Prenatal Outcome Research Articles

Utility of the cerebro-placental-uterine ratio in predicting composite adverse perinatal outcomes in pregestational diabetes: A prospective cohort study.

To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes. This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated. CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity). Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.

Presentation of a weight bias internalization tool for use in pregnancy and a call for future research: A commentary

BackgroundEmerging evidence has shown that weight stigma is a concern during pregnancy, with several studies documenting common sources including healthcare, the media and interpersonal networks. Experiencing weight stigma may lead to weight bias internalization (WBI), whereby individuals accept and self-direct negative weight-related stereotypes, and limited research has assessed this in the context of pregnancy. Pregnancy is unique in terms of weight changes as many individuals will experience gestational weight gain (GWG). Accordingly, a WBI tool that accounts for GWG may be a more population-specific resource to use. MethodsThis commentary presents a pregnancy-specific WBI tool that accounts for GWG. The validated Adult WBI scale was modified to include ‘pregnancy weight gain’. This commentary also presents a brief summary of research that has assessed WBI in pregnancy and recommendations for future work. ResultsRecommended future work includes validation of the pregnancy-specific WBI tool and prospective examinations of weight stigma and WBI in pregnancy and implications on maternal and newborn outcomes. ConclusionUltimately this research may inform development of interventions and resources to mitigate weight stigma and WBI in pregnancy and overall may contribute to improving prenatal outcomes and experiences.

Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper

IntroductionThe COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where...

Outcomes of fetal lower urinary tract obstruction based ontiming of oligohydramnios onset.

Fetal Lower Urinary Tract Obstruction (LUTO) is associated with oligohydramnios and significant fetal morbidity, resulting in poor lung development and perinatal death. However, oligohydramnios may develop at different gestational periods, and the impact of timing on fetal outcomes remains unknown. Our objective was to characterize the impact onset of oligohydramnios had on prenatal outcomes. This study is a retrospective cohort study of all patients with a prenatal diagnosis of LUTO at our tertiary referral center from 2014 to 2023. All patients underwent detailed ultrasonography and interdisciplinary counseling and were subsequently delivered at our institution. Data were obtained from electronic medical records and complete extraction was required for final inclusion. During the study time period, 93 patients met inclusion criteria of which 68 (73.1%) developed oligohydramnios during their pregnancy. 63 (93%) of these pregnancies resulted in livebirths with 28 (41.1%) perinatal deaths. Onset of oligohydramnios was earlier in pregnancies with perinatal death (23 vs. 28weeks, p=0.004) and associated with pulmonary hypoplasia. Our data show the impact of oligohydramnios timing in pregnancy on pulmonary hypoplasia and ultimately perinatal death. This allows for detailed patient counseling on the impact oligohydramnios may have on pregnancies by the gestational age of onset.

Characteristics of pregnancies with fetuses diagnosed with congenital spina bifida: a case series study at Indonesia's second largest referral hospital

Background: Spina bifida leads to unfavourable outcomes for the fetus, particularly in developing countries. This study aims to investigate the characteristics and risk factors associated with spina bifida in Surabaya, Indonesia. The findings could inform improved management strategies. Methods: This study is a descriptive retrospective study that utilized medical records data of pregnant women with fetuses diagnosed with congenital spina bifida, who were treated in the delivery room at Dr. Soetomo General Hospital, Surabaya, from 2016 to 2021. Data on maternal characteristics, risk factors, pregnancy management, and prenatal outcomes were collected. Data was processed descriptively to calculate and display the percentage of each case. Results: Over a span of five years, ten cases of spina bifida were identified. More than 50% of these cases occurred in multigravida pregnancies, with mothers aged 20-29 years. Seventy percent of the cases were referrals. Recorded maternal risk factors included obesity (30%) and low socio-economic status (60%). Only 30% of pregnant women received antenatal check-ups in the first trimester, and most cases were detected after 28 weeks of gestation. Only 10% of cases were associated with other syndromes. Eighty percent of the cases were born after 37 weeks of gestation. The neonates' outcomes were recorded, revealing that the majority of them were male, with 60% having open spina bifida. Ninety percent of cases were non-isolated, and 40% of them were accompanied by hydrocephalus. Only 60% of neonates underwent surgery to close the defect. Perinatal mortality was observed in 50% of cases. Conclusion: Maternal risk factors for spina bifida included obesity and low socio-economic status. The majority of cases involved male neonates, and most were non-isolated spina bifida cases, resulting in a perinatal survival rate of 50%. Most of the cases were detected in the third trimester.

Maternal and prenatal outcomes of hemochromatosis in pregnancy: A population-based study.

This retrospective study investigated the impact of hemochromatosis on maternal and perinatal outcomes among delivery hospitalizations in the United States between 2010 and 2019, revealing notable trends and associations. Utilizing data from over 36 million delivery hospitalizations, we conducted a comprehensive analysis, focusing on maternal complications, perinatal outcomes, and healthcare utilization among women with hemochromatosis compared to those without. Women with hemochromatosis exhibited a longer length of hospital stay (3.27±0.20 days vs. 2.64±0.04 days) and higher total hospital charges ($21,789.66 ± $1124.41vs. $17,751.63 ± $97.71) compared to those without the condition. There was a significant increase in the prevalence of hemochromatosis among delivery hospitalizations over the studied period, from 1.91 per 100,000 hospitalizations to 8.65 cases per 100,000 hospitalizations. Hemochromatosis patients demonstrated a higher prevalence of hypertensive disorders of pregnancy (aOR: 1.50, 95% CI: 1.03-2.19) and VTE(aOR: 20.35, 95% CI: 5.05-82.05).There were no statistically significant differences in rates of peripartum hemorrhage, C-section, preterm birth, fetal growth restriction, large for gestational age infants, and fetal death between the two groups. Our findings underscore higher hypertensive disorders of pregnancy and VTE among women with hemochromatosis, despite unaffected perinatal outcomes. An increasing trend in hemochromatosis prevalence highlights the need for targeted interventions and cost-effective management strategies. Future research is needed to explore potential racial disparities and understand the rising incidence of hemochromatosis among pregnant women.

S1496 Maternal and Prenatal Outcomes of Hemochromatosis in Pregnancy: A Population-Based Study

S1496 Maternal and Prenatal Outcomes of Hemochromatosis in Pregnancy: A Population-Based Study

Patient Acceptance of Primary Care Behavioral Health in a Resident Obstetrics and Gynecology Clinic.

Primary care behavioral health (PCBH) is a patient care model in which a behavioral health consultant (BHC) works alongside the primary care provider to address behavioral components of health conditions. PCBH is well received in the primary care setting; however, little is known about acceptability of the service among prenatal patients. The study was designed to explore the acceptability of PCBH among pregnant patients in a resident obstetrics and gynecology clinic. A survey designed to assess different components of acceptability was administered to eligible pregnant patients who received prenatal care at the resident obstetrics and gynecology clinic. The majority of patients wanted to receive education on pregnancy-relevant topics from the BHC: healthy weight gain (68.4%), healthy eating (70.4%), healthy exercise (73.5%), and mood disorders (63.3%). The majority of participants wanted help from the BHC in managing coexisting conditions affecting pregnancy: stress (63.3%), depression (75.5%), or anxiety (73%). The majority of patients (55.6%) preferred to work with a BHC for mental health concerns rather than an outside psychiatrist or counselor. PCBH service was perceived to be easy to understand (78%). Barriers to engaging in the PCBH service included time (41.4%), lack of perceived need (13.8%), unavailability (6.9%), and others (13.8%). Despite the perceived benefit, there was an implication of stigma among prenatal patients seeking PCBH or mental health care. Overall, the PCBH model had high acceptability among a prenatal care population in a resident obstetrics and gynecology clinic and offers potential to improve prenatal outcomes.

Fetal Monitoring mHealth Apps: A Mixed-Methods Study of Users' Perceptions of App Effects [ID: 1377502

INTRODUCTION: Little is known about users' perceptions of fetal monitoring mHealth apps (FMAs). mHealth guidelines for developing behavior change interventions, like FMAs, recommend consistent evaluation of these apps to examine users' perceptions of app effects and to identify unintended consequences or harms to app users. The objective of this secondary, mixed-methods study was to explore app users' perceptions of the interventions' effects. METHODS: A convenience sample of 806 pregnant individuals aged 18+ who voluntarily downloaded a free, proprietary FMA completed a survey, including open- and closed-ended items in four survey sections: app engagement, perceived efficacy of the app raising awareness of fetal movements, health behaviors and diagnoses, and pregnancy and birth outcomes. We conducted a thematic analysis of the responses of the 299 participants who answered open-ended questions and triangulated themes with app user data (DMU IRB-2021-17). RESULTS: Four major app effects were reported by users: reduced prenatal anxiety and increased parent/family–fetal bonding, awareness of fetal movement, and health-seeking behavior in the presence of decreased fetal movement. Moreover, app user data suggested that these benefits were amplified by more consistent app use. CONCLUSION: Collectively, FMA users in this study associated app use with clinically significant prenatal outcomes and did not report that app use led to consequences or harm. From an institutional perspective, these findings may support health systems and prenatal providers who are investigating whether and how to integrate digital patient support modalities into prenatal care and are seeking evidence to support decision-making.

Effect of Maternal Depressive Symptoms on Prenatal Care Utilization and Milestones [ID: 1376259

INTRODUCTION: Depression is a common complication of pregnancy, but research is limited regarding its effect antepartum. This study assessed the relationship between maternal depressive symptoms and prenatal care utilization. METHODS: This retrospective cohort includes pregnant women who completed first- or second-trimester depression screening using the Edinburgh Postnatal Depression Scale (EPDS) between 2020 and 2021. Patient and pregnancy-related characteristics were compared between women who screened positive versus negative for depression. Multivariate logistic regression models were used to estimate odds of completing prenatal care milestones. The IRB approved a consent waiver. RESULTS: Of 718 women who completed the EPDS in early pregnancy, 85 (12%) screened positive for depression. A greater proportion of these women were younger (P=.034), unpartnered (P=.005), publicly insured (P=.013), had a history of substance use (P&lt;.0001) or prior psychiatric diagnosis (P&lt;.0001), and started prenatal care later (P=.002) than those who screened negative. Although there were no significant differences in total routine prenatal care visits (P=.123), the adjusted odds of completing third-trimester milestones including glucose tolerance testing (odds ratio [OR] [95% CI] 0.596 [0.364–0.975]) and group B streptococcus testing (OR [95% CI] 0.559 [0.330–0.947]) were lower among women who screened positive for depression. In addition, higher EPDS scores were positively correlated with number of labor and delivery triage visits (r=0.103, P=.006). CONCLUSION: Women who screen positive for depression during pregnancy are a socially vulnerable group at risk of starting prenatal care late, missing major milestones, and overusing nonroutine medical services. Early mental health screening and intervention in pregnancy may help improve prenatal outcomes.

The Effect of Oral Magnesium Supplement on Pre-eclampsia and Perinatal Outcomes in Pregnancy: A Meta-Analysis of Randomized Controlled Trials

Background: Magnesium is one of the most important nutritional factors that have a beneficial effect on pregnant women. Many studies evaluated the role of oral magnesium supplements as a non-pharmacological intervention for mother and neonatal protection in terms of these outcomes. There is a conflict between several clinical trials about the efficacy of oral magnesium supplements during pregnancy. Therefore, in this review, we represent class 1 evidence and address an unmet clinical need on the efficacy of different types of oral magnesium in pre-eclampsia, and prenatal outcomes in pregnant women.&#x0D; Method: During the preparation of this meta-analysis, we followed the PRISMA statement guidelines. A literature search of the Web of Sciences, Cochrane Central Register of Controlled Trials, and PubMed were conducted from inception until September 2022. We included randomized controlled trials (RCTs) comparing oral magnesium whether citrate, oxide, or aspartate hydrochloride with a placebo. The records of quality studies were screened and extracted. Additionally, the pre-eclampsia, preterm birth, and neonatal intensive care unit (NICU) admissions data were pooled as odds ratio (OR) in a fixed-effect model using Review Manager (v.3). Subgroup analysis was performed to investigate the efficacy of each type of oral magnesium on the outcomes.&#x0D; Results: Five RCTs were included in this meta-analysis with a total of 2370 patients. The overall effect did not favor either of the two groups in terms of pre-eclampsia (OR= 0.99, 95% CI, [0.72, 1.37], p = 0.9), preterm birth (OR= 0.87, 95% CI, [0.62, 1.22], p = 0.4), and NICU admissions (OR= 1.37, 95% CI, [0.84, 2.22], p = 0.2). Based on the subgroup analysis findings, the use of oral magnesium supplements whether citrate, oxide, or aspartate hydrochloride in this population did not significantly increase or decrease the incidence of pre-eclampsia, preterm birth, and NICU admissions when compared with the control group.&#x0D; Conclusion: Ultimately, oral magnesium supplementation whether citrate, oxide, or aspartate hydrochloride may not have a beneficial effect on maternal and fetal outcomes during pregnancy. Therefore, the current evidence is insufficient to confirm the efficacy of oral magnesium for care practice among pregnant women. Despite that, these results need to be affirmed by major RCTs using magnesium supplements which have related to neonatal and maternal outcomes.

The Incidence and Outcomes of Late-Term Pregnancy.

Little is known about the outcomes of late-term pregnancy. In this study, we aim to assess the incidence and adverse prenatal outcomes associated with late-term pregnancy. We retrospectively assessed all singleton pregnant mothers who gave birth at Khalij-e-Fars Hospital in Bandar Abbas, Iran, between January 2020 and 2022. All preterm and post-term deliveries were excluded. Mothers were divided into two groups: late-term mothers (41 0/7-41 6/7 weeks of gestation) and term mothers (37 0/7-40 6/7 weeks of gestation). Demographic factors, obstetricfactors, maternal comorbidities, and prenatal outcomes were extracted from the electronic data of each mother. The incidence of late-term births was calculated. The chi-squared test was used to compare differences between the groups. Logistic regression models were used to assess the association of prenatal outcome with late-term pregnancy. There were 8,888 singleton deliveries during the study period, and 1,269 preterm and post-term pregnancies were ruled out. Of the 7,619 deliveries, 309 (4.1%) were late-term, while 7,310 (95.9%) were term. There were no sociodemographic differences between term and late-term mothers. The late-term group had a higher prevalence of primiparous mothers, and the term group had a higher prevalence of diabetes. Late-term mothers had a higher risk of macrosomia (adjusted odds ratio (aOR): 2.24 (95% confidence interval (CI): 1.34-3.01)), meconium amniotic fluid (aOR: 2.32 (95% CI: 1.59-3.14)), and fetal distress (aOR: 2.38 (95% CI: 1.54-2.79)). When compared to term pregnancy, the risk of low birth weight (LBW) was lower in late-term pregnancy (aOR: 0.69 (95% CI: 0.36-0.81)). Late-term pregnancy was found to be more likely to be associated with macrosomia, meconium amniotic fluid, and fetal distress, but serious maternal and neonatal adverse events were comparable to term pregnancy.

Which endometrial preparation protocol provides better pregnancy and perinatal outcomes for endometriosis patients in frozen-thawed embryo transfer cycles? A retrospective study on 1413 patients

ObjectiveTo determine the optimal endometrial preparation protocol for a frozen embryo transfer in patients with endometriosis.DesignRetrospective cohort study.SettingTertiary care academic medical center.Patient(s)One thousand four hundred thirteen patients with endometriosis who underwent oocyte aspiration from 2015 to 2020 and frozen embryo transfer from 2016 to 2020 and received natural cycle, hormone replacement treatment with or without GnRHa pretreatment endometrial preparation.Intervention(s)None.Main outcome measure(s)Clinical pregnancy rate, live birth rate, miscarriage rate, multiple pregnancy rate, biochemical pregnancy rate and ectopic pregnancy rate. Singleton live births were assessed for perinatal outcomes and obstetric complications.Result(s)There were no differences in clinical pregnancy outcomes or prenatal outcomes among the three commonly used endometrial preparation protocols for frozen embryo transfer cycles in patients with endometriosis. Results remained after screening variables using univariate logistic regression into multivariate logistic regression. No advantages or disadvantages were found among the three endometrial preparation protocols in patients with endometriosis.Conclusion(s)Natural cycle, hormone replacement cycle, or hormone replacement treatment with GnRHa pretreatment showed no superiority or inferiority in pregnancy and perinatal outcomes in patients with endometriosis.

Prognostic value of the middle cerebral to umbilical artery Doppler ratio in the prediction of outcomes in post-term pregnancy

Objective. To evaluate the diagnostic value of the middle cerebral artery to umbilical artery Doppler ratio (MCA/UA ratio) in predicting poor perinatal outcomes in post-term pregnancies. Patients and methods. This study included patients diagnosed with post-term pregnancy who were admitted to the maternity hospitals in Ain Shams University and Al-Azhar University between January 2019 and December 2021. All patients underwent color Doppler velocimetry and were divided into two groups based on the MCA/UA ratio values: group A (n = 100) – MCA/UA ratio &lt;1, and group B (n = 100) – MCA/UA ratio ≥1. Outcome factors were admission to the neonatal intensive care unit, an Apgar score of less than 7 at 5 minutes, gestational age at delivery, birth weight, and intrauterine growth restriction. Results. The MCA/UA resistance index ratio (MCA-RI/UA-RI) with a cut-off value of 0.88 was found to be the most sensitive parameter in the prediction of adverse prenatal outcomes: sensitivity – 89%, specificity – 71%, positive predictive value (PPV) – 72%, negative predictive value (NPV) – 71%. All parameters combined showed a 93% sensitivity, 92% specificity, 92% PPV, and 89% NPV. Conclusion. To enhance obstetric outcomes and prevent unnecessary treatment and perinatal death, cerebroplacental ratio appears to be a helpful indication in predicting poor neonatal outcomes in post-term pregnancy. Key words: Doppler velocimetry, middle cerebral to umbilical artery ratio, post-term pregnancy

Impact of perceived social support on prenatal outcome among pregnant women

Nigeria’s mortality ranks 14th in the world. Prenatal outcomes such as preterm birth, birth weight and Apgar score are some of the leading causes of prenatal morbidity and mortality worldwide, particularly in sub-Sahara Africa. It is against this backdrop that this study examined the impact of social support on birth outcomes among pregnant women in Eku Baptist Hospital, Delta State. The study was anchored on survey and observational research designs. Primary and secondary data sources were used. The study population was pregnant women in labour. A census of 161 pregnant women who registered at the health facility was taken. Descriptive and inferential statistical tools were used in the study. The study revealed that 23.5% of women with low perceived social support delivered babies with a low birth weight compared to only 5.5% of women who had strong perceived social support. This difference was statistically significant with a p-value of 0.003. Again, 88.2% compared to 72.5% had normal birth weight babies for women with strong social support and weak social support respectively and the differences in birth weight were statistically significant with P= 0.003. Also, 15.7% of women with poor social support had preterm babies compared to 10.9% of women with strong social support. The proportion of babies with neonatal Apgar scores less than 7 born to women who had weak/poor perceived social support (31.4%) was higher than that in women who had strong perceived social support (13.6%) and the relationship was statistically significant with p-value=0.008). The result of the study showed a statistically significant association between perceived social support and neonatal Apgar scores. The regression coefficient R of 0.166 however, shows a low predictive power. Based on the findings of the study, it is suggested that pregnant women should be given emotional, instrumental, informational and appraisal support to achieve better prenatal outcomes.

Impact of perceived social support on prenatal outcome among pregnant women

Impact of perceived social support on prenatal outcome among pregnant women

Prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the risk of inadequate prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States. PubMed/MedLine, Embase, ClinicalTrials.gov and Web of Science were searched from inception up to March 30th, 2022. Studies were included if they reported the risk of inadequate prenatal care and/or pregnancy outcomes among incarcerated pregnant individuals in the United States jails or prisons. Adequacy of prenatal care was quantified by Kessner index. The random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs) using RevMan software. Nine studies were included in thefinal review. A total of 11,534 pregnant individuals, of whom 2,544 were incarcerated while pregnant, and 8,990 who were matched non-incarcerated pregnant individuals serving as control group, were utilized. Compared to non-incarcerated pregnancies, incarcerated pregnant individuals were at higher risk of inadequate prenatal care (OR 2.99 [95% CI: 1.60, 5.61], p<0.001) and were more likely to have newborns with low birthweight (OR 1.66 [95% CI: 1.19, 2.32], p=0.003). There was no significant difference between incarcerated and matched control pregnancies in the rates of preterm birth and stillbirth. The findings of the current systematic review and meta-analysis suggest that incarcerated pregnant individuals have an increased risk of inadequate prenatal care. Considering the limited number of current studies, further research is indicated to both assess whether the risk of inadequate prenatal care has negative impact on prenatal outcomes for this population and to determine the steps that can be taken to enhance prenatal care for all pregnant individuals incarcerated in the United States prisons.

Alterations in some haematological parameters, ascorbic acid and pantothenic acid levels among pregnant women with plasmodium parasitaemia in Sokoto, Nigeria

Malaria in pregnancy is a major contributor to adverse maternal and prenatal outcome. In hyper endemic areas like ours, it is a common cause of anaemia and the haematological abnormalities. This case-control study evaluated the full blood count, ascorbic acid and pantothenic acid level of sixty (60) malaria parasitized pregnant women. Participants were recruited from Antenatal Clinic of Specialist Hospital Sokoto. A structured interviewer-administered questionnaire was used to obtain some socio-demographic characteristic and blood samples were collected and examine for malaria parasite, some haematological parameters (HCT, HGB, WBC, RBC and platelet count) were measured using the HA6000 auto-haematology analyzer (Perlong Medical Equipment Company). Ascorbic acid levels were assayed by a standard chemical method and pantothenic acid levels was analyzed using the ID-VIT pantothenic acid ELISA kit. Malaria parasitaemia and parasite load was confirmed by the examination of a Giemsa- stained thin blood film. Data generated was analyzed using SPSS 22.0 statistical package. A p- value ≤ 0.05 was considered significant in all statistical comparisons. The HCT, HGB RBC and Platelet counts of the parasitized subjects were significantly lower compared with the controls (p&lt;0.05). Also, the ascorbic acid level of parasitized subjects was significantly lower compared to that of controls. There was a strong correlation between ascorbic acid and platelet count (r= 0.413 and p= 0.00). The mean parasite count among the parasitized subjects was 5.93 ± 2.72 × 103/ìL. Findings of this study has shown that malaria in pregnancy causes decrease in vitamin C and some of the haematological parameters. There is need to routinely monitor the vitamin C and full blood count should among parasitized pregnant women. We advocate that vitamin C and pantothenic acid be included in the guidelines of multivitamin supplementation particularly among plasmodium parasitized pregnant women.

Barriers to Access among Indigenous Women Seeking Prenatal Care: A Literature Review

Introduction: Indigenous women in Canada suffer disproportionately adverse prenatal outcomes due to access barriers in Canada's healthcare system. This paper aims to identify barriers Indigenous women face in accessing prenatal care in Canada. Methods: A literature search was conducted by all three authors using the following databases: PubMed, SCOPUS and CINAHL, and the keywords "Indigenous," "prenatal care," "access barriers," "maternal health," and "Canada." The search results yielded a total of 100 studies. Results: The studies included were written in English only, included Indigenous females between the age of 19–35, and excluded review articles. Twelve studies met the inclusion criteria and were included in the review. Participants in the studies examined did not have any severe underlying medical conditions for the duration of the study, and study designs included in the review are prospective cohort, cross-sectional, case report, and case-control studies. Five studies discussed the geographical distribution of facilities as the first major barrier to accessing prenatal care. Four studies identified distrust between patients and healthcare providers as the second major barrier, and six studies identified lack of culturally sensitive prenatal care as the third major access barrier. Discussion: The study found three main barriers Indigenous women face in accessing prenatal care in Canada; the geographical distribution of healthcare facilities, distrust between patients and healthcare professionals, and cultural sensitivity. Some changes in Canada's healthcare system to reduce access barriers to prenatal care include building more birthing and prenatal care facilities in rural areas for Indigenous women, educating healthcare professionals on culturally sensitive healthcare, and involving Indigenous people in decision-making to reduce distrust and power imbalances. Conclusion: The involvement of Indigenous women and community leaders is essential in making decisions regarding implementing effective healthcare and prenatal programs for Indigenous women. However, further research is required to understand the effectiveness of the solutions and the barriers that make prenatal care less accessible for Indigenous women in Canada.

Prenatal Diagnosis and Outcomes in Fetuses with Hemivertebra.

Background: There are few studies on the burden of chromosomal abnormalities and single gene disorders in fetal hemivertebra (HV). We aim to investigate the cytogenetic and monogenic risk and evaluate prenatal outcomes of fetal HV. Method: This study included fetuses diagnosed with HV divided into two groups: isolated HV and non-isolated HV. Data on other sonographic structural anomalies, chromosomal and sub-chromosomal abnormalities, monogenic variations detected by WES, and prenatal outcomes are recorded and reviewed. Results: Among 109 fetal HV cases, forty-seven (43.1%) non-isolated HV cases were associated with structural anomalies. Chromosomal test results were available in 58 cases, identifying six (10.3%) chromosomal aberrations involved in four isolated and two non-isolated HV. WES identified four (likely) pathogenic variants in three cases among 16 fetuses with HV, involving three novel variants, 1250G > T and c.1277G> inherited from parents, respectively, in DLL3 and c.7213C > A ** in the FLNB. The live birth rate (LB) was higher in the isolated fetal HV group than in the non-isolated group (67.7% (42/62) vs. 12.5% (12/47), p < 0.001). Conclusion: This study emphasizes the risk of cytogenetic abnormalities in isolated HV. WES yields a diagnostic rate of 18.3% in HV with normal CMA, probably aiding the prenatal counseling and management of fetal HV.