Mode Of Birth Research Articles

Long-term maternal outcomes 5 years after cesarean section in Sierra Leone: A prospective cohort study.

Cesarean section (CS) is a life-saving procedure when performed for the right indication but carries substantial risks, specifically during subsequent pregnancies. The aim of this study was to evaluate obstetric outcomes for women 5 years after a CS performed by medical doctors and associate clinicians. This was a prospective multi-center observational study of women who had a CS at any of nine hospitals in Sierra Leone. Women and their offspring were followed up with three home visits for 5 years after surgery. Outcomes of interest included long-term complications, mode and place of delivery, and maternal and pediatric outcomes of subsequent pregnancies. Of the 1274 women included in the study, 140 (11.0%) were lost to follow-up. Within 5 years after the index CS, 27.0% of the women became pregnant and 2.5% had a second pregnancy. Women with perinatal death at the index CS had 5.25 higher odds of becoming pregnant within 1 year. Of the 259 women who delivered, 31 (12.0%) had a planned CS and 228 (88.0%) attempted a trial of labor after CS, resulting in either a successful vaginal birth (n = 138; 60.5%) or an emergency CS (n = 90; 39.5%). Peripartum and long-term complications did not significantly differ between those that were operated on by medical doctors and associate clinicians. Within 5 years after CS, one in four women became pregnant again and more than half had a vaginal delivery. Significant differences in place and mode of birth between wealth quintiles illustrate inequities.

Impact of Postpartum Hospital Length-of-Stay on Infant Gut Microbiota: A Comprehensive Analysis of Vaginal and Caesarean birth

BackgroundThe primary concern with prolonged hospitalization following birth is the risk of acquiring hospital-acquired infections (HAIs) caused by opportunistic bacteria, which can alter the early establishment of gut microbiota. ObjectiveThis study aimed to assess the association between postpartum hospital length-of-stay (LOS) and the composition of gut microbiota at 3 and 12 months of age according to birth mode. MethodsA total of 1313 Canadian infants from the CHILD Cohort Study were involved in this study. Prolonged hospital LOS was defined as > 2 days following vaginal and > 3 days after caesarean section (CS) birth. Infants' gut microbiota was characterized by Illumina 16S rRNA sequencing of faecal samples at 3-4 months and 12 months. FindingsFollowing a prolonged hospital LOS, vaginally-delivered (VD) infants with no maternal intrapartum antibiotic (IAP) exposure had a higher abundance of bacteria in their gut known to cause HAIs, including Enterococcus at 3 and 12 months, Citrobacter at 3 months and C. difficile at 12 months. Enterococcus or Citrobacter abundance at 3 months significantly mediated the association between LOS, and low abundance of Bacteroidaceae, or higher Enterococcaeae/Bacteriodaceae or Enterobacteriaceae/Bacteroidaceae abundance ratios at 12 months of age in VD infants without IAP exposure. HAI-causing Enterobacteriaceae were also more abundant in later infancy with a longer hospital LOS following CS. In the absence of exclusive breastfeeding for 3 months or any breastfeeding at 12 months, the Porphyromonadaceae (of Bacteroidota) become depleted in CS infants with a prolonged LOS. ConclusionsProlonged hospital stay after birth is associated with infant gut dysbiosis.

Exploring the acceptability of a decision aid for rural women with a history of prior cesarean birth regarding subsequent mode of birth in Coatepeque, Guatemala.

Decisions regarding mode of delivery in the context of a prior cesarean birth is complicated because both trial of labor after cesarean and elective repeat cesarean birth have risks and benefits. The objective of this study was to understand the perspective of women and obstetricians in Coatepeque, Guatemala, to guide the development of a decision aid about mode of birth for women with a history of prior cesarean. We conducted in-depth semi-structured interviews with obstetricians at Coatepeque Hospital and women at the Center for Human Development in the southwest Trifinio region of Guatemala in February 2020. Using qualitative content analysis, we recorded, transcribed, translated, and analyzed qualitative data for the meaning of themes and concepts exploring the acceptability of counseling with a decision aid regarding mode of delivery. A total of 30 qualitative interviews were conducted with women and physicians. Three themes emerged from the qualitative interviews: Having a decision aid for women with a prior cesarean birth will be useful and helpful. Content of the decision aid should include benefits and risks for women and babies as well as figures. Women described the need of tailoring the content surrounding family's role in their decisions. They felt that a trusted provider from the healthcare system should facilitate the use of the decision aid for counseling. These findings emphasize the support and need for innovative approaches to patient education around mode of delivery after a prior cesarean in the southwest region in Guatemala. There is a need to improve the educational information given to women regarding their mode of delivery after a cesarean birth. Finally, an effective decision aid needs to be tailored to not only the women's needs but also the engagement of the family unit for its successful implementation.

Is confidence in knowledge related to childbirth fear and mode of birth among Polish women?

Abstract Background In Poland, cesarean section (CS) rate is 48% what means that it is one of the highest rate among OECD countries and the highest in the European Union. WHO has considered that CS rates higher than 15% at the population level are not associated with reductions in maternal and newborn mortality rates. Fear and attitudes towards childbirth are shaped years before the first pregnancy. Yet, little is understood about how young people’s knowledge, attitudes and fears concerning the birth process shape their healthcare preferences around birth. Thus, the aim of the study was to examine whether confidence in knowledge was associated with childbirth fear prior to pregnancy and preference for CS. Methods We recruited 782 women aged 18 - 35 (mean 24.7, sd = 3.19) who had never been pregnant but wished to have at least one child in the future. The women answered questions about: (i) socio-economic situation, (ii) confidence in knowledge and educational needs related to pregnancy and childbirth; (iii) fear of childbirth prior to pregnancy; (iv) preferred mode of birth in the hypothetical pregnancy in which there are no medical indications for cesarean section. Results Almost one in four women (22.1%) preferred CS in a hypothetical low-risk pregnancy. In addition, most often young women gained knowledge on pregnancy and birth from experiences and stories of family members (62.3%). Women with moderate and high level of confidence in knowledge had respectively lower odds of high level of childbirth fear prior to pregnancy comparing to women with low level of confidence in knowledge (OR = 0.57, 95% CI: 0.39-0.83 and OR = 0.54, 95% CI: 0.33-0.88, respectively). Conclusions Increasing knowledge about pregnancy and childbirth among young women might lower childbirth fear and thus, indirectly, lower rates of CS in the future. Key messages • The results of this study may solve very important public health problem i.e. the growing rates of cesarean section. • Confidence in knowledge may be an important factor associated with the level of childbirth fear.

Midwifery Continuity of Care During Pregnancy, Birth, and the Postpartum Period: A Matched Cohort Study.

To compare pregnancy outcomes in a midwifery continuity of care (MCoC) model to standard midwifery care in Sweden. Matched cohort study. Public healthcare during pregnancy and childbirth, Stockholm, Sweden. Women giving birth at Karolinska University Hospital site Huddinge in Stockholm between January 1, 2019, and August 31, 2021. Data on all births including MCoC and standard care, during the time period, were retrieved from the national Swedish Pregnancy Register. Propensity score matching was applied to obtain a matched set from the standard care group for every woman in the MCoC model. Based on the matched cohort, we estimated risk ratios (RR) for binary outcomes with 95% confidence intervals (CI). Interventions during labor, mode of birth, and preterm birth (< 37 gestational weeks). Compared with standard care, women in the MCoC model were more likely to give birth spontaneously (RR 1.06 95% CI 1.02-1.10) and less likely to have an elective cesarean on maternal request (RR 0.24 95% CI 0.11-0.51). The risk of preterm birth was also reduced in the MCoC group (RR 0.51 95% CI 0.32-0.82). The MCoC model was associated with fewer medical interventions and improved pregnancy outcomes.

Mixed-method study of women’s experiences of Respectful-Disrespectful Maternity Care in Cyprus

Abstract Background Since the WHO reports on Disrespect and Abuse (D&amp;A) in childbirth, there was an increase in studies across Europe exploring women’s experiences. Even though contentious, a 2024 EU Committee report adopts the term obstetric violence. With the highest caesarean section (C/S) in the EU, the birth environment in Cyprus raises questions about informed choices. Methods The RESPECT mixed-method study gained insights into the experiences of women in Cyprus with focus groups (N = 6, 28 women) and survey (online and in-person) tapping on Rights for Respectful Maternity Care (RMC), as measured by Person-Centred Maternity Care scale (PCMC), autonomy in decision making (MADM), dignity and respect (MoRi) and mistreatment (MIST). Results Among 516 responses (61% first childbirth, 38.5% vaginal, 15% public sector, consistent with official statistics), the 35-item PCMC (range 0-100%) represents a continuum of quality standards deviations (Med=81, IQR=61-92). Lowest scores were recorded for “Communication &amp; Autonomy”, with 28.5% reporting ‘feeling pushed into a decision’, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequity. Based on MADM, 23.8%, 14.1% and 14.7% women were classified as having moderate, low or very low autonomy. For mistreatment, 32.0% reported at least one of 11 indicators, most commonly privacy violations and no freedom of movement. Formula feeding against wishes (13.6%), vaginal examinations (11.6%) and episiotomy (7.8%) where most common among 33.7% reporting procedures without consent. Deductive content analysis of narratives according to RMC triangulate findings of weak shared decision-making processes. Conclusions Given that C/S reduction was identified as a national priority in Cyprus, the RESPECT findings can widen the conversation about quality improvement and form the basis to engage with local stakeholders in an open-dialogue about RMC, guided by participatory action research principles. Key messages • In the medicalized birth environment of Cyprus, women report a range of sub-optimal practices, with ethical implications, primarily affecting the right to autonomy. • Adopting the Respectful Maternity Care framework, the findings can stimulate and shape quality improvement efforts in a participatory and inclusive process with local stakeholders.

Care of late intrauterine fetal death and stillbirth: Green-top Guideline No. 55.

A combination of mifepristone and a prostaglandin preparation should usually be recommended as the first-line intervention for induction of labour (Grade B). A single 200 milligram dose of mifepristone is appropriate for this indication, followed by: 24+0-24+6 weeks of gestation - 400 micrograms buccal/sublingual/vaginal/oral of misoprostol every 3 hours; 25+0-27+6 weeks of gestation - 200 micrograms buccal/sublingual/vaginal/oral of misoprostol every 4 hours; from 28+0 weeks of gestation - 25-50 micrograms vaginal every 4 hours, or 50-100 micrograms oral every 2 hours [Grade C]. There is insufficient evidence available to recommend a specific regimen of misoprostol for use at more than 28+0 weeks of gestation in women who have had a previous caesarean birth or transmural uterine scar [Grade D]. Women with more than two lower segment caesarean births or atypical scars should be advised that the safety of induction of labour is unknown [Grade D]. Staff should be educated in discussing mode of birth with bereaved parents. Vaginal birth is recommended for most women, but caesarean birth will need to be considered for some [Grade D]. A detailed informed discussion should be undertaken with parents of both physical and psychological aspects of a vaginal birth versus a caesarean birth [Grade C]. Parents should be cared for in an environment that provides adequate safety according to individual clinical circumstance, while meeting their needs to grieve and feel supported in doing so (GPP). Clinical and laboratory tests should be recommended to assess maternal wellbeing (including coagulopathy) and to determine the cause of fetal death, the chance of recurrence and possible means of avoiding future pregnancy complications [GradeD]. Parents should be advised that with full investigation (including postmortem and placental histology) a possible or probable cause can be found in up to three-quarters of late intrauterine fetal deaths [Grade B]. All parents should be offered cytogenetic testing of their baby, which should be performed after written consent is given (GPP). Parents should be advised that postmortem examination can provide information that can sometimes be crucial to the management of future pregnancy [Grade B].

Pelvic floor-related sexual functioning in the first 24 months postpartum: Findings of a large cross-sectional study.

The pelvic floor is exposed to differing stresses and trauma depending on the mode of birth. At the same time, the pelvic floor plays a crucial role in female sexual functioning (FSF). Whereby FSF encompasses different dimensions, from subjective satisfaction to physiological aspects, such as lack of pain and orgasm ability. The aim of the study presented here is to assess FSF in relationship to postpartum pelvic floor disorder based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), in a large convenience sample and to identify whether there is an association between mode of birth as well as perineal injuries and FSF of women up to 24 months postpartum. We conducted a cross-sectional online survey and recruited via social media women up to 24 months after birth of their last child. FSF was surveyed using the PISQ-IR. Details were also collected on all previous births and birth-related perineal trauma, as well as current breastfeeding, obesity, and socio-demographics. Multivariate models were then calculated to determine a possible association between FSF and birth mode. The data basis is the responses of 2106 survey participants within the first 24 months postpartum. Even 12-24 months postpartum, 21% of respondents are not sexually active, which burdens almost 44% of these women. With regard to mode of delivery, differences in FSF are only evident in individual dimensions of the PISQ-IR. The dimensions "Condition Impact" and "Condition Specific" were significantly associated with more impairments in sexually active respondents up to 12 months postpartum whose last mode of delivery was forceps or vacuum extraction. If a perineal tear had occurred during last birth, this was significantly associated with a lower PISQ-IR subscore in the "Condition Impact," "Condition-Specific," "Global Quality," "Partner-Related," and "Arousal" models. The low variance explanation shows that further relevant factors on female sexuality may exist. The issue of impairments in FSF following childbirth, persisting for an extended period of time, is a significant postpartum concern. Due to the very different dimensions of FSF, the influence of the mode of delivery must be considered in a differentiated way.

Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study

BackgroundPostpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.MethodsWe conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.ResultsA total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10–1.48], anemia (aOR 1.66; 95% CI 1.34–2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39–5.05), coagulopathy (aOR 25.92; 95% CI 8.59–69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86–4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04–2.47), uterine scar (aOR 1.39; 95% CI 1.15–1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74–4.38), polyhydramnios (aOR 2.52; 95% CI 1.19–4.68) and placenta previa (aOR 25.03; 95% CI 21.04–29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.ConclusionsTen risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.

If the first child is breech, overall outcomes for families with two children are similar regardless of the mode of the first birth

Cesarean section for breech presentation is often recommended. However, cesarean section affects future reproduction. The aim of this study was to assess the effect of mode of the first birth in breech on outcomes of the second birth and the two births together. This is a register-based nationwide cohort study including 23 062 women with a first singleton birth in breech ≥ 34 gestational weeks and a subsequent singleton birth in Sweden 2000–2019. Exposure was mode of first delivery. Main maternal outcome was a composite of fourth-degree perineal injury, postpartum hemorrhage requiring blood transfusion, hysterectomy, or death. Main infant outcome was a composite of stillbirth, extremely preterm birth (< 28 weeks), moderate to severe hypoxic ischemic encephalopathy, therapeutic hypothermia, or death. Outcomes were analyzed using multivariable logistic regression. In the first birth, the infant composite outcome affected < 1% in both groups but the risk was higher in the vaginal breech group (13/1525), compared with the breech CS group (27/21 537), aOR 7.06, 95% CI 2.91–17.1. In the second birth, the infant composite outcome affected < 1% in both groups but the risk was lower for the first vaginal breech group (3/1525) compared with the first breech CS group (152/21 537), aOR 0.26, 95% CI 0.08–0.84. There was no significant difference between the groups in risk of composite infant outcome in the two births assessed together, or in risk of composite maternal outcome. In total, the chance of a two-children family without maternal or infant severe adverse composite outcome was high and similar regardless mode of the breech first birth.

Association between Birth Weight of the Babies and Mode of Delivery: A Cross-Sectional Study

Background: Birth weight has significant short and long-term effects on health and survival and is a useful predictor of prenatal and postnatal development. Birth weight is likely to play a key role for the infant’s survival because it is one of the strongest predictors of infant mortality risk. The aim of the study was to find out the association between birth weight and mode of delivery. Methods: This was a cross-sectional study conducted at Combined Military Hospital, Ghatail from 15 March 2019 to 30 June 2019. Secondary data were used, which were collected from hospital register during the period of 01 January 2018 to 31 December 2018. The study population was all the newborn babies delivered in CMH, Ghatail during that period and mothers of the newborn babies were respondents of the study. Results: Out of 526 respondents majority (64.83%) were in the age group of 23-32 years with mean age 25.14(range: 18-40) years. Of the newborn babies around half (48.3%) were male. The mean birth weight was 2.92 kg with minimum weight 1.2 kg and maximum 4.2 kg. The data showed that the prevalence of Low Birth Weight (LBW) 13.1%. Majority (84.6%) of the mothers didn’t have any comorbidity, few (15.4%) suffered from comorbidity. 53.8% babies were born by caesarean section (CS) and 46.2% were delivered by normal vaginal delivery. Among the low birth weight babies 65.2% were born by CS. Statistically significant association was found between birth weight of the babies and mode of delivery (p&lt;0.05). Conclusion: Caesarean section cannot be routinely recommended, unless there are other obstetric indications. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 8-13

The developing immune system in preterm born infants: From contributor to potential solution for respiratory tract infections and wheezing.

Moderate-late preterm-born infants experience more frequent and severe respiratory tract infections and wheezing compared to term-born infants. Decreasing the risk on respiratory tract infections and wheezing in this group is vital to improve quality of life and reduce medical consumption during infancy, but also to reduce the risk on asthma and COPD later in life. Until now, moderate-late preterm infants are underrepresented in research and mechanisms underlying their morbidity are largely unknown, although they represent 80% of all preterm-born infants. In order to protect these infants effectively, it is essential to understand the role of the immune system in early life respiratory health and to identify strategies to optimize immune development and respiratory health. This review elaborates on risk factors and preventative measures concerning respiratory tract infections and wheezing in preterm-born infants, exploring their impact on the immune system and microbiome. Factors discussed are early life antibiotic use, birth mode, feeding type and living environment. Further, differences in adaptive and innate immune maturation between term and preterm infants are discussed, as well as differences in local immune reactions in the lungs. Finally, preventative strategies are being explored, including microbiota transplantation, immune modulation (through pre-, pro-, syn- and postbiotics, bacterial lysates, vaccinations, and monoclonal antibodies) and antibiotic prophylaxis.

Cesarean birth is associated with lower motor and language development scores during early childhood: a longitudinal analysis of two cohorts

With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley’s Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (β =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (β=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (β=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (β=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest β at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings.

Comparison of intestinal and pharyngeal microbiota in preterm infants on the first day of life and the characteristics of pharyngeal microbiota in infants delivered by cesarean section or vaginally.

This study aimed to explore the distribution of intestinal and pharyngeal microbiota on the first day of life in preterm infants and compare the composition of microbiota in infants delivered by cesarean section or vaginally. This study included 44 late preterm infants with a gestational age of 34-36 + 6 weeks. Stool and throat swab samples were collected from the preterm infants on the first day of life. The infants were divided into cesarean section and vaginal delivery groups. Illumina NovaSeq high-throughput sequencing technology was used to sequence the V3-V4 hypervariable region of the 16S rRNA gene of all bacteria in the samples. Venn diagram was used to identify shared operational taxonomic units (OTUs) in the intestines and pharynges. Microbial analysis was conducted at the phylum and genus levels, and α and β diversity comparisons were performed. (1) Gestational age may have significantly affected the microbial colonization of the intestines and pharynges of preterm infants on the first day after birth (p ≤ 0.001). (2) More OTUs were detected in the pharynx than in the intestines, both have a total of 819 shared OTUs. Proteobacteria, Firmicutes, and Bacteroidota were the dominant phyla in both. At the genus level, Streptococcus had a lower relative abundance in stool samples (0.5%) compared to throat samples (0.5% vs. 22.2%, p = 0.003). 3) The relative abundance of Streptococcus in pharyngeal samples was 26.2% in the cesarean section group much higher than the 3.8% in the vaginal delivery group (p = 0.01). The early postnatal period is a critical time for the establishment of an infant's microbiota. Gestational age at birth may influence microbial colonization, while birth weight, gender, and mode of delivery do not. The intestinal and pharyngeal microbiota composition of preterm infants on the first day after birth showed high similarity, but larger samples are needed for further validation.

Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

Background/Aims Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes. Methods This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically. Results A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years. Conclusions Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care. Implications for practice Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Fear of Childbirth Impairs Breastfeeding Success Independent of Mode of Birth.

Background: The good qualities of breastfeeding are well known. The aim of this study was to closely examine the impact of specific maternal, prenatal, obstetric, and early neonatal factors on the success of breastfeeding. Materials and Methods: We used data from the Kuopio Birth Cohort study and analyzed 2,521 online questionnaires, which were answered by women 1 year after giving birth. Breastfeeding variables were divided into successful breastfeeding (breastfeeding exclusively with one's own breast milk ≥4 months or breastfeeding with formula ≥6 months) and poor breastfeeding (breastfeeding exclusively with one's own milk <4 months and duration of all breastfeeding <6 months) for univariate and multivariable analyses. Results: In this study, 97.8% (N = 2,466) reported breastfeeding their newborns for ≥1 postnatal week, and 75.2% (N = 1,896) breastfed newborns for ≥6 months. The rate of breastfeeding for ≥6 months increased from 71.3% to 84.7% between 2013 and 2020. In the multivariable analysis, poor breastfeeding success was associated most significantly with smoking during pregnancy (adjusted odds ratio [aOR] 4.64; 95% confidence interval [CI] 2.75-7.81), twin pregnancy (aOR 4.13; 95% CI: 2.10-8.15), maternal obesity (body mass index > 35) (aOR 3.27; 95% CI: 2.15-4.99), fear of childbirth (aOR 2.80; 95% CI: 1.89-4.13), and birth during the period of 2013-2014 (aOR 2.94; 95% CI: 2.08-4.14) or 2015-2016 (aOR 2.62; 95% CI: 1.85-3.70). Other significant factors related to poor success were younger maternal age, nonmarried family relationships, passive or quitting smoking before or in the first trimester, any hypertensive disorder during pregnancy, birth by nonelective cesarean, and lowest or highest quartiles of birth weight. Conclusions: Mother's fear of childbirth is strongly associated with the poor breastfeeding success even after controlling for mode of birth.

The role of early life factors and green living environment in the development of gut microbiota in infancy: Population-based cohort study

ObjectiveEarly life microbial exposure influences the composition of gut microbiota. We investigated how early life factors, and the green living environment around infants’ homes, influence the development of gut microbiota during infancy by utilizing data from the Steps to Healthy Development follow-up study (the STEPS study). MethodsThe gut microbiota was analyzed at early (∼3 months, n = 959), and late infancy (∼13 months, n = 984) using 16S rRNA amplicon sequencing, and combined with residential green environment, measured as (1) Normalized Difference Vegetation Index, (2) Vegetation Cover Diversity, and (3) Naturalness Index within a 750 m radius. We compared gut microbiota diversity and composition between early and late infancy, identified significant individual and family level early life factors influencing gut microbiota, and determined the role of the residential green environment measures on gut microbiota development. ResultsAlpha diversity (t-test, p < 0.001) and beta diversity (PERMANOVA, R2 = 0.095, p < 0.001) differed between early and late infancy. Birth mode was the strongest contributor to the gut microbiota community composition in early infancy (PERMANOVA, R2 = 0.005, p < 0.01) and the presence of siblings in late infancy (PERMANOVA, R2 = 0.007, p < 0.01). Residential green environment showed no association with community composition, whereas time spend outdoors did (PERMANOVA, R2 = 0.002, p < 0.05). Measures of greenness displayed a statistically significant association with alpha diversity during early infancy, not during late infancy (glm, p < 0.05). In adjusted analysis, the associations remained only with the Naturalness Index, where higher human impact on living environment was associated with decreased species richness (glm, Observed richness, p < 0.05). ConclusionsThe role of the residential green environment to the infant gut microbiota is especially important in early infancy, however, other early life factors, such as birth mode and presence of sibling, had a more significant effect on the overall community composition.

Mode of birth and clinical factors associated with exclusive breastfeeding at hospital discharge: a retrospective cross-sectional study of women and full-term infants in Greece

World Health Organization recommends exclusive breastfeeding for six months. Despite its well- documented benefits, breastfeeding rates worldwide do not meet the recommended goals. The aim of this study was to identify factors that could influence exclusive breastfeeding at hospital discharge. All live, singleton, term births in a private hospital of Athens, Greece between January and December 2019 were included with a final study sample of 7336 women and newborns. Our study identifies several factors associated with nonexclusive breastfeeding ta hospital discharge: nullipara women compared to multipara (OR 0.73; 95% CI 0.66, 0.82), cesarean delivery compared to vaginal delivery (OR 1.83; 95% CI 1.65, 2.03), smoking during pregnancy (OR 1.28; 95% CI 1.15, 1.44), gestational age at 37+0- 38+6 weeks compared to 39+0- 41+6 weeks (OR 0.70; 95% CI 0.62, 0.78), birthweight &lt;2500g (OR 0.38; 95% CI 0.22, 0.35), and admission to neonatal intensive unit (NICU) after delivery (OR 8.19; 95% CI 6.65, 10.08). No association was observed for maternal age, pregnancy after assisted reproductive technology, gestational diabetes, obstetric complication, and sex of the newborn. It is expected that our results will allow future comparisons between different hospitals in the same country, as well as comparison of practices with other countries. Several perinatal factors related to nonexclusive breastfeeding at hospital discharge, most noteworthy were caesarean section and admission to NICU.

A group prenatal care intervention reduces gestational weight gain and gestational diabetes in American Samoan women.

The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity in American Samoa. We enrolled n = 80 low-risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care-delivered intervention vs. one-on-one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between-group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high-risk setting using a group care-delivered intervention.

Gene expression profiles in placenta and their association with anesthesia, delivery mode and maternal diabetes

IntroductionFetal development is dependent on placenta and affected by multiple factors including maternal diabetes. Here we aimed to identify maternal diabetes-associated changes in placentas and analyzed placental gene expression to understand its modulation by maternal diabetes and birth mode. MethodsPlacental RNAseq transcriptome analyses were performed on maternally-derived decidua and fetal-derived villous tissue from pregnancies of mothers with type 1 diabetes (n=14), gestational diabetes (n=6) and without diabetes (n=14). Information on delivery mode and anesthesia were included as covariables. Analyses were performed separately for decidua and fetal tissues and adjusted for sex. ResultsSubstantial placenta gene expression variation was associated with factors other than maternal diabetes, including site, sex, anesthesia type and delivery mode. Two dominant gene expression clusters aligned to anesthesia and delivery mode were observed for decidua and villous tissue. Upregulation of genes within pathways related to organ morphogenesis and downregulation of immune response to steroid- and hypoxia pathway genes was characteristic of placentas from primary cesarean section deliveries with spinal anesthesia. Opposite profiles were observed for placentas from secondary cesarean and epidural anesthesia deliveries. Placentas from vaginal delivery had intermediate gene expression profiles. More subtle changes were associated with maternal diabetes: upregulation of ribosome activity, down-regulation of maternally-derived decidua chemokine signaling pathways and for gestational diabetes, alteration in hypoxia response genes. DiscussionThe findings reveal suppression of immune pathways and upregulation of ribosome activity in the placenta by maternal diabetes highlighting the importance of confounding factors when examining cell and tissue expression profiles. Further studies should determine whether the observed gene expression differences are related to underlying causes for cesarean section deliveries.