Positive Mothers Research Articles

Timing of post-vaccination tests in infants born to mothers with chronic hepatitis B virus infection.

Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus (HBV) infection within the first 12-24 hours. Detection of hepatitis B surface antibody (HBsAb) resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response. This makes it difficult to detect HBV infection. For this reason, it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunoprophylaxis at birth should have HBsAb testing when they are 9-15 months old.

Harmony in healthcare: recommended infant feeding practices and associated factors among HIV positive mothers in Eastern Ethiopian hospitals

BackgroundFor mothers identified as HIV-infected, recommended infant feeding practices must prioritize the highest likelihood of ensuring HIV-free survival for their children while preserving maternal health. Consequently, understanding the feeding status during critical infancy stages, especially under the risk of HIV, plays a crucial role in enhancing the quality of life within this specific population segment. Hence, this study was conducted to assess the magnitude and associated factors of recommended infant feeding practices and its associated factors among HIV-positive mothers in Eastern Ethiopian Hospitals.MethodsA cross-sectional study conducted in Eastern Ethiopian Hospitals from June to July 2022 included 371 mothers of infants. Participants were selected using systematic random sampling techniques. Data was collected through pre-tested structured face-to-face interviews administered by trained interviewers. Following data collection, information was cleaned and entered using Kobo tool collection software, then exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Binary logistic regression analysis was employed to assess the strength of association between explanatory and outcome variables. Variables with a p-value < 0.25 in univariable logistic regression analysis were considered for multivariable logistic regression analysis, and statistical significance was determined at a P-value < 0.05 with a 95% confidence interval.ResultsThe magnitude of recommended feeding practice was found to be 86% (95% CI: 81.9, 89.1). HIV-positive mothers who had a child age of 0–6 months [AOR = 5.21 (95% CI: 2.54, 10.70], spontaneous vaginal delivery [AOR = 2.11 (95% CI: 1.05, 4.24], and ever provided expressed breast milk [AOR = 2.82 (95% CI: 1.33, 5.95] were significantly associated with recommended Infant feeding practice.Conclusionthe study identified a moderate level of adherence to recommended infant feeding practices among HIV-positive mothers in Eastern Ethiopian hospitals. Key factors influencing adherence included the child’s age, mode of delivery, and the provision of expressed breast milk. Target interventions to improve infant feeding practices among HIV-positive mothers, focusing on younger infants, cesarean-delivered mothers, and those not providing expressed breast milk. Strengthen counseling and education in healthcare facilities to address these significant factors and enhance adherence to recommended feeding practices.

A qualitative study to understand the facilitators of and barriers to retention in care to the national PMTCT Option B+ programme in Uganda.

Effective prevention of mother to child transmission (PMTCT) programmes require women and their infants to have access to a cascade of HIV care and treatment interventions. Retention in care reduces the risk of vertical transmission and opportunistic infections among mothers living with HIV. Uganda has made great strides in ensuring the success of the prevention of mother to child transmission program. Although an increasing number of people living with HIV (PLHIV) in Uganda are benefiting from the rapid scale-up of antiretroviral therapy (ART), retention in HIV care and treatment services remains a major concern. Identifying and understanding the reasons for dropping out of care among mothers enrolled in the Option B+ program among those who were retained and those who dropped out is key to inform policy and program practice. We conducted a qualitative study to understand the facilitators of retention and reasons for loss to follow-up among HIV positive mothers in central Uganda who engaged in the Option B+ program. We conducted 29 focus group discussions (FGDs) with Village Health Teams (VHT) and 'Peer Mothers'. We performed 21 in depth interviews (IDI) with mothers who had been lost to follow up during the post-partum period, and 27 among those who remained in care. These were conducted in 18 districts in Central Uganda. Participants identified barriers and facilitators to retention in HIV care. Barriers included self-stigma and fear of disclosure, mental health challenges, community perceptions, poor health provider attitudes and structural challenges, lack of transportation and food, long waiting time at health facilities and client mobility. Both the clients retained and not retained in care discussed mental illness, feeling sick and competing priorities as barriers. Facilitators for retention in care included adequate community support systems, early initiation on ART, giving birth to HIV negative children and economic stability. These were noted as key enabling factors for retention. It was also highlighted that presence of friendly clinic staff members, scheduling reminders were important aspects of retention. Findings highlighting barriers covering personal, interpersonal, structural and community suggest that developing client-centered models addressing social and community barriers and provide more holistic services is key to retaining mother-infant pairs in care. Emphasis on the use of community health workers and provision of financing, as well as institutionalization of quality improvement would provide alternatives for overcoming barriers to retention in care.

‘The tablets make a certain noise’: uncovering barriers and enablers related to providing PMTCT services to adolescents and young women living with HIV in Zimbabwe

Background Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence. Methods Qualitative data was gathered from four focus group discussions with (2 urban and 2 rural) PMTCT providers (N = 17). Focus group discussions were also conducted among AYW clients (N = 20) from two clinics in Mashonaland East. Results Qualitative analyses identified patterns related to: (1) drop out and loss to follow up, (2) retention and adherence, (3) recurring feelings of internalized stigma; and (4) acceptability of potential MH interventions. MH services are not available and AYW have limited access to adherence counseling (1–2 times at onset). Psychological support was not available at either clinic, despite both providers and clients perceiving high rates of stigma, discrimination, and challenges with disclosure. Challenges related to long waits for ART distribution and gaps in disclosure support emerged as barriers. Providers noted that AYW present as anxious (non-diagnosed), and attribute depression to those clients who are lost to follow up, stating lack of time to screen for MH related issues or actively refer them for services. Challenges related to the ability to provide strong advice and support for disclosure also emerged among providers. Conclusions This study can contribute to policy and practice recommendations to better integrate MH into HIV services and develop person-centered service models for HIV positive AYW. HIGHLIGHTS Perinatal adolescents and young women (AYW) living with HIV have gaps in retention and care in the current Zimbabwe PMTCT service model. Mental health stigma must be addressed to integrate mental health into HIV services. HIV providers are aware of the need to provide mental health support to reduce loss to follow-up. Mental health screening and referrals for services are not part of standard care for perinatal HIV positive AYW in Zimbabwe. Linkages between disclosure and AYW mental health was identified as a challenge by HIV providers. Context responsive interventions can support integration of mental health screening, services, and referrals.

Study of the clinical profile and outcome of the neonates born to COVID-19 positive mothers: a tertiary care centre experience from western Uttar Pradesh

Background: A major concern of SARS-CoV-2 infection in pregnancy is its possible effects on newborns. In the context of mother-to-child transmission, some studies have reported that there were no SARS-CoV-2-positive infants born to a cohort of mothers with COVID-19 while others have reported an incidence of as high as 10%. The study is conducted to describe the clinical profile of neonates born to mothers who tested positive for COVID- 19 infection and to determine the association of neonatal COVID 19 status. Methods: This cross sectional study includes neonates born to COVID 19 positive mothers. Neonates born to mothers who were diagnosed before delivery were tested by RT-PCR within 24 h of birth. Results: Out of 120 babies born to COVID positive mothers, 5 newborns (4.2%) were found to be COVID positive, diagnosed through RT-PCR. Among COVID positive babies four out of five were symptomatic (p&lt;0.001) and required respiratory support in any form (p=0.001). All of the COVID positive neonates were discharged, while there was one mortality noted among covid negative babies (0.9%), however there was no statistically significant association between mortality and COVID infection in the neonates (p=0.498). Conclusions: The proportion of covid positive neonates born to COVID-19-positive women were very low (p=4.2). The study supports milder manifestation in COVID-19 infected neonates and risk of transmission of COVID-19 infection from mother to neonate by rooming in and breastfeeding is low.

Inhaled Nitric Oxide Treatment of Early Pulmonary Hypertension to Reduce the Risk of Death or Bronchopulmonary Dysplasia in Infants Born Extremely Preterm: A Masked Randomized Controlled Trial

To determine whether inhaled nitric oxide (iNO) treatment of early pulmonary hypertension (PH) would decrease the risk of death or bronchopulmonary dysplasia (BPD) among infants born extremely preterm. This was a single-center, masked, randomized controlled trial involving infants born at <29 weeks' gestation and requiring positive pressure ventilation. Exclusion criteria included infants of COVID-19 positive mothers, large patent ductus arteriosus with left to right shunting, left ventricle dysfunction (ejection fraction <40%), significant congenital anomalies/genetic disorders or iNO treatment by clinicians prior to the study echocardiogram. Initial echocardiogram was performed at 72+24 hours of life to randomize infants with early PH into 2 study arms (iNO vs placebo). Serial echocardiograms were performed every 24-48 hours, up to 14 days of life. Treatment was weaned until PH resolved (responders) or if no improvement was documented >72-hours (non-responders). Primary outcome was death or BPD at 36-weeks postmenstrual age. From July 2019 to October 2023, 683 eligible infants were admitted. We excluded 88 infants; 413 mothers declined consent or were not approached. iNO treatment was clinically started for 51 infants due to hypoxic respiratory failure. Screening echocardiograms were completed for 180 infants; of these, 32 infants with early PH were randomized to iNO or placebo groups. After a planned interim analysis, termination of the trial was recommended by the Data Safety Monitoring Committee because of futility. Conclusion iNO treatment does not reduce the risk of BPD or death among extremely preterm infants with echocardiographic evidence of early pulmonary hypertension without hypoxic respiratory failure.

Neonatal outcome in mothers with sickle cell disease compared to neonatal outcome in mothers without sickle cell disease at a tertiary care facility

Abstract Background: Sickle cell illness can complicate pregnancy. Vascular blockage in placenta can result in villous fibrosis, necrosis, and infarction. This can affect uteroplacental circulation, which can have a negative impact on fetus’s health and cause persistent hypoxia. Objective: To compare neonatal outcome of sickling positive mother and nonsickling mother. Materials and Methods: A cross-sectional and comparative study was conducted among 100 neonates. There were two groups of mothers. First group of 50 mothers with sickle cell disease (SCD) and second of 50 mothers without SCD (non-SCD). Detailed history, thorough physical examination, measurements of the neonate’s, assessment of vital signs, various laboratory tests, and sickling solubility test within 48 h of birth were performed. Results: Both groups were comparable for age, education, social class, body mass index, and history of abortion (P &gt; 0.05). Employed women were significantly more in SCD group compared to non-SCD group (P &lt; 0.05). Proportion of anemia and lower segment cesarean section rate were significantly more in SCD group compared to non-SCD group (P &lt; 0.05). Mean hemoglobin was significantly lower in women with SCD compared to women with sickle cell trait and women with non-SCD (P &lt; 0.05). Proportion of preterm was comparable in two groups (P &gt; 0.05). However, proportion of low birth weight, low Appearance, Pulse, Grimace, Activity and Respiration score, admission to neonatal intensive care unit, and adverse fetal outcome were significantly more in SCD group compared to non-SCD group (P &lt; 0.05). Conclusion: Maternal and fetal complications such as preeclampsia, eclampsia, anemia, prematurity, low birth weight, intrauterine growth retardation, IUD, stillbirth, and early neonatal death are significantly higher in pregnant sickle cell patients. Close supervision of these pregnancies with a multidisciplinary approach between hematologist, obstetrician, and pediatrician is essential.

The Relationship Between Knowledge And Attitudes Of Mothers About Premenopause In Silau Paribuan Village Silau Kahean District

Premenopause is something that is very worried and feared by every mother. Changes that occur during the premenopause period will lead to decreased estrogen hormone production accompanied by psychological and physical complaints, which are characterized by irregular menstrual cycles with prolonged menstrual bleeding and large bleeding sizes accompanied by pain. This study aims to determine the relationship between knowledge and attitudes of mothers about pre menopause. This type of research is analytic with a cross sectional design in this study a population of 60 premenopausal women. The sample of this study was 38 people with purvosive sampling technique. The results showed that there was a relationship between knowledge and attitudes of mothers about premenopause (p = 0.00). Mother's knowledge in dealing with premenopause is lacking and mother's attitude in dealing with premenopause is positive. Mother's knowledge is lacking because the mother has never received information about premenopause and has never received health education about premenopause. A positive mother's attitude is caused because the mother is able to divert unpleasant feelings into positive things by doing various activities, and assumes that what is experienced during premenopause is a natural thing that will be experienced by every mother. It is hoped that health workers will provide health education about premenopause, and premenopausal mothers are expected to be proactive in seeking information related to premenopause.

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB&lt;2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Knowledge of newborns’ mothers on breastfeeding during covid-19, hiv and tuberculosis infection attendee in selected hospitals

Background: Two-thirds of the HIV mothers planned to breastfeed their infants while one-third opted for formula feeding; same as during Tuberculosis or COVID-19 infection. What would be the mother do during breastfeeding? Whether the mother could breastfeed their newborn or not. For that it is necessary to assess the level of knowledge of newborns mother on breastfeeding during COVID-19, HIV and Tuberculosis. Methods: It was a descriptive type of cross sectional study was conducted at Maternal and Child Health Training Institute, Azimpur, Dhaka from 1st January to 31st December 2021. Mother of newborns who are willing to participate were conveniently selected. Around 289 sample was selected. Pre tested semi structured questionnaire was used to collect the data. Level of knowledge was measured by knowledge score. Each question of knowledge carries one (01) mark. Each correct answer had 1 mark and incorrect answer had 0 mark. 1-11 score (&lt;60%) was categorized as fair knowledge; 12-15 score (60-79%) was categorized as good knowledge and 16-20% score (80% and above) had very good knowledge. Results: Age and knowledge of whether TB-positive mothers may breastfeed have an association (2=4.488, p = 0.034); age and knowledge of whether HIV-positive mothers can breastfeed have an association (2=9.632, p = 0.002). There is a correlation between occupation and knowledge of whether mothers who have COVID 19 positive status can breastfeed (5.044; p=0.046), as well as a correlation between occupation and knowledge of whether mothers who have TB positive status (9.365; p=0.002). Family income has a correlation with knowledge of whether mothers who are COVID 19 positive, HIV positive, or TB positive can breastfeed (2=17.695, p = 0.0001), COVID 19 positive mothers have a correlation with knowledge of whether they can breastfeed (2=7.511, p = 0.006), and HIV positive mothers have a correlation with knowledge of whether they can breastfeed (2=8.675, p = 0.003). Education level and awareness of whether COVID 19 positive mothers can breastfeed are correlated (2=10.315, p = 0.001), as are knowledge of whether TB positive mothers can breastfeed (2=10.880, p = 0.001). Conclusion: Develop targeted educational programs for mothers based on their demographic characteristics, such as age, occupation, and education level. JOPSOM 2023; 42(1):40-47

Prevalence and Associated Factors Affecting the Uptake of HIV Exposed Children Testing at 18 Months at Selected Clinics of Mansa District in Luapula Province of Zambia

Introduction: HIV remains a significant global public health challenge, with substantial impacts on individuals, communities, and healthcare systems. In 2018, it was estimated that approximately 37.9 million people were living with HIV, including 1.7 million children. The global prevalence of HIV among adults was approximately 0.8%, with a substantial proportion of individuals (around 21%) unaware of their HIV-positive status (UNAIDS, 2019). Since the onset of the HIV epidemic, an estimated 74.9 million people have become infected with HIV, resulting in approximately 32 million deaths from AIDS-related illnesses (UNAIDS, 2019). However, there has been significant progress in reducing AIDS-related deaths, with a notable decline of over 55% in AIDS-related deaths since the peak in 2004 and 2010 (UNAIDS, 2019). Thus, this study aimed at investigating the prevalence of HIV exposed children testing at 18 months and factors affecting the uptake of these services in various clinics of Mansa district, Luapula province, Zambia. The main objective of the study was to evaluate the prevalence of HIV exposed children testing at 18 months and factors associated with the uptake of these services in various clinics of Mansa district in Luapula province. Method: An analytical cross-sectional research design was used for this study. The study population were HIV positive mothers who enrolled in PMTCT at the selected Clinics of Mansa District in Luapula Province. Simple random sampling method was used to select the respondents who were interviewed face to face using a pretested structured interview questionnaire. Data were analyzed using SPSS version 24. The t-test was used to assess statistical significance of associations between variables at significance level of 0.05 and 95% confidence. Furthermore, multiple logistic regression analysis was conducted to examine the relationship between the likelihood of HIV testing at 18 months (dependent variable) and various independent ........

Fecal shedding of SARS-CoV-2 in infants born to SARS-CoV-2 positive mothers: a pilot study.

Fecal shedding of SARS-CoV-2 occurs during infection, particularly in pediatric populations. The gut microbiota are associated with resistance to enteric pathogens. COVID-19 is associated with alterations to the gut microbiome. We hypothesized that the gut microbiome of infants born to SARS-CoV-2+ mothers differs between infants with and without fecal shedding of the virus. We enrolled 10 infants born to SARS-CoV-2+ mothers. We used qPCR on fecal RNA to test for SARS-CoV-2 and 16S rRNA gene sequencing of the V4 region to assess the gut microbiome. Infant SARS-CoV-2 status from nasal swabs was abstracted from medical records. Of the 10 included infants, nine were tested for SARS-CoV-2 by nasal swab with 1 testing positive. Four infants, including the nasal swab positive infant, had at least one sample with detectable levels of SARS-CoV-2 fecal shedding. Detection of both SARS-CoV-2 genes in feces was associated with increased gut alpha diversity compared to no detection by a linear mixed effects model (p<0.001). Detection of both SARS-CoV-2 genes was associated with increased levels Erysipelotrichaceae, Lactobacillaceae, and Ruminococceae by MaAsLin2. Fecal shedding of SARS-CoV-2 occurs in infants who test negative on nasal swabs and is associated with differences in the gut microbiome.

On characterizing gender and locational composition of adult PLHIV in Nigeria: Implications for HIV programming.

Human Immunodeficiency Virus (HIV) remains a global public health menace, and studies have suggested variations across demographic characteristics. This study attempted to characterize the gender and locational variations in the spread and control of HIV among adult Persons Living with HIV (PLHIV) to identify the clustering of PLHIV in Nigeria. We conducted an ecological analysis of data from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) report. To examine the statistical significance of differences between groups (by gender and location), chi-square and Fisher exact tests were conducted using the Real Statistics Resource Pack in Excel, and ArcGIS for visualization. Significance level was set at 5%. Overall, prevalence of HIV among adult PLHIV was 1.4%-the prevalence was slightly higher among women (1.8%) compared to men (1.0%). About 3/10 (29.3%) self-reported having received HIV test results. In the past 12 months before the survey, only 10.0% self-reported HIV testing among the population, with a significant difference (p<0.001) observed in the urban and rural area (12.4% in urban compared to 8.2% in rural). Another significant finding was the difference in the timing of HIV diagnosis between urban and rural areas (p<0.001). Adult PLHIV residing in rural areas had a higher rate of early detection (94.1%) compared to those in urban areas (70.3%). About 40.0% of HIV positive mothers reported awareness of their HIV status-approximately 58.0% of mothers living in the urban were aware of their HIV status compared to 29.8% in the rural area. The concentration of HIV was disproportionately higher in the rural populations compared to the urban. Findings from this study also show gender-disparities in HIV prevalence, diagnosis, and treatment. Interventions to bridge this gap should be promptly embraced in order to effectively combat the HIV epidemic in Nigeria and achieve an AIDS-free generation.

Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp, Western Uganda

IntroductionRefugee HIV positive mothers experience significant obstacles in accessing, utilizing and adhering to antiretroviral therapy (ART). Identifying ART non-adherence can help in the development of interventions aimed at improving adherence and subsequently effectiveness of ART among the refugee mothers. We describe the use and the factors associated with non-adherence to ART among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali Refugee Camp, Uganda.MethodsWe conducted a cross-sectional study among HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp between May and June 2023. Using a structured questionnaire, we collected data on use, and factors associated with non-adherence to ART. We used modified Poisson regression analysis to determine factors associated with non-adherence to ART.ResultsOf the 380 participants enrolled, 192 (50.5%) were married, mean age 32.1 years. Overall, 98.7; 95% Confidence Interval (CI) [97.5–99.8%] were using ART and 27.4; 95% CI [22.9–31.9%] were non-adherent. Non-adherence was associated with: Initiating Prevention of Mother to Child Transmission (PMTCT) care in the third trimester of pregnancy (adjusted Prevalence ration(aPR): 2.06; 95% CI: 1.27–3.35), no need to get permission to seek PMTCT services aPR 1.61; 95% CI [1.07–2.42] and poor attitude of PMTCT providers aPR 1.90; 95% CI [1.20–3.01].Conclusion and recommendationsNon-adherence to ART was generally high; therefore limiting the effectiveness of the PMTCT program in this setting. Refugee context specific education interventional programs aimed at early initiation into HIV care, strong social and psychological support from families, communities and health care providers are vital to improve adherence in this setting.

Infant feeding knowledge, attitudes and practices of HIV-positive breastfeeding mothers.

Assessment of infant feeding knowledge, attitudes and practices of human immunodeficiency virus (HIV)-positive breastfeeding mothers may determine compliance with the chosen feeding method. The study assessed knowledge, attitudes and practices on infant feeding among HIV-positive breastfeeding mothers. The study was conducted at five clinics in the Chief Albert Luthuli sub-district of Mpumalanga, South Africa. A descriptive cross-sectional study with a convenient sample of 155 HIV-positive breastfeeding mothers. More than half of the participants (54.8%) were knowledgeable of exclusive breastfeeding in general. However, less than half were knowledgeable of exclusive breastfeeding in the context of HIV (46.5%), mixed feeding (28.4%) and replacement feeding (49.0%). Most participants (85.8%) reported that they were advised to exclusively breastfeed for 6 months, 61.3% intended to exclusively breastfeed for 6 months, and 29% intended to stop breastfeeding at 6 months. Most participants (64.5%) intended to introduce solids at 6 months, and for participants who intended to introduce solids before 6 months, 37.7% did not believe that exclusive breastfeeding was sufficient for the baby. Although most participants were knowledgeable about exclusive breastfeeding, there were misconceptions that required attention such as the lack of knowledge on exclusive breastfeeding in the context of HIV, mixed feeding and replacement feeding. Exclusive breastfeeding for 6 months was the most emphasised infant feeding practice. This study builds on existing literature on infant feeding knowledge, attitudes and practices and provides a basis for interventions for improved exclusive breastfeeding rates.

Feto-maternal outcome of Rh-Negative pregnancy presenting in a tertiary healthcare centre

Background: The term "Rhesus incompatibility" describes the mismatched Rh types of the mother and the fetus. It is linked to the onset of hemolytic disease of the newborn (HDN) ranging from haemolytic anemia to hydrops fetalis and also related to maternal Rh sensitization. The disease incidence is currently declining globally, having dropped from 1.3%–1.7% in the 1980s to 0.17% in the 1990s1. Erythroblastosis foetalis is one of the most terrible consequences of an ABO incompatible or Rh incompatible pregnancy. About 10% of all Rh-negative pregnancies result in Rh incompatibility in the Rh-negative mother carrying a Rh-positive fetus. Methods: This observational study was carried out among 60 Rh negative pregnant women attending our antenatal clinic and delivered in our institution from October 2022 to March 2024.The Rh negative women were followed up with a series of investigations such as Indirect Coombs Test (ICT), MCA-PSV and with regular antenatal care (ANC). After birth neonates were followed up with blood grouping and Rh typing, direct coombs test (DCT), duration of phototherapy, duration of NICU stay , need for immunoglobulin and exchange transfusion were recorded to evaluate the maternal and neonatal outcomes.The data was collected and tabulated in Microsoft excel sheet and the percentages were calculated. Results: This study included a total of 60 Rh negative mothers ,where 48 (80%) of them were aged less than 30 years and 12 of them (20%) were more than 30 years of age. Antenatally, 51 (85%) women were ICT negative and received RAADP, 9(15%) women were ICT positive and anti D titres were less than 1:16 followed up with MCA-PSV which was normal/less than 1.5MoM. The total preterm births were 6(10%).The total admissions to NICU were 12(20%) in our study. All the 9 babies born to ICT positive mothers turned out to be Direct Coombs test (DCT) positive and were managed with double surface phototherapy. For 2(3.3%) babies, human immunoglobulin was given. Only 1(1.6%) baby required exchange transfusion. Conclusion: We conclude that, severe hyperbilirubinemia and hydrops foetalis, which were observed previously are drastically reduced with recent advances and the use of Routine antenatal Anti D prophylaxis (RAADP). Neonatal morbidity and mortality reduced drastically with newer advances like immunoglobulin reducing the need for exchange transfusion and better NICU care. ICT positivity of 15% despite of postnatal immunisation suggest that there is chances of silent fetomaternal haemorrhage during antenatal period, health care professionals should be more knowledgeble with prenatal screening, the value of blood grouping and Rh typing, anti-D immunisation following sensitising events like MTP, abortion, ectopic pregnancy, ECV and regular implementation of RAADP in clinical practice.

Immunoprophylaxis failure and vaccine response in infants born to mothers with chronic hepatitis B infection in Djibouti.

In endemic areas, vertical transmission of hepatitis B virus (HBV) remains a major source of the global reservoir of infected people. Eliminating mother-to-child transmission (MTCT) of HBV is at the heart of World Health Organization's goal of reducing the incidence of HBV in children to less than 0.1% by 2030. Universal screening for hepatitis B during pregnancy and neonatal vaccination are the main preventive measures. To evaluate the efficacy of HBV vaccination combined with one dose of immunoglobulin in children born to hepatitis B surface antigen (HBsAg)-positive mothers in Djibouti city. We conducted a study in a prospective cohort of HBsAg-positive pregnant women and their infants. The study ran from January 2021 to May 2022, and infants were followed up to 7 mo of age. HBV serological markers and viral load in pregnant women were measured using aVidas microparticle enzyme-linked immunosorbent assay (Biomérieux, Paris, France) and the automated Amplix platform (Biosynex, Strasbourg, France). All infants received hepatitis B immunoglobulin and were vaccinated against HBV at birth. These infants were closely monitored to assess their seroprotective response and for failure of immunoprophylaxis. Simple logistic regression was also used to identify risk factors associated with immunoprophylaxis failure and poor vaccine response. All statistical analyses were performed with version 4.0.1 of the R software. Of the 50 pregnant women recruited, the median age was 31 years, ranging from 18 years to 41 years. The MTCT rate in this cohort was 4% (2/50) in HBsAg-positive women and 67% (2/3) in hepatitis B e antigen-positive women with a viral load > 200000 IU/mL. Of the 48 infants who did not fail immunoprophylaxis, 8 (16%) became poor responders (anti-HB < 100 mIU/mL) after HBV vaccination and hepatitis B immunoglobulin, while 40 (84%) infants achieved a good level of seroprotection (anti-HB > 100 mIU/mL). Factors associated with this failure of immunoprophylaxis were maternal HBV DNA levels (> 200000 IU/mL) and hepatitis B e antigen-positive status (odds ratio = 158, 95% confidence interval: 5.05-4958, P < 0.01). Birth weight < 2500 g was associated with a poor immune response to vaccination (odds ratio = 34, 95% confidence interval: 3.01-383.86, P < 0.01). Despite a failure rate of immunoprophylaxis higher than the World Health Organization target, this study showed that the combination of immunoglobulin and HBV vaccine was effective in preventing MTCT of HBV. Therefore, further studies are needed to better understand the challenges associated with immunoprophylaxis failure in infants in Djibouti city.

Peripartum outcomes and immune responses after SARS-CoV-2 infection in the third trimester of pregnancy

BackgroundSARS-CoV-2 infection in pregnant women during the third trimester resulted in overall adverse pregnancy outcomes compared to non-infected controls and a unique humoral and cellular response at delivery. In this study we aimed to assess the impact of SARS-CoV-2 infection on maternal/neonatal peripartum outcomes andimmunological profiles.MethodIn this study, we recruited 304 SARS-CoV-2 infected pregnant women and 910 SARS-CoV-2 non-infected pregnant women who were admitted for delivery. Peripartum and neonates’ outcomes response to SARS-CoV-2 infection were analyzed. Furthermore, we characterized the antibody and cytokines profile in SARS-CoV-2 infected maternal blood (MB) and cord blood (CB). We also assessed routine laboratory tests and liver function tests in MB before labor. Unpaired T test, Mann-Whitney test and Spearman test were used to analyze the data.ResultsSARS-CoV-2 infected pregnant women were significantly associated with increased risk of adverse pregnancy outcomes, including preterm labor (13.8% vs. 9.5%, p = 0.033) and meconium-stained amniotic fluid (8.9% vs. 5.5%, p = 0.039). The risk of low birth weight (< 2500 g) (10.5% vs. 6.5%, p = 0.021) and Apgar score < 8 at 1-minute (9.2% vs. 5.8%, p = 0.049) significantly increased in newborns from COVID-19 positive mothers than their counterparts. Our results showed that antibodies were increased in adverse-outcome SARS-CoV-2 infected mothers and their neonates, and abnormal proportion of immune cells were detected in SARS-CoV-2 infected mothers. While the immune response showed no difference between adverse-outcome infected pregnant women and normal-outcome infected pregnant women. Thus, SARS-CoV-2 infection during the third trimester of pregnancy induced a unique humoral and cellular response at delivery.ConclusionSARS-CoV-2 infection closer to delivery could incline to adverse pregnancy outcomes. Therefore, the utmost care is required for SARS-CoV-2 infected pregnant women and their newborns.Trial registrationThe study protocol was approved by the Institutional Review Board of the First Hospital of Jilin University with the approval code number 23K170-001, and informed consent was obtained from all enrolled patients prior to sample collection.

Pregnancy-related and Neonatal Outcomes during Omicron Variant-Dominant COVID-19 Pandemic among the Black-Dominant Population.

This study aimed to determine the effect of the Omicron variant on pregnancy-related and neonatal outcomes among the Black-dominant population. We performed a single-center, retrospective cohort study during the prepandemic period from December 1, 2019, to February 29, 2020, and the Omicron surging period from December 1, 2021, to February 28, 2022. A total of 518 pregnant women were admitted for delivery during the study period. Multiple gestations (n = 21) and deliveries at less than 20 weeks of gestation (n = 5) were excluded. We analyzed and compared the sociodemographic and clinical data from mothers and their neonates between the two cohorts as well as between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positive and negative mothers during the Omicron surge. Subgroup analyses were also conducted specifically among the Black-only population. The cohorts were predominantly Black (88.6%), with smaller proportions of Hispanic (8.9%), Asian (0.8%), White (0.8%), and other ethnicities (0.8%). Of 492 singleton deliveries, 275 live births, 8 (2.8%) stillbirths, and 31 (11.3%) preterm births (PTBs) occurred during the prepandemic period, and 207 live births, 2 (1%) stillbirths, and 33 (15.9%) PTBs occurred during the Omicron wave. There was no statistically significant difference in the rates of PTBs, stillbirths, medically indicated PTBs, and cesarean delivery between the two cohorts. SARS-CoV-2-positive mothers were not at an increased risk of adverse outcomes. However, neonatal intensive care unit (NICU) admission rate significantly increased among neonates born to SARS-CoV-2 positive mothers compared with negative mothers (32.3 vs. 16.5%, p = 0.038). In subgroup analyses among Black individuals, this difference was not observed. There was no significant difference in pregnancy-related or neonatal outcomes in the Black-dominant population between the two cohorts. SARS-CoV-2 infection did not alter these findings except for an increased NICU admission rate among neonates born to SARS-CoV-2-positive mothers. · Most pregnant women infected with SARS-CoV-2 during the Omicron wave were asymptomatic.. · The Omicron wave did not increase the risk of pregnancy-related or neonatal adverse outcomes when compared with the prepandemic period.. · Maternal SARS-CoV-2 infection increased NICU admission rate.. · Among Black individuals, no significant increase in adverse outcomes was observed during the Omicron pandemic..

Analysis the Role of Mother-child Interaction in Developing Children’s Positive Character and Mother’s Happiness

Interactions between mothers and children have an important role in developing children's positive character and maternal happiness. This study aims to analyze the characteristics of mothers and children, the role of mother-child interactions in shaping children's positive character, and maternal happiness. This research use a qualitative method describe the reality of the events under study so that it is easier to get objective data. The sample was selected through a convenience sampling technique. Three mothers with children aged 2-6 years and are daily involved in parenting. The data collection techniques used in this study used method triangulation using (semi-structured interview, observation, and Focus Group Discussion). Three themes emerged elaborating parents' understanding of mother-child interactions: forms of interaction, ways of interaction, and the role of mother-child interactions. Three themes emerged from the research objectives further describing the involvement of the role of mother-child interactions in shaping children's positive character, namely: positive parenting, parental example and synergy, and parental strategies. From the last research objective, describing the involvement of the role of mother-child interaction in maternal happiness, three themes were obtained, namely: emotional bonding and support, religiosity, and children's achievement. Specifically, the results proved that all mothers viewed mother-child interactions as playing a significant role in shaping children's positive character and increasing maternal happiness.