Mother-baby Dyads Research Articles

Psychometric Testing of an Arabic Version of the Attitude Toward Skin-to-Skin Contact Instrument among Women in Saudi Arabia: A Cross-Cultural Validation Study.

The World Health Organization recommends skin-to-skin contact immediately after birth, yet the practice rate remains low in Saudi Arabia, impacting the health and well-being of mother-baby dyads. No previous studies have explored Saudi women's attitudes toward skin-to-skin contact, a critical factor in developing strategies to increase its adoption. This study aimed to develop and evaluate an instrument to assess attitudes toward skin-to-skin contact among women in Saudi Arabia. An instrument was developed by modifying the validated "Mother-Newborn Skin-to-Skin Contact Questionnaire". Psychometric testing was conducted to validate the instrument through a cross-cultural survey involving 383 participants recruited from two hospitals in Saudi Arabia using a convenience sampling method. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.885, indicating that the sample size was suitable for performing exploratory factor analysis. The overall Cronbach's alpha value was 0.85, reflecting adequate internal consistency of the questionnaire. The criteria of the two-factor confirmatory factor analysis were also met. The majority of women (85.6%) demonstrated a positive attitude towards skin-to-skin contact. A positive correlation was observed between higher educational levels and the total attitude score (r = 0.161, p = 0.002). The developed questionnaire is a reliable tool for measuring attitudes towards skin-to-skin contact among women in Saudi Arabia. The findings highlight the importance of educational interventions to improve the uptake of this practice.

Maternity care practices supportive of breastfeeding in U.S. advanced neonatal care units, United States, 2022.

To describe breastfeeding-supportive practices in U.S. maternity hospitals with advanced neonatal care units (ANCU). Using 2022 mPINC data, we calculated the percent of hospitals reporting (1) breastfeeding-supportive practices for "most" (≥80%) mother-baby dyads in ANCUs, by hospital demographic characteristics and (2) infant receipt of mother's own milk or donor milk at any time while in the ANCU, by ANCU level. More than 90% of hospitals reported that "most" mothers (≥80%) were advised on some breastfeeding-supportive practices. Fewer hospitals reported that "most" mothers expressed milk within one hour of birth (37%) or that kangaroo care was practiced for "most" eligible newborns (63%). Receipt of mother's own milk varied by unit level and state. Breastfeeding-supportive practices requiring the technical competency of healthcare providers (e.g., early milk expression, kangaroo care) are less likely to be implemented in ANCU settings compared to practices centered around providing advice or education.

The effect of on-site and on-call nurse on exclusive breastfeeding in two different hospital settings: a prospective observational cohort study

BackgroundExclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio.MethodsWe conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group).ResultsA total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group.ConclusionsWe can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section.

Maternal gestational diabetes mellitus associates with altered gut microbiome composition and head circumference abnormalities in male offspring

The impact of gestational diabetes mellitus (GDM) on maternal or infant microbiome trajectory remains poorly understood. Utilizing large-scale longitudinal fecal samples from 264 mother-baby dyads, we present the gut microbiome trajectory of the mothers throughout pregnancy and infants during the first year of life. GDM mothers had a distinct microbiome diversity and composition during the gestation period. GDM leaves fingerprints on the infant's gut microbiome, which are confounded by delivery mode. Further, Clostridium species positively correlate with a larger head circumference at month 12 in male offspring but not females. The gut microbiome of GDM mothers with male fetuses displays depleted gut-brain modules, including acetate synthesis I and degradation and glutamate synthesis II. The gut microbiome of female infants of GDM mothers has higher histamine degradation and dopamine degradation. Together, our integrative analysis indicates that GDM affects maternal and infant gut composition, which is associated with sexually dimorphic infant head growth.

Obstetrical Constraints and the Origin of Extended Postnatal Brain Maturation in Hominin Evolution.

The origin of difficult birth is still a matter of debate in obstetrics. Recent studies hypothesized that early hominins already experienced obstructed labor even with reduced neonatal head sizes. The aim of this work is to test this hypothesis using an extant obstetrical sample with known delivery outcomes. Three delivery outcomes (i.e., instrument-assisted, Caesarean section, and vaginal birth) were evaluated using a discriminant analysis based on 131 mother-baby dyads and 36 feto-pelvic variables. This obstetrical sample was compared with 20 australopithecine "dyads" generated from the combination of six pelvic reconstructions (three for Australopithecus afarensis, two for A. africanus, and one for A. sediba) and three fetal head size estimations. The obstetrical analysis revealed that dystocic births can be predicted by pelvic features such as an anteroposteriorly flattened pelvic inlet. Australopithecines shared these pelvic morphologies with humans and had eutocic birth only for infants of 110 g brain size or smaller, equaling a human-like neonatal/adult brain size ratio of 25-28%. Although birth mechanism cannot be deduced, the newborn/adult brain size ratio was likely more human-like than previously thought, suggesting that australopithecines were secondarily altricial to circumvent instances of obstructed labor and subsequently require a prolonged postnatal brain growth period, implying some aspects of life history pattern similar to modern humans.

Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population.

We prospectively evaluated the association of the insulin resistance of third-trimester Nigerian pregnant women with their newborn infants' insulin resistance and birth size. Pregnancy-associated insulin resistance (IR), often assessed with homeostatic model assessment of IR (HOMA-IR), is associated, especially among women with gestational diabetes (GDM), with abnormal neonatal birth size and body composition, predisposing the baby to metabolic disorders like diabetes and obesity. The associations of maternal IR with neonatal IR, birth size and body composition are less studied in nondiabetic pregnant women, especially in sub-Saharan settings like Nigeria. We originally recruited 401 third trimester, nondiabetic pregnant women to a prospective cohort study, followed up until birth. Blood samples of mothers and babies were obtained, respectively, at recruitment and within 24 hours postbirth for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was calculated as [(FSI × FSG)/22.5)]. Complete data for 150 mother-baby dyads was analysed: the mothers, with a mean (standard deviation [SD]) age of 31.6 (4.5) years, had live births at a mean (SD) gestational age of 39.2 weeks. The proportions of infants with wasting, stunting, impaired fetal growth (either wasting or stunted), small-for-gestation-age, large-for-gestational-age, low birthweight, and macrosomia were 4.2% (95% confidence interval, 1.1-10.3), 19.7% (12.9-28.0), 23.1% (15.8-31.8), 10.1% (5.3-17.0), 12.6% (7.2-19.9), 0.8% (0.02-4.5), and 5.0% (1.8-10.5), respectively. Maternal HOMA-IR was not associated with neonatal HOMA-IR (p=0.837), birth weight (p=0.416) or body composition measured with weight-length ratio (p=0.524), but birth weight was independently predicted by maternal weight (p=0.006), body mass index (p=0.001), and parity (p=0.012). In this nondiabetic/non-GDM cohort, maternal HOMA-IR was not associated with neonatal IR, body size or body composition. Larger studies are required to confirm these findings, with addi-tional inclusion of mothers with hyperglycaemia for comparison.

Early versus late discharge from the hospital for low-risk parturients after spontaneous vaginal deliveries at Moi Teaching and Referral Hospital, Eldoret, Kenya: A randomized controlled trial.

Background: The length of hospital stay after delivery is a major contributor to preventing postpartumcomplications and improving maternal and neonatal outcomes. Globally, the length of hospital stay afterdelivery has been reducing in recent times. However, there is limited understanding of the safety,outcomes, and complications of early discharge compared with late discharge in low- and middle-incomesettings. Objectives: To evaluate the outcomes of early versus late discharge from the hospital for post-spontaneous vaginal delivery low-risk parturient and healthy neonates in Moi Teaching and Referral Hospital, Eldoret, Kenya.Methods: A randomized controlled trial study design was employed. 744 mother-child dyads wererecruited into this study within the first hour postdelivery and were randomized into two groups: theintervention arm was those discharged within 24 hours and the control arm was those discharged after24 hours or more. The study participants were followed up over three months with over-the-phoneinterviews. The primary outcome was maternal rehospitalization.Results: Between July 2022 and October 2022, 744 mother-baby dyads were recruited and 372 wererandomly assigned to the intervention arm, and 372 to the control arm. There were 23 mothers in theintervention arm and 22 in the control arm who were lost to follow-up and subsequently excluded fromthe analysis. Baseline characteristics were similar between the study groups. There were 17 (4.9%)maternal readmissions in the intervention arm and 10 (2.9%) in the control arm (RR 2% (95%CI:-1.1%,5.2%; p-value=0.167).Conclusion: Early discharge for low-risk mothers and healthy neonates is noninferior to late discharge,with similar effects on maternal outcomes, neonatal outcomes, and breastfeeding patterns.

Duration of rupture of membranes and microbiome transmission to the newborn: A prospective study.

To assess whether labour variables (i.e. individuals characteristics, labour characteristics and medical interventions) impact maternal and newborn microbiomes. Prospective monocentric study. Saint-Joseph Hospital tertiary maternity unit, in Paris, France. All consecutive primiparous women with a physiological pregnancy and term labour from 15 April to 1 June 2017. 16S ribosomal RNA gene sequencing of the maternal vaginal, newborn skin and newborn oral microbiomes from 58 mother-baby dyads. Analysis of the effects of 19 labour variables on the composition and diversity of these microbiomes. The 19 labour variables explained a significant part of the variability in the vaginal, newborn oral and skin microbiomes (44%-67%). Strikingly, duration of rupture of membranes was the single factor that explained the greatest variability (adjusted R2: 7.7%-8.4%, p ≤ 0.002) and conditioned, by itself, the compositions of the three microbiomes under study. Long duration of rupture of membranes was specifically associated with a lower relative abundance of the Lactobacillus genus (1.7-fold to 68-fold reduction, p < 0.0001) as well as an increase in microbiome diversity, including genera implicated in nosocomial infections. The effects of duration of rupture of membranes were also present in newborns delivered by non-elective caesarean section. Maternal and newborn microbiomes were greatly affected by labour variables. Duration of rupture of membranes, even in non-elective caesarean sections, should be considered in epidemiological and microbiological studies, as well as in vaginal seeding practices.

Interactive sequences in the mother–baby dyad: a dyadic and longitudinal communication pattern between mothers and babies with extreme and moderate prematurity / Secuencias interactivas en la díada madre-bebé: un patrón de comunicación diádico y longitudinal entre la madre y el bebé con prematuridad extrema y moderada

The goal of this study was to detect communicative sequences in mother–baby dyads according to the degree of prematurity, comparing them in three corrected ages (two, four and six months). The observational methodology was used from the mixed methods perspective, and the design is nomothetic/follow-up/multidimensional. Fifteen mother–baby dyads with extreme prematurity and 15 mother–baby dyads with moderate prematurity participated. An observation instrument was constructed combining an observation instrument and category systems to code the dyads’ behaviours. Fifteen minutes of free interaction were recorded and Type IV data were logged. The programs HOISAN and SDIS-GSEQ/GSEQ were used to analyse the results. The results detected different behavioural patterns related to the interaction in both the expression of communicative behaviours and in the time when they were deployed in the ages evaluated.

Mother-infant bonding and postpartum depression during the COVID-19 pandemic - a risk for nurturing care and child development.

The COVID-19 pandemic Increased the risk of impairing the mother-infant bonding. The objectives of this study were to evaluate the early bond established between mother and infant and postpartum depression (PPD) in pregnancies that occurred during the pandemic period, to identify the factors that may have influenced these outcomes and to verify if there was an association between bonding and probable PPD. This is a cross-sectional study of postpartum women from a public maternity hospital in the city of São Paulo conducted from February to June 2021, involving 127 mother-baby dyads. The initial data were collected in the immediate postpartum period and between 21-45 days after birth, using a semi-structured questionnaire on sociodemographic characteristics, gestational and birth conditions, and baby characteristics; the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Bonding Questionnaire (PBQ) were used to evaluate PPD and bonding, respectively. The presence of probable PPD and unplanned pregnancies were associated with higher PBQ score and risk to impaired bonding (p = 0.001 and p = 0.004, respectively). EPDS showed a high prevalence of PPD (29.1%) and was not associated with any Studied variable. Probably, this high prevalence of probable PPD was due to the context of insecurity secondary to the pandemic. We observed an increase in the prevalence of probable PPD and unplanned pregnancies during the first 18 months of the pandemic, which were associated with worse scores in mother-infant bonding. The impaired bond can affect the future development of children born during this period.

Prenatal Infection by Respiratory Viruses Is Associated with Immunoinflammatory Responses in the Fetus.

Rationale: Respiratory viral infections can be transmitted from pregnant women to their offspring, but frequency, mechanisms, and postnatal outcomes remain unclear. Objectives: The aims of this prospective cohort study were to compare the frequencies of transplacental transmission of respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), analyze the concentrations of inflammatory mediators in maternal and fetal blood, and assess clinical consequences. Methods: We recruited pregnant women who developed upper respiratory infections or tested positive for SARS-CoV-2. Maternal and cord blood samples were collected at delivery. Study questionnaires and electronic medical records were used to document demographic and medical information. Measurements and Main Results: From October 2020 to June 2022, droplet digital PCR was used to test blood mononuclear cells from 103 mother-baby dyads. Twice more newborns in our sample were vertically infected with RSV compared with SARS-CoV-2 (25.2% [26 of 103] vs. 11.9% [12 of 101]; P = 0.019). Multiplex ELISA measured significantly increased concentrations of several inflammatory cytokines and chemokines in maternal and cord blood from newborns, with evidence of viral exposure in utero compared with control dyads. Prenatal infection was associated with significantly lower birth weight and postnatal weight growth. Conclusions: Data suggest a higher frequency of vertical transmission for RSV than SARS-CoV-2. Intrauterine exposure is associated with fetal inflammation driven by soluble inflammatory mediators, with expression profiles dependent on the virus type and affecting the rate of viral transmission. Virus-induced inflammation may have pathological consequences already in the first days of life, as shown by its effects on birth weight and postnatal weight growth.

Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries.

Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research.

Impact of lockdown and visiting restrictions for COVID-19 on breast milk and short-term morbidities in a tertiary neonatal intensive care unit in Turkey

Objective: In the COVID-19 pandemic era, visiting restrictions and lockdown measures have been leaded to serious concerns in breastfeeding and maternal-infant interaction. We aimed to evaluate the effects of visiting restrictions as no physical visits allowed period (March 13th and June 20th, 2020) on feeding with breast milk, breastfeeding and associated morbidities. Material and Methods: Neonates admitted to neonatal intensive care unit in pre-COVID-19 pandemic and during strict visiting restrictions constituted control and study groups. Results: Study and control groups included 197 and 193 mother-baby dyads. Study group had insignificant lower gestational age, birthweight and higher prematurity rate. Median first enteral feeding and first breast milk days were similar. First enteral feeding with breast milk was insignificantly higher in control group. Median breast milk percentage at full enteral feeding (FEF) did not differ. Median time of FEF, FEF with only breast milk and intravenous fluid duration were higher in study group (p&amp;lt;0.050). Full enteral feeding with breast milk during NICU stay was less in study group (78.1 vs 87%, p&amp;lt;0.050) while at discharge there was no difference (78.1% vs 81.3%). Feeding intolerance was insignificantly higher in study group (23.8% vs 14.6%). Median duration of NICU stay was higher in study group but not significant (13.5 vs 12 d, p&amp;gt;0.050). Conclusion: No visits allowed period leaded to impaired breastfeeding, breast milk supply and associated morbidities. Parents should be informed about breastfeeding and breast milk in prenatal period, after birth and during NICU stay in COVID-19 era as before and precautions should be taken.

Abstract 15375: Status of Cardiovascular Health and Early Carotid Artery Changes in Contemporary Young Adults From Disadvantaged Social Backgrounds: The Future of Families and Child Wellbeing Study (FFCWS)

Background: Effects of childhood social determinants of health (SDOH) on young adult cardiovascular health (CVH) are postulated, but few studies have measured both SDOH from birth and CVH status in young adulthood. Methods: In 1998-2000, FFCWS enrolled 4898 mother-baby dyads at delivery in 20 US cities, oversampling mothers who were unmarried, including a disproportionate number of minority and low-income families. In 2021-23, offspring were invited to an in-person exam for CVH measurement and carotid artery ultrasound. Individual CVH metrics (except sleep) and overall Life’s Essential 8 (LE8) scores (range, 0-100; higher = better CVH), as well as carotid intima-media thickness (IMT), were compared between self-identified sex and race/ethnicity groups. LE8 scores were also compared with a representative sample of US young adults aged 19-25 years from NHANES. Results: Among 1211 offspring participants (ppts), mean age was 22y, 55% were female, 50.8% Black, 25.1% Hispanic, 20.5% White, and 3.6% Other; characteristics at birth and through childhood were similar between FFCWS ppts who were/were not examined. Diet, physical activity, nicotine exposure, and BMI scores were unfavorable in FFCWS ppts (Table). Overall LE8 scores did not differ significantly by sex, and ranged from 64.6 in Black ppts to 74.8 in ppts from Other racial/ethnic groups. LE8 scores did not differ between Black and Hispanic ppts, but both groups had significantly lower scores than ppts from White and Other groups (all P≤0.01). After adjustment for age, sex, and LE8 score, Black ppts had significantly greater mean-maximum and mean-mean carotid IMT. Mean LE8 scores were lower among FFCWS ppts compared with young adults from the same racial/ethnic groups in NHANES. Conclusions: In this novel cohort of young adults largely from disadvantaged social backgrounds, overall CVH status was sub-optimal, and ppts who identified as Black had the lowest CVH and highest carotid IMT measures, even at this young age.

Abstract 17880: The Association of Social Determinants of Health at Birth With Cardiovascular Health in Young Adulthood: The Future of Families and Child Wellbeing Study

Background: Social determinants of health (SDoH) are known to influence an individual’s risk for CVD. Childhood is a vulnerable period during which the influences of SDoH may have a stronger impact on future health outcomes. Little is known about early life SDoH and associations with cardiovascular health (CVH) in early adulthood. Methods: In 1998-2000, the Future of Families and Child Wellbeing Study (FFCWS) enrolled 4898 mother-baby dyads from large cities across the US. Births to unmarried mothers were oversampled. When the offspring were 22 yrs, they completed an in-person exam for CVH metrics. SDoH at birth included maternal and paternal education, mother living in a public housing project, having income within the past year from public assistance/welfare/food stamps. Life’s Essential 8 (LE8) Score (without sleep) was assessed at age 22. Linear regression models examined the association of individual SDoH measures with LE8 score adjusting for age, gender and race/ethnicity. Results: This study included 1211 participants, mean age 22 yrs (55% female; 51% Black, 25% Hispanic, 20% White, 4% Other). Adverse SDoH were common with 10% living in a public housing project at birth and 36.7% of mothers having received public assistance within the past year. Adjusted CVH scores were 3.0 (95% CI 1.2-4.8) pts lower for individuals whose mother reported having received public assistance in the past year. Compared to mothers with a college or graduate degree, those with less than high school, high school, and some college had 8.0 (5.0-10.9), 7.1 (4.2-10.0) and 3.2 (0.3-6.1) lower scores CVH scores. Findings were similar for paternal education. No significant associations were observed with living in a public housing project. Conclusion: SDoH at the time of birth have long lasting influence on the CVH of offspring. Interventions to promote CVH within children and families experiencing adverse SDoH are critical to promote health equity and break the inter-generational cycle of CVD.

Abstract 15400: Association of Cardiovascular Health With Early Carotid Artery Changes in Young Adults From Disadvantaged Social Backgrounds: The Future of Families and Child Wellbeing Study (FFCWS)

Introduction: Associations of cardiovascular health (CVH), as measured by the AHA’s Life’s Essential 8 (LE8) score, with early markers of arterial injury have not been described in young adults. Methods: The FFCWS enrolled 4898 mother-baby dyads at delivery in 20 US cities in 1998-2000, oversampling mothers who were unmarried, including a disproportionate number of minority and low-income families. In 2021-23, offspring were invited to attend an in-person exam to measure CVH and perform carotid artery ultrasound. Individual CVH metric and overall LE8 scores (except sleep) were calculated for each participant (ppt). Carotid imaging was performed by 2 trained sonographers and images were analyzed by a core lab. We examined cross-sectional associations of LE8 scores with measures of carotid intima-media thickness (IMT), gray scale (a measure of early arterial injury), and distensibility, using linear regression. Results: Among 1211 offspring ppts, mean age was 22y, &gt;50% self-identified as female, and &gt;75% as Black or Hispanic. Black and Hispanic ppts had lower, and ppts from Other racial/ethnic groups had higher, overall LE8 scores compared with White ppts (all P≤0.01; Table 1A). In unadjusted analyses, Black ppts had thicker carotid IMT and lower Young’s elastic modulus measures. Prevalence of diagnostic plaque was low. In analyses adjusted for age, sex, and race/ethnicity (Table 1B), LE8 scores were significantly associated with lower carotid IMT, higher gray scale median, and lower Young’s elastic modulus. For example, for each 10 point higher (better) LE8 score, mean-maximal carotid IMT was lower by 0.008 mm. Conclusions: Among young adults largely from disadvantaged social backgrounds, the LE8 score was associated with early measures of carotid arterial injury. LE8 may be an important surrogate measure for monitoring long-term CVH and may help identify young adults with emerging subclinical disease and higher long-term cardiovascular risk.

Level and correlates of disrespect and abuse among newborns in selected public hospitals of Addis Ababa, Ethiopia

BackgroundThe provision of respectful and dignified maternal and newborn care is an important component of the quality of childbirth care. Although a growing body of evidence was generated on disrespect and abuse (D&A) of women during childbirth in the past decade there is limited evidence on D&A experienced by newborns. Our study aimed to determine the level of and factors associated with D&A among newborns.MethodsWe conducted the study in three public hospitals in Addis Ababa. We directly observed childbirth care starting from the first stage of labor through two hours after the birth of 498 mother–baby dyads. We used frequencies and percentages to describe different forms of D&A among newborns. We used binary and multivariable logistic regression analysis to assess the association between the D&A among newborns and independent variables.ResultAll of the newborns 496/496 (100%) experienced at least one form of D&A. Physical abuse was experienced by 41.1% of newborns in the form of unnecessary airway suctioning (23.2%) or slapping or holding upside down (33.5%). Additionally, 42.3% weren’t dried immediately after birth, 9.1% weren’t placed on the mother’s abdomen skin-to-skin, 61.7% had their cord cut before 1 min of birth, 34.9% weren’t breastfed within an hour of birth, 24.2% didn’t receive vitamin K and 1.8% didn’t receive tetracycline. All newborns who developed complications (69/69) received treatments without the consent of parents/caregivers. Moreover, 93.6% of parents/caregivers didn’t receive explanations regarding newborn care while the lack of breastfeeding counseling and thermal support during the immediate post-partum period was 87.3%. The likelihood of D&A was higher among newborns who were preterm (AOR = 2.02; 95% CI: 1.11–3.69), female (AOR = 2.01; 95% CI: 1.37–2.95), delivered assisted by instrument (AOR = 2.19; 95%CI: 1.20–3.99), whose mothers reside in rural areas (AOR = 1.97; 95%CI: 1.22–3.20), born from unmarried mothers (AOR = 2.77; 95%CI (1.26–6.06) and whose mothers received fewer than four-time antenatal care (ANC) visits (AOR = 2.37; 95%CI: 1.42–3.96).ConclusionOur study found a high magnitude D&A among newborns. Gestational age at birth, sex of the newborn, maternal residence, maternal marital status, number of ANC visits, and mode of delivery were statistically significantly associated with D&A among newborns.

Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results

Introduction Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. Methods We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients’ scores on these scales and patient satisfaction. Results At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. Conclusions These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers’ ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.

Neonatal outcomes after water birth: A retrospective cohort study

ObjectiveTo compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. MethodsA retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. ResultsA total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4). ConclusionsThe results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.

Effect of the SPRING home visits intervention on early child development and growth in rural India and Pakistan: parallel cluster randomised controlled trials.

Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs. The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat. 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups. The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.