Perinatal Mortality Research Articles

This study aims to evaluate the clinical utility of the Middle Cerebral Artery Diastolic Deceleration Area (MCA DDA) as a novel Doppler parameter for predicting hypoxia and adverse perinatal outcomes in pregnancies complicated by Fetal Growth Restriction (FGR). A prospective observational study was conducted at the Perinatology Clinic of Ankara Bilkent City Hospital between November 2023 and November 2024. A total of 102 singleton pregnancies were enrolled, including 51 FGR cases and 51 gestational age-matched controls. All participants underwent comprehensive ultrasonographic and Doppler assessments at 34 weeks of gestation. Doppler parameters, including Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), Cerebroplacental Ratio (CPR), Cerebroplacental-Uterine Ratio (CPUR), and the novel MCA DDA, were recorded. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the predictive performance of these parameters for composite adverse perinatal outcomes (CAPO), which included NICU admission, 5-min Apgar score < 7, umbilical artery pH < 7.20, and perinatal mortality. MCA DDA was significantly higher in the FGR group (9.26 ± 2.31) compared to controls (7.49 ± 2.98, p < 0.001). ROC analysis revealed that MCA DDA had an area under the curve (AUC) of 0.63 (95% CI: 0.52-0.75, p = 0.023) with an optimal cut-off value of 8.43 (sensitivity 63.6%, specificity 61.0%). In comparison, CPR demonstrated superior predictive performance with an AUC of 0.71 (95% CI: 0.59-0.82, p = 0.001), while CPUR showed an AUC of 0.66 (95% CI: 0.55-0.78, p = 0.006). The FGR group had significantly higher rates of CAPO (80%) and NICU admissions (42.2%) compared to the control group (p < 0.001). While MCA DDA is significantly elevated in FGR cases and provides valuable insights into cerebral diastolic blood flow, its predictive ability for adverse perinatal outcomes is moderate compared to traditional Doppler indices like CPR and CPUR. Integrating MCA DDA with established parameters may enhance fetal surveillance and improve perinatal outcome prediction in pregnancies complicated by FGR.

Birth asphyxia is one of the leading causes of most neonatal deaths. Hence, strengthening and investing in care is crucial, particularly around birth and the first week of life. As a result, several studies, including an umbrella review, were conducted even though significant variations were observed among those investigations. Thus, this is an updated systematic review and meta-analysis aimed to determine predictors of birth asphyxia in Ethiopia. Online databases such as CINAHL, PubMed, Embase, Web of Science, and Cochrane Library were searched. Online searches turned up pertinent grey literature, and repositories of several universities were also searched. Observational studies carried out in Ethiopia were included. The authors conducted an independent search, quality check, and data extraction. The Newcastle Ottawa Scale checklist was used to evaluate the quality of articles. STATA version 17 was used for both data entry and statistical analysis. Since there were variations among studies, a random-effect model was employed for analysis. Egger's regression test and funnel plot were utilized to assess publication bias, and the I-squared test was performed to verify the studies' heterogeneity. This analysis comprised 38 studies with 13,593 sample sizes. The pooled prevalence of birth asphyxia was 23.07% (95% CI: 19.96, 26.18). An intrapartum (i.e., prolonged labor, blood- or meconium-stained amniotic fluid, tight nuchal cord, cord prolapse, intrapartum fetal distress, malposition/malpresentation, and premature rupture of membrane) and obstetric procedure (i.e., labor induction, emergency cesarean sections, instrumental deliveries, and night time deliveries) factors were significantly associated with birth asphyxia. Moreover; neonatal (i.e., low birth weight, premature birth, and the male sex of the neonate), and maternal (i.e., place of residence, primigravida, mother's age, chronic hypertension, pregnancy-induced hypertension, anemia throughout pregnancy, antepartum hemorrhage, absence of antenatal care follow-up) were also significantly associated with birth asphyxia. This meta-analysis indicates nearly one in four newborns suffered from birth asphyxia in Ethiopia. It implicates tailored interventions for an intrapartum, maternal, neonatal, and an obstetrics procedure-related associated factors are needed to reduce birth asphyxia, thereby enhancing achievement of the sustainable development goal that aimed to reduce neonatal mortality to less than 12 per 1000 live births. Therefore, advocacy for public health initiatives aimed at increasing awareness of birth asphyxia and promoting early detection and intervention strategies, multidisciplinary approaches, and interventional studies are crucial.

To determine whether administration of antenatal corticosteroids to patients with twin gestations at risk for late preterm delivery is associated with reduced risk for neonatal respiratory morbidity compared with unexposed twins. This was a multicenter, retrospective cohort study in a large, urban health network (2013-2022) of patients with twin gestations at risk for preterm delivery between 34 0/7 and 36 6/7 weeks of gestation. Patients were excluded if they received antenatal corticosteroids before 34 weeks of gestation or had pregestational diabetes, single-twin death before 34 weeks, or oral steroid exposure during pregnancy. Neonates were excluded if they had major congenital anomalies. The primary outcome was a composite of neonatal respiratory morbidity requiring respiratory support within 72 hours of birth, including continuous positive airway pressure (CPAP) or high-flow nasal cannula for 2 hours or more, supplemental oxygen of 30% for 2 hours or more, extracorporeal membrane oxygenation, mechanical ventilation, and fetal or neonatal death. Secondary outcomes included neonatal hypoglycemia and indications for neonatal intensive care unit (NICU) admission. Adjusted and unadjusted relative risks with 95% CIs were calculated. During the study period, 366 twin gestations and 722 patient-neonate dyads were included: 162 gestations (321 neonates) in the exposed group and 204 (401 neonates) in the unexposed group. There was no difference in the composite outcome of respiratory morbidity in those exposed to antenatal corticosteroids (23.4% vs 20.4%, P=.40, adjusted relative risk [RR] 1.00, 95% CI, 0.71-1.42). The composite was driven mostly by rates of CPAP use (21.2% vs 18.5%, P=.41, adjusted RR 1.05, 95% CI, 0.73-1.53) and high-flow nasal cannula use (6.2% vs 2.2%, P=.02, RR 2.77, 95% CI, 1.16-6.66). Antenatal corticosteroid exposure was associated with a lower risk of need for supplemental oxygen (0.6% vs 3.5%, P=.02, RR 0.18, 95% CI, 0.04-0.79) and mechanical ventilation (0.6% vs 3.2%, P=.03, RR 0.19, 95% CI, 0.04-0.87). Although antenatal corticosteroids exposure was not associated with higher rates of hypoglycemia (44.2% vs 41.7%, P=.57, adjusted RR 0.99, 95% CI, 0.82-1.19), exposure was associated with a higher risk of having hypoglycemia as the only indication for NICU admission (10.3% vs 5.2%, P=.03, RR 1.96, 95% CI, 1.07-3.59). In a large, multicenter, network-wide retrospective cohort study of patients with twin gestations at risk for late preterm birth, antenatal corticosteroid use was not associated with a decrease in overall respiratory morbidity but was associated with a decreased risk of need for supplemental oxygen and mechanical ventilation, as well as a higher risk of NICU admission for hypoglycemia. These results underscore the ongoing need to elucidate the risks and benefits of late preterm antenatal corticosteroids for patients with twin gestations at risk for late preterm birth.

In the extremely preterm period (ePTB; less than 28weeks), non-Hispanic (NH) Black infants in the US show relatively lower risk of neonatal death than do NH white infants. Explanations for this survival advantage include higher levels of stillbirth among NH Black persons, which could leave behind hardier members of the conception cohort that survive to birth. We test this "high stillbirth" explanation in the US and focus on NH Black singleton ePTB males given their large survival advantage. We applied time-series methods to 288 monthly conception cohorts (1995-2018 US fetal, birth, and neonatal death records) for NH Black and NH white singletons in the ePTB range (N = 473,472). We specified positive monthly outliers in male relative to female NH Black stillbirths in the ePTB range to gauge high NH Black male stillbirths. NH Black male ePTB singleton infants show a stronger neonatal survival advantage (relative to NH whites) for cohorts with high NH Black male stillbirth (4.4 fewer deaths per 100 live births, standard error = 1.3, p < .001). Cohort variation in fetal loss, as measured by high NH Black male stillbirth, may explain a portion of the counterintuitive racial/ethnic patterns in live birth mortality among extremely preterm births.

This study aimed to evaluate the impact of antenatal corticosteroid (ACS) administration prior to delivery on neonatal outcomes in extreme preterm neonates delivered between 21 and 23 weeks of gestation.This retrospective cohort study used data from the National Center for Health Statistics Vital Statistics database. Linked birth and infant death data files from 2015 to 2021 were included in the analysis. The study included singleton, nonanomalous pregnancies that were delivered between 21 and 24 weeks of gestation. Analysis was limited to births with known ACS status. The outcomes of interest were infant mortality, 5-minute Apgar score < 6, and neonatal intensive care unit admission. Univariate analysis was performed to determine the association between exposure and outcome. Logistic regression analysis was performed to determine the association, adjusting for potential confounders.There were 50,671 births included in the analysis. In this group, 15,601 (31%) received ACS prior to delivery. ACS administration prior to delivery was associated with lower neonatal death rate between 21 and 24 weeks (32.9 vs. 56.1%, p < 0.0001, adjusted odds ratio [aOR]: 0.53 [0.51-0.56]). Sub-analysis based on delivery at each gestational week demonstrated a protective effect at 21 weeks (70.1 vs. 80.7%, p = 0.001, aOR: 0.56 [0.34-0.91]); at 22 weeks (54.1 vs. 75.9%, aOR: 0.40 [0.35-0.47]); at 23 weeks (39.1 vs. 50.9%, aOR: 0.65, aOR [0.61-0.70]); and at 24 weeks (24.6 vs. 30.1%, aOR: 0.78 [0.73-0.83]).ACS administration in extreme preterm neonates born between 21 and 24 weeks was associated with improved survival. · ACSs lowered neonatal death from 56.1 to 32.9% at 21 to 24 weeks.. · Greatest survival benefit was seen at 22 weeks with a 60% risk reduction.. · ACSs were linked to higher use of ventilation, surfactant, and antibiotics..

The World Health Organization encourages all countries to implement Maternal and Perinatal Death Surveillance and Response (MPDSR), a continuous quality improvement cycle of death identification, reporting, and review to prevent future mortality. However, MPDSR implementation in humanitarian settings requires contextual adaptations for effective implementation. The aim of this study was to understand the landscape of existing health surveillance and information systems that capture maternal and perinatal mortality in crisis-affected areas of Eastern Democratic Republic of the Congo (DRC) to inform future implementation of MPDSR. A mixed-methods study was conducted in North Kivu and South Kivu in Eastern DRC. Within each province, three health zones were targeted. We conducted 109 key informant interviews to identify and understand how existing surveillance and health information systems capture data on maternal and perinatal mortality. Surveys were administered for each identified system (N = 53). Data collection occurred in December 2022 in South Kivu and in June 2023 in North Kivu. Descriptive statistics of survey findings were conducted to compare key characteristics of reporting systems. Thematic content analysis of interview transcripts was conducted and triangulated with survey findings to understand implementation realities by system and health zone type. Two categories of death reporting systems were identified: health systems (National Health Information System, MPDSR, and their extensions into communities via community health workers) and administrative systems (civil registration and other community-based systems). Commonly reported implementation challenges in all health zones included insufficient human and financial resources, unavailable tools, and complex socio-cultural dynamics which created obstacles in the identification, reporting, and review of deaths. Insecurity within the region often limited system functionality. However, promising practices related to health authority and community engagement were implemented to overcome implementation challenges. Our findings uncover a wealth of implementation experience that is essential to inform the development, implementation, and extension of MPDSR systems tailored for optimal functionality in crisis-affected contexts. Structural system inputs must be addressed alongside socio-cultural dynamics that influence reporting and review of maternal and perinatal deaths. The intervention mechanism in crisis contexts must include a component aimed at strengthening the community networks involved in information gathering.

BackgroundHypertensive disorders of pregnancy (HDP) remain a major cause of maternal and perinatal morbidity and mortality globally. Quantifying the effects of HDP on complications during pregnancy is vital for enhancing risk prediction and improving pregnancy outcomes.MethodsThis study leveraged data from a cohort of 3652 women from a prior study investigating the prevalence of HDP at a tertiary maternity hospital in Kenya - between 1st January, 2018 and 31st December, 2019. Sociodemographic characteristics, pregnancy outcomes, and complications among women diagnosed with HDP compared with normotensive women were analysed. The maternal complications explored included acute renal injury, antepartum haemorrhage and postpartum haemorrhage. The perinatal complications included intrauterine foetal demise, intrauterine growth restriction, small-for-gestational-age neonates, preterm birth and low APGAR (7 or below). Log-binomial regression was used to estimate the risk ratios of maternal and perinatal complications between these groups. Both composite and individual complication analyses were done.ResultsThe rate of maternal complications within the study was 1.3% (46/3652), whereas perinatal complications occurred in 13.0% (474/3652). After adjusting for maternal age ≥ 35 years and caesarean delivery, women with HDP had 3.34 times the risk of maternal composite complications compared to normotensive women (adjusted risk ratio 3.34; 95% CI 1.81– 6.16). These complications included acute renal injury and postpartum haemorrhage. Furthermore, there was a significant association between HDP and composite perinatal complications (adjusted risk ratio 1.38; 95% CI 1.07– 1.77). Specifically, the risk of intrauterine foetal demise and intrauterine growth restriction was elevated among the HDP group compared to normotensive women.ConclusionHDP continues to pose a significant burden on pregnancy and childbirth in Kenya. A strong association between pregnancy complications and HDP has been demonstrated. Regionally adapted pregnancy surveillance and optimised management approaches for acute kidney injury, post partum haemorrhage and perinatal morbidity prevention are urgently needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-07941-1.

ABSTRACT Aim To determine the impact of a community‐oriented model integrating first‐trimester risk stratification, fetal Doppler and routine antenatal ultrasound on preeclampsia (PE) and perinatal mortality rates in a rural population of central India. Methods The program covered 168 public sector centres providing pregnancy care services to nearly 1500 pregnancies annually. First‐trimester assessments included measurement of mean arterial blood pressure, mean uterine artery pulsatility index, risk stratification for preterm PE, recommending low‐dose aspirin 150 mg for women at high risk for preterm PE, and health education for public sector community health workers, pregnant women and their families. Second and third trimester assessments included fetal biometry, growth, fetal Doppler studies of uterine, umbilical, middle cerebral arteries and estimation of the cerebroplacental ratio, staging and protocol‐based management of fetal growth restriction and individualised clinical management of PE. Results The analysis included 4808 pregnant women screened from September 2019 to May 2025. Childbirth outcomes were available for 4016 (83.5%) women. The first trimester screening protocol ( n = 2933) identified 4.2% ( n = 124) women only at high risk for preterm PE and 10.7% ( n = 313) women at high risk for both preterm PE and fetal growth restriction. PE was reported in 28 (0.7%) of the 4016 women with childbirth outcomes. The perinatal mortality rate was 16.4/1000 childbirths in 2025 compared to 37.0/1000 childbirths in 2016. Health education was provided to all screened pregnant women and healthcare staff of the healthcare centres. Conclusion The community‐oriented model reduced the magnitude of PE and perinatal mortality in this rural community.

Objectives: This study therefore aims to determine the perinatal prognosis and delineate the key risk factors associated with outcomes in fetuses with a prenatal diagnosis of absence of pulmonary valve syndrome (APVS), with particular emphasis on Doppler ultrasound parameters, the presence of extracardiac anomalies, and comprehensive genetic findings - including rare monogenic mutations - as significant contributors to the observed perinatal course. Methods: This retrospective study included eight fetuses diagnosed with absent pulmonary valve syndrome (APVS) between 2020 and 2024 at a tertiary perinatology referral center. One patient with major extracardiac anomalies was electively terminated and excluded from the outcome analysis. For the remaining seven fetuses, detailed fetal echocardiographic assessments—including cardiac anatomy and Doppler hemodynamic parameters - were evaluated alongside genetic testing results (prenatal and/or postnatal), associated extracardiac anomalies, and postnatal clinical and surgical outcomes. Results: Among eight fetuses prenatally diagnosed with APVS, one case was electively terminated due to major extracardiac anomalies and excluded from further analysis. All of the remaining seven cases resulted in live births. Four neonates underwent surgical intervention, three of whom survived postoperatively, yielding a surgical survival rate of 75%. Two fetuses that developed hydrops fetalis died in the early postnatal period before surgery could be performed. The overall perinatal mortality rate was 57.1%. Clinically significant genetic anomalies, including trisomy 21, 22q11.2 deletion, and a novel ABAT gene mutation detected via prenatal whole-exome sequencing, were identified in three patients (42.9%). Nonsurvivors were more likely to present with an absent ductus arteriosus and severely dilated pulmonary arteries. Conclusions: Our study highlights that prognosis is more strongly influenced by prenatal hemodynamic markers - such as pulmonary artery velocities, ductus arteriosus status, and hydrops - than by anatomic subtype. The identification of both common chromosomal anomalies and novel ABAT gene mutations underscores the value of comprehensive genetic evaluation.

The maternal and neonatal mortality rates remain high in the second most populous nation in Africa. Unfortunately, the role of Christian missionary health work in Ethiopia has declined, and the challenge is to revitalize this essential aspect of the work. Our previous mission health work found that targeted, well-implemented interventions, such as decentralizing Comprehensive Emergency Obstetric Care (CEmOC) and improving healthcare infrastructure, can substantially enhance maternal and neonatal health, even in resource-limited settings. However, it is challenging for faith-based organizations to run large-scale programs, and this paper outlines ideas for enhancing the delivery of maternal and child health services to smaller, but well-defined populations. This paper uses experiences from Ethiopia to reduce maternal and neonatal deaths, primarily by offering essential obstetric care near the homes of women. The work began in mission hospitals and gradually expanded to involve close collaboration with local and regional health authorities. The aim was to improve the coverage of maternal and neonatal services in the population. The Norwegian Agency for Development Cooperation (Norad) funded the work. While such a work has definite advantages and has improved the health of the populations, one could raise the question of whether mission- and church-based institutions should instead focus on smaller catchment areas. By doing so, they can sustain their work and maintain their core Christian values for more extended periods. Furthermore, the paper discusses the sustainability of church-based health work, examining it in a context where larger funding organizations are beginning to withdraw their support. The paper places this within the framework of Christian missionary work, which also encompasses a spiritual dimension.

Background: Preeclampsia is a heterogeneous disorder, with emerging evidence indicating the presence of multiple phenotypes. Identifying distinct clinical phenotypes may facilitate precise therapies and improve the clinical outcomes. This study aims to identify and validate preeclampsia phenotypes using machine learning and evaluate their associations with adverse pregnancy outcomes. Hypothesis: Machine learning-based clustering methods applied to routinely-collected clinical variables can identify distinct preeclampsia phenotypes, each associated with unique clinical profiles and differential risks of adverse pregnancy outcomes. Methods: In the derivation cohort (n=2,386), phenotypes were derived using k-means clustering applied to 26 routinely-collected clinical variables. A machine learning classifier incorporating key biomarkers was developed and externally validated to assign phenotypes within the validation cohort (n=1,570). Biological markers, clinical outcomes (primary outcome: composite of small for gestational age [SGA], preterm delivery, stillbirth, and neonatal death), and heterogenous impacts of delivery timing in term preeclampsia were analyzed across phenotypes. Results: Four distinct phenotypes were identified in the derivation cohort. Phenotype A exhibited hypocoagulation, while Phenotype B displayed relative thrombocytopenia. Phenotype C demonstrated hypercoagulation, and Phenotype D presented with hepatic and renal dysfunction, elevated potassium, and coagulation abnormalities. These findings were replicated in the validation cohort. Compared with Phenotype A, Phenotype D had the highest risk for the primary outcome (relative risk [RR] 2.83, 95% CI 2.48–3.23, P &lt; 0.001), followed by Phenotypes C (RR 1.72, 95% CI 1.49–1.99) and B (RR 1.28, 95% CI 1.08–1.50). In term preeclampsia, delivery at 37 weeks increased adverse outcome risks relative to after 40 weeks in Phenotypes A, B, and D; Phenotype C exhibited elevated risks from 37–39 weeks. Conclusion: Four clinical phenotypes of preeclampsia were identified by using routinely-collected health data, each characterized by unique maternal feature profiles and associated with varying fetal outcomes. These phenotypes reflect diverse underlying pathophysiological processes, and may inform individualized decisions regarding delivery timing. Machine learning-based phenotyping represents a promising strategy to advance precision obstetrics and improve the understanding and management of preeclampsia.

The human placenta serves as the predominant endocrine organ throughout pregnancy, assuming a central role in preserving endocrine homeostasis, facilitating maternal physiological adaptation, and safeguarding fetal well-being. Preeclampsia (PE), a multifaceted and systemic gestational complication, stands a primary contributor to maternal and perinatal morbidity and mortality. Defective placental development has been extensively acknowledged as the fundamental pathological foundation underlying this condition. Accumulating evidence has unveiled a disruption in the balance of steroid hormone production within placentas affected by early-onset PE (E-PE). Considerable endeavors have been undertaken to decipher the endocrine mechanisms driving E-PE. Recent investigations have illuminated a complex, multi-tiered regulatory system that governs placental steroidogenesis, encompassing epigenetic controls such as microRNAs (miRNAs) activity and metabolic flux-conjugated histone acetylation, post-translational modifications including O-linked β-N-acetylglucosamine (O-GlcNAc), as well as intricate endocrine feedback loops among steroids and other signaling molecules like melatonin. Notably, a growing body of evidence robustly supports a causal link between elevated placental testosterone (T0) synthesis and the onset of PE. Nevertheless, comprehensive studies exploring the endocrine pathophysiology of PE remain essential to illuminate novel therapeutic avenues for mitigating this adverse pregnancy outcome.

Background Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity and mortality. Choline, essential in one-carbon metabolism and vascular function, may influence placental health. We examined associations of total, subtype-, and source-specific dietary choline with PE odds in Chinese women. Methods We conducted a 1:1 matched case–control study of 982 pregnant women (491 PE cases; 491 controls) in Zhengzhou, China. Dietary intake over the preceding three months was assessed using a validated semi-quantitative food-frequency questionnaire. Conditional logistic regression calculated odds ratios (ORs) and 95% confidence intervals (CIs) for total choline, lipid- vs. water-soluble forms, and animal- vs. plant-derived sources, adjusting for covariates. Restricted cubic splines explored possible non-linear dose–response associations. Results Among 982 participants (491 PE cases; 491 controls), mean total choline intake was 335.8 mg/day, with eggs contributing 42.5%. In multivariable-adjusted models, compared with the lowest quartile, those in the highest quartile of total choline intake had 58% lower odds of PE (OR = 0.42; 95% CI, 0.26–0.68), with similar associations for lipid- (0.33; 0.22–0.48) and water-soluble forms (0.37; 0.25–0.54). Both animal- (0.43; 0.30–0.63) and plant-derived choline (0.31; 0.21–0.46) were protective, while their intake ratio was not. Each additional 25 g/day of egg (~half an egg) was linked to an 11% lower PE odds. Conclusion Higher habitual dietary choline intakes from animal and plant sources were independently associated with significantly lower odds of PE, suggesting that adequate, source-diverse choline intake in early pregnancy may offer a practical dietary strategy for PE prevention.

Background: Maternal hypertensive disorders (MHD), a leading cause of maternal and perinatal morbidity and mortality, remain a critical public health issue even in high-income countries (HIC) with advanced obstetric care. Despite progress in healthcare systems, the evolving trends in MHD burden across HIC remain poorly characterized. Methods: We employed the Global Burden of Disease Study 2021 analytical framework to estimate the burden of MHD across HIC. Case definitions were standardized using ICD-10 codes, and estimates were generated through DisMod-MR 2.1, a Bayesian meta-regression tool. Mortality was modeled using cause-of-death ensemble modeling, while years lived with disability (YLDs) were computed by applying disability weights to prevalence estimates. Temporal trends in age-standardized rates were evaluated using log-linear regression to calculate annual percentage changes (APCs). Results: Between 1990 and 2021, the total number of prevalent cases of maternal hypertensive disorders increased in High-income North America (HINA) from 124,114 (95% UI: 77,999–192,941) to 131,063 (85,937–185,149), in Southern Latin America from 24,774 (15,450–37,690) to 31,021 (20,449–45,050), and in Western Europe from 82,654 (51,187–127,529) to 85,625 (53,336–127,823). Conversely, declines were observed in High-income Asia Pacific (from 31,578 [19,282–48,836] to 18,741 [12,085–27,289]) and Australasia (from 8,037 [5,348–11,685] to 7,408 [4,516–10,924]). The highest annual increase in age-standardized incidence was seen in Germany (0.97%), followed by France (0.86%), Denmark (0.66%), and Israel (0.58%), while the USA exhibited a slight decline (−0.13%). In terms of mortality, Canada was the only high-income country to report an increasing APC (0.19%), whereas all others, including the USA, showed declines, with the USA decreasing by −0.67%. Across all time points, the burden was greatest in women aged 20–29 years, with HINA consistently exhibiting the highest incidence, mortality, and YLDs, despite declining death rates elsewhere and persistently elevated disability burden. Conclusion: Despite declining mortality, MHD remain a persistent challenge in HIC , with rising incidence in parts of Europe and substantial disability burden in HINA. The disproportionate burden among women aged 20–29 years underscores the need for region-specific maternal health strategies focused on early detection, long-term management, and equitable care access.

Background: Congenital heart disease (CHD) is the most common congenital anomaly, affecting 8–10 per 1,000 live births globally, and is a leading cause of perinatal morbidity and mortality. Despite advances in fetal imaging, early and accurate CHD detection remains challenging, hindered by operator dependency and the subtlety of prenatal cardiac anomalies. Artificial intelligence (AI), particularly deep learning algorithms, offers a novel analytical framework for automated, high-throughput analysis of fetal cardiac imaging, with the potential to transform prenatal diagnostic pathways. Objectives: To systematically evaluate and quantitatively synthesize the diagnostic performance of AI algorithms in detecting fetal CHD. Methods: A comprehensive literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and Ovid Medline was conducted from inception through June 2025 for studies reporting diagnostic accuracy of AI algorithms for fetal CHD using any imaging modality. Three reviewers independently screened studies, extracted data, and assessed risk of bias using QUADAS-2, resolving discrepancies by consensus. Random-effects meta-analyses were performed in R, adhering to PRISMA-DTA guidelines, to generate pooled accuracy estimates for AI algorithms. Results: Across eligible studies, AI-augmented clinical decision-making achieved a pooled diagnostic accuracy of 0.86 (95% CI, 0.81–0.89), significantly exceeding the accuracy of non-AI approaches (0.83 [0.82–0.85]; p = 0.0043). Subgroup analyses stratified by clinician expertise (trainee, generalist, fellow, expert) consistently demonstrated incremental accuracy gains with AI augmentation, with the greatest relative improvement among trainees (AI: 0.82 [0.64–0.93] vs. non-AI: 0.72 [0.49–0.87]; p = 0.0047). Heterogeneity was moderate to high (I 2 up to 91.2%), but the directionality of effect was robust. Conclusions: AI and deep learning algorithms substantially enhance the diagnostic accuracy of fetal CHD detection, particularly benefiting less experienced clinicians. These findings highlight the transformative potential of AI to address critical diagnostic gaps, reduce operator dependency, and improve prenatal outcomes in CHD.

Background: Hypoplastic Left Heart Syndrome (HLHS) is a severe congenital heart defect, representing approximately 2–4% of all congenital heart diseases and accounting for 23% of neonatal cardiac deaths. Umbilical cord-derived hematopoietic stem cell (HSCs) therapy has emerged as a promising therapy. The therapy has the potential for cardiac regeneration via differentiation, paracrine signaling, and immunomodulation. Compared to bone marrow or embryonic sources, umbilical cord cells are ethically obtained, non-invasively collected, and exhibit low immunogenicity. Hypothesis: Early administration of umbilical cord-derived HSCs in HLHS may enhance myocardial recovery, reduce postoperative complications, and support long-term cardiac function. Methodology: This study aims to evaluate clinical trials involving post-operative intramyocardial delivery of autologous umbilical cord-derived HSCs in HLHS patients. Effectiveness has been analyzed using the right ventricular ejection fraction (RVEF) measures. Results: The studies have shown that HLHS infants receiving HSCs therapy have shown a significant improvement in RVEF up to 7.1% in 18 months. At 36 months, the RVEF was reported to be improved by 8.0%. The therapy was well-tolerated with no major adverse events. Conclusion: Umbilical cord-derived HSCs therapy is a promising therapy in infants with its regenerative and cardioprotective potentials. Long-term safety profile and the personalized treatment protocol need large-scale randomized clinical trials.

Worldwide, an estimated five million children under the age of five die each year; 47% of these deaths occur during the neonatal period, and the vast majority in low- and middle-income countries. Events during labor are the cause of one quarter of neonatal deaths globally. Basic resuscitation with positive pressure ventilation reduces these deaths but is challenging to execute. To characterize barriers to implementation of basic neonatal resuscitation, we conducted a qualitative study using focus group discussions with midwives at three health facilities in Kinshasa, Democratic Republic of the Congo. We analyzed qualitative data using an inductive content approach in order to identify emergent themes and trends. Twenty-four midwives participated with a median age of 49 and over 80% with more than 10 years of clinical experience. We categorized challenges to implementing basic neonatal resuscitation into three themes with subthemes: 1) limited resources (subthemes: human resource limitations, inadequate and unprepared equipment, insufficient monitoring during labor); 2) inadequate simulated and clinical experience (subthemes: poor systems to support maintenance of skills, infrequent opportunity to resuscitate); 3) emotional burden of resuscitation (subthemes: decision-making under time pressure, tendency to stick to the routine, acute stress during resuscitation, moral distress after unsuccessful outcome). Our findings suggest that while simulation training is key, learning from clinical events may be a critical companion to address these barriers. We call for a new focus on developing and evaluating strategies that support providers in learning from every newborn resuscitation.

Worldwide, an estimated five million children under the age of five die each year; 47% of these deaths occur during the neonatal period, and the vast majority in low- and middle-income countries. Events during labor are the cause of one quarter of neonatal deaths globally. Basic resuscitation with positive pressure ventilation reduces these deaths but is challenging to execute. To characterize barriers to implementation of basic neonatal resuscitation, we conducted a qualitative study using focus group discussions with midwives at three health facilities in Kinshasa, Democratic Republic of the Congo. We analyzed qualitative data using an inductive content approach in order to identify emergent themes and trends. Twenty-four midwives participated with a median age of 49 and over 80% with more than 10 years of clinical experience. We categorized challenges to implementing basic neonatal resuscitation into three themes with subthemes: 1) limited resources (subthemes: human resource limitations, inadequate and unprepared equipment, insufficient monitoring during labor); 2) inadequate simulated and clinical experience (subthemes: poor systems to support maintenance of skills, infrequent opportunity to resuscitate); 3) emotional burden of resuscitation (subthemes: decision-making under time pressure, tendency to stick to the routine, acute stress during resuscitation, moral distress after unsuccessful outcome). Our findings suggest that while simulation training is key, learning from clinical events may be a critical companion to address these barriers. We call for a new focus on developing and evaluating strategies that support providers in learning from every newborn resuscitation.

Respiratory syncytial virus (RSV) is a leading cause of hospitalization and mortality in early infancy. Maternal immunization offers a preventive strategy, but uncertainties regarding safety and economic value have limited its implementation. To synthesize phase 3 randomized trial evidence on the efficacy and safety of maternal RSV vaccination and to estimate its potential population and economic impact. By integrating a scenario-based modeling framework derived from pooled meta-analytic estimates, this review provides high-certainty, policy-relevant evidence to guide maternal immunization strategies in diverse settings. PubMed, MEDLINE, Scopus, and Google Scholar were searched up to April 2025 using predefined terms for RSV vaccination, pregnancy, and randomized controlled trials (RCTs). Phase 3 RCTs comparing maternal RSV vaccination with placebo and reporting neonatal or maternal outcomes were included. Non-randomized studies, monoclonal antibody trials, or reports lacking extractable data were excluded. Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB-2). Pooled risk ratios (RR) and absolute risk differences were calculated with random-effects models. Certainty of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A scenario-based cost-effectiveness model was applied to the Mexican birth cohort. Four phase 3 RCTs (17 391 women) were included. Maternal RSV vaccination halved the risk of infant RSV infection (risk ratio [RR] 0.47, 95% confidence interval [CI]: 0.29-0.76; number needed to vaccinate [NNV] 85) and reduced severe disease by 64% (RR 0.36, 95% CI: 0.21-0.60; NNV 127). No increased risks were observed for preterm birth, pre-eclampsia, or stillbirth. Certainty was moderate (any RSV) to high (severe RSV). In Mexico, universal vaccination at list price (US$295 per dose) would prevent approximately 20 769 infections and 228 neonatal deaths annually, though with high costs per case averted. At public-sector pricing (US$50 per dose), cost-effectiveness improved substantially. Maternal RSV vaccination is effective, safe, and potentially cost-justifiable in high-burden settings, supporting its integration into national immunization programs. PROSPERO registration: CRD420251014636 (March 2025).

Outside pregnancy, blood pressure variability (BPV) predicts cardiovascular events. We aimed to study associations (if any) between visit-to-visit BPV in pregnancy and (1) adverse maternal/perinatal outcomes, and (2) long-term maternal cardiovascular outcomes. We conducted a secondary analysis of data from ALSPAC (Avon Longitudinal Study of Parents and Children). Adjusted logistic regression assessed relationships between visit-to-visit BPV (by the measures of SD, average real variability, and variability independent of mean) and pregnancy outcomes (gestational/severe hypertension, preeclampsia, preterm birth, small-for-gestational-age infants, neonatal intensive care unit admission, stillbirth, and perinatal death). Adjusted Cox regression assessed relationships between visit-to-visit BPV measures and long-term maternal outcomes: hypertension (measured), diabetes (self-reported), and heart disease (self-reported) as a composite. Among 12 509 women in ALSPAC, 4956 answered a follow-up questionnaire and 4426 attended a follow-up clinic, an average of 22 years after the index pregnancy. Measures of variability in systolic and diastolic BP (by each of SD, average real variability, and variability independent of mean) were associated with adverse pregnancy outcomes, particularly severe hypertension and preeclampsia by SD and variability independent of mean (adjusted odds ratios, 1.30-2.11). BPV in pregnancy was not associated with hypertension, diabetes, or heart disease at follow-up in adjusted analyses. Our findings indicate that BP variation between antenatal visits is informative for identifying risk of short-term adverse pregnancy outcomes, but BPV provides no long-term utility in predicting cardiovascular risk.