for CRL at 8 or 10 weeks. Similar associations with cold, but not heat, were observed in the replication cohort (N = 1520).ConclusionModerate cold and heat exposure during early pregnancy may affect fetal development as early as the first trimester. These findings indicate that early gestational development may be sensitive to ambient temperature and, as environmental conditions shift, may have potential clinical implications for birth outcomes and long-term health.

Fetal malpresentation, such as breech, transverse, and oblique presentations, is a frequent diagnosis in obstetrical practice. While several maternal factors have been studied, the potential relationship between maternal sedentary behavior and fetal malpresentation remains underexplored. This study aimed to examine the association between sedentary behavior during pregnancy and fetal malpresentation using data from a large longitudinal cohort study conducted in Japan. This prospective longitudinal cohort study recruited approximately 100,000 pregnant women from 15 Regional Centers in Japan. Participants completed self-administered questionnaires in the first and either the second or third trimester of pregnancy. Sedentary behavior was defined as the number of hours spent sitting or lying down per day. The fetal presentation at delivery was recorded from medical records. Logistic regression analyses were conducted to estimate the odds ratio of the association between sedentary time and the likelihood of fetal malpresentation. Here we show that among 73,813 eligible participants, the mean maternal age is 31.3 years, 27.4% deliver at ≥35, 3.0% experience fetal malpresentation, and 48.7% have female infant. The median sedentary time is 5 hours (interquartile range: 3-8). Women who report ≥12 hours sedentary time per day have higher odds for fetal malpresentation compared to those reporting <6 hours (adjusted odds ratio: 1.17; 95% confidence interval: 1.02-1.35). The findings emphasize the need to address sedentary behavior as a modifiable risk factor during pregnancy, which may implicate future interventions aimed at reducing the incidence of fetal malpresentation.

Background: Neonatal birth weight is a key determinant of short- and long-term health outcomes. Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are important predictors of birth weight; however, their independent associations remain unclear, particularly in settings where national GWG guidelines are lacking. Methods: A prospective cohort study was conducted among 340 pregnant women in Ulaanbaatar, Mongolia in 2022. Data were collected using standardized questionnaires and anthropometric measurements. Pre-pregnancy BMI and GWG were classified according to World Health Organization criteria and the 2009 Institute of Medicine guidelines. Multivariable linear regression models were used to examine independent associations with neonatal birth weight. Results: The mean maternal age, pre-pregnancy BMI, and GWG were 30.3 ± 6.0 years, 23.5 ± 4.4 kg/m2, and 14.3 ± 6.2 kg, respectively. Both BMI and GWG were independently associated with neonatal birth weight (p < 0.001), with no significant interaction observed (p = 0.147). Birth weight increased by 29.7 g (95% CI: 18.6–40.8) per 1 kg/m2 increase in BMI and by 31.7 g (95% CI: 24.0–39.4) per 1 kg increase in GWG. Compared with normal BMI, overweight/obesity was associated with higher birth weight, while excessive GWG increased and inadequate GWG decreased birth weight (all p < 0.05). Conclusions: Pre-pregnancy BMI and GWG were independently associated with neonatal birth weight, with GWG showing a slightly stronger association. These findings highlight the importance of optimizing maternal weight before and during pregnancy. Countries undergoing rapid nutritional transitions may benefit from developing context-specific GWG guidelines, with Mongolia representing a relevant example.

Maternal adult congenital heart disease (ACHD) has been associated with increased offspring congenital heart disease (CHD), but evidence from resource-limited regions remains scarce. The association between maternal acquired heart disease (AHD) and offspring CHD is unknown. To quantify the overall and subtype-specific CHD risk in offspring associated with maternal ACHD and AHD, examine the association of maternal ACHD and AHD with outcomes in offspring with CHD, and identify maternal factors that may modify the associations between maternal cardiac diseases and offspring CHD risk. This prospective birth cohort study enrolled pregnant women receiving prenatal care between August 1, 2011, and December 31, 2021, at a major cardiac referral center in China. Participants included pregnant women with ACHD, with AHD, or without cardiac disease and were followed up through delivery; their offspring were followed up until 1 year of age. All follow-ups were completed by December 15, 2023. Data were analyzed from April 1, 2024, through April 31, 2025. Maternal ACHD and AHD, confirmed via the center's electronic medical records. The main outcome was offspring CHD, which was diagnosed using echocardiography. Log-binomial regression was used to estimate relative risks (risk ratios [RRs]) and 95% CIs. Adverse outcomes were compared using pairwise tests. Stratification analyses identified potential effect modifiers. A total of 14 336 pregnant women with 15 677 offspring (8480 males [54.1%]) were included. The mean (SD) maternal age and gestational age at enrollment were 31.4 (4.5) years and 16.4 (6.4) weeks, respectively. Both maternal ACHD and AHD were associated with higher CHD risk in offspring (RR, 1.71 [95% CI, 1.26-2.31] and 1.38 [95% CI, 1.02-1.87], respectively). Minor CHDs, particularly septal defects, were the subtypes with the greatest magnitude of associations with maternal ACHD (RR, 2.95; 95% CI, 1.97-4.43) and AHD (RR, 2.28; 95% CI, 1.50-3.45). Right ventricular outflow tract obstruction (RR, 6.17; 95% CI, 3.59-10.60) and valvular heart disease (RR, 1.65; 95% CI, 1.11-2.45) were the key contributors to offspring CHD risk. Preterm birth had higher rates among offspring with CHD and mothers with ACHD as well as offspring with CHD and mothers without ACHD compared with offspring without CHD and mothers without cardiac disease (12 of 39 [30.8%] and 121 of 780 [15.5%] vs 1287 of 14 088 [9.1%]; all P < .001). Higher rates of chromosomal (5 of 39 [12.8%] and 38 of 780 [4.9%] vs 75 of 14 088 [0.5%]; all P < .001) and genetic aberrations (3 of 39 [7.7%] and 16 of 780 [2.1%] vs 57/14 088 [0.4%]; all P < .001) were found among offspring with CHD and mothers with AHD as well as offspring with CHD and mothers without AHCD compared with offspring without CHD and mothers without cardiac disease. Associations between maternal cardiac disease and offspring CHD were robust in primiparous women (ACHD: RR, 2.15 [95% CI, 1.48-3.11], P for interaction < .001; AHD: RR, 1.73 [95% CI, 1.17-2.56], P for interaction = .02) and those with periconceptional exposure to hazardous substances (ACHD: RR, 2.22 [95% CI, 1.56-3.16], P for interaction < .001; AHD: RR, 1.57 [95% CI, 1.05-2.36], P for interaction = .02). In this cohort study, maternal ACHD and AHD were associated with increased risks and adverse outcomes of offspring CHD. Targeted modification of identified maternal factors could help mitigate offspring CHD risk in this high-risk population.

Background and aim: Postpartum depression (PPD) is a mental health condition that adversely affects both maternal and infant well-being. Kangaroo Mother Care (KMC), involving skin-to-skin contact and exclusive breastfeeding, has shown promising maternal and neonatal outcomes. This study explored post-KMC observed improvement in maternal depressive symptoms among women with PPD. The present study aimed to evaluate Kangaroo Mother Care as a supportive intervention for postpartum depression in mothers.Materials and methods: This descriptive study was conducted at Shaikh Zayed Hospital for Women, Larkana, from April 2025 to September 2025. A total of 128 women aged 18-40 years, delivering infants between 28-36 weeks of gestation and diagnosed with postpartum depression (Edinburgh Postnatal Depression Scale {EPDS} ≥13), were enrolled using non-probability consecutive sampling. The EPDS, a validated 10-item screening tool for postpartum depression, was administered at baseline and repeated once after completion of the intervention. Kangaroo Mother Care (KMC) was provided to mothers with postpartum depression for 1 h daily over one week. Data were analyzed using SPSS version 20 (Armonk, NY: IBM Corp.). Results were stratified by age, gestational age, parity, and mode of delivery. Paired t-test or Wilcoxon signed-rank test, chi-square test, multivariable logistic regression, and multiple linear regression analyses were applied where appropriate, with p≤0.05 considered statistically significant.Results: The mean maternal age was 30.91±5.14 years, and the mean gestational age was 32.28±2.39 weeks. The baseline mean EPDS score was 13.56±8.59. After the intervention, 36 (28%) women demonstrated post-KMC observed improvement, defined as an EPDS score <13. A statistically significant association was observed between gestational age and post-KMC observed improvement (p=0.003).Conclusion: This study demonstrates post-KMC observed improvement in depressive symptom scores among a subset of participants, with gestational age showing a significant association with outcome. As a descriptive case series without a control group, causal inferences cannot be made. Further controlled studies are required to confirm these findings and explore underlying mechanisms. These results provide preliminary evidence supporting the feasibility of KMC as a supportive, low-cost intervention in maternal mental health within resource-limited settings.

Guillain-Barré syndrome in pregnancy: A systematic review of published case reports and case series with obstetric and neonatal outcomes.

BackgroundCongenital anomalies are a public health concern and the leading cause of infant mortality, particularly in low- and middle-income countries. Established risk factors include pregestational diabetes, maternal obesity, folic acid deficiency, and limited access to prenatal care. The aim of this exploratory study was to describe maternal characteristics in relation to isolated and multiple non-syndromic congenital anomalies in a series of cases from a secondary-care hospital in Puebla, Mexico.Materials and methodsAn observational, cross-sectional, exploratory case series with ambispective data collection was conducted in the Genetics Department of General Hospital Zone No. 20 of the Mexican Social Security Institute in Puebla, Mexico. The study included 31 mothers of patients with non-syndromic congenital anomalies. Data collected included sociodemographic characteristics, anthropometric measurements, and environmental exposures. Congenital anomalies were categorized as isolated or multiple. Categorical variables were compared using Fisher's exact test and continuous variables using the Mann-Whitney U test.ResultsA total of 31 mothers of patients with congenital anomalies were analyzed. Twenty-one (67.7%) cases presented isolated anomalies, and 10 (32.3%) multiple anomalies, with craniofacial anomalies being the most frequent. The mean maternal age at the time of pregnancy was 27.71 ± 5.58 years. Higher frequencies were observed among mothers with higher educational attainment, employment, and exposure to teratogens; however, these differences did not reach statistical significance.ConclusionIn this exploratory case series, no statistically significant differences were found between maternal characteristics and the presence of isolated or multiple congenital anomalies. Observed differences should be interpreted in the context of the study design and limited sample size, and these findings are hypothesis-generating and require confirmation in larger, controlled studies.

Symptomatic gallstone disease is amongst the most common non-obstetric surgical conditions encountered during pregnancy. Historically, conservative management was favoured due to concerns regarding foetal safety during anaesthesia and laparoscopy. However, advances in minimally invasive surgery, anaesthetic techniques, and perioperative monitoring have led to increasing acceptance of laparoscopic cholecystectomy (LC) as a safe and effective treatment option during pregnancy. To evaluate perioperative outcomes, operative feasibility and maternal-fetal safety in pregnant patients undergoing LC in a tertiary care centre. A hybrid retrospective-prospective observational study was conducted, including pregnant patients who underwent LC between January 2021 and December 2025. The study comprised a retrospective analysis (2021-2023) and a prospective cohort (2024-2025). Data collected included demographic characteristics, gestational age, surgical indication, operative details, maternal complications and neonatal outcomes. Descriptive statistics were used for the analysis. Thirteen pregnant patients underwent LC during the study period. The mean maternal age was 28.5 ± 4.2 years, and the mean gestational age at surgery was 18.5 ± 3.1 weeks (range 14-28 weeks). Ten procedures were performed during the second trimester and three during the third trimester. All surgeries were completed laparoscopically without conversion to open surgery. Mean operative time was 45 min (range 35-65 min). One patient developed transient post-operative uterine contractions, which resolved with tocolytic therapy. No foetal distress, congenital anomalies or maternal surgical complications were observed. LC during pregnancy is a safe and feasible procedure when performed with multidisciplinary planning, pregnancy-specific technical modifications and appropriate foetal monitoring. Our findings support the growing body of evidence that minimally invasive surgery can be safely performed in selected pregnant patients requiring definitive treatment for symptomatic gallstone disease.

Introduction Pregnancy in women with inflammatory bowel disease (IBD) is associated with increased risk of complications, particularly when disease activity is uncontrolled. Antenatal hospital admissions may reflect underlying disease activity or pregnancy-related complications and may adversely affect pregnancy outcomes. We aimed to examine the causes of antenatal hospital admissions and obstetric and fetal outcomes. Methods We included completed pregnancies in women with a confirmed diagnosis of Crohn’s disease (CD), ulcerative colitis (UC) or IBD-unclassified (IBD-U), followed between May 2014 and March 2025 who had at least one hospital admission during pregnancy. Data were collected retrospectively on IBD history, disease activity assessed according to the Global Physician Assessment, treatment, reasons for admission, investigations and pregnancy outcomes. Results A total of 56 pregnancies in women with IBD were included. The mean maternal age was 31 years; 27 had CD, 26 UC and 3 IBD-U. 36 of all hospitalisations were IBD-related. The main reason for the admission was disease flares. Other IBD-related causes included stoma complications, abdominal pain, perianal issues, gastrointestinal bleeding and one intestinal perforation. Non-IBD admissions were mainly for obstetric complications or infections. Conclusion Pregnant women with IBD remain at risk of both disease-related and obstetric complications requiring hospitalisation, underscoring the need for tailored multidisciplinary care and proactive monitoring throughout pregnancy.

Respiratory syncytial virus (RSV) is a leading cause of infant hospitalizations. In August 2023, the US Food and Drug Administration approved a bivalent RSV prefusion F subunit-based vaccine (RSVpreF) for maternal immunization to protect newborns. Sequential surveillance analysis provides information on the safety of a vaccine during its initial uptake. To report the sequential surveillance findings for 10 prespecified safety outcomes of exposure to RSVpreF during pregnancy over the course of its first vaccination season in the US. This cohort study with a sequential surveillance design used health plan data from 5 research partners. Health insurance data were analyzed across 5 sequential surveillance periods from April 25, 2024, through April 10, 2025. Pregnancies of individuals aged 15 to 54 years that culminated in a live birth or stillbirth and reached 32 gestational weeks were included. Cohorts included pregnancies exposed to RSVpreF (between September 22, 2023, and August 9, 2024); comparator pregnancies receiving influenza, COVID-19, and/or Tdap (tetanus, diphtheria, and acellular pertussis) vaccines but not the RSVpreF concurrently; and historical comparator pregnancies (vaccinated between September 1, 2018, and January 31, 2023). RSVpreF or comparator vaccines (influenza, COVID-19, and/or Tdap but not RSVpreF) between 32 through 36 weeks' gestation. Primary outcomes were preterm birth and pregnancy-associated hypertensive disorders (composite of gestational hypertension; preeclampsia; eclampsia; hemolysis, elevated liver enzymes, and low platelet syndrome; or preexisting hypertension superimposed with preeclampsia or eclampsia). Secondary outcomes included premature rupture of membranes (PROM), preterm labor without preterm delivery, preterm PROM, maternal Guillan-Barré syndrome, and stillbirth. Infant outcomes were large for gestational age, small for gestational age, and low birth weight. Crude incidence proportions (IPs) and adjusted relative risks (ARR) were identified for these outcomes. Among the 13 619 RSVpreF-exposed pregnancies included in the analysis, the mean (SD) maternal age was 33.3 [4.6] years. The most common safety outcomes were pregnancy-associated hypertensive disorders (IP, 17.3%; 95% CI, 16.6%-17.9%) and PROM (IP, 14.1%; 95% CI, 13.5%-14.7%). Risk of preterm birth was not elevated compared with the concurrent comparator (ARR, 0.79; 95% CI, 0.65-0.98) or historical comparator (ARR, 0.87; 95% CI, 0.78-0.96). Beginning with the second surveillance period, statistically significantly elevated risks were detected for pregnancy-associated hypertensive disorders (concurrent comparator: ARR, 1.14 [95% CI, 1.02-1.27]; historical comparator: ARR, 1.29 [95% CI, 1.24-1.34]), PROM (concurrent comparator: ARR, 1.09 [95% CI, 0.97-1.22]; historical comparator: ARR, 1.14 [95% CI, 1.09-1.19]), and preterm PROM (historical comparator: ARR, 1.18; 95% CI, 1.08-1.29). No other increased risks were observed. In this study using a sequential surveillance design, there was no association between RSVpreF vaccination during pregnancy and preterm birth; however, potential increased risks of pregnancy-associated hypertensive disorders, PROM, and preterm PROM could not be ruled out, due to limited confounding control available in the early postlicensure period. Further epidemiological studies are needed to refine risk estimates and account for other confounding factors.