Risk For Poor Birth Outcomes Research Articles

Multicomponent Behavioural Intervention during Pregnancy to Reduce Home Exposure to Second-Hand Smoke: A Pilot Randomised Controlled Trial in Bangladesh and India.

Pregnant women exposed to second-hand smoke (SHS) are at increased risk of poor birth outcomes. We piloted multicomponent behavioural intervention and trial methods in Bangalore, India, and Comilla, Bangladesh. A pilot individual randomised controlled trial with economic and process evaluation components was conducted. Non-tobacco-using pregnant women exposed to SHS were recruited from clinics and randomly allocated to intervention or control (educational leaflet) arms. The process evaluation captured feedback on the trial methods and intervention components. The economic component piloted a service use questionnaire. The primary outcome was saliva cotinine 3 months post-intervention. Most pregnant women and many husbands engaged with the intervention and rated the components highly, although the cotinine report elicited some anxiety. Forty-eight (Comilla) and fifty-four (Bangalore) women were recruited. The retention at 3 months was 100% (Comilla) and 78% (Bangalore). Primary outcome data were available for 98% (Comilla) and 77% (Bangalore). The multicomponent behavioural intervention was feasible to deliver and was acceptable to the interventionists, pregnant women, and husbands. With the intervention, it was possible to recruit, randomise, and retain pregnant women in Bangladesh and India. The cotinine data will inform sample size calculations for a future definitive trial.

Effectiveness of a midwife-led continuity of care model on birth outcomes and maternal mental health in vulnerable women: study protocol for a randomised controlled trial with an internal pilot, process evaluation and economic analysis

IntroductionWomen from social disadvantage are at greater risk of poor birth outcomes. The midwife-led continuity of care (MCC) model, which offers flexible and relational care from a small team of...

The Birth Bundle Project: A Rainier Valley Midwifery-led Collaborative Care Initiative Offering Patients and Providers a Paradigm Shift to Impact Health Equity.

Innovative midwifery-led collaborative care models have the potential to build on grassroots approaches to make transformative change within systems that work with families. Rainier Valley Midwives operates the Bundle Birth Project, a successful program that serves communities who are at higher risk for poor birth outcomes and face barriers to adequate medical, prenatal, and postpartum care, including Black, Indigenous, and persons of color. This project offers wraparound perinatal care services to provide a missing community of support to traditionally marginalized families before, during, and after birth while also bridging the gaps between midwives and physicians who attend births in different settings. By strengthening and formalizing the relationships between different types of perinatal providers including community-based doulas and lactation support professionals, this midwifery-led initiative improves the continuity and quality of care available to families including immigrant, refugee, and families of color in south Seattle, Washington.

Determinants of Malnutrition and its associated factors among pregnant and lactating women under armed conflict areas in North Gondar Zone, Northwest Ethiopia: a community-based study

IntroductionMaternal malnutrition remains a major public health problem, particularly in low and middle-income countries and war-affected areas like Ethiopia. Malnourished pregnant and lactating women with low nutrient stores have babies with poor mental and physical development, increasing the risk of poor birth outcomes. Despite the fact that the majority of Ethiopian mothers are malnourished, there is little evidence in war-affected areas. Therefore, the objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant and lactating mothers in the war affected area of North Gondar Zone, northwest Ethiopia.MethodsA community-based cross-sectional study was conducted from April 10 to May 25, 2022. A multistage random sampling technique was used to select 1560 pregnant and lactating mothers. MUAC was to ascertain the outcome variable. Data was entered and analyzed by using EPI INFO version 3.5.3 and SPSS version 24, respectively. A multivariable logistic regression analysis was employed to identify the factors associated with acute malnutrition. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association.ResultsThe prevalence of acute malnutrition among pregnant and lactating women was 34.3% at the 95% CI (31.9–36.8). The age of the mothers (AOR = 0.73; 95% CI: 0.54, 0.99), family size 6–8 (AOR = 1.21; 95% CI: 1.03, 1.82), and greater than or equal to 9 family sizes (AOR = 0.44; 95% CI: 0.19, 0.97), were significantly associated with acute malnutrition.ConclusionsIn the current study, the prevalence of acute malnutrition among pregnant and lactating mothers is high in the study area. Mother’s age and family size were factors associated with acute malnutrition in war-affected areas. As a result, mothers with large families will require special assistance to reduce the impact of malnutrition.

Prenatal care and infant outcomes of teenage births: a Project WATCH study

IntroductionInfants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations.PurposeTo determine the association between inadequate PNC (< 10 visits) and poor infant outcomes neonatal intensive care unit (NICU) stay, low APGAR score, small for gestational age (SGA) and length of stay (LOS).MethodsThe study used West Virginia (WV) Project WATCH population level data (May 2018-March 2022). Multiple logistic regressions and survival analysis were performed on infant outcomes; NICU stay, APGAR score, infant size, and infant length of stay (LOS) with PNC categories inadequate (< 10 PNC visits) vs adequate (10 or more) adjusting for covariates including maternal race, insurance status, parity, smoking status, substance use status, and diabetes status.ResultsOf births to teenagers, 14% received inadequate PNC. Teens who received inadequate PNC had increased odds of infant admitted to NICU (aOR: 1.84, CI:(1.41, 2.42), p < 0.0001), low 5- minute APGAR score (aOR: 3.26, CI:(2.03,5.22), p < 0.0001), and increased LOS (Est. = -0.33, HR: 0.72, CI:(0.65,0.81), p < 0.0001).ConclusionsResults demonstrated that infants of teenagers who received inadequate PNC are at increased risk of requiring a NICU stay, having a low APGAR score and requiring an increased LOS. PNC is particularly important for these groups as they are at increased risk of poor birth outcomes.

Losing Connection: Experiences of Virtual Pregnancy and Postpartum Care During the COVID-19 Pandemic.

The rapid uptake of telehealth for perinatal care during the coronavirus disease-2019 (COVID-19) pandemic has led to mixed evidence as to its effectiveness, with limited research demonstrating satisfaction and appropriateness for communities at risk for poor birth outcomes. The purpose of this article is to describe the experiences of virtual care during pregnancy and postpartum among a diverse group of pregnant/birthing people in Washington State during the COVID-19 pandemic. We conducted a thematic analysis study exploring experiences of care during the COVID-19 pandemic for 15 pregnant and birthing people in Washington State. This secondary analysis utilized data specific to experiences receiving care via telehealth. Three dominant themes were identified: loss of connection and relationships with providers; need for hands-on interactions for reassurance; and virtual care is good for some things but not all-desire for immediate, accessible care when appropriate. The majority of participants felt that it was subpar to in-person care due to a lack of connection and the inability to receive necessary tests and hands-on reassurance. Our study findings encourage very judicious use of virtual care for communities that are at high risk for birth disparities to avoid impacting relationship building between patient and provider.

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

BackgroundWomen with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AimTo evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. MethodsRealist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FindingsExperiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women’s anxiety, enabled the development of a supportive network and improved women’s ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. ConclusionThe identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents.

Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.

Sanitation and Multiple Micronutrient Supplementation in Pregnancy Outcomes: Literature Review

BACKGROUND: Around 2.6 billion people lack proper sanitation. In addition, nutritional problems such as multiple micronutrient (MMN) deficiency can increase morbidity, mortality, and impaired neurocognitive growth at later stages of life. In addition to the need for a sanitary approach, a globally applicable strategy to prevent micronutrient deficiencies in pregnant women, UNICEF recommends the use of MMN for prenatal supplementation as an initial program in developing countries, to reduce the risk of poor birth outcomes. AIM: The aim of this literature study was to analyze the relationship between sanitation and the multimicronutrient (MMN) approach in pregnancy and birth outcomes. METHODS: This research was conducted using literature review method. Various references were collected from online database including reports, journals, and books. The journals were mostly from the scholarly journals. The articles were screened according to the research objectives. The keywords used are sanitation, pregnancy, and multiple micronutrient approach. RESULTS: Several studies have shown that sanitation and the multi micronutrient (MMN) approach play a role in determining pregnancy outcomes. We conclude that the importance of sanitation on pregnancy outcome is to reduce the chance of infection. The importance of MMN in pregnancy outcomes is that mothers who consume MMN during pregnancy can reduce the risk of poor birth output. The role of stakeholders is needed in the future. CONCLUSIONS: Several studies have shown that sanitation and multi micronutrient (MMN) play a role in determining pregnancy outcome.

Folate Deficiency Is Spatially Dependent and Associated with Local Farming Systems among Women in Ethiopia

ABSTRACTBackgroundFolate is essential for the synthesis and integrity of DNA, normal cell formation, and body growth. Folate deficiency among women of reproductive age (WRA) increases the risk of poor birth outcomes including neural tube defect (NTD)-affected pregnancies. Folate status is largely dependent on dietary intakes.ObjectivesWe aimed to explore the spatial distribution of biomarkers of folate status and their association with farming systems among nonpregnant WRA in Ethiopia.MethodsSerum and RBC folate concentration data were derived from the Ethiopia National Micronutrient Survey of 2015. The spatial dependencies of folate concentration of WRA were investigated and its relation with the dominant local farming system was explored.ResultsThe median serum folate and RBC folate concentrations were 12.3 nmol/L and 567.3 nmol/L, respectively. The national prevalence of folate deficiency using homocysteine concentration as a metabolic indicator based on serum and RBC folate concentration was 11.6% and 5.7%, respectively. The majority of women (77.9%) had low RBC folate concentrations consistent with increased risk of NTD-affected pregnancies. Folate nutrition was spatially dependent at distances of ≤ 300 km. A marked variability in folate concentration was observed between farming systems: greater RBC folate concentration (median: 1036 nmol/L) was found among women from the Lake Tana fish-based system, whereas the lowest RBC folate concentration (median: 386.7 nmol/L) was observed in the highland sorghum chat mixed system.ConclusionsThe majority (78%) of WRA in Ethiopia had low folate status potentially increasing the risk of NTD-affected pregnancies. These findings may help national and subnational nutrition intervention strategies to target the most affected areas in the country.

Initial Psychometric Testing of a Brief Maternal Oral Symptom Survey

IntroductionOral health is an important component of maternal health. Pregnant women face unique oral health challenges. Although there is abundant evidence of the strong association between poor oral health and adverse pregnancy outcomes, oral health assessment is frequently overlooked by prenatal care providers. The purpose of this study was to test the reliability and validity of a brief maternal oral symptom survey for potential use by prenatal care providers to screen pregnant women for oral health concerns.MethodsThis study provides results of preliminary psychometric testing of a brief maternal oral symptom survey. The survey was administered to 455 pregnant African American women at 2 time points: early pregnancy (8‐14 weeks) and late pregnancy (24‐30 weeks). Saliva samples were collected on a small subset of the larger sample (n = 34). Cronbach's alpha was used to measure the internal consistency of the survey. Content validity was assessed using an expert panel (n = 32), and criterion validity was assessed by testing the association of survey items with salivary biomarkers.ResultsThe oral health survey showed moderate overall content validity. Scores on the content validity index identified that 5 out of 10 survey items were relevant, clear, and important. Log‐transformed C‐reactive protein levels were associated with reported “dry mouth” and education. Cronbach's alpha value was 0.502.DiscussionSuggested revisions of the oral symptom survey include removing items that performed poorly on the content validity index and additional inclusion of sociodemographic variables. With further testing and validation, this survey has the potential to be an effective screening tool to assess for prenatal oral health concerns that increase risk for poor birth outcomes.

Birth Outcomes for Medically High-Risk Pregnancies: Comparing Group to Individual Prenatal Care.

Group prenatal care models were initially designed for women with medically low-risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birth weight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group versus individual prenatal care. This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI > 45 kg/m2). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (one or more groups) or minimum threshold (five or more groups). Participation in group prenatal care at either treatment exposure level was associated with a lower risk of neonatal intensive care unit (NICU) admissions (10.2 group vs. 13.8% individual care, odds ratio [OR] = 0.708, p < 0.001). Participating in the minimum threshold of groups (five or more sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR = 0.569, p < 0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR = 0.483, p < 0.001). No differences in birth weight were observed. This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birth weight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups. · This study compares outcomes for women who receive group versus individual prenatal care. · The study population was limited to women with diabetes, hypertension, and/or high BMI.. · Group participants did not have higher rates of preterm birth, low birth weight, or NICU admissions..

Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study.

BackgroundSafe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual.ObjectiveThis study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events.MethodsParticipants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys.ResultsBased on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02).ConclusionsAlthough both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events.

Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how?

BackgroundBlack and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity services and communicate concerns to healthcare professionals. To address the language barrier, many UK maternity services offer telephone interpreter services. This study explores whether or not women with social risk factors find these interpreter services acceptable, accessible and safe, and to suggest solutions to address challenges.MethodsRealist methodology was used to refine previously constructed programme theories about how women with language barriers access and experience interpreter services during their maternity care. Twenty-one longitudinal interviews were undertaken during pregnancy and the postnatal period with eight non-English speaking women and their family members. Interviews were analysed using thematic framework analysis to confirm, refute or refine the programme theories and identify specific contexts, mechanisms and outcomes relating to interpreter services.ResultsWomen with language barriers described difficulties accessing maternity services, a lack of choice of interpreter, suspicion around the level of confidentiality interpreter services provide, and questioned how well professional interpreters were able to interpret what they were trying to relay to the healthcare professional during appointments. This resulted in many women preferring to use a known and trusted family member or friend to interpret for them where possible. Their insights provide detailed insight into how poor-quality interpreter services impact on their ability to disclose risk factors and communicate concerns effectively with their healthcare providers. A refined programme theory puts forward mechanisms to improve their experiences and safety such as regulated, high-quality interpreter services throughout their maternity care, in which women have choice, trust and confidence.ConclusionsThe findings of this study contribute to concerns highlighted in previous literature around interpreter services in the wider healthcare arena, particularly around the lack of regulation and access to high-quality interpretation. This is thought to have a significant effect on pregnant women who are living socially complex lives as they are not able to communicate their concerns and access support. This not only impacts on their safety and pregnancy outcomes, but also their wider holistic needs. The refined program theory developed in this study offers insights into the mechanisms of equitable access to appropriate interpreter services for pregnant women with language barriers.

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study.

BackgroundPrevious research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children.MethodsWe draw on the UK Millennium Cohort Study (sweeps 1–6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics.ResultsIn baseline models, MAR LBW children [age 3: β = 0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β = 0.21, 95% CI: 0.009, 0.418; age 7: β = 0.163, 95% CI: -0.148, 0.474; age 11: β = 0.003, 95% CI: -0.318, 0.325; age 14: β = 0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14.ConclusionsDespite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents.

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study.

BackgroundPrevious research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children.MethodsWe draw on the UK Millennium Cohort Study (sweeps 1–6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics.ResultsIn baseline models, MAR LBW children [age 3: β = 0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β = 0.21, 95% CI: 0.009, 0.418; age 7: β = 0.163, 95% CI: -0.148, 0.474; age 11: β = 0.003, 95% CI: -0.318, 0.325; age 14: β = 0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14.ConclusionsDespite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents.

Maternal Hemoglobin Concentration and Pregnancy Outcome in a Sample of Iraqi Women

Aim of study: To analyze the maternal and perinatal outcome in varying degree of anemia and assess whichlevel of hemoglobin concentration has best pregnancy outcome in Iraqi women.Patients and Method: A cohort study that was conducted at Al-Elwiya Maternity Teaching Hospital duringthe period from 1st of Dec 2017 till end of Dec 2019. It included 500 pregnant women who were followedup in labor until delivery and their maternal and perinatal outcome were noted. Hemoglobin and MCV ofeach pregnant woman were measured at late second and third trimester. Hemoglobin groups were relatedto the maternal characteristics, delivery characteristics and pregnancy outcome. The patients underwent acomplete blood count, blood film examination and hematocrit estimation.Results: In this study, 33.4 % of study participants had mild anemia and 22% of them had normal hemoglobinand MCV. Incidence of adverse perinatal outcome was 32.6% and adverse maternal outcome was 11.8%.Maternal hemoglobin and MCV levels are significantly affected by mother’s age. Hemoglobin level is alsoaffected by parity while MCV level doesn’t. Low maternal hemoglobin was associated with increased riskof poor birth outcomes including LBW, preterm birth and adverse maternal health outcomes, includingcesarean section and induction of labor.Conclusion: Maternal anemia is strongly associated with several different types of maternal morbidity andperinatal morbidity.

Enhanced Doula Support to Improve Pregnancy Outcomes Among African American Women With Disabilities

This article is a meta-analysis of studies examining the influence of doula support on birth outcomes among African American women with disabilities. While an estimated 11% of women in their childbearing years are impacted by some type of disability, mothers with disabilities are faced with risks during pregnancy. When risks in addition to maternal disability are present, mothers may encounter extra barriers that impede receipt of effective care. A meta-analysis of studies revealed women with disabilities are at risk for poor birth outcomes. Specifically, women of color living in poverty-stricken areas are at a greater risk for adverse birth outcomes. As a result of adverse experiences related to birth, mothers may experience levels of traumatic stress. To advocate for better pregnancy and birth outcomes, the intervention of doula support is emphasized. There is a widely recognized need to promote better pregnancy outcomes among African American women to address disproportionate birth outcomes. Strategies to enhance doula support among African American women with disabilities are offered. Implications include future research surrounding the development of a training program for doulas specific to disability, trauma-informed care, and maternal mental health.

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress.

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries.

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care.

Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. Twenty-two women of color living in the San Francisco Bay Area and receiving support services from a community-based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person-centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community-centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.