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BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with the growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue. METHODS: The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,605). RESULTS: Over the cumulative 15-year period, a higher prevalence of GDM was observed across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and obese pre-pregnancy BMI age-adjusted prevalence, with noticeable rural-urban disparities. From 2005 to 2019, women, including Asians (OR: 2.73, 95% CI 2.58%-2.88%), American Indian or Alaskan Natives (OR: 1.58, 95%, CI 1.44-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06-1.12%), with advanced maternal age (35-39 years, OR: 4.83 95% CI 4.47%-5.22%; ≥40 years, OR: 6.36 95%, CI 5.80-6.98%), with lower educational status (less than high school, OR: 1.15, 95% CI 1.10%-1.20%; high school graduate, OR: 1.10, 95% CI 1.06%-1.13%), Medicaid users (OR: 1.10, 95% CI 1.06%-1.13%), or with an overweight (OR: 1.78, 95% CI 1.72%-1.84%) or obese (OR: 3.61, 95% CI 3.50%-3.72%) pre-pregnancy BMI were found to be at an increased risk of developing GDM. CONCLUSIONS: There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlight the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women.

Maternal mortality rates within the United States have reached an all-time high.  Annually, nearly seven hundred women die from pregnancy-related complications, a number of which were highly preventable.  When taking a closer look at these statistics, these deaths disproportionately affect Native American and African American women, making them two to three times more likely to suffer from poorer pregnancy outcomes.  This paper examines the variety of factors that contribute to such a disproportionate maternal mortality rate, including geographic differences, racial and economic inequalities, and the accessibility of healthcare.  Despite attempts to fix these issues, systemic and intrinsic issues persist, and individuals continue to suffer.  This paper highlights the need to address maternal mortality disparities that affect marginalized groups, improved accessibility to healthcare for all, and overall policy reform in order to solve this issue indefinitely.

Maize (Zea mays L.) production in sub-Saharan Africa can be improved by using hybrids with genetic resistance to maize lethal necrosis (MLN). This study aimed to assess the general (GCA) and specific combining ability (SCA), reciprocal effects, and quantitative genetic basis of MLN resistance and agronomic traits in tropical maize inbred lines. A total of 182 hybrids from a 14-parent diallel, along with their parents, were evaluated under artificial MLN inoculation and rainfed conditions for 3 years in Kenya. Disease ratings at four time points, grain yield (GY), and other agronomic traits were analyzed using Griffing's Method 3 and Hayman's diallel models. Significant (P < 0.001) GCA and SCA mean squares were observed for all traits under disease conditions and most traits under rainfed conditions, highlighting the importance of both additive and non-additive genetic effects. However, additive gene action predominated for all traits. Narrow-sense heritability estimates for MLN resistance (h 2 = 0.52–0.56) indicated a strong additive genetic component. Reciprocal effects were not significant for MLN resistance, suggesting minimal maternal or cytoplasmic inheritance. Four inbred lines showed significant negative GCA effects for MLN resistance and positive GCA effects for GY under artificial MLN inoculation. Inbred lines CKL181281 and CKL182037 (GCA effects for MLN4 = -0.45 and -0.24, respectively) contained the most recessive alleles for MLN resistance. The minimum number of groups of genes involved in MLN resistance was estimated to be three. Breeding strategies that emphasize GCA could effectively be used to improve MLN resistance in this germplasm. [ABSTRACT FROM AUTHOR]

Objective: To determine the change in English emergency postnatal maternal readmissions 2007–2017 (pre‐COVID‐19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS). Design: National cohort study. Setting: All English National Health Service hospitals. Population: A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017. Methods: Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database. Main Outcome Measures: Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS. Results: A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28–1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31–1.39); age < 20 years (aOR 1.09, 95% CI 1.05–1.12); 40+ years (aOR 1.07, 95% CI 1.03–1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91–0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82–1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53–1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06–2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83–2.21). Conclusions: The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) affects up to 20% of new mothers and has adverse consequences for the well-being of both mother and child. Exposure to stress during pregnancy as well as dysregulation in the mesolimbic dopamine (DA) reward system and its upstream modulator oxytocin (OT) have been independently linked to PPD. However, no studies have directly examined DA or OT signaling in the postpartum brain after gestational stress. Here we employed a chronic variable stress procedure during pregnancy and evaluated behavioral measures of mood and reward along with assessments of DA and OT signaling in postpartum rats. Our results show that gestational stress induced postpartum depressive-like and anxiety-like behavior in addition to producing reward-related deficits including anhedonia, impaired maternal care, and reduced maternal motivation. Consistent with a hypodopaminergic state, histological analysis revealed reduced expression of tyrosine hydroxylase in the NAc shell and core as well as reduced expression of the dopamine transporter and dopamine D2 receptor in the NAc shell of postpartum females exposed to gestational stress. A reduction in accumbal DA content as determined by liquid chromatography-mass spectrometry was also observed in gestationally-stressed dams. Lastly, we assessed mRNA expression of OT and OT receptors (OTR) and found that gestational stress increased OT expression in the hypothalamus but reduced OTR expression in the postpartum ventral tegmental area (VTA), a target of hypothalamic OT neurons. In the VTA, a reduction in OT-immunoreactive fibers following gestational stress was also seen. Taken together, these data demonstrate that the DA and OT systems within the postpartum reward circuit are sensitive to gestational stress and suggest that mood and maternal disruptions in PPD may arise from dysfunctional oxytocinergic regulation of the dopaminergic reward system. [ABSTRACT FROM AUTHOR]

Background: Previous guidelines have clearly stated that dance is safe and beneficial during pregnancy and for childbirth. However, due to the small sample size of individual studies and different interventions, there were inconsistencies about the effect of dance on maternal childbirth. Methods: We included studies evaluating the effect of dance on women in labor. Risk of bias was assessed using the revised Risk of bias assessment tool for randomized controlled trials (RCTs). Data analyses was performed using Review Manager Software version 5.4. Results: A total of 12 RCTs comprising 1,486 pregnant women were included in the analysis. We found that the rate of natural childbirth and satisfaction with delivery were higher in the dance group than in the control group.The pain at 30 min and at 60 min after the intervention were lower in the dance group than in the control group. Meanwhile, the duration of the first stage, the second stage and the total labor duration was shorter in the dance group than in the control group.However, there were no statistically significant differences in the pain at 90 min after intervention, the duration of the third stage, and the rate of the normal 1-minute Apgar scores > 7 points between the two groups. Conclusions: Dance during labor could reduce labor pain to an extent, shorten the duration of labor, promote natural childbirth, and improve satisfaction with labor, with no adverse effects on neonatal outcomes. Trial registration: The protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001. [ABSTRACT FROM AUTHOR]

Background: Afghan refugees in Pakistan, particularly in Quetta, Balochistan, encounter formidable barriers in accessing maternal, newborn, and child health (MNCH) services. These challenges have been intensified by the COVID-19 pandemic and entrenched systemic health inequities. Methods: This qualitative study, conducted from February to April 2023, aimed to assess the obstacles within health systems and community environments that hinder MNCH service access among Afghan refugees. The study involved 20 key informants through in-depth interviews and focus group discussions, including Afghan refugee women, community elders, health workers, and representatives from non-governmental organizations and government agencies. The research focused on experiences during the initial four waves of the COVID-19 pandemic (2020-2021), utilizing a conceptual framework integrating Health Emergency Disaster Risk Management (Health-EDRM) with primary health care. Findings: The study identified significant systemic barriers to accessing MNCH services, such as insufficient funding, inadequate health infrastructure, and discriminatory practices within the healthcare workforce. Additionally, community-level obstacles were prominent, including cultural and language differences, geographical isolation, and economic constraints. The integration of Health-EDRM into local health systems was minimal, with many stakeholders either needing to be made aware of or unengaged with the framework. Conclusion: The findings highlight a critical need for comprehensive policy reforms, infrastructure enhancement, and community-centered approaches to address Afghan refugees' health needs effectively. Strengthening the integration of health-EDRM into health systems is crucial for enhancing resilience and ensuring continuous care during health emergencies. The study calls for concerted efforts to implement culturally sensitive health interventions that include disaster risk management components to improve MNCH outcomes among Afghan refugees in crisis-affected settings. Addressing systemic and community-level barriers makes creating a more resilient and equitable health system for vulnerable populations possible. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric emergencies are sudden, unexpected life-threatening medical conditions that occur during pregnancy, labour, delivery or puerperium and are challenging moments because of frightening and traumatic experiences. Obstetric emergencies, which threaten the well-being of the woman and the unborn child, account for the majority of causes of maternal death. Objective: The study sought to explore Midwives' experiences in obstetric emergencies in the Kwahu West Municipality of Ghana Methods: A phenomenological study design with a qualitative approach was employed to explore the midwives' experiences in the management of obstetrics. Participants were selected using purposive sampling. The sample size of 13 was reached upon data saturation. A semi-structured interview guide was used to interview midwives who have experienced and managed obstetric emergencies. The obtained data was transcribed and analysed using a thematic analysis approach. Results: Overall, five themes and 13 subthemes emerged. The emerging themes encompass factors influencing midwives' experiences in managing obstetric emergencies, Reactions of midwives during obstetric emergencies, Challenges of midwives in managing obstetric emergencies, Healthcare challenging factors, and Client-centred limitations. Conclusion: It is evident that midwives play a critical role in addressing obstetric emergencies, often being the frontline healthcare providers in such situations. Their experiences shed light on both the challenges they face and the strategies they employ to provide effective care under demanding circumstances. The findings highlight the need for further investment in training and resources for midwives, particularly in rural areas where access to healthcare services may be limited. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Exclusive breastfeeding for the first 6 months is the recommended infant feeding practice, with established benefits. In India, exclusive breastfeeding rates have seen some improvement, but Uttar Pradesh has experienced a decline. Various factors influence breastfeeding practices, such as socio-cultural beliefs, maternal knowledge, and support. Considering urbanization, industrialization, and a significant migrant population, it is crucial to understand the determinants of breastfeeding practices in urban Uttar Pradesh. This study aimed to fill these knowledge gaps by examining factors influencing breastfeeding practices in the region. Methods: This cross-sectional study was conducted at Sharda Hospital's Pediatrics Outpatient Department (OPD) in Uttar Pradesh over 1.5 years from January 1, 2019 to June 30, 2020. The minimum sample size of 96 was determined for the study. Study participants included 200 mothers with children aged 6 months to 2 years attending the Pediatrics OPD. Data were collected through a 42-item questionnaire administered by trained interviewers who ensured privacy and comfort. Data analysis was performed using Statistical Package for Social Sciences, including descriptive statistics and the Chi-square test for categorical variables (P < 0.05). Results: The study involved 200 mothers with children aged 6 months to 2 years attending a Pediatrics OPD in Uttar Pradesh. Mothers aged 21–30 years (78%) were predominant. Among the children, 62.5% were male. Colostrum was given by 86% of mothers, and 40% introduced pre-lacteal feeds. Exclusive breastfeeding was practiced by 60% of mothers. The analysis did not show statistically significant differences based on socio-economic status, maternal education, or occupation (P > 0.05). Conclusion: In conclusion, the findings from this study provide a comprehensive understanding of feeding practices among mothers in urban areas of Uttar Pradesh. While many mothers adhere to recommended practices, there is room for improvement in reducing pre-lacteal feeding and promoting exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Systematic crises may disrupt well‐designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID‐19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics). Key messages: Well‐designed nutrition interventions may be disrupted by crises that affect the interventions themselves and the platforms on which they run.Combining contextualized expertise in operational settings with a data‐driven decision‐making process can facilitate the timely identification of intervention disruptions and enable swift adaptations.Continuity of nutrition services amidst crises is feasible by adopting hybrid modalities including both original and adapted implementation paths.Visualizing adaptations to the intervention paths sheds light on how to deliver nutrition services during major systematic disruptions.Knowledge of how to adapt nutrition interventions during crises is critical going forward to respond successfully in future disruptive events. [ABSTRACT FROM AUTHOR]

This study sought to understand reported impacts of the COVID‐19 pandemic on maternal and child health and nutrition behaviours during the first 1000 days of life. This qualitative and participatory substudy was embedded within mixed methods formative research conducted during 2020–2022 across two urban, three rural and one estate sector site in Sri Lanka. Semi‐structured interviews among caregivers of children aged 6–23 months (n = 34), influencers of caregivers, such as health workers (n = 37), leaders (n = 10) and pregnant women (n = 20) were conducted. Participatory workshops (n = 14) triangulated interview findings. Interview data were analyzed to identify salient themes using Dedoose. Numerical data from voting conducted in workshops were summed and triangulated with interview data. Findings suggest that the COVID‐19 pandemic and imposed restrictions shaped maternal and child health and nutrition behaviours through a complex interplay of factors. Imposed restrictions and changes to the food system contributed to temporary unemployment for wage workers and reduced purchasing power to maintain food security for vulnerable households. While deciding whether to seek care, fears of infection prevented usual care‐seeking decisions. Also, reduced incomes and disrupted public transportation made transport to health care facilities for antenatal care services difficult. Once women reached facilities, medical services and quality of care were negatively impacted. Implementing expanded community‐based services during home visits focused on the first 1000 days and beyond was one effective strategy to maintain maternal and child health and nutrition during the early pandemic in Sri Lanka. Key messages: The effects of the COVID‐19 pandemic, coupled with the consequences of national‐level restrictions put into place during 2020–2021, made usual maternal and child health and nutrition behaviours more challenging during the first 1000 days of life throughout Sri Lanka.The Sri Lankan health system adapted quickly during 2020–2021 to help ensure little disruption to usual services needed during the antenatal period through effective expansion of community‐based health care provided by its existing Public Health Midwifery workforce. [ABSTRACT FROM AUTHOR]

Background Premature rupture of membranes (PROM) is the early rupture of fetal membranes before labor, leading to spontaneous amniotic fluid leakage. [1] It occurs in 5-10% of pregnancies, with 80% at term. [2] PROM is associated with complications such as chorioamnionitis, increased caesarean section rates, sepsis, and endometritis in mothers, and fetal distress, respiratory distress syndrome (RDS), early neonatal sepsis, and fetal death in neonates. [3] The risk of infection increases with the duration of PROM, making timely diagnosis and management crucial. [4] This study aims to evaluate feto-maternal outcomes in term pregnancies with PROM. Methods A retrospective study was conducted from May to August 2023 in the Department of Obstetrics and Gynaecology, Cheluvamba Hospital, Mysuru Medical College. Data from 176 term PROM cases were collected, including maternal and neonatal outcomes. Statistical analysis was performed to identify significant trends. All the collected data were recorded and entered in the microsoft excel data sheet. Data analysis was done using SPSS version-22 software. Results Of 2,483 deliveries during the study period, 176 (7%) were term PROM in primigravida. The mean maternal age was 22.49 years, and 89.77% of cases were delivered within 18 hours of PROM. Vaginal delivery was achieved in 53.41%, while 46.59% underwent caesarean sections, primarily due to fetal distress (82.73%) and failure to progress (15.85%). NICU admission was required for 37.5% of neonates, with complications such as early-onset neonatal sepsis (65.21%) and respiratory distress syndrome (21.73%). Perinatal mortality was 2.84%. Maternal complications, including puerperal sepsis (12.5%) and endometritis (5.69%), were noted in 23.8% of cases. Conclusion Prolonged PROM-to-delivery intervals were associated with increased morbidity and mortality. Appropriate and systematic approach is needed for favorable outcome. The obstetrician and neonatologist role is very important in providing optimal care for both mother and baby. [ABSTRACT FROM AUTHOR]

Introduction: In clinical settings, digital dashboards display medical data, with the aim of identifying trends and signals. In so doing these contribute towards improving service delivery and care within hospitals. It is not clear whether the utility of perinatal health equity dashboards could be used to identify health inequality trends that could potentially impact on health service delivery, care and public health interventions. This study aims to evaluate the implementation of health inequality dashboards that address disparities in maternal and neonatal outcomes, with a specific focus on identifying key challenges encountered during their deployment and use in healthcare settings. Methods: Three databases, namely Embase, CINAHL, and Medline were searched to identify relevant studies in English Language published between 2010 and 2022. All findings were reported according to PRISMA guidelines for scoping reviews. Results: Of 670 identified articles, only 13 met the inclusion criteria. The study identified three key themes: dashboard functionality, data accuracy, and challenges in collecting health inequality data. Dashboards were used to visualize disparities, with functionalities focusing on specific audiences, contents, and utility. Issues with data completeness, standardization, and challenges in collecting consistent health inequality data, especially from diverse ethnic groups, hindered the accurate tracking of maternal and neonatal disparities. Conclusion: The use of perinatal health inequality dashboards is a critical step forward in optimizing maternal and neonatal care by providing targeted interventions. However, further research is needed to assess their long-term impact on reducing health inequalities, while addressing challenges related to data accuracy, completeness, and standardization to improve their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Women with a body mass index (BMI) >35 kg/m2 carry an increased obstetric risk; however, the experience of the Class IV and above obese nulliparous women is less understood. Aims: To describe maternal and perinatal outcomes in nulliparous women of booking BMI > 50 kg/m2. Materials and methods: A cohort study of 48 nulliparous women who delivered between 2015 and 2019 in a tertiary hospital and had a booking BMI > 50 kg/m2. Obstetric outcome data was collated via electronic and written patient records. The relationship between mode of delivery and BMI was assessed using direct logistic regression. Multiple pregnancies and severe congenital malformations (n = 3) were excluded. Results: The mean booking BMI was 53.7 kg/m2 (SD 4.05) and mean maternal age was 30.4 years (SD = 5.7). Comorbidities included asthma (43%), essential hypertension (20%) and diabetes (61%). Antenatally, accuracy was compromised in 80% of morphology scans (n = 35). In the perinatal period, 33 women (68.8%) were induced compared to a spontaneous onset of labour in two (4.1%) women. There were nine elective caesarean sections (CS), five of which were for breech presentation. Of those who intended on vaginal delivery (n = 35), 51% (n = 18) had an emergency CS. In these women, the risk of CS increased by a factor of 1.36 for every one point increase in BMI > 50 kg/m2. The average gestational age was 37.5 weeks (SD 2.4) with 14% (n = 6) experiencing preterm deliveries. The incidence of babies born >90th percentile for gestational age was 15 (34%). Conclusion: Increased BMI impairs maternal and perinatal outcomes and significantly increases the risk of emergency CS. BMI > 50 kg/m2 is associated with higher‐level interventions and obstetric complications. [ABSTRACT FROM AUTHOR]

Objective: Congenital malformations (CM) are structural defects of the human body that arise during development. They significantly impact neonatal outcomes such as morbidity and mortality, hence identification of risk factors and their reduction is vital to improve materno-fetal outcomes. In Karachi, Pakistan, there is insufficient data on the incidence of congenital malformations. Therefore, it is necessary to initiate a prospective case control study. The desired objective was to determine the association of congenital malformations with sociodemographic and maternal risk factors in different ethnicities. Methods: This multi-center case control study spanned over a duration of six months (December 2022 - May 2023) and included women ranging from 18-45 years using purposive sampling technique. It was conducted at Jinnah Postgraduate Medical Center and Tanveer Ultrasound Clinic. Sample of 120 participants fulfilling the inclusion criteria were included in this study after purposive sampling. Sonoscape S22 ultrasound system and Toshiba Aplio 500 ultrasound system were used to detect congenital malformations. Results: Participants were divided into five groups based on ethnicity. Most of the congenital anomalies of the central nervous system were seen in Urdu-speaking group with a p-value = 0.016. An association between maternal age, education level, family income and medications with congenital malformations in fetuses was observed with p-values of 0.003, 0.000, 0.024 and 0.000 respectively. Conclusion: It was evident that various maternal sociodemographic and risk factors play a significant role in the development of congenital anomalies. [ABSTRACT FROM AUTHOR]

Background: Pregnancy in women with biventricular circulation and a systemic right ventricle (sRV) is considered high risk, with limited data available on pregnancy outcomes. This study aimed to investigate pregnancy outcomes in this population. Materials and Methods: A systematic review was conducted using four major electronic databases. Pregnant women with a complete transposition of great arteries (d-TGA) after an atrial switch operation or a congenitally corrected transposition of the great arteries (ccTGA) were included. Results: In total, 15 studies including 632 pregnancies in 415 women with an sRV and biventricular circulation were identified, of whom 299 (72%) had d-TGA and 116 (28%) ccTGA. Maternal mortality or cardiac transplantation occurred in 0.8% of pregnancies. The most frequent maternal complications were the worsening of systemic atrioventricular valve regurgitation [pooled estimate (PE): 16%, 95% CI: 5;26], the deterioration of sRV function (PE: 15%, 95% CI: 2;27), the worsening of the NYHA class (PE: 13%, 95% CI: 6;20), all-cause hospitalization (PE): 10%, 95% CI: 7;12), arrhythmias (PE: 8%, 95% CI: 5;11), and symptomatic heart failure (PE: 6%, 95% CI: 3;10). Stillbirth occurred in 0.7% of pregnancies and neonatal death in 0.4%. Small-for-gestational-age neonates were encountered in 36% (95% CI: 21;52) of pregnancies and preterm delivery in 22% (95% CI: 14;30). A subgroup analysis showed no significant difference in outcomes between women with d-TGA and those with ccTGA, except for the worsening of the NYHA class, which occurred more often in d-TGA (18%, 95% CI: 12;27 vs. 6%, 95% CI: 3;15, respectively, p = 0.03). Conclusions: Maternal and fetal/neonatal mortality are low among pregnant women with biventricular circulation and an sRV. However, significant maternal morbidity and poor neonatal outcomes are frequently encountered, rendering management in specialized centers imperative. [ABSTRACT FROM AUTHOR]

Introduction: Maternal‐neonatal healthcare services were severely disrupted during the COVID‐19 pandemic in even high‐income countries within the World Health Organization (WHO) European Region. The objective of this study was to compare trends in the quality of maternal and neonatal care (QMNC) in Sweden and Norway to 12 other countries from the WHO European Region during the COVID‐19 pandemic, and to identify domains for improvement. Material and Methods: This cross‐sectional study included women giving birth in Europe from March 1, 2020 to December 31, 2022. Women answered an online, anonymous questionnaire which included 40 WHO Standard‐based Quality Measures collectively scored as the total QMNC index (0–400) and separately in four subdomains (0–100): provision of care, experience of care, availability of human and physical resources, and reorganizational changes due to COVID‐19. To assess reported QMNC changes over time, we used adjusted quantile regression models. ClinicalTrials.gov Identifier: NCT04847336. Results: Of the 45151 women included in the study, 13 117 (29.1%) were from Sweden and Norway and 32034 (70.9%) from the 12 WHO European countries. The total QMNC index for Sweden and Norway (median: 325, IQR: 285–355) was higher than the 12 WHO European countries (median: 315, IQR: 265–350, p < 0.001) as were trends in QMNC index over time (Sweden and Norway median: 310–345; 12 WHO European countries median: 305–340). Sweden and Norway also had higher scores in three‐of‐four QMNC subdomains, with the 12 WHO European countries scoring higher only for reorganizational changes due to COVID‐19. In adjusted quantile models of the total QMNC index, Sweden and Norway had higher scores, with largest differences in the lower quantiles (p < 0.001 in all percentiles). Conclusions: Across Europe, there are significant gaps in the quality of maternal‐neonatal healthcare services. Although women giving birth in Sweden and Norway reported higher QMNC scores in all subdomains except for "reorganizational changes due to COVID‐19," there is room for improvement and shared learning across Europe. Policymakers should prioritize long‐term investments in maternal and neonatal healthcare, ensuring that facilities are adequately equipped during public health crises and that all women have access to high‐quality, evidence‐based, equitable, and respectful care. [ABSTRACT FROM AUTHOR]

Background: This study investigates the effects of administering intravenous esketamine at a dose of 0.25 mg/kg to pregnant patients receiving epidural anesthesia for emergency cesarean section on both maternal and neonatal outcomes. Methods: Medical records of pregnant patients transitioning from labor analgesia to epidural anesthesia for emergency cesarean sections between January 2020 and December 2022 were analyzed. The patients were categorized based on whether they received esketamine infusions during the incision-to-delivery interval. The variables compared between the groups included hemodynamic parameters, perioperative and postoperative adverse reactions, and neonatal outcomes (gender, weight, Apgar scores at 1 and 5 min, need for neonatal intensive care, and umbilical artery/vein blood gas analysis). Results: For maternal outcomes, the systolic blood pressure (SBP) in the esketamine group showed a significant increase at 5 and 10 min' post-administration, and the diastolic blood pressure (DBP) significantly increased at 5 min, compared to the control group (p < 0.01). No significant differences were observed in heart rate (HR) and oxygen saturation (SpO2) at any time point (p > 0.05). The esketamine group experienced a significant rise in the incidence of arrhythmias, dizziness, and nystagmus during the perioperative period, a notable decrease in hypotension incidence, and an increase in postoperative nausea and dizziness. Regarding neonatal outcomes, there were no significant differences in gender, weight, Apgar scores ≤7 at 1 and 5 min, and the need for neonatal intensive care. However, the pH level in the umbilical artery blood of the esketamine group was significantly higher. The levels of PCO2 and PO2 in umbilical artery and venous blood did not show significant differences between the groups. Conclusions: In pregnant women undergoing emergency cesarean section, intravenous administration of 0.25 mg/kg esketamine is correlated with favorable maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Epidural analgesia could increase the risk of maternal fever during labor, and the potential mechanisms involved inflammation. Neutrophil-to-lymphocyte ratio (NLR) was a sensitive inflammatory composite indicator and related to adverse outcomes in parturients. This study aimed to investigate the association between NLR levels and epidural related maternal fever (ERMF). Methods: This prospective cohort study included 614 parturients who underwent epidural analgesia at the Women's Hospital School of Medicine Zhejiang University from November 2021 to May 2023. NLR level was calculated before epidural analgesia for women. The outcome was ERMF. Univariate and multivariate logistic regression models were utilized to explore the association between NLR level and ERMF. And the association was further investigated in subgroups of age, body mass index (BMI) before pregnancy, and parity of delivery. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Totally, 614 parturients, of whom 171 (27.85%) had ERMF. High NLR level was associated with higher incidence of ERMF (OR = 2.70, 95% CI: 1.58-4.69). Parturients with ERMF had higher proportion of postpartum hemorrhage, longer labor times, and other adverse outcomes in parturients. The association also observed in subgroups of age <35 years old (OR = 2.74, 95% CI: 1.55-4.29), BMI <24 kg/m2 before pregnancy (OR = 2.32, 95% CI: 1.32-4.13), BMI ≥24 kg/m2 before pregnancy (OR = 38.28, 95%CI: 3.67-854.66), primipara (OR = 2.26, 95% CI:1.27-4.04), and multipara (OR = 30.60, 95% CI: 3.73-734.03). Conclusion: High NLR levels were associated with ERMF in women. It indicated that physicians may measure NLR levels as a regular measurement, which may beneficial for pregnancy outcomes. [ABSTRACT FROM AUTHOR]

While the pathophysiology of pre‐eclampsia has been postulated as being secondary to placental dysfunction, a cardiac origin has more recently been proposed. Although an association between fetal congenital cardiovascular disease and pre‐eclampsia has been demonstrated, no precise pathophysiologic mechanism for this association has been described. This review highlights the current biophysical (including echocardiography and Doppler indices) and biochemical (including proteomic, metabolomic and genetic/transcriptomic) markers of cardiac dysfunction that have been investigated in maternal and fetal cardiac disease and their overlap with predictors of pre‐eclampsia. Common pathways of inflammatory and anti‐angiogenesis imbalance, endothelial damage, and oxidative stress have been demonstrated in both cardiovascular disease and pre‐eclampsia and further investigation into these pathways could help to elucidate the common pathophysiologic mechanisms linking these disorders. Synopsis: Cardiac dysfunction in the mother and fetus have been linked with pre‐eclampsia. This review highlights that shared pathways can elucidate common pathophysiology linking the disorders. [ABSTRACT FROM AUTHOR]

Exposure to fathers' positive parenting has been associated reducing mental disorder symptoms during adolescence, evidence on the mechanisms underlying this association is lacking. One potential mechanism linking fathers' positive parenting and mental disorders is environmental sensitivity (ES). Here we studied whether the increased positive behaviors of both parents (1) separately, (2) relatively, (3) and jointly predict reduced depression, attention deficit hyperactivity disorder (ADHD) symptoms, suicidal ideation (SI), and increased well-being in Chinese adolescents. Additionally we investigated (4) whether ES moderates these relationships. This study involving 7010 Chinese adolescents (55.6 % girls) aged 15 to 18 from six junior high schools in Shaanxi, China was conducted at four timepoints. ES was assessed using the Highly Sensitive Child (HSC) scale at ages 15 and 16, parental positive behaviors using the Parental Bonding Instrument (PBI) at ages 16 and 17, and psychopathology symptoms using the 9-item Patient Health Questionnaire (PHQ-9), Strengths and Difficulties Questionnaire (SDQ), and Positive and Negative Suicide Ideation (PANSI) Inventory at ages 17 and 18. (1) Multilevel analyses revealed that increased positive parenting predicted reduced psychiatric disorder symptoms and improved well-being; (2) trend interaction indicated that the compensatory effect of fathers' positive parenting was stronger in alleviating mental problems in adolescents than that of mothers'; (3) Simple slope analyses suggested that both high levels of fathers' and mothers' positive parenting predicted fewer subsequent psychiatric disorder symptoms, particularly for sensitive adolescents. This study was limited to its generalizability to the Western Chinese adolescents. Substantial differences in the effects of positive paternal and maternal parenting highlight the important role of fathers' positive parenting in mental development, especially for highly sensitive adolescents. • The present study builds upon previous research by examining whether longitudinal increases in ES during adolescence is a mechanism by which positive paternal parenting is associated with fewer occurrences of psychopathology, and also helps to explain compensatory effects of positive paternal and maternal parenting. • We observed a predominant effect of fathers on Chinese adolescents' development compared with mother. • We found that father played a more substantial role in the association between adolescents' ES and psychiatric disorder symptoms. • These results contribute to a deeper understanding of the influence of fathers on contemporary conceptualizations of developmental psychopathology and adolescent mental health. [ABSTRACT FROM AUTHOR]

Background: Women with a body mass index (BMI) >35 kg/m2 carry an increased obstetric risk; however, the experience of the Class IV and above obese nulliparous women is less understood. Aims: To describe maternal and perinatal outcomes in nulliparous women of booking BMI > 50 kg/m2. Materials and methods: A cohort study of 48 nulliparous women who delivered between 2015 and 2019 in a tertiary hospital and had a booking BMI > 50 kg/m2. Obstetric outcome data was collated via electronic and written patient records. The relationship between mode of delivery and BMI was assessed using direct logistic regression. Multiple pregnancies and severe congenital malformations (n = 3) were excluded. Results: The mean booking BMI was 53.7 kg/m2 (SD 4.05) and mean maternal age was 30.4 years (SD = 5.7). Comorbidities included asthma (43%), essential hypertension (20%) and diabetes (61%). Antenatally, accuracy was compromised in 80% of morphology scans (n = 35). In the perinatal period, 33 women (68.8%) were induced compared to a spontaneous onset of labour in two (4.1%) women. There were nine elective caesarean sections (CS), five of which were for breech presentation. Of those who intended on vaginal delivery (n = 35), 51% (n = 18) had an emergency CS. In these women, the risk of CS increased by a factor of 1.36 for every one point increase in BMI > 50 kg/m2. The average gestational age was 37.5 weeks (SD 2.4) with 14% (n = 6) experiencing preterm deliveries. The incidence of babies born >90th percentile for gestational age was 15 (34%). Conclusion: Increased BMI impairs maternal and perinatal outcomes and significantly increases the risk of emergency CS. BMI > 50 kg/m2 is associated with higher‐level interventions and obstetric complications. [ABSTRACT FROM AUTHOR]

Efficiency analysis of the Maternal, Newborn, and Child Services Network (MNCSN) is crucial for achieving SDG 2030. However, the mortality rates of maternal, newborn, and child have not reduced since 2018, and there have been limited studies conducted in Morocco on this subject. This study aims to analyze the technical efficiency of 82 MNCSN across primary healthcare Establishments Network (PHCEN) in Morocco in 2021 and identify factors influencing their efficiency. Technical efficiency was estimated using the Data Envelopment Analysis (DEA) method with an input orientation. Tobit regression was employed to analyze factors affecting the technical efficiency of maternal and child healthcare. In the initial stage, the average efficiency score of the 82 MNCSN was 0.779 for constant returns, with 36 MNCSN achieving a score of 1. However, the Boujdour MNCSN recorded the lowest efficiency score of 0.033. In the second stage, Tobit regression revealed that Model 2 was more significant than Model 1. Specifically, the explanatory variable Rural Dispensary exhibited strong statistical significance and a positive impact on maternal and child health, followed by variables such as High-risk Pregnancies Supported and High-risk Pregnancies. The study findings suggest that the resources allocated for MNCSN in Morocco are not being efficiently utilized compared to some other African and European countries. Therefore, the Ministry of Health in Morocco should review the functions of MNCSN, aiming to improve the delivery of maternal, newborn, and child healthcare, regardless of the setting, be it urban or rural. [ABSTRACT FROM AUTHOR]

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i -PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i -PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15–49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0–59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62–2.92, P  < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91–0.97, P  < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i -PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care. [ABSTRACT FROM AUTHOR]

Background: Existing meta-analyses suggest that exercise intervention may play a crucial therapeutic role in improving maternal depression, anxiety and fatigue symptoms. However, the efficacy varies across different exercise content, duration, frequency, cycle, intensity, format and intervention period. Objective: Using meta-analysis to propose the best intervention program and examine the effect of exercise intervention on maternal depression, anxiety, and fatigue. Methods: Five databases (PubMed, Web of Science, Embase, Cochrane Library, CNKI) were searched from inception to June 2024, a total of 37 literatures were included. The methodological quality of the included literatures was assessed using the Cochrane Risk of Bias tool and the PEDro scale. When heterogeneity was high, we used random-effects models. Funnel plots were used to assess publication bias. Sensitivity analysis was used to verify the robustness of the combined results. Subgroup analysis was used to explore sources of heterogeneity. Results: Exercise has beneficial effects on the improvement of maternal depression [ g = −0.71, 95%CI (−0.93, −0.49), p = 0.00], anxiety [ g = −1.09, 95%CI (−1.42, −0.76), p = 0.00] and fatigue [ g = −0.64, 95%CI (−0.88, −0.40), p = 0.00] symptoms. Postnatal interventions may be more effective than prenatal. Low-moderate intensity yoga with group + individual, 4–5 times/week, 40–60 min/time, duration 4–8 weeks is most effective in improving depressive symptoms. Low-intensity yoga with group + individual, 4–5 times/week, 40–60 min/time, duration 4–8 weeks is most effective for improving anxiety symptoms. Low-intensity Pilates with group, 1–2 times/week, 40–60 min/time, duration 4–8 weeks is most effective for improving fatigue symptoms. Conclusion: This meta-analysis demonstrates the positive effect of exercise on improving maternal depression, anxiety and fatigue and suggests the best intervention program. Maternal perceptions that postpartum exercise is safer may account for the better outcomes of postpartum intervention. Further higher quality and large-scale trials are needed to substantiate our findings. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , CRD42024567987. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy and the postnatal period represent a time of heightened risk for women to experience mental health difficulties. Some mothers may require specialist inpatient psychiatric support made available through Mother and Baby units (MBUs). Although there is evidence of the therapeutic benefits of MBUs, many studies have utilised methodologies vulnerable to interviewer and social desirability biases. The repertory grid technique (RGT), derived from personal construct theory (PCT), has been successfully used to explore how the way in which a person thinks about and defines the self (i.e., self-construal) changes following therapeutic intervention in samples of people experiencing mental health conditions. Therefore, this study aimed to explore change in maternal self-construal following MBU admission, utilising the RGT, thereby enhancing our understanding for the therapeutic role of MBU admissions in women's mental health recoveries. Methods: Participants were recruited from two MBUs in England. RGT was undertaken with participants shortly after admission and again at discharge, allowing for comparisons between grids to assess change in how a mother viewed herself in relation to certain aspects of the self (e.g., ideal self) and other people, a concept referred to as construing in PCT. Data were analysed using principal component analysis, Slater analysis, and content analysis. Results: There were 12 participants who completed repertory grids at admission, with eight (66.67%) participants also completing discharge grids. Most of the eight participants demonstrated improvements in overall self-esteem and self-esteem as a mother, a shift towards a more positive self-perception, and increased construed similarity between the self and positively construed others, and construing became more varied. Conversely, a few participants displayed a reduction in self-esteem, particularly in the maternal role and increased construed similarity between the self and negatively construed others, and construing became more rigid. Conclusions: All participants exhibited changes to construing during their MBU admission, with most participants displaying positive changes to self-esteem and self-perception and a more adaptive process of construing. Potential implications are offered for service users, families, clinicians, and stakeholders. Recommendations for future research are also provided. [ABSTRACT FROM AUTHOR]

AbstractDiminished/decreased ovarian reserve (DOR), which refers to a decline in oocyte number or quality, has a profound impact on women’s quality of life and fertility. In recent years, the incidence of DOR has been increasing, and more cases of this complication have been reported at younger ages. Therefore, finding the reasons for its occurrence is of great importance. Despite the great inter-individual differences in women’s ovarian reserves, environmental and epigenetic effects cannot be ignored in this regard. Since women’s ovarian reserves are developed in the prenatal period, the present evidence-based review study has addressed the effects of maternal nutrition, specifically undernutrition and overnutrition, during pre-conception, pregnancy, and lactation on the ovarian reserve of offspring. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx.The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta‐analysis Protocols (registration number: INPLASY202310052).Twenty‐four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider‐initiated births.The maternal and perinatal outcomes of 40 live births post‐UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established. [ABSTRACT FROM AUTHOR]

Background: The health literacy and numeracy skills of women in Pakistan are very low compared to other low- and middle-income countries. Objective: The aim of this study was to improve the health literacy and numeracy skills of unschooled women in Northern Pakistan by developing a Maternal and Child Health Calendar (MCHC). The MCHC utilizes locally contextualized icons to promote and enhance service utilization and maternal and child health (MCH) outcomes. Methods: We conducted a qualitative exploratory study design to understand the experiences and usefulness of the MCHC among women. We recruited the participants using purposive sampling. Using a semi-structured interview guide, we conducted individual interviews with nine Key informants, that is, Agha Khan Rural Support Staff and Community-based savings group staff and five focus group discussions with unschooled women. We followed Braun and Clarke's steps to conduct an inductive thematic data analysis. Results: The findings of our study are categorized into the following themes: (1) the benefits of using MCHC, (2) the usefulness of the MCHC in women's healthcare decision-making, (3) empowerment of poorly schooled women, (4) enabling numeracy and record-keeping skills, (5) MCHC implementation challenges, and (6) participants suggestions to improve the MCHC. Our findings revealed that the MCHC improved the health literacy and numeracy of illiterate or less educated women by using localized images to help them comprehend their own and their children's health. Additionally, it effectively empowered these women in their healthcare decision-making, such as discussing family planning with their husbands. Women also suggested modifying some images in the MCHC to enhance their clarity and usefulness. Conclusion: The MCHC has the potential to safely and sustainably build basic MCH literacy and numeracy skills among both literate and illiterate women in Northern Pakistan. Further research is needed to assess its potential as a stand-alone intervention to improve MCH outcomes. Plain language summary: Empowering mothers: Advancing maternal health literacy and numeracy through the introduction of Maternal and Child Health Calendar This study aimed to improve health literacy and numeracy skills among unschooled women in Northern Pakistan by developing a Maternal and Child Health Calendar (MCHC). The MCHC uses locally relevant images to help women better understand and use health services for themselves and their children. We found that it helped women in Northern Pakistan understand health information through familiar images, make informed healthcare decisions, and manage their health records. Despite some challenges and suggestions for improvement, the MCHC shows promise in enhancing health literacy and numeracy among both literate and illiterate women. Further research is needed to see if it leads to better health outcomes for mothers and children. [ABSTRACT FROM AUTHOR]

Consistent individual behavioral differences (CIDs) among livestock are known to be inherent qualities of the animal that are repeatable over time and across contexts and can be related to production. Shepherds rely on qualities of the ewe to promote lamb health, survival, and performance, and selecting ewes based on desirable phenotypes may be one way to benefit lamb outcome. Previous research indicates that traits observed among breeding ewes in restrained contexts during human-animal interactions (HAIs) may have a greater association with maternal care and lamb outcome than responses in an open testing environment. The current study investigated the relationship between several behaviors in multiparous ewes (n = 42) in two distinct contexts: 1) human-animal interactions, with no lamb present, during post-breeding, gestation, and weaning, which were performed three times per year for 2 years (six trials in total), and 2) HAIs, with the lamb present, after parturition once per year for 2 years (two trials in total). Tests without the lamb present included a Human Contact, Presence, and Approach test within each of the six trials, and tests with the lamb present included a Lamb Handling and Tie Down test. General additive models with a random term for individual were used to investigate the relationship between behaviors from outside of the lambing season to behaviors within the lambing season. The proportion of time in the 'peripheral zone' in the Human Presence test, at post-breeding, was a significant negative predictor of 'environmental vigilance' (i.e., being on look-out rather than attending to lamb) in the Lamb Tie Down test (P=0.02). A post-hoc negative relationship was found between 'environmental vigilance' and 'sniffing/grooming' the lamb in the Lamb Tie Down test. In addition, sheep who were more environmentally vigilant in the Lamb Tie Down test were less avoidant of the human in the Human Presence test (post-breeding). Weaning weights, yet not birth weights, were highly repeatable within ewes [R=0.70, P =0.001, CI(0.29, 0.91)], and weaning weight models were improved with the inclusion of time in the 'peripheral zone' in the Human Presence test and grooming and 'environmental vigilance' in the Lamb Tie Down test. Of note, the avoidance of the human, when the lamb was not present, was associated with weaning weights and therefore could be considered as a metric to consider when selecting ewes. Ewe behavior in response to humans outside of the lambing season be useful in gauging future maternal behavior (i.e., grooming) and lamb birth and weaning weights. [ABSTRACT FROM AUTHOR]

Background: Peripherally inserted central catheter (PICC) are a necessary procedure for preterm newborns care. Despite the use of analgesic treatments, its insertion can be painful. Our objective was to study the effect of maternal voice on pain during PICC insertion. Method: We conducted a pre post study for 2 years. Pain was compared between the two groups (with/without maternal presence) using a neonatal pain scale (FANS). Infection rate, procedure time, number of failures, mothers' anxiety and caregivers'anxiety were compared between the two groups. Results: Ninety neonates were eligible. Finally, 63 neonates were included. Thirty-four placements were realized without maternal voice (first period) and 29 with maternal voice (second period). Mean FANS during PICC placement was lower in the maternal voice group than in the control group (1.15 ± 1.27 vs. 1.41 ± 1.49, p = 0.033). The FANS was also lower in the maternal voice group during the time of the first cutaneous effraction (p = 0.032). There was no significant difference between the two groups concerning the other outcomes. Conclusion: Maternal voice added to conventional care decreased acute pain during PICC insertion without increasing infection rate, number of failures or procedure time. [ABSTRACT FROM AUTHOR]

Background: Fetal heart rate (FHR) monitoring has caused a clinical dilemma due to widespread misinterpretation of the physiology influencing various FHR patterns and the development of cerebral palsy. This study aimed to correlate various category II FHR patterns with maternal risk factors and birth outcomes. Methods: This prospective observational study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Chennai, from December 2020 to March 2022. A total of 150 parturients with category II cardiotocography (CTG) were studied, and all were followed up through delivery and in the neonatal period. Results: Of the pregnant mothers, 79.9% were aged between 21 and 29 years. Most patients were primigravida 113 (75.3%), and 97 (64.7%) were in the early term (37w-38w 6d). On studying the association between maternal risk factors and category II CTG, 68% had an associated risk factor. In our study, intrauterine resuscitation maneuvers did not help in improving the abnormal fetal heart pattern. Variable deceleration was the most commonly encountered CTG abnormality (50.7%). Common category II CTG abnormalities with risk factors were variable deceleration followed by tachycardia, minimal beat-to-beat variability, and bradycardia. The most common category II CTG abnormality associated with induced labor was tachycardia, and with spontaneous labor, it was variable deceleration with good beat-to-beat variability which was statistically significant. The difference in the mode of delivery between the different CTGs was statistically significant. The difference in the APGAR score and cord blood pH between CTG abnormalities was statistically significant. Conclusion: In our study, there was higher correlation seen between minimal beat-to-beat variability, tachycardia, and variable decelerations with adverse neonatal outcomes and when present should be carefully monitored and decision to be taken accordingly. [ABSTRACT FROM AUTHOR]

This study aims to describe the level of knowledge of pregnant women regarding antenatal care (ANC) services in the Sitiotio Health Center working area, Samosir Regency. ANC is an essential health service for pregnant women to reduce maternal and infant mortality rates, which is one of the global targets within the Sustainable Development Goals (SDGs). This research employs a descriptive design with a cross-sectional approach, involving 50 respondents selected through total sampling techniques. Data collection was conducted using a questionnaire, and data analysis was performed univariately using SPSS. The study results show that 27 pregnant women (54%) have sufficient knowledge, 13 women (26%) have inadequate knowledge, and 10 women (20%) possess good knowledge. Good knowledge regarding ANC is crucial to improving maternal and infant health and reducing morbidity and mortality rates. This study provides recommendations to enhance health education for pregnant women to strengthen their understanding of ANC. [ABSTRACT FROM AUTHOR]

Introduction: Motherhood is a lifelong learning process. Becoming a mother involves huge changes and a major shift in identity. We usually don't pair loneliness with motherhood, but researchers have found that motherhood could be filled with lonely feelings. A study by the British Red Cross found that more than 83% of mothers under 30 years old feel lonely at some time. Even before COVID, one study found that more than 90 percent of moms reported feeling lonely after having kids, over one-third said they cried regularly, and more than half suffered from anxiety. This study aims to determine the problems with loneliness in motherhood and how they influence the whole family's long-term growth and wellness. Methods: PubMed and Google Scholar were searched using the following keyword: (loneliness) AND (motherhood) AND (mental health) AND (maternal) using the journal publication filter for the 2018-2023 issue. Review: Loneliness isn't only a concern for mothers but also for all family members. Mothers who experience a high degree of loneliness are likely to be depressed, which in turn leads to decreased self-esteem and poor health, and consequently the poor health of their children. Stronger involvement of the mother's family, friends, and other support systems should be promoted. Conclusions: Researchers should pay attention to the facts that building close connections with others can stop social isolation in mothers from taking a toll on their mental health [ABSTRACT FROM AUTHOR]

Introduction: Epidural analgesia is a gold standard for the management of labour pain. Despite that, there was a small incidence of interscapular pain, which can be as severe as contraction pain and interfere with patient management. This study's objective was to identify possible risk factors associated with interscapular pain during epidural labour analgesia and its delivery outcome. Materials and methods: This study was carried out in the Department of Anaesthesia, Hospital Sultan Ismail, Johor Bharu. A total of 256 parturient who received epidural labour analgesia from January 2017 to December 2019 were recruited. Patients' demographics, epidural technique, local anaesthetic drugs used, and delivery data were recorded. Results: : Simple logistic regression analysis showed primigravida, odds ratio 2.66 (95% CI 1.48, 4.76), maternal obesity, odds ratio 7.73 (95% CI 3.99, 14.97), conventional technique during epidural initiation, odds ratio 4.22 (95% CI 2.29, 7.79) and use of patient controlled epidural analgesia (PCEA) machine, odds ratio 3.62 (95% CI 1.06, 12.31) were associated with increased risk of interscapular pain. However, further analysis showed only high volume of local anaesthetic, odds ratio 29.74 (95% CI 5.12, 172.64) was significantly associated with increased risk. Moreover, interscapular pain did not significantly associated with the delivery outcome (P = 0.546). Conclusion: A higher volume of local anaesthetic infused epidurally was associated with an increased risk of interscapular pain during epidural labour analgesia. The other risk factors such as primigravida, maternal obesity, conventional epidural, and PCEA machine use showed an association with interscapular pain but did not significantly increase the risk. [ABSTRACT FROM AUTHOR]

Birth weight is an indicator of neonatal survival and development; however, poor nutrient intake during pregnancy is a primary contributor to low birth weight. Moringa is a multipurpose tree high in macro‐ and micronutrients. There is insufficient evidence on the relationship between fresh moringa leaf consumption during pregnancy and birth weight. The purpose of this study was to determine the association between maternal fresh moringa leaf consumption on birth weight in southern Ethiopia. A community‐based, prospective cohort study design was used with 230 pregnant women who consumed fresh moringa leaves and 230 who did not consume moringa leaves. The mothers were enrolled in their second trimester and monitored until delivery. The structural equation model was used to analyze β coefficients with p‐values <.05. The mean birth weight of newborns born to mothers who took fresh moringa leaves during pregnancy was 3334.42 g, which was considerably higher than the non‐consumer 3196.73 g (p =.008). Consuming it during pregnancy significantly increased birth weight by 115.77 g compared to non‐consumers (β = 115.77; SE = 43.03: p =.007). The study found that eating fresh moringa leaves during pregnancy increased the birth weight of the newborn. As a result, policymakers and managers of mother and child health programs should strive to promote the use of fresh moringa leaves throughout pregnancy. However, more clinical trials are required to discover the ideal/optimal amount per day and duration of fresh moringa leaves for best outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding rates in Indonesia remain low, lagging behind global standards. Many factors affect this condition before and after birth. They include social, demographic, biological, and psychological factors. Many studies have shown that breastfeeding is very healthy for the baby and mother, but it's not as expected. Modern development causes shifts that are social, cultural, and economic. They erode support for breastfeeding mothers. This research aims to analyze the association between social determinants of health and exclusive breastfeeding in Palembang city, South Sumatra, Indonesia. These factors include jobs, education, parity, family, ethnicity, knowledge, attitudes, and sources of information. Materials and methods: This research used a cross-sectional approach. It studied eight tribes: Ogan, Bugis, Arab, Chinese, Javanese, Sundanese, Padang, and Batak. The sample for this research was 220 breastfeeding mothers . We collected samples using the cluster random sampling technique. Results: Around 70% of respondents provided exclusive breastfeeding. Multivariate analysis showed that mothers with some children ≤ 2 (aOR=2.050; CI 95%=1.019-4.126; p=0.044), partner support during delivery (aOR=2.280; CI 95%=1.019-4.126; p=0.013), and maternal in-law support (aOR=3.200; 95% CI= 1.725-5.936; p<0.001) have a significant association with exclusive breastfeeding. Conclusion: This research shows that, apart from parity, the relatively low level of exclusive breastfeeding is influenced by social determinants of health perspectives such as maternal and partner support. [ABSTRACT FROM AUTHOR]

The link between inflammatory disorders, such as asthma, and attention deficit hyperactivity disorder (ADHD) is attracting increasing attention but few studies have examined cross-generational associations. We sought to examine associations of maternal asthma and asthma exacerbation during pregnancy, as well as paternal asthma, with the risk of ADHD in children. This population-based cohort study used data from the Taiwan National Health Insurance Research Database from 2004 to 2017. Cox regression models compared the risk of ADHD in children of parents with and without asthma, adjusting for parental sociodemographic, physical, and mental health conditions, as well as the child's birth weight, and number of births. A sibling control approach was employed to compensate for unmeasured confounders of asthma exacerbation during pregnancy. In the fully adjusted models, maternal and paternal asthma were both significantly associated with an increased risk of ADHD in offspring, with hazard ratios (HRs) of 1.36 (1.31-1.40) and 1.10 (1.05-1.14), respectively. Acute asthma exacerbation during pregnancy was not associated with the risk of further offspring ADHD (adjusted HR 1.00, 95% CI: 0.75-1.34). Both maternal and paternal asthma are associated with an increased risk of ADHD in offspring. The risk was higher from maternal asthma. However, no such association was found with maternal asthma exacerbation during pregnancy of sibling comparison. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood–brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle–Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data. PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018. [ABSTRACT FROM AUTHOR]

Patterns of mother–embryo fractionation of 13C and 15N were assessed for their predictability across three species of batoids caught as by‐catch in south‐eastern Australia. Stable isotope analysis of 24 mothers and their litters revealed that isotope ratios of embryos were significantly different from their corresponding mothers and that the scale and direction of the difference varied within and across species. The range of variation across species was 3.5‰ for δ13C and 4‰ for δ15N, equivalent to a difference in trophic level. In one species (Urolophus paucimaculatus) litters could be significantly enriched or depleted in 13C and 15N relative to their mothers' isotope signatures. These results suggest that patterns of mother–embryo isotope fractionation vary within and between species and that these patterns may not be explained only by developmental mode. Contrasting patterns of fractionation between and within species make it difficult to adjust mother–embryo fractionation with broad‐scale correction factors. [ABSTRACT FROM AUTHOR]

Context. Supplementary feeding may alter sheep enterprise production and profit margin, but use may vary across regions, sheep breeds and mating seasons. Supplementary feeding is a means of ensuring adequate nutrition but increases operating costs. Modelling has previously indicated the most profitable sheep enterprises optimise stocking rate and target lamb production, whereas those that minimise supplementary feeding incur the least financial risk. Aims. To explore the impact of increasing supplementary feed allowance on production, profit and financial risk. Methods. Seventytwo sheep farm enterprises were simulated across eight southern Australian locations, including three breeds and three mating seasons. For each enterprise a low grain allowance (LGA) of 30 kg/head.year (threshold used in previous modelling) was compared to a high grain allowance (HGA) of 35 kg/head.year and 42 kg/head.year for Merino and non-Merino ewes (current industry recommendations), respectively. The financial risk of each enterprise was determined via Conditional Value at Risk of gross margins over 30 years, exploring downside risk in the worst 20% of scenarios. Key results. AHGA increased production and profit in 32% of farm enterprises, but financial risk was often increased. Merino enterprises were generally the most profitable, least risky and consumed the greatest amount of supplementary feed, followed by Composite and then Maternal enterprises. Summer and autumn mating was often most profitable, but high supplement consumption in autumn-mated enterprises increased financial risk. Conclusions. Increasing supplementary feeding may improve production and profit but may also increase financial risk using the parameters examined. Implications. Producers may be able to improve the production, profit and financial risk of an enterprise through increased supplementary feeding, but this will be dependent on breed, input costs, commodity prices and location. [ABSTRACT FROM AUTHOR]