Pregnancy Visit Research Articles

Https://thejmch.com/index.php?journal=thejmch&page=issue&op=view&path%5B%5D=41

Background: Good antenatal care helps a woman face labour in good health and optimum conditions. The National Institute for Health and Care Excellence (NICE) and WHO guidelines suggest 15 visits in the whole pregnancy. Keeping in view the COVID-19 pandemic to reduce the exposure of pregnant ladies the number of antenatal visits was reduced to 7 milestone visits and outcome was noted. This study aimed to do a comparative study of feto-maternal outcome in antenatal cases at our centre using standard WHO protocol vs. revised antenatal protocol during COVID-19 pandemic. Subjects and Method: This was an observational study done at a tertiary care center of an Armed forces hospital with target population as pregnant ladies attending antenatal care Out patient department of the hospital during COVID19 pandemic Vs Antenatal cases in previous 1 year. A comparative analysis of pregnancy outcome, maternal variables during pregnancy and delivery along with neonatal variables was done. Results: There were lesser deliveries by 41.7% as compared to non-COVID times. There was an increase in the caesarean delivery rate and instrumental delivery rate during COVID times by 11% and 53% respectively. There was increase in Vaginal birth after caesarean (VBAC) by 26.6%. The incidence of fetal growth restriction, placental abruption, maternal anaemia and gestational diabetes mellitus, oligohydramnios and polyhydramnios was low. The incidence of spontaneous abortions was also low in our study. In contrast, the incidence of pre-term deliveries doubled from 7.4% to 13.4%. Neonatal morbidity and mortality indicators like Neonatal Intensive care unit (NICU) admissions showed a rising trend of 1.7% during the COVID (14.6% to 16.3%) with a minimal rise in early neonatal deaths by 0.2%. Conclusion: Our model doesn't show an increase in maternal, neonatal morbidity, and mortality. This model can be used as a standard of care for Antenatal patients during Pandemics. It reduces the risk exposure of the gravid mother without any significant increase in maternal and neonatal morbidity and mortality. Keywords: antenatal care, COVID-19 pandemic, revised antenatal schedule. Correspondence: Dr Vipin Kumar Prajapati, Graded Specialist Department of Obstetrics Gynecology, AFMC, Pune. E Mail: vipinafmc@gmail.com. Contact No: 8811015130. Journal of Maternal and Child Health (2023), 08(01): 125-133 https://doi.org/10.26911/thejmch.2023.08.01.12

Perineal Massage During Pregnancy to Prevent Severe Perineum Laceration in Labor for Mrs. N

As a woman, labor experience could be a best memory, but it was also became a trauma for them especially perineum laceration. Perineum laceration occurred during labor process naturally or instrumentally (episiotomy, extraction). Perineum laceration caused a discomfort and pain especially for heacting process. The trauma caused fearness and affected mother psychology. To minimize the perineum laceration, perineal massage could prevent the perineum laceration and perineum laceration grade II incidence. To determined the application of perineal massage, We did a case study report using descriptive method for Mrs. N 28th years old, second gravide, in Sudagaran Village, Banyumas Regency. Perineal massage was applied for 3 times during the pregnancy visit starting at 29 weeks of gestation and also 2-3 times a week by herself. The labor outcome showed there was nothing perineum laceration occurred during labor. Therefore, perineal massage should be routinely apply to minimize severe perineum laceration incidence.

SARS-CoV-2 Infection Anxiety, Knowledge and Attitudes in University Degree Pregnant Women from Romania-A Cross-Sectional Observational Survey in the First Two Pandemic Years.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a high economic cost, morbidity, and death toll. Due to high rates of mortality and morbidity from coronavirus disease 2019 (COVID-19), pregnant women were at particular risk during this pandemic. We designed and conducted a cross-sectional observational survey in Romanian pregnant women to evaluate the outcome of the SARS-CoV-2 pandemic along with the preventive measures taken by authorities. We applied a 43-item questionnaire. We included 147 women over 18 years old from Romania who were pregnant or gave birth between March 2020 and March 2022. All pregnancies were monitored, most of them by a gynecologist, and only 23% faced rescheduled pregnancy visits. The majority (84%) were screened through the TORCH panel, 95.91% felt anxious because of the pandemic, 87% followed SARS-CoV2 preventive recommendations, and 82% were not infected with the coronavirus. Additionally, 80% were vaccinated against COVID-19. They felt the consequences of the pandemic through anxiety, and their level of anxiety influenced their vaccination decisions, the TORCH testing and the method of giving birth despite the level of education. Fortunately, their pregnancies were monitored properly, and there were no consequences noticed for fetuses at birth.

Psychiatric visits during the postpartum year in women with eating disorders who continue or discontinue antidepressant treatment in pregnancy.

To determine the association between continued antidepressant use in pregnancy and postpartum psychiatric visits for eating (ED) or mood/anxiety disorders in women with preexisting ED. Using Danish health registry data (1998-2015), we identified 3529 pregnancies in women with ED prepregnancy: (i) 564 with continued antidepressant use before and during pregnancy; (ii) 778 with discontinued antidepressants before pregnancy; (iii) 2137 unexposed. Outpatient and inpatient postpartum visits for an ED or a mood/anxiety disorder constituted the outcome measures. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) using Cox regression with inverse probability of treatment weighting, and performed stratified analyses by antidepressant prescription filling in the first 3 months postpartum. The weighted cumulative incidence for an ED visit at end of follow-up was 4.5% (continued) and 4.8% (discontinued). We found no association between continued antidepressant and postpartum ED visit, relative to discontinued (HR: 0.89, 95% CI: 0.52-1.52). The HR for postpartum mood/anxiety disorder visit was 1.27 (95% CI: 0.68-2.36) with continued antidepressants versus discontinued but decreased if more than two antidepressant prescriptions were refilled. Continued antidepressant use was associated with a 57% reduced likelihood of a postpartum ED visit versus discontinued use in pregnancies with antidepressant prescription refills in the early postpartum. Among women with preexisting ED, there was no association between continued antidepressant use during pregnancy and the likelihood of postpartum psychiatric visits, relative to discontinued antidepressants before pregnancy. Continuation of treatment into the early postpartum is associated with reduced likelihood of postpartum ED visit. Based on data from the Danish registries, we identified 3529 pregnancies among women with preexisting eating disorders before pregnancy. Women with continued antidepressant treatment both before and during pregnancy did not have a lower probability of having postpartum psychiatric visits for an eating disorder or for mood/anxiety disorders (often coexisting with eating disorders), relative to those who discontinued antidepressants before pregnancy. Further continuation of antidepressant treatment into the early postpartum is associated with improved maternal postpartum outcomes. However, residual confounding by disease severity limits confidence in this conclusion.

MATERNAL FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT NEWBORN IN A TERTIARY CARE CENTRE OF SOUTHERN RAJASTHAN

Objective: Low birth weight is defined as weight at birth of <2500 g as per the World Health Organization. Low birth weight (LBW) newborns have higher risk of morbidity and mortality during perinatal period. The aim of the study was to ascertain the maternal factors leading to low birth weight in newborns. Methods: A cross-sectional study was done for a period of 1 year. Mothers delivering term LBW babies from singleton pregnancy were taken as cases and mothers with term, normal weight newborns from singleton pregnancy were termed as control group. Babies with congenital malformations, still births, and multiple gestations were excluded from the study. Written consent for the study in local language from each subject was taken. Institutional ethical clearance was obtained. Results: One thousand two hundred and fifty-six babies were born during the study period and out of these 258 babies were weighing <2.5 kg thus the incidence of LBW <2.5 kg was 20.54%. Young maternal age (<30 years) and multi parity (≥3) had significantly increased LBW incidence of 28.7% and 32%, respectively. Pregnancy complications such as anemia and pre-eclampsia had significantly increased incidence of LBW newborn of 33.455 and 29.1%, respectively. Conclusion: Pregnancy-related anemia and hypertension are an important risk factor for LBW. Young maternal age pregnancy and poor ante natal visits also contribute toward LBW.

Relationship between Knowledge of Pregnant Women and Compliance with Pregnancy Visits (Antenatal Care) K1 to K4 Sijambi Village, Datuk Bandar District, Uptd Work Area of Datuk Bandar Health Center 2022

The maternal mortality rate is an indicator to assess the success of achievements in maternal health efforts. One of the efforts to reduce maternal mortality is antenatal care, which is an examination of pregnancy that aims to improve the health of pregnant women, both physically and mentally optimally, and restore the health of reproductive organs. This study aims to see whether there is a relationship between knowledge of pregnant women and compliance Pregnancy Visit (Antenatal Care). This research is a non-experimental research with a descriptive correlation. The population in this study were all pregnant womenthird trimesterwho visited the Datuk Bandar Health Center UPTD, a total of 47 pregnant women. The sampling technique was carried out using the Accidental Sampling technique so that the total sample was 32 people. Data analysis used the Chi-Square test. The results of this study indicate that from the results of the knowledge questionnaire the majority of respondents had high knowledge (64.5%), while from the results of the pregnancy visit the majority were obedient (58.1%). The results of data analysis showed a value of P = 0.014, where 0.014 < 0.05. This shows that there is a relationship between knowledge of pregnant women and compliance with antenatal care K1 to K4.

Determinants of Low Birth Weight Newborns in Indonesia: Literature Review

LBW is a health problem that requires special attention in various countries, especially in developing countries with low socio-economic conditions. LBW has a greater risk of experiencing morbidity and mortality than babies born with normal weight. Factors that affect low birth weight (LBW) are teenage pregnancy, preeclampsia, anemia, and ANC visits. LBW is also one of the factors that can cause babies to die before reaching the age of 1 year. The purpose of this systematic literature review is to analyze the relationship between maternal age, preeclampsia, anemia, and ANC visits to determine the cause of LBW so that it can suppress IMR. Using the Critical Appraisal Skills Program (CASP) method with data sources obtained from PubMed, Google Scholar, and Research Gate, there are 145 articles reviewed. Inclusion criteria were (1) Teenage pregnancy, infant; (2) the incidence of LBW; (3) Factors influencing the incidence of LBW; (4) Full text; (5) Articles published from 2017 to 2021; and (6) national journals. There are 5 articles that meet the inclusion criteria. The results of this literature review are the factors that affect low birth weight (LBW), namely Teen Pregnancy, Preeclampsia, Anemia, and ANC visits.

Knowledge, attitude, and practice of the 2009 Institute of Medicine (IOM) recommendations on the nutritional management of diabetes in pregnancy: an online national survey

AimsAs recommended by the Institute of Medicine (IOM), health practitioners should encourage a healthy nutrition and adequate weight gain during pregnancy in order to ensure favorable pregnancy and fetal outcomes, and to prevent diseases later in life for both mother and child. The purpose of this online survey was to determine the knowledge, attitude, and practice of the 2009 IOM recommendations among healthcare professionals managing nutritional therapy in pregnancies complicated by diabetes in Italy.MethodsA cross-sectional survey was conducted by using an online self-administered questionnaire undertaken between October and December 2021.ResultsOf the 220 participants 89% were diabetologists/endocrinologists/internal medicine specialists and 11% dietitians/nutritionists. The survey found that the 53% of respondents provide a personalized diet to pregnant women with diabetes, while 32% a standard diet plan and only 15% healthy dietary advice. The 69% of the participants investigated for appropriate gestational weight gain, mainly based on pre-pregnancy BMI (96%), gestational weight gain (GWG) at first prenatal visit (80%) and presence of twin pregnancy (58%). Maternal weight gain was evaluated at each regularly scheduled prenatal visit and compared with IOM recommendations for the 87% of healthcare professionals. Diet plan was periodically re-evaluated and/or modified (90% of participants), based on inadequate maternal weight gain and/or fetal growth abnormalities (78%), trimester transition (53%), changes in physical activity and/or a “feel hungry” (50%).ConclusionsThis survey reported the knowledge and attitude of IOM guidelines and the nutritional knowledge and practice of Italian professionals on the nutritional management of diabetes in pregnancy. The application of these recommendations seemed more feasible in clinics/team dedicated to "Diabetes in Pregnancy".

O92 - COVID-19 and beyond – changes to provision of maternity care and future plans in Victorian maternity services

BackgroundDue to the COVID-19 pandemic, rapid service changes were made to maternity care provision in Victorian maternity services. From March 2020 many routine face-to-face visits in pregnancy were replaced by telehealth (telephone or video), along with changes to routine screening. Many providers plan to continue these changes despite a lack of evidence to guide practice. We aimed to describe the changes in maternity care provision, understand the perceived impact and explore services’ future plans regarding these changes.MethodsA population-based cross-sectional study of midwifery managers of all Victorian public and private maternity services was conducted between March and October 2021. Questions explored health service characteristics, changes to maternity care delivery, telehealth practices, perceived impact of changes, and future plans.ResultsFifty percent of services (34/68, 27 public and 6 private) responded, with broad representation of location, birth numbers and size of service. Around 50% of all pregnancy visits became telehealth. There were multiple combinations of which visits were face-to-face and which were telehealth. No visit was conducted face-to-face by all responding services. Visits most likely to be face-to-face were at 39 and 40 weeks gestation (65%). For telehealth appointments there was an ad hoc approach to advising women on routine screening, e.g., measuring blood pressure (11% did not advise at all), fetal growth (26% – no specific strategy) and fetal heart rate (15% – no specific strategy). Over half (52%) would consider maintaining telehealth post-pandemic.ConclusionsEven in a single state there is great variation in telehealth timing, when pregnant women should have face-to-face visits, and what routine screening is maintained. In light of emerging evidence of some potentially poorer clinical outcomes associated with telehealth in pregnancy, these findings need to be considered.

First-Trimester Sequential Screening for Preeclampsia Using Angiogenic Factors: Study Protocol for a Prospective, Multicenter, Real Clinical Setting Study.

IntroductionThe incidence of preeclampsia (PE) is about 2–8%, making it one of the leading causes of perinatal morbidity and maternal mortality in the world. Early prophylactic low dose administration (150 mg) of acetylsalicylic acid is associated with a significant reduction in the incidence of early-onset PE, intrauterine growth restriction (IUGR), and neonatal mean stay in the intensive care unit (ICU). Universal implementation of a first-trimester screening system including angiogenic and antiangiogenic markers [the Placental Growth Factor (PlGF) and/or soluble fms-like Tyrosine Kinase-1 (sFlt-1)] has shown a prediction rate of 90% for early-onset PE but entails a high financial cost. The aim of this study is to determine the predictive and preventive capacity of a universal PE first-trimester two-step sequential screening model, determining the PlGF only in patients previously classified as intermediate risk by means of a multivariate model based on resources already used in the standard pregnancy control, in a real clinical setting. We hypothesize that this screening model will achieve similar diagnostic performance as the universal determination of PlGF but at a lower economic cost.Methods and AnalysisThis is a prospective, multicentric, cohort study in a real-world clinical setting. Every singleton pregnancy will be recruited at the routine first pregnancy visit. In a first step, the first-trimester risk of PE will be calculated using a multivariate Gaussian distribution model, based on medical history, mean blood pressure, Pregnancy-Associated Plasma Protein A (PAPP-A), and Uterine Artery Doppler Pulsatility Index (UTPI). Patients will be classified into three risk groups for PE: (1) risk ≥ 1/50, high-risk with no further testing (blinded PlGF); (2) risk between 1/51 and 1/500, medium-risk requiring further testing; and (3) risk ≤ 1/501, low-risk with no further testing. In a second step, the PlGF will only be determined in those patients classified as intermediate risk after this first step, and then reclassified into high- or low-risk groups. Prophylactic administration of aspirin (150 mg/day) will be prescribed only in high risk patients. As a secondary objective, sFlt-1 values will be blindly determined in patients with high and intermediate risk to assess its potential performance in the screening for PE.Ethics and DisseminationThe study will be conducted in accordance with the principles of Good Clinical Practice. This study is approved by the Aragon Research Ethics Committee (CEICA) on 3 July 2020 (15/2020).Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT04767438.

Association between sociodemographic, obstetric, and lifestyle factors among Hungarian pregnant women-A cross-sectional study.

To learn the association between sociodemographic and obstetric factors and lifestyle characteristics of pregnant women, and to identify factors that can influence pregnant women's health consciousness. A cross-sectional, questionnaire-based study was performed among women who gave birth in Szeged in 2014-2015. Data collection was based on a self-administered questionnaire and health documentations. Overall maternal health promoting behavior (MHPB) index was defined by summarizing the scores obtained from diet, physical activity, smoking status, and alcohol consumption. The final analysis included 1548 mothers; 41.3% (n=602) of the sample had healthy diet, 9.0% (n=134) were physically active and attended special pregnancy exercise classes, 84.4% (n=1279) did not drink alcohol, and 93.5% (n=1447) were nonsmokers. Regarding the MHPB index, 0.8% (n=11) of the women reached the maximum score (20), while the average was 14.8 (SD=2.58). Advanced maternal age (p < 0.001), having a spouse or partner (p < 0.001), higher educational level (p < 0.001), planned pregnancy (p < 0.001), and early visit at pregnancy care (p=0.046) were significantly associated with higher MHPB index. The lifestyle of pregnant women can have a great impact on the developing fetus, either in a positive or negative way. In order to evaluate maternal lifestyle, overall health behavior should be considered. Lifestyle of the included women was not satisfactory, an improvement in health consciousness is needed at every social level; however, the differences between the various social classes may suggest the importance of further promotion and improvement of pregnancy planning and pregnancy care among younger and lower educated women.

The role of psychological self-care on worry of vaccination against COVID-19 in Iranian pregnant women: A cross-sectional study.

Background and AimsAlthough previous studies have reported some psychological factors to prevent the worry of vaccination against COVID‐19 in pregnant women, the role of psychological self‐care is unclear. The present study aimed to investigate the role of psychological self‐care in pregnant women on the depressive symptoms, psychological distress, and worry of vaccination against COVID‐19.MethodsThe present cross‐sectional study was conducted during the peak of the Delta variant of COVID‐19 in Babol city (North, Iran) from August to November 2021. Two hundred pregnant women referring to three prenatal clinics completed five questionnaires including; demographic characteristics, Edinburgh postnatal depression scale, psychological self‐care, brief symptom inventory 18, corona disease anxiety scale, and acceptance of vaccination‐3 inventory.ResultsPregnant women were in relatively good condition based on psychological self‐care but were not significantly associated with demographic characteristics, such as age, gestational age, educational background, pregnancy, and risk of parity. It was psychological self‐care of pregnant women which negatively predicted the depressive symptoms (β = −0.311, p < 0.001), anxiety symptoms (β = −0.269, p < 0.001), psychological distress (β = −0.269, p < 0.001), and worry of vaccination against COVID‐19 (β = −0.214, p < 0.001).ConclusionWomen's psychological self‐care plays a protective role against the depressive symptoms, anxiety symptoms, psychological distress, and worry of vaccination against COVID‐19 during pregnancy. Clinicians need to pay more attention to the role of psychological self‐care as an important factor in preventing the symptoms of anxiety and depression during regular pregnancy visits.

1047-P: To Assess the Physiological Changes of Glucose Metabolism Associated with Increased BMI in Pregnancy

Background: Maternal overweight is a risk factor for Gestational Diabetes Mellitus (GDM) . However, there is emerging evidence that increased maternal BMI has considerable impact on the development of large for gestational age (LGA) offspring even in women who do not develop GDM, possibly related to subtle impairments in glucose metabolism. This study aims to assess physiological changes associated with increased BMI. Methods: 21 women with overweight and 21 normal weight controls were included in this explorative study and received a metabolic assessment at early pregnancy (13.3 weeks) (Visit 1) , including a 60 min frequently sampled intravenous glucose tolerance test (FSIGT) . An OGTT was performed between 24 and 28 weeks of gestation (Visit 2) in women who remained normal glucose tolerant. Results: At V1 mothers with overweight showed significantly elevated fasting glucose and HbA1c values, a well as impaired insulin sensitivity at fasting condition and dynamically assessed during the FSIGT, whereby the Calculated Insulin Sensitivity index (CSI) was lower in the overweight group as compared to normal weight controls (3.5 vs. 6.7 10-4⋅[μU/mL]-1⋅min-1, p=0.025) . The Disposition Index (DI) as a parameter of β-cell function was significantly decreased in mothers with overweight. Likewise, maternal BMI was inversely related to fasting (rho=0.56, p=0.005) and dynamically assessed insulin sensitivity (rho=0.51, p=0.014) as well as the DI (rho=0.51, p=0.014) and the AUC of glucose (rho=0.66, p&amp;lt;0.001) and C-Peptide (rho=0.46, p=0.020) during the OGTT in mothers who remained normal glucose tolerant during pregnancy at V2. Conclusions: Increased maternal BMI is associated to insulin resistance and impaired β-cell function already at early pregnancy. We also observed that maternal BMI was associated with impaired glucose metabolism and especially elevated glucose levels during the OGTT at mid gestation in women who did not develop GDM and remained normal glucose tolerant. Disclosure T.Linder: None. D.Eppel: None. C.Monod: None. G.Kotzaeridi: None. A.Tura: None. C.S.Göbl: Research Support; Dexcom, Inc., Sanofi.

Outcomes of Hepatitis E in Pregnancy

Introduction: Hepatitis E virus infection is an emerging challenge of the developing world. During pregnancy, hepatitis E Virus results in devastating effects endangering the life of both mother and fetus. Hepatitis E contribute to 19% to 25% of maternal and 7-13% of all neonatal deaths. Purpose of this study is to see the association between hepatitis E virus infection and feto-maternal outcomes in pregnancy. Material &amp; Methods: A prospective study design was used. Study was conducted in a tertiary health care sector for a period of March 2018 to January 2021 with sample size of 60 pregnant women. Study was conducted after getting institutional approval and informed consent was taken from all the study participants. Ethical considerations were followed throughout the study period. Data was analyzed using SPSS version 23.0 and descriptive statistics was used. Results: Out of 60 pregnancies, 19 (30%) suffered with PPH, 14 (23.33%) had history of DIC and 16 (26.66%) cases of hepatic encephalopathy were evident. Preterm SVD was a majority reason seen for ending the pregnancy. Results showed that hepatitis E virus caused multiple fetal morbidities. Conclusion: High mortality rate was evident in hepatitis E virus infection affected pregnancies in this study. There is a need to educate pregnant ladies regarding preventive measures to avoid fulminant consequences. Emphasis should be given to follow hygienic practices during pregnancy and proper antenatal visits are mandatory to educate the women. Keywords: Hepatitis E, Fetus Outcomes, Pregnancy, Maternal.

HUBUNGAN PENGALAMAN MENYUSUI PADA IBU BERSALIN CAESAR DENGAN PENGETAHUAN PEMBERIAN ASI EKSKLUSIF DI RSUD Dr. H.ABDUL MOELOEK KOTA BANDAR LAMPUNG

WHO stated that the average number of exclusive breastfeeding in the world in 2018 was 38%, which means that it still has not reached the target in the coverage of breastfeeding up to 80%. The coverage of breastfeeding is influenced by several factors. In Northwest Ethiopia, breastfeeding is influenced by the age of the baby, the mother's employment status, breastfeeding counseling during pregnancy visits, place of delivery, type of delivery and counseling on breastfeeding techniques. Cesarean deliveries are increasing worldwide, it exceeds the WHO range limit which exceeds up to 10% -15%. This type of research uses an analytical design with a cross sectional approach. This research was conducted in RSUD Dr. H. Abdul Moeloek Bandar Lampung City. This study was conducted in March 2021. The population used in this study were all mothers with caesarean delivery. Of the total population of 30 people. The sampling technique in this study is non-probability sampling, purposive sampling type. The criteria for sampling must meet several conditions that meet the inclusion and exclusion criteria. The inclusion criteria in this study are to provide respondents, mothers with caesarean deliveries, have a minimum education of elementary school. While the exclusion criteria in this study were mothers with normal delivery and mothers with caesarean deliveries who were not respondents. The tests carried out were univariate analysis and bivariate analysis. The bivariate analysis test used was the Chi-square test with a value of = 0.05. The results of the study obtained a value of = 0.042, which means that there is a relationship between the experience of caesarean delivery mothers and exclusive breastfeeding.

Meta Analysis: Relationship of Husband’s Knowledge and Support During Pregnancy with Antenatal Care (ANC) Visits by Pregnant Mothers

Antenatal Care (ANC) is a health service by trained health workers for mothers during their pregnancy, which must be carried out routinely, according to standards and in an integrated manner. ANC services are indispensable and recommended for pregnant women in order to maintain the health of the mother and fetus during pregnancy, detect and treat abnormalities early and prepare the mother for safe delivery. In fact, there are still many pregnant women who do not access ANC services according to standards, so this situation can contribute to morbidity and mortality rate (MMR).The research was conducted in November 2020 – March 2021 by searching for secondary data from two electronic databases, namely Google Scholer and Pubmed (2015 to 2020). Studies were selected through the PRISMA protocol and critically assessed using JBI’s Critical Appraisal Tool. Test for heterogeneity, summary effect and publication bias using the JASP application version 0.14.1. Odd ratio with 95% confidence level (CI) was used to calculate the effect size. From the selected data, the husband’s knowledge and support factors have quite a lot of differences in research results, so it is necessary to re-analyze the relationship of husband’s knowledge and support during pregnancy with ANC visits by pregnant women to produce more accurate conclusions. Based on the inclusion criteria, there were 17 studies that could be included in the meta-analysis, with 3.956 respondents from Indonesia, Ethiopia and Vietnam. Homogeneous data with the combined OR value of knowledge of pregnant women with ANC visits is 2,48 (95% CI; 2,01-3,03) and the relationship of husband’s support during pregnancy with ANC visits is 2,03 (95% CI; 1,65-2,51), and there are publications biased. This meta-analysis confirms that there is a significant positive relationship between husband’s knowledge and support during pregnancy and ANC visits.

Identifying Programmatic Factors that Increase Likelihood of Health Facility Delivery: Results from a Community Health Worker Program in Zanzibar.

Community health worker (CHW) interventions have been utilized to address barriers that prevent pregnant women from delivering in health facilities in low- and middle-income countries (LMICs). The objective of this research was to assess the programmatic factors that increase the likelihood of health facility delivery within a large digital health-supported CHW program in Zanzibar, Tanzania. This study included 36,693 women who were enrolled in the Safer Deliveries program with a live birth between January 1, 2017 and July 31, 2019. We assessed whether long-term enrollment, recency of CHW pregnancy visit prior to delivery, and number of routine home pregnancy visits were associated with an increased likelihood of health facility delivery compared to home delivery. We used Chi-squared tests to assess bivariate relationships and performed logistic regression analyses to assess the association between each programmatic variable and health facility delivery, adjusting for relevant confounders. We found that long-term enrollment was significantly associated with increased likelihood of health facility delivery, with the strongest relationship among women with a previous home delivery (OR = 1.4, 95%CI [1.0,1.7]). Among first-time mothers, two or more pregnancy visits by a CHW was positively associated with health facility delivery (OR = 1.8, 95%CI [1.2, 2.7]). Recent pregnancy visit by a CHW was positively associated with health facility delivery, but was not significant at the α = 0.05 level. In this program, we found evidence that at least two routinehome pregnancyvisits, longer length of enrollment in the program, and recency of home visit to the delivery date were strategies to increase health facility delivery rates among enrolled mothers. Maternal and child health programs should undertake similar evaluations to improve program delivery.

FAKTOR DETERMINAN KEJADIAN ANEMIA PADA IBU HAMIL TRIMESTER III

The incidence of anemia in pregnant women in Indonesia was 48,9% in 2018 up from 37,1% in 2013. The number of pregnant women with anemia at the Ketapang I Sampit Community Health Center in Central Kalimantan increased to 150 in 112 in 2017. The research aimed to describe the determinants factor of anemia in Trimester III pregnant women at the Ketapang I Sampit Community Health Center in Central Kalimantan. This research used descriptive quantitative methods with a cross-sectional approach. A total of 31 respondents were sampled using the purposive sampling technique. The research data are tabulated before being describe. The findings revealed that pregnant women with anemia were between the ages 20-35 years old (71%), had completed high school (52%), nullipara (45%), had a two-year gap between pregnancies (29%), not working (75%), low income (58%), did not take blood-booster tablets (84%), pregnant women who do not make a pregnancy visit in the Trimester I (81%) and the most commonly consumed food pregnant women is rice, chicken eggs, tofu, spinach and mangoes. This research concluded that the determinants factors in the incidence of anemia in pregnant women were parity, birth spacing, occupation, income, adherence to blood-booster intake and pregnancy frequency.

Pregnant and bleeding: A model to assess factors associated with the need for emergency care in early pregnancy.

To assess the prevalence of Critical or Emergent patient classification among pregnant patients presenting to the Emergency Department (ED) and to identify characteristics that discriminate between patients requiring Emergency care from those who can be safely triaged to the ambulatory setting. In this cross-sectional study conducted in 3 urban EDs, patients under 16 weeks gestation who presented with bleeding and/or cramping completed a 7-item questionnaire. We compared baseline clinical variables and survey responses among patients classified as Critical or Emergent per the American Board of Emergency Medicine's patient acuity definitions with those classified as Lower Acuity to identify independent risk factors for outcomes. Of 484 participants, 21 (4.3%) were classified as Critical or Emergent and required interventions. While no demographic characteristics differentiated Critical patients from Lower Acuity patients, survey questions associated with a higher likelihood of emergency intervention included history of prior ectopic pregnancy (OR 8.7, 95% CI 3.2-23.5) heavy bleeding in the past two hours (OR 11.8, 95% CI 3.8-36.1), as well as having made a prior ED visit in the current pregnancy (OR 1.9, 95% CI 0.7-5.1). Joint consideration of these risk factors in a multivariable model performed well at discriminating between Critical and Lower Acuity patients with an area under the ROC curve of 0.82 (95% CI 0.71-0.93). Patients with a history of ectopic pregnancy, heavy bleeding in the past two hours, and/or prior presentation to the ED in the current pregnancy had the highest risk of needing emergency-level care. The vast majority of patients presenting to the ED with early pregnancy complaints were discharged without intervention.

Exposure to childhood maltreatment and systemic inflammation across pregnancy: The moderating role of depressive symptomatology

BackgroundChildhood maltreatment (CM) has long-term consequences for dysregulation of the immune system which is particularly pronounced when mental and physical health sequelae have manifested. Higher proinflammatory state has been shown in non-pregnant state in association with CM as well as with depression, one of the most frequent and pernicious psychiatric sequelae of CM. During pregnancy, however, this association is less clear. Given the important role of maternal inflammatory state during pregnancy for fetal, pregnancy, and birth outcomes, we sought to examine the association between CM and proinflammatory state during pregnancy considering the moderating role of maternal depressive symptoms characterized serially across pregnancy. MethodsA prospective, longitudinal study of 180 healthy pregnant women was conducted with serial assessments in early (12.98 ± 1.71 weeks gestation), mid (20.53 ± 1.38 weeks gestation) and late (30.42 ± 1.4 weeks gestation) pregnancy. Maternal history of CM was assessed with the Childhood Trauma Questionnaire (CTQ) and the total score was used as an indicator of CM experience. Maternal depressive symptoms were assessed at each pregnancy visit with the Center for Epidemiologic Studies Depression Scale (CES-D). Serum concentrations of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were obtained at each pregnancy visit and combined to a composite maternal proinflammatory score. Linear mixed effects models were employed to assess the association between CTQ score, CES-D score, and proinflammatory score during pregnancy, adjusting for potential confounders. ResultsGestational age was associated with the proinflammatory score (B = 0.02; SE = 0.00; p < .001), indicating an increase in inflammation across gestation. Neither CTQ score nor depressive symptoms were independently associated with the proinflammatory score (ps > 0.28). However, the interaction between CTQ score and depressive symptoms was associated with the proinflammatory score (B = 0.03, SE = 0.01, p < .05), indicating higher inflammation across pregnancy with increasing levels of depressive symptoms during pregnancy in women with higher CTQ scores. Exploratory analyses suggested that this interaction was mainly driven by CTQ subscale scores assessing experiences of abuse rather than neglect. ConclusionsThese findings suggest a moderating role of maternal depressive symptoms during pregnancy on the association of early life stress with inflammation and thus highlight the importance of the timely assessment of both CM exposure and depressive symptoms which might allow for the development of targeted and individualized interventions to impact inflammation during pregnancy and to ameliorate the detrimental long-term effects of CM. The current findings add to a better understanding of the prenatal biological pathways that may underlie intergenerational transmission of maternal CM.