Past Pregnancy Research Articles

Associations between postpartum haemorrhage, postnatal mental health and longer term mental illness: a record-linked cohort study

ABSTRACT Aim To investigate the associations between primary postpartum haemorrhage (PPH), postnatal mental health and longer-term mental illness in a high-income setting. Methods A population-based retrospective cohort study of 18,798 women giving birth between 2008 and 2016 in Grampian, Scotland, was conducted, using linked data from the Aberdeen Maternity and Neonatal Databank and Scottish administrative healthcare datasets. ‘Longer-term mental illness’ was assessed using a composite outcome comprising mental-health related hospitalisation, prescription or death, from the end of the first postnatal year to 10 years after birth. We used extended Cox regression models to investigate the association between primary PPH in any first or subsequent births (the exposure) and subsequent mental illness, adjusted for sociodemographic, past medical history and pregnancy and birth-related factors, stratified by the presence of mental illness in the first postnatal year. Results We found no association between PPH and longer-term mental illness beyond the first postnatal year, regardless of severity of PPH or mode of birth [adjusted hazard ratio (aHR) 0.97, 95% confidence interval (CI) 0.81–1.16, p = 0.75]. Women who received psychotropic medication, or were hospitalised for mental illness in the first postnatal year, were around 12 times more likely [aHR 12.77,95% CI 10.94–14.91,p < 0.001] to experience mental illness in the second and third postnatal year, with a continuing association for up to 10 years after the first postnatal year, independent of PPH status. Conclusions This study provides no evidence of an association between PPH and longer-term mental illness, after taking into account the presence of mental illness in the first postnatal year.

Maternity care experiences of women with a BMI> 35 kg/m2: An interpretive phenomenological analysis.

Maternity care experiences of women with a BMI> 35 kg/m2: An interpretive phenomenological analysis.

Prevalence of postpartum depression and associated factors among women attending primary health care centers in Baghdad

Although it usually appears in the first 4 weeks after delivery, postpartum depression (PPD) is a form of depression that can strike at any time within a year after childbirth. Generally, the symptoms of PPD subside after 3 months of giving birth. The risk factors should be identified to determine the prevalence of PPD. In this study, we conducted a cross-sectional survey in which women (n = 400) attending four main healthcare facilities in Baghdad, Iraq, who were in 6 &amp;ndash; 8 weeks postpartum, were recruited from January 18 to February 25, 2024. Systematic random sampling was used to select the participants. The Edinburg Postpartum Depression Scale (EPDS) was employed to assess the symptoms of PPD, with a cutoff score of &amp;ge; 12. Among the 400 participants in the study, 202 (50.5%) of the participants complained of having PPD. Approximately 216 (54%) of the participants were between the ages of 20 and 29, and 320 (80%) of them were housewives. This analysis found a significant association of PPD occurrence with the level of education (p = 0.018), complications that happened to the mothers during or after delivery (p = 0.0001), preference of the sex of the last baby (p = 0.014), family support after delivery (p = 0.001), quality of relationship with their partners (p = 0.006), and previous symptoms of depression before or during the past pregnancy (p = 0.0001). Nearly half of the women suffer from PPD during their puerperium, and it is substantially linked to the child&amp;rsquo;s sex, postpartum difficulties, history of depressive disorders, and lack of parental assistance. Half of the participants suffered from PPD, significantly associated with a lack of education, family support, maternal complications, and undesirable newborn sex.

Women's perceptions of maternal and fetal health benefits of physical activity during pregnancy and what factors impact them-A cross-sectional study.

Despite the WHO and ACOG's recommendations for at least 150 min of weekly moderate-intensity physical activity during pregnancy, adherence remains low, partly due to concerns about safety and efficacy of specific exercise modalities. To evaluate pregnant women's outcome expectancy for maternal and fetal health regarding specific physical activity modalities and the influence of healthcare provider discussions on these perceptions. A cross-sectional survey, distributed through Qualtrics (a platform to help design and distribute surveys) and word of mouth of 507 pregnant women assessed perceptions of moderate, vigorous, and resistance activities. Provider discussions and past adverse pregnancy experiences were likewise examined for their influence on outcome expectancy. Walking and yoga were perceived as the most beneficial modalities for both maternal and fetal health, with the outcome expectancies being 9.5 ± 2.1 and 8.8 ± 2.9 for maternal health and 9.0 ± 2.5 and 8.2 ± 3.0 for fetal health. Higher intensity and resistance activities were viewed less favorably, especially CrossFit® resistance training with outcome expectancies being 5.2 ± 3.4 for maternal health and 4.8 ± 3.3 for fetal health. All physical activities were viewed as more beneficial for maternal health than fetal health. Discussions with healthcare providers occurred in over 70 % of cases but did not generally relate to these perceptions. Past adverse pregnancy experiences were not related to statistically significant changes in outcome expectancy. Previously being prescribed bed rest had some weak associations with greater maternal and fetal outcome expectancy for a few physical activity modalities. Pregnant women's perceptions of health benefits clearly differ based on modality of activity and dependent on whether maternal or fetal health. Targeted communication strategies from healthcare providers and public health efforts are needed to improve perceptions of physical activity during pregnancy, especially for vigorous and resistance activities.

Detection of hypertension and blood pressure phenotypes using ambulatory blood pressure monitoring in women with past hypertensive disorders of pregnancies.

To evaluate the incidence of hypertension and blood pressure (BP) phenotypes using 24-hour ambulatory BP (24hr-ABP) in women with past pregnancy complications who were recruited into a Women's Heart Clinic (WHC). We recruited 156 women aged 30-55years with past hypertensive disorders of pregnancy (HDP) and/or gestational diabetes (GDM) to a multidisciplinary six-month WHC that provided cardiovascular risk management in Melbourne, Australia. Women were referred for 24hr-ABP monitoring if clinic BP was ≥130/80mmHg. Primary outcome was incident hypertension, defined by 24hr-ABP monitoring as daytime hypertension ≥135/85mmHg, nocturnal hypertension ≥120/70mmHg, and/or 24hr-average hypertension ≥130/80mmHg. From 156 women, 54 women underwent 24hr-ABP monitoring (mean age 41.3±4.5years; 3.9±2.6years post-partum), with 64.8% HDP and 45.2% GDM. Incidence of hypertension was 61.1% [95% CI 48.2%-74.0%]. Higher proportion of women with past HDP had daytime hypertension compared to those with GDM only (57.1% vs. 26.3%; p=0.05) and higher nocturnal mean systolic-BP [116.0±11.2mmHg vs. 109.6±8.7mmHg; p=0.04]. Women with HDP had increased odds of hypertension [adjusted-OR 5.26 95% CI (1.07-32.76); p=0.05]. Following management at the WHC, women diagnosed with hypertension had significantly improved BP control (6.1% at baseline vs. 75.8% at six-month follow-up; p<0.001). Women with past HDP had five-fold increased incidence of hypertension, with higher daytime hypertension and nocturnal systolic-BP, compared to women with GDM. After attending WHC, BP control significantly improved. Our findings suggest routine postpartum follow-up with 24hr-ABP monitoring, through a WHC, may be useful in early detection and management of hypertension in these women.

Addressing uncertainty in identifying pregnancies in the English CPRD GOLD Pregnancy Register: a methodological study using a worked example.

Electronic health records are invaluable for pregnancy-related studies. The Clinical Practice Research Datalink (CPRD) Pregnancy Register (PR) identifies pregnancies in primary care records, including uncertain cases. This paper outlines a method to reduce uncertainty in identifying pregnancies within CPRD GOLD PR data, exemplified through a study investigating the provision of pre-pregnancy care. We used CPRD Mother Baby Link (MBL) and Maternity Hospital Episode Statistics (HES) to clean and augment the CPRD PR data. The study included all women aged 18-48yrs, registered at an English GP practice within CPRD on 01/01/2017, with a year of prior registration and eligibility for hospital data linkage. We developed a cleaning and combining algorithm and further applied strict data quality criteria to form three populations: 'as provided', 'derived' (using our algorithm) and 'strictly derived' (with stricter data quality criteria). We compared characteristics and outcomes across these populations, examining potential biases in effect estimates using the 'as provided' population. Our algorithm added 22,270 (~7%) pregnancies from hospital data to the CPRD PR (1997-2021), eliminated conflicting pregnancies and pregnancies with unknown outcomes, and minimised potentially non-contemporaneous records of past pregnancies or partial records of pregnancies.For all pregnancies across women's reproductive history, in the 'strictly derived' population, characterised by better data quality, a higher prevalence of pre-existing medical conditions and increased pre-pregnancy care were observed. In this dataset, recording of both exposure and outcome was better, and the magnitude of the association between exposure and outcome was reduced compared to the 'as provided' population. PR data requires cleaning before use. This study presents a pragmatic and practical method to identify pregnancies using existing CPRD data and linked records, without needing additional data. Researchers should carefully consider their studies' specific requirements and may adapt our proposed methodology accordingly to align with their research questions.

Survey of Reproductive Health in Women with Tuberous Sclerosis Complex Suggests a Risk for Preeclampsia

Purpose: Limited retrospective studies have investigated reproductive health outcomes in women with tuberous sclerosis complex (TSC). We sought to understand the baseline reproductive health of women in a single large TSC clinic. Background: Tuberous sclerosis complex (TSC) is a rare genetic disease occurring in approximately 1 in 6000 live births. Mutations in TSC1 or TSC2 genes lead to overactivation of the mTOR pathway resulting in a multiorgan disease affecting the skin, heart, brain, lungs, and kidneys (Northrup et al. Ped Neurol 2021). Currently, disease-modifying therapy is available through using mTOR inhibitors (everolimus or sirolimus). Previous studies have demonstrated menstrual dysregulation which is more pronounced in those taking mTOR inhibitors to treat their TSC (Mowry et al Frontier in Reproductive Health 2022). Additionally, there is a knowledge that there may be increased risks during pregnancies affected by TSC but providers are unsure of how to manage or provide recommendations (Rose et al. Orphanent J Rare Disease 2024). As more mild cases of TSC are diagnosed, understanding how the disease and treatments interact with reproductive health is of great importance to providing optimal obstetric and gynecologic care. Methods: We conducted a cross-sectional cohort study of women diagnosed with TSC and who are over the age of 18 years at the Cincinnati Children’s Hospital Medical Center Tuberous Sclerosis Clinic. All women or their legal guardians were invited to participate and after consent, completed a self-report survey on menarche, menstrual irregularity, menorrhagia, past pregnancies, pregnancy outcomes, and menopause and its associated symptoms. Individuals were excluded if they presented to the clinic without a legal guardian. Descriptive statistics were performed. The participants were also separated based on mTOR inhibitor use, socioeconomic status, and education level to better compare differences between populations. A Chi-square analysis was performed to further analyze these differences. Results: In the first 50 participants, the average age at the time of participation was 32.5 ± 12 years. Within the cohort, 25% of surveys were completed by a legal guardian, 30% of women were college graduates and 48% had a household income &gt;$75,000. The age of menarche is 12.2 ± 1.7 years. Irregular menstrual cycles were experienced by 18 respondents (36%) and of those treated with mTOR inhibitors 22% (4/18) experienced changes in their menstrual cycles. Among the patients we surveyed, 74% reported past or present use of contraception, although the majority of respondents reported no use of contraception at the time of the survey. The most common method of contraception was the intrauterine device. The average age of menopause was 44 ± 7 years (N=16). The majority of respondents reported heat flashes (N=9), mood changes (N=8), sleep changes (N=8), and weight gain (N=8) while a minority reported vaginal dryness (N=4). There were 52 reported pregnancies in 22 participants ( 2.4 ± 1 pregnancies per individual). About 10% of pregnancies resulted in spontaneous abortion, which is comparable to the incidence in the general population and 26% of pregnancies had recurrent bleeding. Interestingly, 19% of pregnancies (N = 14) were complicated by pre-eclampsia which is higher than the rate reported in the general population. Conclusion: Tuberous sclerosis complex is a rare genetic condition that has multiorgan involvement, however, the impact on reproductive health is understudied. In our cohort, one-quarter of the women who reported mTOR inhibitor use reported changes in their menstrual patterns. Additionally, the rate of pre-eclampsia among participants was higher than the rate of pre-eclampsia in the general population. These findings suggest that increased attention to women with TSC is needed during pregnancy and that TSC-induced changes may be influencing reproductive health. Our study is limited by sampling of a single medical center, racial/ethnic homogeneity, and by self-reporting of medical diagnoses. Future prospective work is needed to collect data that will help manage reproductive changes induced by TSC disease and treatments which will require multidisciplinary collaboration in caring for women with TSC.

Impact of a Women’s Heart Clinic on Cardiovascular Disease Risk Awareness in Women with Past Pregnancy Complications: A Prospective Cohort Study

Gestational diabetes mellitus (GDM), hypertension during pregnancy (HDP) and/or having small-for-gestational-age (SGA) babies increase cardiovascular disease (CVD) risk. We investigated CVD risk awareness in women with past pregnancy complications and the impact of attending a Women's Heart Clinic (WHC) on this awareness. Women aged 30-55 years with past GDM, HDP and/or SGA babies were prospectively recruited into a 6-month WHC delivering education and management of CVD risk factors (Melbourne, Australia). A nine-item CVD risk Awareness Survey, consisting of six general/three female-specific questions, was administered at baseline and 6-month follow-up. The primary outcome was a change in overall CVD risk awareness before and after attending a WHC, analysed using a McNemar test. Logistic regression assessed for associations between CVD risk awareness and lifestyle behaviours. A total of 156 women (mean age 41.0±4.2 years, 3.9±2.9 years postpartum) were recruited with 60.3% past GDM, 23.1% HDP, 13.5% both HDP/GDM and 3.2% SGA babies. The majority were White (68.6%), tertiary-educated (79.5%), and from higher income (84.6%). At baseline, 19.2% (95% confidence interval [CI] 13.0%-25.4%) of women had high overall CVD risk awareness, while 63.5% (95% CI 55.9%-71.0%) had high female-specific CVD risk awareness. At 6-month follow-up, overall CVD risk awareness (19.2%-76.1%, p<0.001) and female-specific CVD risk awareness (63.5%-94.8%; p<0.001) significantly increased. Improvement in CVD risk awareness was not associated with higher physical activity (adjusted odds ratio 0.49; 95% CI 0.04-3.21; p=0.51) or heart-healthy diet (adjusted odds ratio 2.49; 95% CI 0.88-6.93; p=0.08) at 6-month follow-up. Attendance at a WHC significantly increased women's CVD risk awareness, however, this did not independently associate with lifestyle behaviours.

Risk factors for the onset of cervical intraepithelial neoplasia

BACKGROUND: Persistent human papillomavirus (HPV) infection is a well-established cause of cervical intraepithelial neoplasia (CIN). Epidemiological studies show that while HPV infection is common, it is far more prevalent than CIN itself. Consequently, HPV testing exhibits moderate specificity and positive predictive value for detecting high-grade CIN. Currently, there is no optimal strategy for identifying HPV-positive women at high risk of CIN. AIM: This study aims to assess the socioeconomic, behavioral, and comorbidity factors associated with an increased risk of developing cervical intraepithelial neoplasia. MATERIAL AND METHODS: The study included 121 women who presented to the Medical Research and Education Center of Moscow State University in the period from 2022 to 2023. Pap-smear revealed normal data in 66 women (Group 1, NILM), mild cervical intraepithelial neoplasia in 27 (Group 2, LSIL), and severe cervical intraepithelial neoplasia in 28 (Group 3, HSIL). A comparative analysis of clinical data and medical history, data of liquid cytology and HPV typing was performed in all patients. Statistical analysis was performed using the MedCalc software package. RESULTS: The analysis showed that the risk of severe cervical intraepithelial neoplasia increased 5.4-fold in patients aged 30 years, 3.4-fold in smokers, 9.9-fold in patients who had been sexually active for more than 10 years, 6.3-fold in patients who had ≥4 sexual partners, 4.1-fold in patients who used withdrawal method of contraception (coitus interruptus), 7.0-fold in patients who had ≥3 pregnancies, 4.7-fold in patients with HPV infection (in particular, 4.3-fold in women infected with HPV 16). Patients with cervical intraepithelial neoplasia had significantly greater probability to be infected with high-risk HPV types (88.9% in patients with LSIL and 85.7% in patients with HSIL vs. 56.1% in NILM women), in particular, HPV 16 was detected in more than half of patients with HSIL. CONCLUSION: In this study sample, the risk of cervical intraepithelial neoplasia was associated with age over 30 years, smoking, duration of the sexual activity 10 years, number of sexual partners (4), lack of barrier contraception, number of past pregnancies (3), and persisting high-risk HPV infection, especially HPV 16.

Prediction of low birth weight from fetal ultrasound and clinical characteristics: a comparative study between a low- and middle-income and a high-income country

IntroductionAdverse perinatal outcomes (APO) pose a significant global challenge, particularly in low- and middle-income countries (LMICs). This study aims to analyse two cohorts of high-risk pregnant women for APO to...

Labor and Delivery Outcomes in Australian Mothers after Kidney Transplantation.

Key Points Women with kidney transplantation had higher rates of cesarean sections, deliveries without labor, and vaginal delivery complications.Women with a kidney transplant had more cesarean sections, even after accounting for maternal factors, preterm delivery, and past cesarean sections.Hypertensive disorders of pregnancy and breech presentation were the main drivers of planned cesarean section delivery among transplant recipients. Background Factors influencing high cesarean section rates among mothers with a kidney transplant remain unclear. Methods Using linked Australia and New Zealand Dialysis and Transplant Registry (1970–2016) and perinatal datasets (1991–2013), we compared deliveries of women with a functioning kidney transplant with those without KRT (non-KRT). Results Of 2,946,851 babies (1,627,408 mothers), 211 were born to 137 mothers with a kidney transplant. Overall cesarean section rates were twice more frequent in the transplant cohort (63% versus 26% non-KRT; P &lt; 0.001) across all gestational periods compared with the non-KRT cohort and highest in preterm births (≥37 weeks, 48% versus 25%; P &lt; 0.001, 33–36 weeks, 77% versus 40%; P &lt; 0.001, and &lt;33 weeks, 75% versus 41%; P &lt; 0.001). Cesarean section rates remained higher after adjusting for maternal factors (incidence rate ratio, 1.5; 95% confidence interval, 1.3 to 1.7). In women with a kidney transplant with past pregnancy, 53% with no previous cesarean sections had a cesarean section in the current pregnancy (versus 19% non-KRT; P &lt; 0.001). Mothers with a kidney transplant had less spontaneous labor (30% versus 63%; P &lt; 0.001) and more planned deliveries (induced or elective cesarean sections; 70% versus 36%; P &lt; 0.001) than non-KRT mothers. Nearly half of the women with transplantation (45%) delivered by nonlabor cesarean sections, mostly occurring preterm (&lt;37 weeks, 70% versus ≥37 weeks, 30%; P = 0.002). In the transplant cohort, the main indications for nonlabor cesarean sections were hypertensive disorders of pregnancy and breech presentation (&gt;50% versus 18% non-KRT cohort; P &lt; 0.001) and were linked to gestational age. Nonlabor cesarean sections for fetal distress were higher in women with transplantation (10% versus 4% non-KRT; P = 0.03). In the non-KRT cohort, previous cesarean sections were the main indication for nonlabor cesarean sections (40% versus 24% transplant; P = 0.06). Postpartum hemorrhage (13% versus 7% non-KRT; P = 0.003) and fetal distress (18% versus 10% non-KRT; P = 0.001) were higher among the transplant cohort. Conclusions Women with a kidney transplant have higher rates of cesarean section delivery even after accounting for maternal factors, preterm delivery, and past cesarean sections compared with non-KRT cohorts.

Knowledge of Periconceptional Folic-Acid among Women of Childbearing age Visiting Tertiary Care Hospital in Nepal

The value of periconceptional folic acid supplementation in reducing the incidence of neural tube abnormalities in newborns is widely known. Yet, Nepalese women of childbearing age are mainly ignorant of it. The current study examined different sociodemographic and health factors related to women’s level of knowledge about folic acid among women visiting Obstetrics and Gynaecology outpatients at a Tertiary Care Center in Nepal. It also evaluated the awareness and relevance of knowledge regarding folic acid and its periconceptional supplementation. 400 women aged 18 and 45 who sought Obstetrics and Gynecology Outpatient Services at the Tertiary Care Facility participated in this cross-sectional study. Sociodemographic information was gathered with the help of a self-report questionnaire and processed in IBM-SPSS software at a significance threshold of 0.05. Results of the studies showed that while 47.3% had heard of it, only 34.25% had adequate knowledge of periconceptional folic acid supplementation. Also, besides age (p=.493), knowledge of folic acid was significantly associated with factors including education(p=.026), ethnicity (p=&lt;.001), income (p=.011), employment (p=.001), marital status (p=.007), past pregnancies (p=.031) and ANC visits (p=&lt;.001). The study demonstrates the need for more public awareness to boost folic acid knowledge, adherence, and intake and ultimately lower the prevalence of related birth abnormalities. To quantify the hidden issue, further studies on the prevalence of NTDs in Nepalese society and the contribution of folic acid to their reduction are required.

Pregnancy history and estradiol influence spatial memory, hippocampal plasticity, and inflammation in middle-aged rats

Pregnancy history and estradiol influence spatial memory, hippocampal plasticity, and inflammation in middle-aged rats

Incidence of Hypertension and Blood Pressure Phenotypes Using Ambulatory Blood Pressure Monitoring in Women With Past Pregnancy Complications

Incidence of Hypertension and Blood Pressure Phenotypes Using Ambulatory Blood Pressure Monitoring in Women With Past Pregnancy Complications

“If it has happened once, it can happen again”. The impact of previous pregnancy loss on anxious women's ongoing pregnancies: A qualitative study from Pakistan

“If it has happened once, it can happen again”. The impact of previous pregnancy loss on anxious women's ongoing pregnancies: A qualitative study from Pakistan

European Health Data Space, Use of Data and Data Subjects' Control over Their Own Health Data: Can an Opt-Out Restore the Balance?

The creation of the European Health Data Space is a milestone. It establishes something new and makes it possible to have faster and more efficient health treatment, but also to untap the potential of unused data for policy-making and development of new technologies. However, for the EHDS to be functional, it is imperative that a balance it struck between the aim of having useful data to achieve important public objectives on one side and the goal of enabling patients to have control over their health data. The original Draft Report of the European Parliament came closest to achieving these objectives and should have represented the blueprint for the final compromise. Having a harmonised opt-out for secondary use is crucial for striking the right balance between the mentioned objectives. The end result is far from perfect regarding primary use, but represents a good balance in the area of secondary use concerning the opt-out.

Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia.

Despite a decline in unintended teenage pregnancy in Australia, rates remain higher amongst justice-involved adolescent girls, who are more likely to be from disadvantaged socio-economic backgrounds, have histories of abuse, substance use and/or mental health issues. Furthermore, exposure to the criminal justice system may alter access to education and employment and opportunities, potentially resulting in distinct risk-factor profiles. We examine factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland. Data from the Mental Health, Sexual Health and Reproductive Health of Young People in Contact with the Criminal Justice System (MeH-JOSH) Study was analysed on 118 sexually active adolescent girls. Participants were aged between 14 and 17 years, purposefully sampled based on justice-system involvement and completed an anonymous telephone survey. We constructed two multivariate models taking reproductive outcomes as the dependent variables. Over one quarter (26%, 30/118) reported a past unintended pregnancy, 54 did not use any contraception at their last sexual encounter, and 17 reported LARC use. Following adjustments in the multivariate analysis, lifetime ecstasy use was associated with both unintended pregnancy (aOR 3.795, p = 0.022) and non-contraception use (aOR 4.562, p = 0.004). A history of physical abuse was also associated with both any contraception (aOR 3.024, p = 0.041) and LARC use (aOR 4.892, p = 0.050). Identifying as Aboriginal & Torres Strait Islander, education/employment status and geographic location appeared to have no association. Our findings suggest that justice-involved adolescent girls have distinct risk factors associated with unplanned pregnancy and contraception use compared to the general population, but more research is required to understand the mechanisms and contexts underlying these risk factors. How exposure to physical violence may encourage contraception and LARC use, in particular, warrants further attention as does the association with ecstasy use.

Burden of malaria during pregnancy in perennial transmission settings of two densely forested and remote blocks (Baihar and Birsa) of district Balaghat, Madhya Pradesh, central India.

Background Malaria in pregnancy (MIP) is a major public health problem due to the vulnerability of pregnant women to infections, resulting in adverse maternal/foetal outcomes in endemic areas. Methods We did a field-based study to assess the burden of MIP (prevalence at the time of enrolment and follow-up) and to identify risk factors for MIP in the Birsa and Baihar blocks of district Balaghat in Madhya Pradesh, which have perennial malaria transmission. Malaria screening (during 2015-2017) was done by microscopy and bivalent rapid diagnostic test (SD Bioline RDT, malaria antigen Plasmodium falciparum/Plasmodium vivax Pf/Pv). Dried blood spots were used for haemoglobin estimation. Sociodemographic details with past and present pregnancy status were obtained. A subset of pregnant women were followed up for malaria during pregnancy. Women were also screened for malaria post delivery. Malaria treatment was given as per the National Guidelines of 2013. Multivariate analysis was done to assess independent risk factors for malaria. Results A total of 1728 pregnant women were screened, of which 1651 were included in the final analysis. Malaria prevalence at first screening was 23.4% (Pf 88%). Prevalence and Pf parasitaemia both were significantly higher among primigravid (G1) compared to multigravid (G>2; p value 0.012 and 0.019, respectively). Pregnant women of the Baiga ethnic group were more likely to have malaria compared to those belonging to the Gond group (OR [95% CI]; 2.4 [1.7-3.4]; p<0.00001) and non-indigenous group (OR [95% CI]; 8.3 [3.9-19.7]; p<0.00001). Primigravid status of women, first and second trimester of pregnancy, women belonging to indigenous ethnic tribal group and cash crop insufficiency for whole year (a socioeconomic indicator) in the family were the independent risk factors for malaria. Conclusion MIP is a major public health problem in forested tribal settlements of Birsa and Baihar blocks of Balaghat district in Madhya Pradesh and requires immediate intervention.

Turkish Hematologists’ Preferences for Related Donor Selection: Results of a Multicenter Survey

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a widely utilized treatment for various hematological diseases. While selection criteria for unrelated donors are well established, there is a lack of consistency and standardization in the selection of related donors. This study investigated the current approach of hematologists to the selection of related donors at Turkish HSCT centers. The study employed a cross-sectional survey design, distributing a self-administered questionnaire to 95 adult and pediatric transplantation centers in Türkiye to investigate their approaches to related donor selection for allo-HSCT. The questionnaire collected data on various topics including the center’s experience in performing allo-HSCT, patient groups treated, number of allo-HSCT procedures conducted between 2015 and 2021, preferences for related donors, considerations in related donor selection (such as sex and past pregnancies), guidelines utilized for related donor selection, upper age limit for related donors, and the use of specialized advanced analyses for elderly donors. The response rate to the survey was 38.9%. Variability was observed across centers in terms of sex consideration and the impact of past pregnancies on related female donor rejection. Different guidelines were employed for related donor selection, with the European Bone Marrow Transplantation guidelines being the most commonly used. Regarding the upper age limit for related donors, 8.1% of centers accepted an upper age limit of 55 years, 48.7% preferred an upper age limit of 65 years, and 43.2% selected related donors aged 65 and above. The lack of standardized guidelines for related donor selection in HSCT centers leads to variability in criteria and potential risks. Collaboration among centers is essential to establish consensus and develop standardized protocols.

Prevalence and determinants of anaemia during the second or third trimester of pregnancy in Bangladesh: a cross-sectional study protocol

Background Anaemia in pregnancy remains a critical global health problem and has long-term adverse health outcomes for both the mother and child. In developing countries like Bangladesh, there has been limited progress in reducing the burden of anaemia in pregnancy. This community-based survey will provide insight into the prevalence and determinants of anaemia during the second and third trimesters of pregnancy. Methods This cross-sectional survey will be conducted in three Upazilas (sub-districts) in rural Bangladesh. A total of 1,500 pregnant women will be recruited in second and third trimester, calculated from last menstrual period. The primary outcome is to determine the prevalence of anaemia (Hb&lt;11 g/dL); haemoglobin will be measured in venous blood by HemoCue. The association between iron deficiency and anaemia will be determined, and the role of drinking water iron level in anaemia aetiology will be explored. Key secondary outcomes include the prevalence of moderate (Hb &lt;10 g/dL) and severe anaemia (Hb &lt;7 g/dL), iron deficiency (ferritin &lt;15 mg/L), and iron deficiency anaemia (concurrent iron deficiency and anaemia). Detailed information on socioeconomic status, current and past pregnancies, knowledge on nutrition and anaemia, water-sanitation-hygiene and maternal mental health status will be collected. Conclusions This study will provide comprehensive information on the prevalence and determinants of anaemia in second and third trimester of pregnancy, and inform anaemia intervention strategies to improve maternal and child health outcomes. Ethics and dissemination This study has been approved by the Ethical Review Committee of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the Human Research Ethics Committee of the Walter and Eliza Hall Institute of Medical Research (WEHI), Melbourne, Australia. The results will be actively disseminated through reports and presentations to stakeholders, symposiums and scientific publications. Registration The protocol is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000982819; 26/07/2021).