Pregnancy Risk Research Articles

Voting Restrictions and Increased Odds of Adverse Birth Outcomes in the US.

Disparities persist in adverse birth outcomes - preterm birth and small-for-gestational age (SGA) among racialized populations. Previous studies have indicated that voting restrictions are associated with health outcomes, such as access to health insurance and teenage birth rates. This paper examines whether the association between voting restrictions and adverse birth outcomes varies according to birthing individuals' race/ethnicity. These analyses merged individual-level 2019-2020 Pregnancy Risk Assessment Monitoring System (PRAMS, 8th edition) data with state-level exposure information. The exposure, the Cost of Voting Index (COVI), is a 2020 state-level measure of voting restrictions, and the outcomes were preterm birth and SGA. Multilevel logistic regression, survey-weighted models adjusted for sociodemographic and geographically-based characteristics. Subanalyses examined if the association differed by race (non-Hispanic White, non-Hispanic Black, Hispanic, API, Other). In the unadjusted model, a standard deviation increase in COVI was associated with increased odds of preterm birth (OR = 1.11, 95% CI = 0.98, 1.25) and SGA (OR = 1.12, 95% CI = 1.02, 1.22). The association for SGA was still significant in the fully adjusted models. Results differed by race/ethnicity with the largest effects among API (OR = 1.20, 95% CI = 0.95, 1.52) for preterm birth and OR = 1.27, 95% CI = 1.01, 1.59) for SGA respectively). Our results suggest structural voting barriers disproportionately increase the odds of adverse birth outcomes, especially for API-birthing individuals. Increasing voting restrictions may amplify existing birth inequities.

Comprehensive Monitoring System for High-Risk Pregnancies

Prenatal care protects the Health of both mother and baby, influencing the development and well-being of the mother-child duo. Risks during pregnancy, such as preeclampsia or gestational diabetes, can have long-term effects on the mother’s Health. Effective monitoring of pregnancy risks is essential for improving health outcomes. Therefore, we propose the development of an integrated high-risk pregnancy monitoring mobile application incorporating IoT sensors (smartwatches) to monitor critical biomedical variables. This allows healthcare professionals to collect and analyze data, reducing prenatal risks and improving maternal and fetal health outcomes. Functional and non-functional requirements were gathered and refined through continuous support and iterative meetings with an experienced gynecologist. We identified multiple functional requirements through user stories. Non-functional requirements were also collected to design the proposed architecture and comply with current legislation, prioritizing the security and privacy of biomedical data. We conducted Load tests on the proposed architecture, verifying the system’s quality attributes. Additionally, we carried out usability tests through interviews with a sample of ten pregnant women. Participants found the application intuitive and essential for monitoring their Health, and it could provide a constant source of confidence throughout their pregnancy. The proposed system could be a valuable tool for high-risk pregnancy monitoring. However, large and intensive clinical trials are essential to validate its effectiveness in real-life scenarios.

New AHA/ASA Stroke Guidelines Focus on Prevention, Pregnancy Risks and the New Weight-loss Drugs

New AHA/ASA Stroke Guidelines Focus on Prevention, Pregnancy Risks and the New Weight-loss Drugs

Intimate Partner Violence and Pregnancy and Infant Health Outcomes - Pregnancy Risk Assessment Monitoring System, Nine U.S. Jurisdictions, 2016-2022.

Intimate partner violence (IPV) can include emotional, physical, or sexual violence. IPV during pregnancy is a preventable cause of injury and death with negative short- and long-term impacts for pregnant women, infants, and families. Using data from the 2016-2022 Pregnancy Risk Assessment Monitoring System in nine U.S. jurisdictions, CDC examined associations between IPV during pregnancy among women with a recent live birth and the following outcomes: prenatal care initiation, health conditions during pregnancy (gestational diabetes, pregnancy-related hypertension, and depression), substance use during pregnancy, and infant birth outcomes. Overall, 5.4% of women reported IPV during pregnancy. Emotional IPV was most prevalent (5.2%), followed by physical (1.5%) and sexual (1.0%) IPV. All types were associated with delayed or no prenatal care; depression during pregnancy; cigarette smoking, alcohol use, marijuana or illicit substance use during pregnancy; and having an infant with low birth weight. Physical, sexual, and any IPV were associated with having a preterm birth. Physical IPV was associated with pregnancy-related hypertension. Evidence-based prevention and intervention strategies that address multiple types of IPV are important for supporting healthy parents and families because they might reduce pregnancy complications, depression and substance use during pregnancy, and adverse infant outcomes.

High fetal risk in pregnancies of myositis patients—a Hungarian cohort study

BackgroundSeveral systemic autoimmune rheumatic diseases may affect both fetal and maternal outcomes during pregnancy. However, little information is available regarding pregnancy outcomes in women with idiopathic inflammatory myopathy. Previously published articles stated that the activity of maternal disease may worsen pregnancy outcomes. A former multicenter study suggested that anti-Jo1 antibody positivity and joint involvement could distinguish a more vulnerable group regarding pregnancy complications. Our aim was to identify prognostic factors among clinical symptoms at disease onset and auto-antibody profiles for identifying a high-risk group for poor pregnancy outcome.MethodsThe clinical data of the myositis cohort of the Division of Clinical Immunology, University of Debrecen, Hungary, were reviewed retrospectively. IIM diagnoses were made by Bohan and Peter's criteria or European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria. Disease activity was evaluated based on physician opinion. Gynecological definitions were used to evaluate fetal outcomes.ResultsReviewing clinical data of overall 763 patients (542 women and 221 men) revealed that 5.2% of female patients had pregnancies in the same time or after myositis onset. Among these, 71.4% of the mothers suffered from polymyositis (PM) and 28.6% suffered from dermatomyositis (DM). Their mean age at the time of myositis diagnosis was 25.28 years, and the average interval between myositis diagnosis and first pregnancy was 55.4 months. Maternal complications included preeclampsia in one case and pregnancy-induced myositis in 25% of cases. All cases of pregnancy-induced myositis improved after immunosuppressive treatment. Twenty-eight patients reported 60 pregnancies overall, with multiple pregnancies occurring in 57% of cases. Early or late fetal loss was detected in 41.7% of the pregnancies, and stillbirth occurred in 18.3% of deliveries. Although late fetal loss was observed mainly due to placental insufficiency in patients with anti-Jo1 positivity and complications seemed more frequent in PM cases, logistic regression analysis only confirmed that multiple pregnancies could be an independent risk factor for fetal (p = 0.0112) and interstitial lung disease of maternal complications (p = 0.02).ConclusionInternal organ involvement and the number of pregnancies could influence pregnancy outcomes in myositis patients. Patients’ family planning should be well organized and counseled by myositis experts. Prospective, multicenter collaborations are needed to precisely identify high-risk groups and state managing guidelines.

Insights into pregnancy risks associated with active juvenile idiopathic arthritis

Insights into pregnancy risks associated with active juvenile idiopathic arthritis

Evaluation and comparison of disability and functioning of low-risk pregnant women in 2nd and 3rd trimester using the world health organization disability assessment schedule 2.0

Background: Pregnancy is a physiological phenomenon where there is progressive anatomical, physiological, and biochemical change not only confined to the genital organs but also to all the systems of the body. There is a lack of knowledge in the field of functioning and disability among women with low-risk pregnancy without severe complications, and the condition that can lead to limitation in activity and restriction of participation. Considering the lack of research and the fact that the physiological changes of pregnancy can impact negatively on women’s functioning, the purpose of this study was to evaluate disability and functioning of low-risk pregnancy and its associated factors using a specified diagnosed tool developed by the World Health Organization (WHO). Aims and Objectives: The aim of the study was to evaluate disability and functioning of low risk pregnancy using the WHO disability assessment schedule 2.0 (WHODAS 2.0). Materials and Methods: This is an observational hospital-based prospective study, 140 women aged 18–35 year with low-risk pregnancy were interviewed first in 2nd trimester using WHODAS 2.0 questionnaire which was followed by 2nd interview in 3rd trimester with a minimum gap of 8 weeks and comparison was done between both trimester. Results: Higher level of disability observed in cognition in 2nd trimester (P=0.009) while mobility and life activities domain were high in 3rd trimester (P=0.01 and P=0.027). Self-care domain had P=0.008 which was statistically significant with increasing level of difficulty in self-care as pregnancy advances. Getting along (P=0.005), participation (0.042) indicating greater difficulty as pregnancy progresses. Conclusion: The findings showed that even in a low risk pregnancy, functioning can be affected in different domains. The identification of impairments to functioning could enable improvement in care. Longitudinal studies involving the first trimester and postpartum are necessary to gain insight into women’s disability and functioning during the pregnancy puerperal period.

Association between Pregnancy and Musculoskeletal Conditions in Active-Duty Military Service Members.

Non-combat musculoskeletal conditions are endemic among service members and disproportionately affect females. Pregnancy and childbirth contribute to lower physical fitness assessment scores and higher body mass index, both risk factors for musculoskeletal conditions, for up to one-year post-pregnancy. However, there is a paucity of information regarding the impact of pregnancy on musculoskeletal conditions. To explore the association between the post-pregnancy period and incident musculoskeletal conditions (MSK). Retrospective, longitudinal cohort study. Medical and administrative data from the Medical Assessment and Readiness System. Female military service members with and without a pregnancy. Months since pregnancy end, health history, and demographic and military service data were abstracted for each subject. Subsequent MSKs were identified with relevant ICD-10 codes. A multivariable logistic regression model assessed the association between the time since pregnancy end and MSK incidence. A total of 298,607 female service members were identified, of which 19,980 had a pregnancy. A larger percentage of post-pregnancy service members (65.8%) had a MSK diagnosis as compared to the non-pregnant cohort (60.3%). Adjusting for covariates, the model suggests a temporal influence on post-pregnancy MSK incidence, such that service members 3- to 4-months and 5- to 6-months post-pregnancy were more likely to be diagnosed with a MSK as compared to the non-pregnant cohort. However, service members <2 months post-pregnancy were less likely to be diagnosed with an MSK, and the odds of an MSK beyond 6-months decreased out to 24-months post-pregnancy. Pregnancy may increase a service member's odds of sustaining an MSK 3- to 6- months post-pregnancy. Understanding the relationships between pregnancy and MSK risks may lead to changes in postpartum return-to-duty/activity policies, better enabling service members to care for themselves and their families.

Pregnancy Among Reported Lyme Disease Cases-United States, 1992-2019.

Lyme disease (LD), the most common vector-borne disease in the United States, typically presents with a localised erythema migrans rash (EM). Left untreated, infection can disseminate to cause severe heart, joint or nervous system manifestations. Summaries of LD surveillance data have been published previously but did not include the frequency, demographic or clinical characteristics of LD cases during pregnancy. We summarised confirmed and probable LD cases by pregnancy status as reported to the U.S. Centers for Disease Control and Prevention during 1992-2019. We defined an LD case during pregnancy as one with (1) female sex, (2) age 14-49 years and (3) positive pregnancy indication. We evaluated the frequency, seasonality, age distribution, race and ethnicity, geographic distribution and clinical manifestations of LD cases during pregnancy and cases among non-pregnant females. We compared proportions using chi-squared tests. Among 698,876 reported LD cases, 112,002 (16%) were confirmed or probable cases among females aged 14-49 years; 32,301 (29%) were specifically reported as non-pregnant and 643 (0.6%) (568 confirmed and 75 probable cases) reported as pregnant. Illness onset peaked in June among LD cases during pregnancy, but in July for cases among non-pregnant females. A higher proportion of confirmed LD cases during pregnancy had only EM rash than did cases among non-pregnant females (66% vs. 60%, p = 0.019). LD cases during pregnancy are rare. Compared to non-pregnant females, cases among pregnant females more commonly involve early clinical manifestations. These patterns could suggest earlier detection or more complete reporting of LD cases during pregnancy than their non-pregnant counterparts. Earlier detection could be due to frequent contact with healthcare or increased self-advocacy during pregnancy. Prompt antimicrobial treatment is critical for preventing severe disease and reducing risk of adverse pregnancy or birth outcomes.

Family Planning Counseling and Practices in Kidney Transplant Recipients.

Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited. This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14-45 years. A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified. Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients' reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.

Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials

Globally, approximately 19.4% of women of reproductive age use intrauterine contraception, encompassing both copper intrauterine devices (Cu-IUDs) and levonorgestrel intrauterine devices (LNG-IUDs). Despite current guidelines endorsing intrauterine contraception as a primary method, there remains debate regarding device selection. Notably, the lack of data regarding reasons for discontinuation has limited previous meta-analyses. This study aims to comprehensively evaluate the potential differences between intrauterine devices using available multinational data, thereby providing a basis for global policy and healthcare services. We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for primary studies published from inception to January 13, 2024, with no language or geographic restrictions. The study was registered on PROSPERO (CRD42024496400). We included only randomized controlled trials comparing Cu-IUDs and LNG-IUDs. Data extraction was independently conducted by two reviewers, with unresolved discrepancies referred to a third senior reviewer for consultation. The primary outcome was pregnancy, with secondary outcomes encompassing continuation, reasons for discontinuation, expulsion, satisfaction, and other adverse events. Data were synthesized using a random-effects model. Risk of bias was evaluated with the Cochrane Collaboration's tool, and evidence quality was assessed using the GRADE framework. An analysis of 20 trials showed that compared to Cu-IUDs, LNG-IUDs were associated with lower risks of pregnancy (Risk Ratio 0.22, 95% confidence interval 0.12-0.39), ectopic pregnancy (RR 0.12, 95% CI 0.03-0.47), discontinuation due to increased bleeding (RR 0.49, 95% CI 0.28-0.85), increased bleeding (RR 0.42, 95% CI 0.25-0.7), heavy bleeding (RR 0.41, 95% CI 0.22-0.75), and dysmenorrhea (RR 0.41, 95% CI 0.34-0.48), but they carried a higher risk of discontinuation due to amenorrhea (RR 21.05, 95% CI 8.83-50.00). When comparing LNG (52mg) IUD with copper (380mm2) IUD, The LNG-IUD showed a lower risk of discontinuation due to increased bleeding (RR 0.68, 95% CI 0.55-0.58) and dysmenorrhea (RR 0.42, 95% CI 0.34-0.53), but a higher risk of discontinuation due to bleeding issues (RR 2.83, 95% CI 2.47-3.25) and amenorrhea (RR 5.92, 95% CI 2.81-12.49). There were no significant differences between the two terms of continuation, expulsion, non-medical reasons for discontinuation, satisfaction, and other adverse outcomes. LNG-IUDs and Cu-IUDs are both highly effective contraceptive methods. Compared to Cu-IUDs, LNG-IUDs were associated with a lower risk of pregnancy and adverse reactions. However, LNG-IUDs carry a higher risk of amenorrhea. When recommending contraceptive methods, healthcare providers should fully inform patients of these potential risks and consider patient preferences. The research was funded by Hunan Provincial Natural Foundation of China (2021JJ30040), the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University (2021KFJJ06), and the National Natural Science Foundation of China (No. 81672225).

Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.

There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births. To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset. Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events). Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions

PurposeAnti-seizure medications (ASM) can lower the efficacy of hormonal birth control (BC), while estrogen-containing BC can increase ASM metabolism, altering seizure frequency. Despite these adverse interactions, many youth with epilepsy demonstrate inadequate knowledge about this topic. Thus, there is a need to develop tools that empower youth with epilepsy to make more informed contraceptive decisions. This study assesses the use of a video-based educational tool to raise awareness of BC and ASM interactions in this population. MethodsWe created a video that gives an overview of possible interactions between certain BC methods and ASMs, mainly increased risk of pregnancy and change in seizure frequency. The video was shown to female patients aged 12 and older with epilepsy in a child neurology clinic and followed by a discussion with their treating neurologist. Fifteen patients completed two surveys that collected demographics, ASM regimen, BC history, and assessed exposure to and understanding of the subject matter before and after viewing the educational tool using 11-point Likert scales. We received seven responses from provider opinion surveys that were administered after the visit to assess the practicality of the video tool in teaching patients about their medication interactions. Data was analyzed with descriptive statistics and one-tailed paired t-tests (α = 0.05). ResultsPatients ranged from ages 16 to 24, with 46.7 % being in the 16 to 18 year-old range, 26.7 % in the 19 to 21 year-old range, and 26.7 % in the 22 to 24 year-old range. The median age was 19. 33 % of the patients reported having used BC, with 27 % reporting current interest in using BC. 33 % of patients were taking ASM that could reduce BC efficacy, and 27 % were on ASM with efficacy that can be reduced by BC. While 80 % of patients endorsed having previously discussed BC and ASM interactions with a doctor, patients rated their knowledge of the subject pre-video as moderately low with high interest in learning more about the topic. Patients’ understanding of how BC and ASM interactions can increase risk of pregnancy showed a significant increase post-video. Patients also indicated a high likelihood that they would think of the video when choosing a BC method and that they are more likely to start a discussion with their doctor about BC and ASM interactions because of the video. Treating neurologists showed high agreement that the video is useful in teaching their patients about BC and ASM interactions. ConclusionYouth with epilepsy deserve engaging resources that empower them to make informed decisions about BC. Despite most of our patients having had prior education about BC and ASM interactions, our results support the need for educational tools beyond patient-provider discussion and the efficacy of video as a tool to enhance understanding of this topic. The tool also showed potential to influence future patient decision making regarding BC and to empower patients to take an active role in discussing BC with their doctor. Our findings support a role for educational videos as an effective way to teach youth with epilepsy about reproductive health concerns and to promote active participation in decision making.

Nonuse of Contraception at Conception Due to Partner Objection and Pregnancy-Related Health Care Utilization, Postpartum Health, and Infant Birth Outcomes.

Objective: Reproductive coercion has been associated with adverse reproductive health experiences. This study examined the relationship between nonuse of contraception due to partner objection, one aspect of reproductive coercion, and selected pregnancy-related outcomes. Methods: We used 2016-2020 data from the Pregnancy Risk Assessment Monitoring System in 22 jurisdictions to assess the prevalence of nonuse of contraception due to a partner objection by select characteristics among individuals with a recent live birth who reported an unintended pregnancy. We calculated adjusted prevalence ratios (aPRs) to understand associations with health care utilization, postpartum behaviors and experiences, postpartum contraceptive use, and infant birth outcomes. Results: Among people with a recent live birth in the study jurisdictions (n = 29,071), approximately 5% reported nonuse of contraception due to a partner objection and unintended pregnancy. This experience was associated with lower prevalence of attending a health care visit before pregnancy (aPR 0.8, 95% confidence interval [CI] 0.7-0.9), first trimester prenatal care, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6-0.9 for both). Higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1-1.6) and partner objecting to using birth control postpartum (aPR 2.8, 95% CI 2.1-3.9). Conclusions: Nonuse of contraception due to a partner objection at conception was associated with poor mental health and lower health care utilization around the time of pregnancy. Prevention efforts may include strategies that ensure provider screening for intimate partner violence, and evidence-based approaches that teach about healthy relationships, enhance self-efficacy, and address underlying drivers of violence.

The impact of caregiver and intended mode of birth on the public cost of care: Cost analysis of maternity and neonatal care in New Zealand

ProblemWomen who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability. BackgroundNew Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care. AimTo compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system. MethodsPopulation-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques. Findings248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 – 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 – 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers. DiscussionConsistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences. ConclusionsFunding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models. Statement of significanceProblem: Health systems seek to improve maternity care and contain healthcare budgets.What is already known: Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women.What this paper adds: This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.

Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion. This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices. The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups. The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

Parental Somatic Mosaicism Detected During Prenatal Diagnosis.

Accurate recurrence risks are essential for genomic counselling and parental reproductive choices. Historically, Sanger sequencing was used to test parental samples, which has a limited sensitivity of ∼10% for detecting somatic mosaicism. Next generation sequencing (NGS) methods, utilised for non-invasive prenatal diagnosis (NIPD) and trio prenatal exome sequencing in our laboratory, have greater sensitivity. Here we review the cases of parental somatic mosaicism we have detected and discuss its impact on management. Laboratory databases from 1 January 2015 to 30 September 2022 were reviewed to identify all cases where parental somatic mosaicism was detected during NIPD and prenatal exome testing. During the development of NIPD testing, we identified 10/131 (7.6%) families with parental somatic mosaicism. In six cases where NGS detected levels between 0.37% and 8.82%, prior testing with Sanger sequencing had not detected mosaicism. In our exome sequencing cohort, we detected parental mosaicism in 4/101 (3.96%) cases. Clinical features of the condition were identified in 2/14 parents. The sensitivity of the testing technique needs to be considered when counselling parents on recurrence risk. Parents need to be aware that modern approaches to prenatal diagnosis may allow identification of mosaicism, which may have implications for their own health and change recurrence risks for future pregnancies.

Study on Adolescents Reproductive Health &amp; Problems in a Tertiary Care Hospital, Chattogram

Background: Adolescence is a stage where the physical and psychological development of a child takes place. Inother words, teenagers passing the years between the puberty and adulthood, from ages 10-19 years. Adolescents are likely to face a range of health and social challenges, for instance initiation of sexual activity while there is still lack of adequate knowledge and skill. High prevalence of early marriage and child bearing are associated with higher rate of morbidity and mortality. They are also in higher risk of unwanted pregnancy, unsafe abortion and sexually transmitted infections. The main objective of this study is to suggest the strategies for improvement of adolescents reproductive health status in Bangladesh. Materials and methods: This retrospective observational study was conducted in the Obs and Gynae Department of Chattagram Maa-O-Shushu Hospital Medical College (CMOSHMC) from July to December 2022. Total 436 adolescents were included in this study who were admitted in Obs and Gynae Department instudy period. All cases reviewed retrospectively from in patients records. An inclusion criterion of age in this study is 10-19 years. Results: A Total 436 patients were enrolled in this study with age limit between 10- 19 years. Total Obstetric patients were 360 (82.57 %). Among them antenatal patients were 348 (97 %), postnatal patients were 12 (3%). Among antenatal patients primipara 344 (99 %), multi para (2nd pregnancy) 4 (1%). Total delivery occurred in 302 patients. Vaginal delivery occurred in 147 patients (49 %), cesarean section were needed in 140 patients (46%). Repair of perineal tear done in 2 post natal patients. Secondary wound closure was done in 1 patient. Conservative management was given to 70 patients. Sexual abuse in 3 patients, came with 14, 16 and 25 weeks of pregnancy and medical termination were done in all cases. Maternal death was 1 (4.2%) due to primary PPH following LSCS due to central placenta Previa with postoperative cardiac arrest. Total baby delivered 302, alive 287(95%), intrauterine death 15 (5%). LBW (Low Birth Weight) 49 (17 % of alive baby ), IUGR (Intrauterine Growth Restriction) 6 (2%), NND (Neonatal Death) 5 (1.7%). Total Gynae patients admitted were 76 (17.43%), abortion related complications were 52 (68%), menstrual abnormality were 7(9.2%), ruptured ectopic pregnancy following sexual abuse was 1 (0.92% of total patients ) . Conclusion: There is growing attention being paid to improving access to quality maternal care for pregnant and parenting adolescents preventing pregnancy among adolescents are fundamental to achieving positive health outcomes across the life course and imperative for achieving the SDGS (Sustainable Developmental Goals) related to maternal and newborn health. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 60-63

Holistic Analysis and Development of a Pregnancy Risk Detection Framework: Unveiling Predictive Insights Beyond Random Forest

Holistic Analysis and Development of a Pregnancy Risk Detection Framework: Unveiling Predictive Insights Beyond Random Forest

Unveiling barriers to reproductive health awareness among rural adolescents: a systematic review.

Sexual and reproductive health (SRH) among adolescents is a critical aspect of global health. Rural adolescents often encounter significant barriers to reproductive health awareness, elevating their risks for unintended pregnancies, sexually transmitted infections (STIs), and other reproductive health issues. This systematic review seeks to identify and analyze the barriers hindering reproductive health awareness among rural adolescents. This review followed PRISMA guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Taylor & Francis, focusing on studies published from 2019 to 2024. Keywords included "Adolescent," "Rural," "Reproductive Health," "Awareness," and "Barriers." Studies were screened based on eligibility criteria, and data were extracted and analyzed to identify key barriers at the individual, interpersonal, social/community, and health services levels. Out of 669 records, 20 studies met the inclusion criteria. Identified barriers at the individual level included lack of knowledge, myths, misconceptions, and feelings of shame and fear. Interpersonal barriers were related to poor communication between parents and adolescents and misinformation from peers. Social and community barriers encompassed rigid social norms, stigma, and discrimination. Health services barriers included limited access and negative experiences with reproductive health services. Rural adolescents face complex barriers to reproductive health awareness driven by factors at the individual, interpersonal, social, and health services levels. Comprehensive interventions, such as educational campaigns, training for healthcare providers, and improved access via mobile or online platforms, are essential to enhance reproductive health awareness and outcomes. https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).