Pregnancy-related Issues Research Articles

The Utilization of Antenatal Care Services among the Pregnant Women in Somalia: A Scoping Review

Background: Women in Somalia suffer from one of the highest maternal mortality rates in the world. The good utilization of antenatal care (ANC) services significantly minimizes maternal and child mortality. The study aimed to identify the utilization of antenatal care services among pregnant women in Somalia. Methodology: We performed a scoping review based on the York methodology. This methodology entails a thorough search of published academic articles, conference proceedings, and grey literature via PubMed, Scopus, Google, and Google Scholar, focusing on English-language material. Results: Findings revealed that a significant number of Somali pregnant women utilize the ANC services, though not to the required number of visits as recommended by the WHO. Financial constraints, poor attitude of the healthcare providers, partner's attitude toward ANC services, lack of accessibility due to ANC services being far away, long waiting times, family matters, lack of awareness or media exposure, gravida, parity, and a good number of them believing that ANC is not necessary for their health were among the reasons given for an inadequate visit or non-utilization of the ANC services. Conclusion: The motivation to utilize ANC services, the initiation of visits within the early stages of pregnancy, and the completion of the required number of visits during pregnancy are crucial in preventing pregnancy-related issues and reducing maternal mortality. This must be encouraged among Somali women.

The Role of Digital Health in the Early Detection and Management of Obstetric Complications in the Community: A Systematic Review

BACKGROUND: According to the World Health Organization, obstetric complications are thought to be the cause of death for 10.7 million mothers worldwide. In developing countries like Indonesia, maternal mortality rates are still high. Compared to 2019, there were 418 more incidents of maternal death in 2020. AIM: The goal of the study was to explain how much digital technology contributed to the early identification of risk factors for obstetric complications. METHODS: The work stages were observed while conducting the review, and relevant publications from databases were used. These databases included PubMed, Embase, ScienceDirect, ProQuest, and Scopus. The papers were retrieved between July 1, 2012, and June 30, 2022, using the keywords “pregnant lady” AND (Telemedicine OR “Mobile Health” OR Telehealth OR mHealth) AND (“Labor Complication” OR “Pregnancy Complication” OR “Puerperal Disorder”). Forty-five articles that discussed early obstetric detection and management were obtained based on the established inclusion criteria and met the inclusion requirements. RESULTS: The term “telemedicine applications” refers to the use of health communications technology to provide remote consultation, diagnosis, education, and treatment services to detect and diagnose pregnancy complications and manage pregnancy and care during pregnancy. Applications for smartphones offer a tremendous deal of potential to enhance pregnant women’s health. Support is required for maternal health services to help with antenatal care services in the community setting. The program can identify and manage pregnancy-related issues like weight gain, diabetes mellitus, nausea, vomiting, HIV, hemolysis, and depression. CONCLUSION: It is expected that this review would be able to identify any difficulties that mothers may face early on in their pregnancies. In addition, it is believed that existing applications would be able to manage the moms’ health and perform the necessary interventions and tactics to reduce difficulties.

Traditional and cultural newborn care practices in the Dakace and Tsibiri communities of Nigeria: an ethnographic study

Traditional and cultural practices related to newborn care have been passed down through generations in various cultures worldwide, often with the belief that they are effective in improving the health and well-being of newborns. These practices can differ significantly between cultures. The aim of this study was to assess the traditional and cultural newborn care practices in the Dakace and Tsibiri communities of Nigeria, and to identify potential opportunities for the integration of these practices into modern healthcare approaches. An ethnographic study was conducted in the Dakace and Tsibiri communities of Nigeria, which involved observing 54 deliveries and traditional rituals surrounding newborn care through participant observation. A total of 30 participants, including traditional birth attendants, community health workers, traditional leaders, and mothers who had given birth within the past year, were included in the study, and participated in in-depth interviews and focus group discussions. The main themes that emerged from the data included the provision of warmth, nutrition, cord care, and traditional medication. In these communities, there is a strong emphasis on keeping newborns warm and providing proper nutrition, including breastfeeding and the use of traditional remedies. Cord care is also considered important, with the umbilical cord typically cut with a new razor blade and the stump treated with hot compresses and oil massages. Traditional and cultural beliefs also influence the use of traditional medication, including the use of traditional remedies to address common pregnancy-related health issues and the importance of proper nutrition during pregnancy. The study also identified the important role of fathers and other male family members in childbirth preparation. The findings of this study provide valuable insights into the traditional and cultural practices of newborn care in the Dakace and Tsibiri communities of Nigeria and identify potential opportunities for integrating these practices into modern healthcare approaches in a way that is safe and effective for the mother and child. These findings may be of interest to healthcare professionals, researchers, and policy makers working in maternal and child health, as well as to members of the Dakace and Tsibiri communities.

Abstract ED3-3: Oncofertility and other quality of life issues

Abstract The current availability of effective systemic treatment strategies has significantly improved the prognosis of patients with early breast cancer. However, this survival gain is often obtained at the cost of higher toxicity. The increase in life span among breast cancer survivors calls for the need to address both early and late potential adverse effects of anticancer therapies to maximize their quality of life. Among them, the potential gonadotoxicity of anticancer therapies and its implications on fertility and ovarian function need to be discussed with all young patients. According to available guidelines, oncofertility counseling should now be considered mandatory in the care of young women with newly diagnosed cancer. This counselling should focus on the risk of developing treatment-induced premature ovarian insufficiency and on the available techniques to preserve fertility and/or ovarian function. Oocyte/embryo cryopreservation, or ovarian tissue cryopreservation in those not eligible for gamete cryopreservation, are standard strategies to be offered to young patients interested in preserving fertility, i.e. to increase their chances of post-treatment pregnancies. Ovarian suppression with gonadotrophin-releasing hormone agonists (GnRHa) during chemotherapy can be offered to premenopausal patients interested in ovarian function preservation, i.e. to decrease their risk of developing chemotherapy-induced early menopause. Current available data confirm that pregnancy occurring following proper treatment for breast cancer and period of follow-up is safe, both in terms of long-term clinical outcomes for the patients and safety for the babies. However, there is a slightly higher incidence of obstetric and birth complications that require the need for a closer monitoring of these pregnancies. Beyond fertility and pregnancy-related issues, a long-term follow-up of young women with breast cancer by the oncofertility unit is recommended for improving the management of other additional gynecological-related issues faced by these women. Among them, contraception should be considered during active treatment and in the follow-up of women who do not wish to get pregnant. Moreover, in the current era of more complex endocrine therapy approaches with a major negative impact on the quality of life of premenopausal patients with breast cancer, it is essential to properly and proactively care about their treatment-related side effects. Among them, menopause related-symptoms and sexual dysfunction may be better managed by implementing a close collaboration between oncologists and gynecologists within the oncofertility unit. Citation Format: Matteo Lambertini. Oncofertility and other quality of life issues [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr ED3-3.

A Review of Awareness of Pregnancy-Related Issues Among Reproductive-Aged Croatian Women with Epilepsy

Pregnancy-related epilepsy issues (PREIs) are crucial in managing women with epilepsy (WWE). The main PREIs are reduced compliance and self-discontinuation of antiseizure medications (ASMs), pharmacokinetic alterations during pregnancy, and the teratogenic potential of particular ASMs. According to a recent study, knowledge of PREIs among reproductive-aged WWE in Croatia is unsatisfactory, as are neurologist consultations about PREIs. Two hundred WWE were polled on their knowledge, sources, and needs for information about PREIs and their current ASMs usage. Prior consultation with a neurologist and increased use of books/brochures were the main predictors of knowledge. Forty-five percent of participants had a prior neurologist consultation on PREIs. Most women (61 %) chose their neurologist as their favourite future source of information, and 13 % favoured Internet. The most usually prescribed ASM was levetiracetam (34.5 %). Valproate was utilized by 26 % of respondents, among which 59 % claimed no prior PREIs consultation with a neurologist. A new campaign called Epilepsy and Pregnancy was launched by the International Bureau for Epilepsy in 2021. In February 2021, a poll of nearly 900 women was conducted across Europe as the first stage in this significant project, including 94 respondents from Croatia. Forty-two percent of Croatian WWE were given no information on pregnancy-related risks. In contrast with the aforementioned study, neurologists provided 82 percent of information about the risks of ASMs. Seventy percent reported they were not given contraception information. Providing clear, accurate and timely information on PREIs should become the norm for all neurologists caring for WWE.

Comparison of oxidative stress levels during the third Trimester in normal pregnancy and preeclampsia.

The placenta is a complex transiently formed organ which plays a crucial role in the development of the foetus. As the placenta is responsible for maintaining pregnancy placental defects are mainly responsible for pregnancy-related issues. Preeclampsia is a pregnancy-related disorder due to uteroplacental insufficiency resulting from deficient remodelling of spiral arteries causing ischemic reperfusion injury which is finally responsible for the generation of reactive oxygen species and oxidative stress by the placenta. So, this study was planned to determine and compare serum levels of oxidative stress markers (ischemia-modified albumin and malondialdehyde) in preeclampsia and normal pregnancy in the third trimester. Study design: Cross-sectional comparative study Settings Gynae/Obs Department and Pathology Laboratory, Lahore General Hospital, Lahore. Study population: 42 Pregnant females at 34-36 weeks of gestation were selected. Group 1 compromised 21 normal healthy pregnant females and group 2 included 21 preeclamptic patients. Sampling technique: non-probability purposive sampling. Blood samples were taken at 34-36 weeks of gestation. Serum was stored for ischemiamodified albumin and malondialdehyde. Data was analyzed using SPSS version 20. An Independent t-test was used to compare values between the groups during the third trimester. A pvalue of ≤0.05 was considered significant. Comparison of ischemia-modified albumin and malondialdehyde values between group I and group 2 showed a highly significant difference of pvalue of <0.001. Oxidative stress markers were higher in preeclamptic patients as compared to normal pregnant females during the third trimester suggesting the role of the placenta in oxidative stress.

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

BackgroundHigh-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services.MethodsWe conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke’s thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output).ResultsSeveral inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services.ConclusionSeveral input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.

A case control study on maternal complications of teenage pregnancy in Nepal

Background:. WHO defines Teenage pregnancy as pregnancy in a female under the age of 20. Pregnant teenagers face many of the same pregnancy related issues as other women with additional concerns for as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth.For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age. Objective: To compare the maternal complications of teenage pregnancies with those of normal pregnancies. Method: A case control study was conducted in a tertiaty hospital in Nepal. A total of 75(case)i.e teenage pregnancy and 75(control)i.e women with optimal age group were studied.This was a hospital based study and the data were collected during 5th January 2018 to 5th January 2019. The preformed proforma was used for history taking and examination of all participants.Only those participants who gave written consent were included in the study. Odds Ratio and its 95% CI was calculated by using conditional logistic regression. P-value of&lt;0.05 was considered as significant. Result: Most of the teens were in their first pregnancy with mean age being 17. This study concluded that maternal complications were higher in teenage pregnancy (40%Vs 15%).The maternal complications like Hypertensive Disorders (OR 2.65, 95%CI :1.07-6.54, P=0.031), Anemia (OR 2.07, 95%CI:1.07-4.02, P=0.031), Preterm Labour (OR 2.28, 95%CI:1.15-4.52,P=0.017) and PPH(OR 2.49, 95%CI:1.04-5.94, P=0.04) were associated with the teenage presidencies respectively. Conclusion: The teenage pregnancies are at the increase risk of maternal complications like Hpertensive disoreders, Anemia ,Preterm labour and PPH. The complications are even higher in developing countries like ours where there are limited health resources and restrictive marriage laws. Therefore, an adequate antenatal visit for early detection and timely management will reduce the maternal complications during teenage pregnancy.Similarly strict marriage laws should be implicated to prevent teenage pregnancies.

COVID-19 Vaccine Hesitancy among Pregnant Women Attending Antenatal Clinics in Pakistan: A Multicentric, Prospective, Survey-Based Study.

This study aimed to assess the vaccination status and factors contributing to vaccine hesitancy among pregnant women in the largest province of Pakistan. A multicentric, prospective, survey-based study using an interviewer-administered tool was conducted among pregnant women attending antenatal clinics between 1 December 2021 through 30 January 2022 across seven hospitals in Pakistan. The healthcare professionals providing care at the participating hospitals administered the survey. Four hundred and five pregnant women fully consented and completed the study. The majority of the study participants (70.6%, n = 286) were aged between 25 and 34 and had a previous successful pregnancy history. More than half of the study participants (56.0%, n = 227) did not receive COVID-19 vaccination at the time of data collection despite their family members (93.9%, n = 372) had already received at least one dose of COVID-19 vaccine. Among those who received COVID-19 vaccination (n = 173), vaccine efficacy, protection for the foetus, and risk of COVID-19-associated hospitalisation were the main driving factors for vaccine hesitancy. The majority of the unvaccinated women (77.8%, n = 182) had no intention of receiving the vaccine. However, more than two-thirds (85.7%, n = 342) consulted the doctor about COVID-19 vaccines, and most were recommended to receive COVID-19 vaccines by the doctors (80.7%, n = 280). Women were significantly more likely to be vaccinated if they had employment (odds ratio [OR] 4.47, 95% confidence interval [CI]: 2.31-8.64) compared with their counterparts who were homemakers, consulted their doctors (OR 0.12, 95% CI: 0.04-0.35), and if they did not have pregnancy-related issues (OR 6.02, 95% CI: 2.36-15.33). In this study, vaccine hesitancy was prevalent, and vaccine uptake was low among pregnant women. Education and employment did impact COVID vaccination uptake, emphasising the need for more targeted efforts to enhance the trust in vaccines.

Medical Family Therapy with Diverse Populations Part I: interracial Couples Navigating Infertility, Racialized Pregnancy, and Pregnancy Loss

ABSTRACT Medical Family Therapy (MedFT) is a much-needed and growing specialization in the United States and internationally, bringing attention to the relationship between acute and chronic illness and their reciprocal impact on couple and family systems. Despite the growth of MedFT and the growing body of research affirming its effectiveness in general, there remains a need for greater research demonstrating its effectiveness with specific medical conditions, such as pregnancy-related issues, namely infertility, racialized pregnancy, and pregnancy loss. Much of the research related to these losses leaves out at least two important populations impacted by these events – interracial couples and men. In this paper, we discuss the experiences of interracial couples, generally, and men, specifically, to: (1) draw attention to unique struggles faced by interracial couples, with special attention to cisgender male (cis male) partners’ experiences, (2) describe how MedFTs utilizing a systemic, relational, BPSS focus, are well-positioned to effectively work with interracial couples experiencing infertility, racialized pregnancy, and pregnancy loss, and (3) include a case example to illustrate how a MedFT might approach working with an interracial couple experiencing these struggles. Finally, we conclude by providing clinical recommendations and practical future directions for research in the areas of infertility, racialized pregnancy, and pregnancy loss, and discuss future MedFT training needs.

Musculoskeletal Disorders in Pakistani Women during Pregnancy: A Population Base Study

Introduction: Changes in posture, blood physiology, weight increase, changes in musculotendinous strength, and joints and ligaments laxity are only some of the physical changes that occur during pregnancy. According to several studies, pregnancy-related back discomfort affects 25% to 75% of women. The primary goal of this research is to provide a comprehensive picture of women's musculoskeletal issues during pregnancy and identify the most prevalent triggers of pregnancy-related musculoskeletal discomfort.&#x0D; Methodology: From Jan 2019 to Jan 2020, the Department of Orthopedic Surgery Territory Care Hospital performed this investigation. In this research, 92 women were enrolled after the IRB (Institutional Review Board) of the Territory Care Hospital approved the study's ethical standards. This research monitored patients throughout their pregnancies to see if they had any musculoskeletal issues. Pregnant women between the ages of 18 and 45 who had a term pregnancy (37-42 weeks) were included in the research. The authors didn't include women with any history of rheumatoid arthritis, osteoarthritis, or SLE, a systemic autoimmune disease.&#x0D; Findings: Participants in the research were 32.18 years old on average with a standard deviation of 7.82 years. Moreover, half of the participants were college graduates, 71. (76.44%) while pregnant, participants gained an average weight of 14.70 and 7.82 kg. Only four (4 %) of these women engaged in aerobic activity. Most study participants reported musculoskeletal complaints at night with 75 reporting nighttime symptoms (85%). There were 82 (90%) people with low back pain, 10 (10%) participants with arthralgia, 35 (40%) participants with arthritis, and 32 (35%) participants with neck pain in the study. Pregnancy-related musculoskeletal issues substantially drain the health care system's budget. Arthritis and neck discomfort is among the most prevalent musculoskeletal complaints. Pregnancy-related weight gain and inactivity exacerbate these issues. The findings of this research need to be validated in more extensive trials.

Difference of Frap Levels Between Preeclamptic and Normotensive Women: A Cross-Sectional Analysis from a Tertiary Care Hospital, Pakistan

Objective: To determine the association between FRAP levels and preeclampsia Methodology: A case control study was conducted at Social Security Teaching Hospital Multan Road, Lahore between September 2019 March 2020. A total of 309 women were enrolled in the study using the non-probability convenience sampling technique. Women at 28 weeks or higher gestation, equal to or older than 18 years of age were included in the study. Those with a history of hypertensive issues before 20 weeks of gestation or other comorbidities were excluded from the study. For antioxidative analysis, the serum FRAP was measured using colorimetric assay. Patients sociodemographic, clinical, and reproductive history were recorded. For data analysis, SPSS version 24 was used and a p-value of 0.05 or less was considered as statistically significant. Results: Preeclampsia was found in 40 (13%) pregnant women in our study. The mean age + SD for the group with pre-eclampsia was 21.56 + 4.2 years while the mean age + SD for the normotensive group was 22.12 +5.6 years. The mean + SD FRAP levels were significantly higher in women with preeclampsia than the normotensive control group (p=0.01); 684.2 + 21.2 μmole/L in the preeclampsia group and 603.1 + 15.6 μmole/L in the control group. Conclusion: The FRAP levels were significantly higher in women with preeclampsia than the normotensive women indicating a correlation between high oxidative stress and risk of developing threatening pregnancy related issues. Keywords: antioxidant, FRAP, gestational, oxidative stress, preeclampsia

Markers of Oxidative Stress in Obstetrics and Gynaecology-A Systematic Literature Review.

Oxidative stress has been implicated in many diseases, including reproductive and pregnancy disorders, from subfertility to maternal vascular disease or preterm labour. There is, however, discrepancy within the standardized markers of oxidative stress in obstetrics and gynaecology in clinical studies. This review aims to present the scope of markers used between 2012 and 2022 to describe oxidative stress with regard to reproduction, pregnancy, and pregnancy-related issues. Despite the abundance of evidence, there is no consensus on the set of standardised markers of oxidative stress which poses a challenge to achieve universal consensus in order to appropriately triangulate the results.

The description of neuromyelitis optica spectrum disorder: Patient registry in Yangtze River Delta area of China

ObjectiveTo describe the clinical features of neuromyelitis optica spectrum disorder (NMOSD) through patient registry in Yangtze River Delta area of China. MethodsA total of 502 consecutive patients diagnosed with aquaporin-4 antibody (AQP4-ab)-positive NMOSD were registered between December 2018 to January 2021 in multiple tertiary referral centers within the framework of Yangtze River Delta of China. Their baseline data were reviewed, and follow-up clinical information were collected prospectively. ResultsThe mean age at onset was 37.3 (range 3–80 years) years and the female-to-male ratio was 8.1:1. The median disease duration was 47 months (interquartile range [IQR] 25–84 months). A total of 1372 attacks of the 502 patients were recorded till the last follow-up, with a median annualized relapse rate of 0.4 (IQR 0.3–0.6). Nearly one-fourth (24.5%, 336/1372) of the attacks had prodromic events, including upper respiratory tract infection (36.3%, 122/336), fever (20.2%, 68/336) and pregnancy-related issues (17.9%, 60/336), etc. Myelitis was the most common attack type throughout the disease course (51.4%, 705/1372), followed by optic neuritis (ON, 43.1%, 592/1372). As for onset phenotype, ON (37.3%, 187/502) prevailed over myelitis (28.3%, 142/502). The median time to first relapse was 12 months (IQR 5–25 months). Patients with brainstem encephalitis at onset were more likely to have other anatomical region involved in subsequent attacks (p < 0.001), compared to other onset type. The median serum AQP4-ab titer measured by cell-based assays was 1:100 (IQR 1:32–1:320, range 1:10–1:10,000). The baseline AQP4-ab titer in cerebrospinal fluid (r = 0.542, p <0.001), overall ARR (r = 0.232, p< 0.001) and the EDSS scores at last follow-up (r = 0.119, p = 0.022) significantly correlated with baseline serum AQP4-ab titer. Antinuclear antibodies (48.4%), thyroid peroxidase antibodies (30.7%), and anti-SSA antibodies (26.2%) represented the most frequent concomitant antibodies, while autoimmune thyroid disorders (13.1%, 66/502) and Sjogren's syndrome (10.8%, 54/502) were the most common accompanying autoimmune diseases. Till the last follow-up, 403 patients received preventive treatments. Azathioprine represented the most common initial treatment, mycophenolate mofetil and rituximab was the most common second and third-line treatment, respectively. The EDSS score at the last follow-up ranged from 0 to 8.5 with a median of 2 (IQR 1–3). ConclusionsA comprehensive clinical picture of patients with AQP4-ab-positive NMOSD in Yangtze River Delta area of China was presented. More information on disease tragedy and predictive prognostic factors could be generated through long-term observations.

Managing Inflammatory Bowel Disease in Pregnancy: Health Care Professionals' Involvement, Knowledge, and Decision Making.

The management of pregnant women with inflammatory bowel disease (IBD) is complex. We aimed to assess health care professionals' (HCPs) theoretical and applied knowledge of pregnancy-related IBD issues. A cross-sectional international survey was distributed to HCPs providing IBD care between October 2020 and March 2021. Knowledge was assessed using the validated Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow; range, 0-17). Decision-making was assessed by free text responses to 3 clinical scenarios scored against predetermined scoring criteria (maximum score 70). Among 81 participants, median CCPKnow score was 16 (range, 8-17), and median total scenario score was 29 (range, 9-51). Health care professionals who treat >10 IBD patients per week (CCPKnow P = .03; scenarios P = .003) and are more regularly involved in pregnancy care (CCPKnow P = .005; scenarios P = .005) had significantly better scores. Although CCPKnow scoring was consistently high (median score ≥15) across all groups, consultants scored better than trainees and IBD nurses (P = .008 and P = .031). Median scenario scores were higher for consultants (32) and IBD nurses (33) compared with trainees (24; P = .018 and P = .022). There was a significant positive correlation between caring for greater numbers of pregnant IBD patients and higher CCPKnow (P = .001, r = .358) and scenario scores (P = .001, r = .377). There was a modest correlation between CCPKnow and scenario scores (r = .356; P < 0.001). Despite "good" theoretical pregnancy-related IBD knowledge as assessed by CCPKnow, applied knowledge in the scenarios was less consistent. There is need for further HCP education and clinical experience to achieve optimal standardized care for IBD in pregnancy.

Disease-Modifying Drugs and Breastfeeding in Multiple Sclerosis: A Narrative Literature Review.

Pregnancy-related issues in women with multiple sclerosis (MS) have been receiving increasing attention, with particular interest for the use of disease-modifying therapies (DMTs) before conception, during pregnancy, and postpartum, including breastfeeding. The risk of relapse is higher in the early postpartum period, especially in cases of significant disease activity prior to pregnancy, and thus treatment resumption and/or switching strategies might be necessary. Moreover, breastfeeding provides unmatched health benefits for babies and mothers, and is recommended as the best source of nutrition for infants. Furthermore, a protective role of breastfeeding on MS disease course has not been fully demonstrated and it remains debatable. At the same time, a source of concern is the potential transfer of DMTs into breastmilk and the resulting infant exposure. The use of most DMTs is unlicensed during breastfeeding mainly due to the limited data available on the excretion in human milk and on the effects on infants' exposure. Consequently, women have to face the difficult challenge of choosing between breastfeeding and DMT resumption. The present narrative review summarizes and discusses the available evidence on the safety of DMTs during breastfeeding and the relative approved labels. At the time of diagnosis of MS, specific counseling should be offered to women of childbearing age, making them aware of the possible therapeutic options and their impact on pregnancy and breastfeeding. Women can be encouraged to breastfeed, if clinically feasible, following a review of their medications and clinical status, with a personalized approach.

Role of Community mobilization as improving maternal health and proposed strategies in low-income countries: Narrative Review

Poor maternal outcome is one of the significant public health concerns globally. More than 295,000 women died in 2017, with 94% of deaths occurring in developing countries. There is a general lack of awareness about pregnancy-related issues. The current narrative review was planned to highlight the role of community mobilization in improving maternal health. Literature suggested five principal community mobilization strategies: improving home-based issues, such as the provision of and accessibility to healthcare facilities; community health education, including nutrition awareness; reducing the risk of maternal mortality; emergency care provision, like the uptake of misoprostol to prevent postpartum hemorrhage; and decision-making regarding birth preparedness. In Pakistan, there is a lack of evidence about the integration mode of community mobilization. It is necessary to determine how community mobilization integration helps reduce maternal mortality and its efficacy. Keywords: Maternal Health, LMICs, Community Mobilization, Developing countries, maternal care

Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer.

PURPOSEFertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues.METHODSA 19-item questionnaire adapted from an international survey exploring issues about fertility preservation and pregnancy after breast cancer was sent by e-mail between November 2019 and January 2020 to physicians from LMICs involved in breast cancer care. Descriptive analyses were performed.RESULTSA total of 288 physicians from Asia, Africa, America, and Europe completed the survey. Median age was 38 years. Responders were mainly medical oncologists (44.4%) working in an academic setting (46.9%). Among responders, 40.2% and 53.8% reported having never consulted the available international guidelines on fertility preservation and pregnancy after breast cancer, respectively. 25.0%, 19.1%, and 24.3% of responders answered to be not at all knowledgeable about embryo, oocyte, or ovarian tissue cryopreservation, respectively; 29.2%, 23.6%, and 31.3% declared that embryo, oocyte, and ovarian tissue cryopreservation were not available in their countries, respectively. 57.6% of responders disagreed or were neutral on the statement that controlled ovarian stimulation can be considered safe in patients with breast cancer. 49.7% and 58.6% of responders agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence overall or only in those with hormone receptor–positive disease, respectively.CONCLUSIONThis survey showed suboptimal knowledge, practice, and attitudes of physicians from LMICs on fertility preservation and pregnancy after treatment completion in young women with breast cancer. Increasing awareness and education on these aspects are needed to improve adherence to available guidelines and to promote patients' oncofertility counseling.

Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy

Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory, and degenerative disease that is up to three times more frequent in young women. MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth. The Pregnancy in Multiple Sclerosis Study in 1998 showed that pregnancy, mostly in untreated women, did not adversely affect MS, as disease activity decreased during pregnancy (although it significantly increased in the first trimester postpartum). These findings, together with the limited information available on the potential risks of fetal exposure to disease modifying treatments (DMTs), meant that women were advised to delay the onset of DMTs, stop them prior to conception, or, in case of unplanned pregnancy, discontinue them when pregnancy was confirmed. Now, many women with MS receive DMTs before pregnancy and, despite being considered a period of MS stability, up to 30% of patients could relapse in the first trimester postpartum. Factors associated with an increased risk of relapse and disability during pregnancy and postpartum include relapses before and during pregnancy, a greater disability at the time of conception, the occurrence of relapses after DMT cessation before conception, and the use of high-efficacy DMTs before conception, especially natalizumab or fingolimod. Strategies to prevent postpartum activity are needed in some patients, but consensus is lacking regarding the therapeutic strategies for women with MS of a fertile age. This, along with the increasing number of DMTs, means that the decision-making processes in aspects related to family planning and therapeutic strategies before, during, and after pregnancy are increasingly more complex. The purpose of this review is to provide an update on pregnancy-related issues in women with MS, including recommendations for counseling, general management, use of DMTs in pre-pregnancy, pregnancy, and postpartum periods, and breastfeeding-related aspects of DMTs.

Pregnancy safety of COVID-19 vaccines is validated by the Vaccine Adverse Event Reporting System

Healthcare providers, vaccine manufacturers, and the public can submit reports to the CDC's Vaccine Adverse Event Reporting System (VAERS) which was created to collect reports of adverse events and reactions that occur following vaccination. Our objective was to assess the safety of COVID-19 vaccines for pregnancy-related events as reported by VAERS. This is a retrospective cohort study utilizing the United States VAERS. We included reproductive age (18-49 years old) females in this study who reported pregnancy-related events as of July 23, 2021 for the three COVID-19 vaccines available in the United States. Overall there were 1,146,536 VAERS events, of which 435,077 were COVID-19 vaccines related, 143,934 of these were reported in reproductive age women with 5,537 different symptoms. 2.7% of events (3,915/143,934) were pregnancy-related. Spontaneous abortion constituted the largest number of adverse events (0.47%: 678/143,934) There were no serious maternal sequelae reported after COVID-19 vaccinations nor was there an increase in other pregnancy-related adverse outcomes. The table shows the top 30 pregnancy-related symptoms reported. There were no significant differences in pregnancy-related issues among the 3 different COVID-19 vaccines. Our study of VAERS confirms the safety in pregnancy after COVID-19 vaccinations for each of the three different vaccines. Only 3,915 events after COVID-19 vaccines were pregnancy-related out of a total of 143,934 events among reproductive age women. The number of spontaneous abortions were in line with expected numbers, and there was no significant difference between the three vaccine manufactures. The strength of VAERS is that it is national in scope, can quickly provide an early warning of a safety problem with a vaccine, and is designed to rapidly detect unusual or unexpected patterns of adverse events, also known as “safety signals.” There were no “safety signals” for pregnancy-related events after COVID-19 vaccinations.