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Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

BACKGROUND: Professional societies such as the American College of Obstetricians and Gynecologists (ACOG) promote the idea that postpartum care is an ongoing process where there is adequate opportunity to provide services and support. Nonetheless, in practice, the guidelines ask clinicians to perform more clinical responsibilities than they might be able to do with limited time and resources. METHODS: We conducted an online survey among practicing obstetric clinicians (obstetrician/gynecologists (OB/GYNs), midwives, and family medicine doctors) in California about their priorities and care practices for the first postpartum visit and explored how they prioritize multiple clinical responsibilities within existing time and resources. Between September 2023 and February 2024, 174 out of 229 eligible participants completed the survey, a 76% response rate. From a list of care components, we used descriptive statistics to identify those that were highly prioritized by most clinicians and those that were considered a priority by very few and examined the alignment between prioritized components and recommended care practices. RESULTS: Clinicians were highly invested in the care components that they rated as most important, indicating that they always check these components or assess them when they perceive patient need. Depression and anxiety, breast health/breast feeding issues, vaginal birth complications and family planning counseling were highly ranked components by all clinicians. In contrast, clinicians more often did not assess those care components that infrequently ranked highly among the priority listing, consisting mainly of social drivers of health such as screening and counseling for intimate partner violence, working conditions and food/housing insecurity. In both instances, we found little discordance between priorities and care practices. However, OB/GYNs and midwives differed in some care components that they prioritized highly. CONCLUSIONS: While there is growing understanding of how important professional society recommendations are for maternal-infant health, clinicians face barriers completing all recommendations, especially those components related to social drivers of health. However, what the clinicians do prioritize highly, they are likely to perform. Now that Medi-Cal (Medicaid) insurance is available in California for up to 12 months postpartum, there is a need to understand what care clinicians provide and what gaps remain.

BackgroundPregnant and postpartum women in Sub-Saharan Africa are at high risk of HIV acquisition. We evaluated a person-centered dynamic choice intervention for HIV prevention (DCP) among women attending antenatal and postnatal care.SettingRural Kenya and Uganda.MethodsWomen (aged 15 years or older) at risk of HIV acquisition seen at antenatal and postnatal care clinics were individually randomized to DCP vs. standard of care (SEARCH; NCT04810650). The DCP intervention included structured client choice of product (daily oral pre-exposure prophylaxis or postexposure prophylaxis), service location (clinic or out of facility), and HIV testing modality (self-test or provider-administered), with option to switch over time and person-centered care (phone access to clinician, structured barrier assessment and counseling, and provider training). The primary outcome was biomedical prevention coverage-proportion of 48-week follow-up with self-reported pre-exposure prophylaxis or postexposure prophylaxis use, compared between arms using targeted maximum likelihood estimation.ResultsBetween April and July 2021, we enrolled 400 women (203 intervention and 197 control); 38% were pregnant, 52% were aged 15-24 years, and 94% reported no pre-exposure prophylaxis or postexposure prophylaxis use for ≥6 months before baseline. Among 384/400 participants (96%) with outcome ascertained, DCP increased biomedical prevention coverage 40% (95% CI: 34% to 47%; P < 0.001); the coverage was 70% in intervention vs. 29% in control. DCP also increased coverage during months at risk of HIV (81% in intervention, 43% in control; 38% absolute increase; 95% CI: 31% to 45%; P < 0.001).ConclusionA person-centered dynamic choice intervention that provided flexibility in product, testing, and service location more than doubled biomedical HIV prevention coverage in a high-risk population already routinely offered access to biomedical prevention options.

BackgroundPrior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.MethodsWe conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"ResultsOf 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.ConclusionsWell-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

Background and Purpose Recent changes to medical recommendations for exercise in pregnancy and postpartum have expanded to include recreational athletes. While women are transitioning into motherhood at the height of their athletic careers, there is limited guidance on musculoskeletal training from pregnancy through safe return to activity. The lack of education and support in this population may lead to increased prevalence of symptoms and delay of treatment, ultimately hindering athletic performance. The purpose of this case series is to assess pelvic floor symptoms through implementing a new pre- and postnatal exercise training paradigm in a group of women aiming to return to recreational athletics. Study Design Case series Methods Six recreationally athletic women between 25-35 years of age were referred to physical therapy during pregnancy to participate in this protocol. The women completed a standardized pregnancy and postpartum rehabilitation plan focused on core and pelvic floor control in addition to specific strength and mobility training. Results Pain, urinary dysfunction, and pelvic floor muscle strength were assessed at six weeks postpartum and at discharge. Meaningful improvement was noted in pain, urinary dysfunction, and muscle strength by the time of discharge. Conclusion The decrease in symptoms and improvements in measures of musculoskeletal health suggests that a physical therapist guided rehabilitation protocol may be useful as part of the standard of care to reduce prevalence of pain and dysfunction, particularly in the recreational athlete population. Improving understanding of exercise training in this population may minimize musculoskeletal symptoms and encourage additional research to improve the standard of care for this group of patients. Level of Evidence Level 4 [ABSTRACT FROM AUTHOR]

Background: Cord care is one component of essential newborn care that reduces newborn morbidity and mortality. Poor cord care practice leads to a large amount of neonatal death due to infection. In Ethiopia, many women give birth at home, where neonates are exposed to unclean cord care practices or application of different traditional substances. Despite the severity of the problem, studies related to postnatal cord care practice are scarce. Hence, this study is aimed to assess umbilical cord care practices and associated factors in the postnatal period in Arba Minch town. Objective: To assess postnatal cord care practices and associated factors among mothers who gave birth in the last six months in Arba Minch Town, southern Ethiopia, 2019. Methods: Cross-sectional study design was conducted and using simple random sampling method 423 mothers who gave birth with in the last six months in Arba Minch town from November 11 to December 02, 2019, were selected. Data was collected using structured questionnaire administered by the interviewer. EpiData version 4.4 was used for data entry and SPSS version 25 was used for data analysis. Variables with p ≤ 0.25 in bivarible logistic regressions were considered as potential candidates for multivariable logistic regression analysis to control confounders. Adjusted Odds Ratio with 95% confidence interval was applied in multivariable logistic regression models, to identify variable, which has significant association. Results: The overall proportion of women who had good postnatal cord care was 67.1%. The maternal age group of 25 to 29 years (AOR = 2.51; 95% CI: 1.35–4.68), maternal educational status of secondary school and above (AOR = 4.19; 95% CI: 2.05–8.54), mothers with good knowledge of cord care (AOR = 1.77; 95% CI: 1.03–3.05), and health facility delivery (AOR = 2.60; 95%CI: 1.05–6.41) were independent factors associated with good cord care. Conclusions: The proportion of good cord-care practice reported in this study was relatively worthy. Maternal age group of 25–29 years, maternal educational status of secondary school and above, having good knowledge of cord care, and delivering at health facility were factors that increased good postnatal cord care practice. Therefore, investing in improving these factors would positively affect maternal postnatal cord care practice. In order to reduce neonatal morbidity and mortality, routine counseling of cord care practice to mothers would attain good knowledge about postnatal cord care practices. Community health education would also increase awareness and practice of postnatal cord care. [ABSTRACT FROM AUTHOR]

Our study delves into postpartum depression (PPD) extending observation up to six months postpartum, addressing the gap in long-term follow-ups and uncover critical intervention points. Through a continuous three-wave cohort study involving 3174 of 10,730 invited postpartum women, we utilized machine learning to predict PPD risk, incorporating self-reported surveys and health records from October 2021 to Jan 2023. PPD prevalence slightly decreased from 30.9 % to 29.1 % over six months. The Random Forest model emerged as the most effective, identifying key predictors of PPD at different stages. The top three factors at first month were newborn's birth weight, maternal weight before delivery and before pregnancy. The EPDS scores of last time, newborn's birth weight and maternal weight before pregnancy and before delivery were main predictors for EPDS scores at third and sixth months postpartum. The study faces limitations such as potential selection bias due to the convenience sampling method and the reliance on self-reported measures, which may introduce reporting bias. Furthermore, the high attrition rate could affect the representativeness of the sample and the generalizability of the findings. There is a slight decrease in PPD rates over six months, yet the prevalence remains high. This underscores the need for early and ongoing mental health support for new mothers. Our study highlights the efficacy of machine learning in enhancing PPD risk assessment and tailoring intervention strategies, paving the way for more personalized healthcare approaches in postpartum care. • Extensive follow-up reveals PPD trends up to six months postpartum, emphasizing continuous monitoring necessity. • Machine learning utilized in a three-wave cohort study identifies PPD risk predictors. • Key predictors for PPD include newborn's birth weight and maternal pre-delivery weight, highlighting intervention targets. • PPD prevalence demostrates a slight decline over six months, maintaining a significant impact. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high‐level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework's adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five‐part survey for the evaluation of maternity care across diverse settings.International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test–retest was conducted to assess reliability.Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α in 12 of the survey's 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657 to 0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed.This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable, and comprehensive tool for measuring service user perceptions of the quality of care over time. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings. Methods: A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs). Results: Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34–0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54–0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5–0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50–0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40–0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66–0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77–0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15–9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61–0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65–0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44–0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03–1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22–5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21–0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45–0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66–0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77–0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65–0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45–0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29–0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53–0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54–0.74, 3 studies, and RR: 0.61; 95% CI: 0.48–0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45–0.62, 2 studies, and RR: 0.86; 95% CI: 0.77–0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43–0.59, 1 study, and RR: 0.79; 95% CI: 0.65–0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66–0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62–0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19–0.81, 1 study). Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research. Methods: We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool. Results: Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care. Conclusions: Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health. Protocol Registration: This review was registered in PROSEPRO (CRD42023454900). [ABSTRACT FROM AUTHOR]

Background: Postnatal care (PNC) is the care of a newborn and mother for up to six weeks from one hour of placenta birth. The postnatal period is one of the most hazardous stages for mothers and their baby's health. The PNC is influenced by several maternal, family, biological, and socio-economic factors and it is necessary to identify the most significant factors of PNC. Therefore, the authors focus on determining the significant determinants of postnatal care in Bangladesh. Methods and materials: This study is based on a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS)-2017/18. Descriptive statistics, chi-square test, and multilevel logistic regression have been used to determine the contributing factors of PNC. Results: The rate of postnatal care was highest in Sylhet (73.7%) and lowest in Dhaka (57.1%). Female babies had 10.1% less odds of having postnatal care than male babies. Findings depict that the children with 1–3 siblings have 1. 82 times more odds (odds ratio (OR):1.82, 95% confidence interval (CI):0.03–3.21) of PNC than babies without any siblings. Children who suffered from fever recently had 1.25 times (OR = 1.25, 95% CI:1.09–1.45) more odds of taking PNC than their counterparts. Children of working mothers had 1.33 times (OR:1.33, 95% CI:1.14–1.56) more odds of having PNC than children of non-working mothers. Conclusion: The sex of a child, birth order number, place of residence, region, receiving Bacillus Calmette-Guérin (BCG) vaccine, number of antenatal care visits, having fever recently, number of household members, media exposure, and household facilities are significantly linked with PNC in Bangladesh. To ensure the good health of a child, it is necessary to focus on the targeted groups and put emphasis on the identified variables. The authors believe that the findings will be helpful to the policymakers of Bangladesh to lessen childhood morbidities which will be helpful in achieving the target of the Sustainable Development Goals (SDGs) for reducing preventable maternal and under-five deaths by 2030. [ABSTRACT FROM AUTHOR]

Postnatal care immediately after birth is a crucial component to save lives of mothers and the newborns. A paucity of evidence indicated that women's unwillingness to receive care after birth is a remained challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the utilization of postnatal care within 48 h after birth and its determinants in northwest Ethiopia. A community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had birth within the last one year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and p value of 0.05. The study revealed that 13.3% (95% CI 10.9–15.7%) of women attended postnatal care visits within 48 h after birth. Attending secondary and above education (AOR = 2.39; 95% CI 1.18, 4.84); health extension workers home visiting during pregnancy (AOR = 1.74; 95% CI 1.08, 2.82); birth order (AOR = 2.07; 95% CI 1.03, 4.14); place of delivery (AOR = 7.49; 95% CI 3.73, 15.06); and short distance to health facility (AOR = 4.19; 95% CI 1.64, 10.70) were significantly associated with postnatal care utilization within 48 h after birth. Postnatal care utilization within 48 h is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider multilevel intervention strategies focusing on maternal health education, engaging community health workers in health promotion, and ensuring physical accessibility of healthcare facilities to be more effective in improving postnatal care utilization within 48 h. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post‐traumatic stress disorder (PTSD) in women with ACEs is lacking.A systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random‐effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software.Seven studies were included in the system review. One study was identified as an outlier and excluded from the meta‐analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%–29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta‐regression to identify factors influencing study heterogeneity was not conducted.The incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses. This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses.Out‐of‐pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income.We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid‐insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well‐being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid‐insured birth and 2,909 with a commercially insured birth.We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid‐insured births were free to the patient, compared with 15.7% of commercially insured births (p < 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, p < 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, p < 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, p < 0.001) and financial worry (55% vs. 34%, p < 0.001).The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain. [ABSTRACT FROM AUTHOR]

Background:Methods:Results:Conclusions:Black birthing people in the United States are disproportionately impacted by maternal mortality and more frequently report physical and verbal mistreatment during intrapartum care. Birth plans for prenatal and postpartum care promote autonomy and agency but have not been used as tools to address disparities in perinatal care.We reviewed the literature on the use of birth plans and communication in the pregnancy care setting. We provide an expert analysis and a recommendation for a comprehensive birth plan that incorporates patient preferences and individualizes patient risks as a communication tool.In this expert opinion we outline how an equity birth plan can address social determinants of health, promote respectful communication and prioritize attention to patient narratives. This instrument can be used to address systemic problems that result in health inequities on a community, provider and institutional level.A birth plan with attention to equity serves as a new paradigm for care which can empower patients and reduce racial inequities in perinatal and postpartum outcomes. [ABSTRACT FROM AUTHOR]

Background: Lack of sunlight exposure is the primary reason for the worldwide epidemic of vitamin D deficiency. There was a meta-analysis conducted under the title of Knowledge and Practice of Mothers towards sunshine exposure of their children in Ethiopia. However, studies conducted on factors associated with sunlight exposure practice among infants showed non-conclusive and inconsistent findings. Hence, this systematic review and meta-analysis were conducted to estimate the pooled prevalence of good sunlight exposure practice and its associated factors among infants in Ethiopia. Methods: All articles were systematically searched by PubMed, Hinari, Global Health and CINAHL, Epistemonikos, African Journal of Online (AJOL), Google Scholar and Google. All studies, until the end of May 30, 2023, were included in this review. Pure qualitative studies and studies in which the outcome was not reported were excluded from the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used. Meta-analysis was conducted by using STATA 17 software. Forest plots were used to present the pooled prevalence of good sunlight exposure practices. A random effect model was used to compute the pooled prevalence, while subgroup analysis was performed to identify the possible source of heterogeneity. Publication bias was assessed by begg's and Egger's tests. We use Trim and fill analysis was used to treat the publication bias. Results: This review involved 14 studies and 6,121 participants. The pooled prevalence of good sunlight exposure practice among infants in Ethiopia was 53.46% (95%CI: 45.98, 60.95). Mothers had PNC follow-up [OR = 2.22 (95% CI: 1.31, 3.47)], mothers with secondary and above educational status [OR = 4.17, (95% CI: 1.73, 10.06)], employed mothers [OR = 3.72, (95% CI: 2.71, 5.11)], urban residence [OR = 2.67, (95% CI: 1.17, 6.08)] and not fear of sunlight exposure [OR = 4.08, (95% CI: 1.44, 16.00)] were positively associated with good sunlight exposure practice. Conclusions: The pooled prevalence of good sunlight exposure practices among infants in Ethiopia is low. Had postnatal care follow-up, being urban residents, mother's employment status, mother's educational status and not fear of sunlight exposure were independent factors of good sunlight exposure practice among infants. Therefore, health professionals create awareness for mothers to increase postnatal follow-up, and the importance of health education especially for rural residents. [ABSTRACT FROM AUTHOR]

L'hémophilie acquise A est une maladie auto-immune rare secondaire au développement d'anticorps (inhibiteur) dirigés contre le FVIII, avec un pronostic vital encore engagé. Le diagnostic est en règle évoqué devant des ecchymoses sous-cutanées plus ou moins diffuses associées à un allongement du TCA. Le plus souvent idiopathique, elle peut être associée à une maladie auto-immune, un cancer, la grossesse ou le post-partum ou à la prise de médicaments. La prise en charge thérapeutique passe par la correction éventuelle du syndrome hémorragique par des agents hémostatiques (facteur VII recombinant activé, concentré de complexe prothrombique ou facteur VIII humain porcin recombinant). L'éradication de l'inhibiteur fait appel à un traitement immunosuppresseur par corticoïdes seuls souvent associés à un agent cytotoxique ou du rituximab, dont l'indication doit tenir compte du taux de FVIII résiduel et du titre d'inhibiteur. Le but de cette revue est de faire le point sur les données épidémiologiques, cliniques, physiopathologiques, diagnostiques et de discuter les recommandations thérapeutiques actuelles. Acquired hemophilia A (AHA) is a rare autoimmune disorder due to autoantibodies against factor VIII, with a high mortality risk. It should be suspected in subjects with abnormal bleedings, especially subcutaneous bleed associated with prolonged activated partial thromboplastin time (aPTT). AHA is often idiopathic but is associated with autoimmune diseases, malignancies, pregnancy and postpartum period or drugs. Treatment is based on haemostatic agents as by-passants agents such as factor VIIa and activated prothrombine concentrate complex or recombinant porcine factor VIII for severe bleeding. Eradication of inhibitor should be established as soon as the diagnosis is confirmed with steroid alone often associated with cytotoxic agents or rituximab, depending on FVIII activity and inhibitor titer. The purpose of this review is to summarize the epidemiology, etiopathogenesis, diagnosis, treatment of AHA and discuss current recommendations. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that orofacial clefts are the most common facial congenital abnormalities in humans • To read a case study presenting an overview of the care provided for an infant born with a cleft palate • To recognise the vital role of children’s nurses in supporting family-centred care. Orofacial clefts are the most common facial congenital abnormalities in humans. Their management is complex due to a range of immediate and ongoing challenges. These include breathing, feeding, speech, hearing and dental issues. This article uses a case study approach to outline these challenges for a patient who was born with a cleft palate. The case is followed by a discussion of contemporary evidence-based care. The article focuses on family-centred care and multidisciplinary teamwork, and the author also details the central role of the children’s nurse. [ABSTRACT FROM AUTHOR]

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability. [ABSTRACT FROM AUTHOR]

To explore clients' and clinicians' perspectives about the acceptability and perceived outcomes of the Sustaining New South Wales (NSW) Families (SNF) program shifted to a hybrid service delivery model during the COVID‐19 pandemic. Mixed methods design comprising cross‐sectional online surveys and a focus group. Eighty clients who accessed the SNF service and 12 SNF clinicians. Anonymous client survey comprising questions about perceived benefits and impacts of the hybrid SNF program model, and suggestions for change. Clinician focus group discussion about perceived benefits and challenges of the hybrid SNF model. The hybrid SNF program is a child and family health nursing home visitation program for families with moderate level psychosocial risks. It comprises a mix of face‐to‐face and virtual telehealth/telephone appointments, delivered during pregnancy and up to 2 years postpartum. Clients reported high levels of satisfaction with the program, and improvements in confidence and decision‐making. Clinicians spoke of increased efficiency and flexibility, and capacity for ongoing service provision during the COVID‐19 period. Technology access issues were identified as a barrier. Overall, however, both clients and clinicians expressed a preference for face‐to‐face SNF service provision. While further studies are required to test clinical outcomes, the hybrid SNF model is acceptable to clients and clinicians. [ABSTRACT FROM AUTHOR]

Objective Fetal diagnosis of coarctation of the aorta (CoA) is currently associated with a high false-positive rate. Many predictive markers may be gestational age (GA)-specific. We sought to establish GA-specific traditional and speckle-tracking fetal echocardiography (STE) markers predictive of true CoA in neonates with prenatal suspicion. Study Design This is a retrospective case–control study. We compared the fetal ventricular and arch dimensions, as well as the deformation parameters by STE, of infants who required a postnatal intervention for their CoA with those who did not. Cohort was stratified based on GA before or after 30 weeks. Data extractors were masked to the outcome. The first fetal echocardiogram available was used. Results Seventy-five newborns with a fetal echocardiography performed between October 2013 and May 2022 for an antenatal suspicion of CoA were included, of which 59 (79%) had an aortic arch with nonsignificant obstruction upon ductal closure, and 16 (21%) underwent a neonatal intervention for a confirmed CoA. Before 30 weeks' GA, the right ventricular to left ventricular (RV/LV) end-diastolic width and end-diastolic area (EDA) ratios were most associated with postnatal CoA confirmation (area under the curve [AUCs] = 0.96 and 0.92). After 30 weeks' GA, the RV/LV end-diastolic width ratio (AUC = 0.95), the Z-score for the ascending aorta (AUC = 0.93), and the LV end-diastolic width Z-score (AUC = 0.91) performed the best. A decreased RV peak longitudinal strain was observed in those who developed true CoA and performed well by receiver operating characteristic analysis after 30 weeks (AUC = 0.85). In the overall cohort, the RV/LV EDA ratio was the most sensitive predictor of CoA and identified all cases with CoA. Indeed, a cutoff > 1.24 had a specificity of 69.5% and a sensitivity of 100% (receiver operating characteristic curve with an AUC of 0.88). Conclusion We outlined sensitive and specific fetal markers associated with postnatal CoA based on GA at suspicion. Key Points Fetal ventricular disproportion predicts postnatal coarctation. A decreased right ventircular contraction was observed in those with coarctation. Fetal markers differ based on gestational age at fetal evaluation. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify the clinical and growth parameters associated with retinopathy of prematurity (ROP) in infants with necrotizing enterocolitis (NEC) and spontaneous ileal perforation (SIP). Study Design We conducted a retrospective cohort study that compared clinical data before and after NEC/SIP onset in neonates, categorizing by any ROP and severe ROP (type 1/2) status. Results The analysis included 109 infants with surgical NEC/SIP. Sixty infants (60/109, 55%) were diagnosed with any ROP, 32/109 (29.3%) infants (22% type 1 and 7.3% type 2) with severe ROP. On univariate analysis, those with severe ROP (32/109, 39.5%) were of lower median gestational age (GA, 23.8 weeks [23.4, 24.6] vs. 27.3 [26.3, 29.0], p < 0.001), lower median birth weight (625 g [512, 710] vs. 935 [700, 1,180], p < 0.001) and experienced higher exposure to clinical chorioamnionitis (22.6 vs. 2.13%, p < 0.006), and later median onset of ROP diagnosis (63.0 days [47.0, 77.2] vs. 29.0 [19.0, 41.0], p < 0.001), received Penrose drain placement more commonly (19 [59.4%] vs. 16 [34.0%], p = 0.04), retained less residual small bowel (70.0 cm [63.1, 90.8] vs. 90.8 [72.0, 101], p = 0.007) following surgery, were exposed to higher FiO 2 7 days after birth (p = 0.001), received ventilation longer and exposed to higher FiO 2 at 2 weeks (p < 0.05) following NEC and developed acute kidney injury (AKI) more often (25 [86.2%] vs. 20 [46.5%], p = 0.002) than those without ROP. Those with severe ROP had lower length, weight for length, and head circumference z scores. In an adjusted Firth's logistic regression, GA (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: [0.35, 0.76]) and diagnosis at later age (aOR = 1.08, 95% CI: [1.03, 1.13]) was shown to be significantly associated with any ROP. Conclusion Infants who develop severe ROP following surgical NEC/SIP are likely to be younger, smaller, have been exposed to more O 2 , develop AKI, and grow poorly compared with those did not develop severe ROP. Key Points Thirty percent of infants with NEC/SIP had severe ROP. Those with severe ROP had poor growth parameters before and after NEC/SIP. Risk factors based ROP prevention strategies are needed to have improved ophthalmic outcomes. [ABSTRACT FROM AUTHOR]

• High level of agreement on the OASIS classification system. • High level of agreement on immediate management such as the site, choice of suture material, and need for adequate analgesia during the OASIS repair. • Differences in the recommended timing of OASIS repair, involvement of specialists, and use of prophylactic antibiotics. • Considerable variability in post-operative care and follow-up practices. To review and compare existing guidelines on the intrapartum management and postpartum follow-up of obstetric anal sphincter injuries (OASIS) We conducted a systematic review of clinical guidelines related to OASIS management, focusing on intrapartum care and postpartum follow-up. Searches were performed in July 2024 across multiple databases, including PubMed, Embase, and the Cochrane Library. Guidelines published after 2010 in English were included. Nine national guidelines were included. There was a consensus on OASIS classification and immediate management, particularly regarding suture techniques, materials, and the necessity of adequate analgesia. However, notable variations were identified in the timing of repair, specialist involvement, use of prophylactic antibiotics, and post-operative care protocols. Postpartum follow-up practices also varied, especially regarding the role of physiotherapy and the timing of specialist consultations, reflecting inconsistencies in long-term care recommendations. Significant variability existed in the guidelines for the management and follow-up of OASIS, particularly in postpartum care. This study underscored the need for standardized, evidence-based guidelines to ensure consistent and optimal care for women affected by OASIS. [ABSTRACT FROM AUTHOR]

• Telemedicine in obstetrics enhances access for remote and underserved areas. • Video calls and monitoring apps are key tools in telemedicine for obstetrics. • Telemedicine improves maternal outcomes, including adherence and stress reduction. • Patients prefer a mix of digital and traditional care, showing high satisfaction. • More research is needed on fetal outcomes and telemedicine cost-effectiveness. The use of telemedicine has spread to all areas of medicine, including obstetrics, over the last few decades. To identify and map the diversity and applicability of telemedicine in the obstetric literature, in the antenatal, intrapartum or postnatal period. To assess patient satisfaction and possible areas for future development. This scoping review was conducted following the Joanna Briggs Institute (JBI) methodological guidelines for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and its extension for scoping reviews (PRISMA-ScR). We searched the databases PubMed (Medline), CINAHL, CENTRAL (Cochrane Library), EMBASE Ovid and Scopus. We also searched Google Scholar, clinicaltrial.gov , the WHO International Clinical Trials Registry Platform (ICTRP-WHO) and the reference lists of the included studies. We included any primary study design that focused on a population of women in the antenatal, intrapartum or postnatal period. Studies selection and data extraction were performed blindly and independently by two authors. We summarised the results narratively and used graphs and tables to present key concepts thematically. We included 66 studies. We categorised the studies according to population, type of intervention, outcomes and user satisfaction. Most of the studies involved pathological (36%) and physiological (30%) pregnancy management, the type of intervention was mainly divided into televisits or video calls with professionals (43%) and the use of specific apps or devices (40%). The maternal outcomes studied were mainly quantitative, i.e., improvement in blood chemistry tests or vital parameters (65%) and treatment adherence (frequency of follow-up visits or keeping appointments, 27%). Patient satisfaction was positive in the majority of cases. There is still little international agreement on the concept and possible applications of telemedicine in obstetrics, although it is increasingly being used in clinical practice. Studies have shown positive results in terms of improved care, particularly in terms of treatment adherence and as an alternative strategy in the management of pregnancy, postpartum and abortion care. Both patients and health professionals were satisfied with it, especially when offered as a complement or alternative to the traditional method of face-to-face visits. Future developments seem to be the time and cost-saving potential of telemedicine and its application to couples' infertility. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use. Methods: Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics. Results: A total of 29% of women (n = 45,573) had a mental health need identified by the CHV, and 7% (n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70–0.79), EPDS: HRa 0.67 (0.58–0.78)), as were descendants (CHV: HRa 0.77 (0.70–0.86), EPDS: HRa 0.69 (0.55–0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare. Conclusions: Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of in situ simulation-based training on quality indicators of patient care at a level IV neonatal intensive care unit. A before-and-after, non-controlled quality improvement study was performed at the Division of Neonatology, Medical University of Graz. The educational intervention comprised a period of 4 months, with structured in situ simulation training delivered regularly for neonatal providers and nurses in interprofessional teams. The primary study outcome was the quality of non-technical skills and team interaction during actual postnatal stabilization and resuscitation. This was assessed using video recording during two 2-month observational phases before (pre-training) and after the educational intervention (post-training). Delivery room video recordings were assessed by two external, blinded neonatologists using the Anaesthetists' Non-Technical Skills (ANTS) score. Furthermore, we collected clinical patient data from video-recorded neonates during the pre- and post-training periods, and training participants' individual knowledge of neonatal resuscitation guidelines was assessed using a before- and after-questionnaire. A total of 48 healthcare professionals participated in 41 in situ simulation trainings. The level of non-technical skills and team interaction was already high in the pre-training period, and it did not further improve afterwards. Nonetheless, we observed a significant increase in the teamwork event "evaluation of plans" (0.5 [IQR 0.0–1.0] versus 1.0 [1.0–2.0], p = 0.049). Following the educational intervention, training participants' knowledge of neonatal resuscitation guidelines significantly improved, although there were no differences in secondary clinical outcome parameters. Conclusion: We have successfully implemented a neonatal in situ simulation training programme. The observed improvement in one teamwork event category in the post-training period demonstrates the effectiveness of the training curriculum, while also showing the potential of in situ simulation training for improving postnatal care and, ultimately, patient outcome. What is Known: • In situ simulation-based training is conducted in the real healthcare environment, thus promoting experiential learning which is closely aligned with providers' actual work. • In situ simulation-based training may offer an additional benefit for patient outcomes in comparison to other instructional methodologies. What is New: • This observational study investigated translational patient outcomes in preterm neonates before and after delivery of high-frequency in situ simulation-based training at a level IV neonatal intensive care unit. • There was a significant increase in the frequency of one major teamwork event following the delivery of in situ simulation-based training, indicating a notable improvement in the non-technical skills domain, which is closely linked to actual team performance. [ABSTRACT FROM AUTHOR]

Prolactin (PRL) assumes a pivotal role during the postpartum phase, particularly within the hippocampus—a region densely populated with receptors for stress hormones, where stress significantly inhibits adult hippocampal neurogenesis (AHN). The reduction in neurogenesis is implicated in the pathogenesis of anxiety and depression. Mothers are at an increased risk of developing depression when exposed to chronic stress. Therefore, it is imperative to investigate the potential role of PRL in depression-like behaviors stemming from prolonged postpartum stress, and to explore any underlying mechanisms. Despite pup separation (PS) being a natural postpartum care practice, the impact of various PS methods on lactating dams remains uncertain. Lactating C57BL/6J mice, from postpartum day (PPD) 1 to PPD 21, underwent no PS (NPS), brief PS (15 min per day, PS15), or long PS (180 min per day, PS180), followed by 21 days of chronic restraint stress (CRS). Behavioral tests were conducted, and measurements included serum PRL concentration, PRL-R expression, and AHN in the hippocampus. Dams with CRS exhibited cognitive decline, depressive- and anxiety-like behaviors, and reduced PRL secretion, correlating with lower levels of AHN. PS15 dams displayed lower levels of depressive- and anxiety-like behaviors and cognitive decline compared to NPS and PS180 dams. Significantly, PS15 dams exhibited higher levels of AHN, PRL-R expression in the hippocampus, and serum PRL concentration. This study collectively reveals reduced serum PRL and AHN in dams with cognitive decline and depressive- and anxiety-like behaviors after CRS. Brief PS confers resistance to behavioral deficits after CRS, increasing serum PRL concentration and reversing AHN decrease in dams. [ABSTRACT FROM AUTHOR]

Objectives. To assess the relationship between doula utilization and health outcomes of females enrolled in Medicaid-affiliated plans in the United States. Methods. In this retrospective, observational cohort study, we used Medicaid claims data from a national health insurer to compare health outcomes between females who used and who did not use a doula (2014–2023). We conducted propensity score matching using a 1:1 case‒control match, without replacement, and fit logistic regressions to analyze the relative risks for maternal health outcomes. Results. The study population included 722 matched pairs with and without a doula. Results indicate females with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup (all differences P <.05). Conclusions. Doula care is associated with improved health outcomes among Medicaid enrollees. Public Health Implications. Doulas have garnered increasing interest from policymakers as a strategy to address increasing trends in maternal morbidity and persistent health disparities. This study provides evidence from Medicaid enrollees across the United States that doula care can improve maternal health. (Am J Public Health. 2024;114(11):1275–1285. https://doi.org/10.2105/AJPH.2024.307805) [ABSTRACT FROM AUTHOR]

Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making ; 2) communication and collaboration in the caregiver–woman relationship ; 3) individualized and holistic care ; and 4) continuity of care. Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period. There is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. In this concept analysis, women-centered care is evaluated and recommendations for postpartum care are offered based on the findings. [ABSTRACT FROM AUTHOR]

Background: Approximately half of all women develop palpitations during pregnancy, with a quarter experiencing arrhythmias. While most presentations are benign, some cases can result in sudden cardiac death or serious symptom development. Considering such clinical presentation, healthcare providers must acquire knowledge in this area to provide comprehensive prenatal, perinatal, and postnatal care. However, no study could be located that focused on women's life experiences of such complications during or in the post-pregnancy period. Objectives: The study aims to share the results of a study that explored the life experience of one woman who developed non-sustained ventricular tachycardia during her third pregnancy that lasted into the postpartum period. Methods: Using narrative inquiry self-study methodology, a woman's experiences were explored to uncover the challenges she faced in coping with such complications during a period of transition for herself and her family. This methodology allowed for an in-depth understanding of how these complications could affect all aspects of her life. Results: Four narrative threads were produced: (1) diagnostic challenges and delayed recognition; (2) impact on maternal identity and family dynamics; (3) navigating healthcare systems and treatment decisions; and (4) long-term adaptation and resilience. Conclusions: The intention was to add to this topic area to ensure future researchers, current and future healthcare providers, and patients have literature they can refer to when studying, providing care for, or experiencing similar health complications. Acquiring this knowledge can aid healthcare professionals to ensure appropriate care is provided, risks are minimized, and their recovery is well supported. [ABSTRACT FROM AUTHOR]

Background & Objective: The postpartum period is often accompanied by significant pain which affects maternal well-being and care of newborns. With an increasing interest in natural and safe alternatives to conventional pain management strategies, this study was performed with the aim to evaluate the efficacy of ginger extract and lavender oil capsules in managing postpartum pain. Materials & Methods: This single-blind, randomized clinical trial study was conducted at Baghdad Teaching Hospital, Iraq in 2023-2024. Ninety postpartum women were allocated to receive either ginger extract (250 mg per capsule) or lavender oil (100 μL per capsule) capsules orally (n=45 in each group). Pain was assessed using the Visual Analog Scale (VAS) at baseline and one-hour post-intervention, with follow-up over the first 24 hours post-delivery. The changes in pain scores, maternal satisfaction, and the incidence of side effects were compared between the two groups. Results: Both ginger extract and lavender oil capsules significantly reduced postpartum pain scores compared to baseline (P<0.001), with the lavender oil group experiencing a marginally greater reduction (from 6.1 ± 1.2 to 2.8 ± 1.0) compared to the ginger extract group (from 6.2 ± 1.3 to 3.4 ± 1.1) (P=0.035). Side effects were minimal and not significantly different between the two groups (P=0.29). Maternal satisfaction was significantly higher in the lavender oil group (91%) compared to the ginger extract group (82%) (P=0.044). Conclusion: Orally administered ginger extract and lavender oil capsules are effective in reducing postpartum pain, with lavender oil showing marginally higher efficacy and greater maternal satisfaction. These findings support the integration of these natural remedies into postpartum care, offering safe and effective alternatives for pain management. [ABSTRACT FROM AUTHOR]

In Senegal, where pregnancy is “women’s business,” men’s roles in prenatal and postpartum care are mediated by gendered expectations of what expectant fathers are allowed to know and do. Expectant fathers’ roles map onto masculine expectations of the authoritative, sovereign head-of-household. Using the state-authored Handbook of Mother and Child Health, I argue that state surveillance is refracted through preexisting masculine prenatal care roles, and that men willingly articulate themselves to the role of the surveillance state by relying on the Handbook as a guide for how to watch their pregnant partners and make sure they are adhering to its guidance. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the risk factors associated with thrombotic events in obstetric antiphospholipid syndrome (OAPS) patients and to develop a predictive model specifically tailored to predict the risk of postpartum thrombosis in OAPS patients without prior thrombotic events. This research seeks to enhance clinician’s awareness regarding the postpartum care and monitoring of OAPS patients. Methods: A retrospective study was conducted at the First Affiliated Hospital of the Fourth Military Medical University including 269 consecutive inpatients diagnosed with antiphospholipid syndrome (APS) from July 1, 2008 to July 31, 2022. All participants met the 2006 Sydney APS classification criteria or the “noncriteria OAPS classification”. Out of 98 candidate clinical and laboratory parameters considered, 40 potential variables were selected for analysis based on expert opinion. The logistic regression mode with the Least Absolute Shrinkage and Selection Operator (LASSO) were used to identify optimal predictive characteristics. All samples were included in the model building and a nomogram was generated based on these characteristics. The differentiation, calibration, and clinical utility of the predictive model were evaluated using the area under the curve (AUC), calibration curve, and decision curve analysis. The model was also validated by a 1000 bootstrap tests. Results: 126 patients with OAPS were enrolled, and a total of 89 OAPS patients who had never experienced thrombosis were retrospectively analyzed. After 3 years follow-up, 32.58% of the patients (29/89) developed thrombosis. In order to create, LASSO logistic regression identified three optimal variables: the platelet count less than 125×109/L, more than one positive aPLs (antiphospholipid antibody), and the use of low molecular weight heparin (LMWH) or low dose aspirin (LDA) after delivery. A predictive model was conducted using these three predictive indicators for patients with OAPS who experience thrombosis for the first-time. This prediction model has good distinction, good calibration, and fair clinical practicality. Conclusion: Our model has good predictive ability in assessing the risk of thrombosis in patients with OAPS without prior thrombotic events. This model is easy to predict, has good discriminability and calibration, and can be utilized as a routine tool for thrombus screening in OAPS patients. [ABSTRACT FROM AUTHOR]

Background: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia. Methods: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level. Results: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (β: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (β: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (β: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (β: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (β: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (β: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia. Conclusion: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services. [ABSTRACT FROM AUTHOR]

Background: Optimal feeding practices for sick children are crucial to prevent morbidity and mortality. Despite global and national policies emphasizing the importance of optimal feeding practices for sick children, studies have revealed varying levels of practice in different regions, including Ethiopia. However, there is a research gap in focusing on community-based contexts to determine sick child feeding practices among mothers with young children. Objective: To assess maternal feeding practices for sick children under 2 years in Wolkite town, Gurage zone, Central Ethiopia: 2024. Methods: A community-based cross-sectional study involving a total of 419 mothers of young children was conducted in Wolkite town, Gurage zone, Central Ethiopia from September 15 to November 15, 2023. Participants were chosen using computer-generated random numbers. Structured, interviewer-administered, and pretested data collection tool were used. The data were coded and entered into EpiData 3.1 before being exported to SPSS version 25 for analysis. Logistic regression was employed to identify factors influencing mothers' practice. Statistical significance was set at p < 0.05 with a 95% confidence interval. Results: The study found that 54.4% (95% CI: 50–59%) of mothers demonstrated good feeding practices for their sick children. Significant factors contributing to these practices included mothers having at least a secondary education (AOR: 3.7, 95% CI: 1.5–9.1), delivering their child in a health facility (AOR: 2.3, 95% CI: 1.4–3.8), and receiving support from the father (AOR: 2.3, 95% CI: 1.4–3.8). Additionally, mothers who were counseled on infant and young child feeding had higher odds of practicing good feeding (AOR: 4.1, 95% CI: 2.3–7.03), access to postnatal care (AOR: 3.8, 95% CI: 2.1–6.95) and having a good knowledge of feeding practices (AOR: 2.5, 95% CI: 1.4–4.5) were also strongly associated with effective feeding practices. Conclusions: The study highlights more than half of mothers in Wolkite town, Gurage zone, Central Ethiopia have good sick child feeding practices. Factors such as the higher educational status of the mother, having the father's support, place of delivery, receiving PNC services, counseling on infant and young child feeding, and knowledge about sick child feeding were significantly associated with their practice. Implementing targeted education programs, strengthening postnatal care services, counseling on infant and young child feeding, and encouraging the involvement of fathers in childcare and feeding were strongly recommended. [ABSTRACT FROM AUTHOR]

Background: In Italy, exclusive breastfeeding (EBF) rates at hospital discharge range unsatisfactorily between 20–97%. Methods: In 2023, the Project for Hospital Policy on Breastfeeding (HPB) has been launched to promote breastfeeding in Italian Maternity Hospitals (MHs) as a joint initiative of the Italian Scientific Societies involved in perinatal care together with the National Midwife (FNOPO) and Nurse (FNOPI) Boards and with Vivere Onlus, a family association. The HBP Project has been designed as an uncontrolled before-after study to increase EBF rate at hospital discharge in the population of healthy, term infant with a normal weight at birth following an intervention bundle comprising: 1) Establishment of a local hospital Working Group; 2) Adoption of a hospital policy; 3) Implementation of breastfeeding monitoring; 4) Training for perinatal care professionals; 5) Enhanced implementation of the practices of skin-to-skin contact (SSC) and mother-baby rooming-in; 6) Development/Improvement of perinatal care protocols. Results: We report the pre-intervention assessment of 89 out of the 111 enrolled MHs (80.2%) at the beginning of the Project (Time 1 or T1). Almost all MHs (96.6%) have a multi-professional Breastfeeding Working Group, while a hospital policy on breastfeeding is available only in 48.2%. Moreover, only 56.2% of the 9,777 perinatal health workers have been trained in breastfeeding. Over a 1-month period, SSC has been practiced in the delivery room by 76.9% of 6,304 term healthy newborn infants and rooming-in by 83.4% of 6,735 healthy term newborns of normal weight at birth. Over a 4-month period, 69.1% of 33,367 healthy term newborns of normal birth weight were exclusively breastfed at hospital discharge. Noticeably, EBF rate of MHs ranges from 4% up to 100%, the second quartile being 73%. Conclusion: At T1 of the HPB Project, breastfeeding rates at hospital discharge for healthy, term infants with a normal weight at birth appear to be suboptimal among Italians MHs. Particularly, the range of EBF rates among participating centers is wide, with 50% of the MHs having EBF rate lower than 73%. Therefore, the ongoing HPB Project might represent not only an opportunity to increase the initiation of breastfeeding and to improve quality of health care in the whole study group of MHs, but possibly also to level differences between centers. [ABSTRACT FROM AUTHOR]

Introduction: Our study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework. Methods: Data from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother's age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables. Results: Newborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities. Conclusion: Considering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby's body temperature and umbilical cord care could also effectively help reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Molar–incisor hypomineralization (MIH) is a qualitative enamel defect that is highly prevalent in children. It has been reported that patients with MIH have higher caries occurrence with an increased need and frequency of dental treatment compared to patients without MIH. The objective of this study was to analyze the association between MIH and a series of factors related to maternal health status during pregnancy and children´s medical history in early childhood. Methods: A retrospective study of cases (patients with MIH) and controls (patients without MIH) was designed between 2023 and 2024. A total of 280 children (cases = 140; controls = 140) aged 6 to 14 years (138 boys and 142 girls) were examined according to the European Academy of Pediatric Dentistry (EAPD) criteria for MIH. A survey was carried out with mothers regarding the potential exposure of their children to etiological factors of MIH. Possible prenatal and postnatal etiological factors were obtained through a personal interview with the patients' mothers. The statistical analysis was carried out with the contrast test and the chi-square test. Results: During pregnancy, folic acid consumption, alcohol intake, systemic viral and/or bacterial infections, and gestational diabetes were statistically significantly related to MIH, as were breastfeeding, asthma, and corticosteroid consumption during childhood. Conclusions: Although there are different factors that may have statistically significant relationships with MIH, they cannot be predicted. Therefore, longitudinal studies, with a large sample size, are needed to determine the influence of prenatal and postnatal factors on the prevalence and severity of MIH in children. [ABSTRACT FROM AUTHOR]

The effects of the COVID-19 pandemic on comprehensive maternal deaths in Brazil have not been fully explored. Using publicly available data from the Brazilian Mortality Information (SIM) and Information System on Live Births (SINASC) databases, we used two complementary forecasting models to predict estimates of maternal mortality ratios using maternal deaths (MMR) and comprehensive maternal deaths (MMRc) in the years 2020 and 2021 based on data from 2008 to 2019. We calculated national and regional standardized mortality ratio estimates for maternal deaths (SMR) and comprehensive maternal deaths (SMRc) for 2020 and 2021. The observed MMRc in 2021 was more than double the predicted MMRc based on the Holt-Winters and autoregressive integrated moving average models (127.12 versus 60.89 and 59.12 per 100,000 live births, respectively). We found persisting sub-national variation in comprehensive maternal mortality: SMRc ranged from 1.74 (95% confidence interval [CI] 1.64, 1.86) in the Northeast to 2.70 (95% CI 2.45, 2.96) in the South in 2021. The observed national estimates for comprehensive maternal deaths in 2021 were the highest in Brazil in the past three decades. Increased resources for prenatal care, maternal health, and postpartum care may be needed to reverse the national trend in comprehensive maternal deaths. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Postnatal care (PNC) is a critical service for the health and well‐being of new mothers and newborns. However, in sub‐Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA.This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer‐reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co‐ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data.Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed‐method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high.Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills. [ABSTRACT FROM AUTHOR]

Background/Objectives: Truncus arteriosus communis (TAC) is a rare congenital heart defect characterized by a single arterial trunk that supplies systemic, pulmonary, and coronary circulations. This defect, constituting approximately 1–4% of congenital heart diseases, poses significant challenges in prenatal diagnosis, management, and postnatal outcomes. Methods: A retrospective analysis was conducted at the local tertiary referral center on cases of TAC diagnosed prenatally between 2019 and 2024. Additionally, a systematic literature review was performed to evaluate the accuracy of prenatal diagnostics and the presence of associated anomalies in fetuses with TAC and compare already published data with the local results. The review included studies that especially described the use of fetal echocardiography, the course and outcome of affected pregnancies, and subsequent management strategies. Results: The analysis of local prenatal diagnoses revealed 14 cases. Of the 11 neonates who survived to birth, the TAC diagnosis was confirmed in 7 instances. With all seven neonates undergoing surgery, the intention-to-treat survival rate was 86%, and the overall survival rate was 55%. By reviewing published case series, a total of 823 TAC cases were included in the analysis, of which 576 were diagnosed prenatally and 247 postnatally. The presence of associated cardiac and extracardiac manifestations as well as genetic anomalies was common, with a 22q11 microdeletion identified in 27% of tested cases. Conclusions: Advances in prenatal imaging and early diagnosis have enhanced the management of TAC, allowing for the detailed planning of delivery and immediate postnatal care in specialized centers. The frequent association with genetic syndromes underscores the importance of genetic counseling in managing TAC. An early surgical intervention remains crucial for improving long-term outcomes, although the condition is still associated with significant risks. Long-term follow-up studies are essential to monitor potential complications and guide future management strategies. Overall, a coordinated multidisciplinary approach from prenatal diagnosis to postnatal care is essential for improving outcomes for individuals with TAC. [ABSTRACT FROM AUTHOR]

Background: Evidence generated on utilization of maternal health services during times of conflict can inform the development of targeted interventions. The deadly war in Tigray caused the health system to collapse. However, utilization of maternal health services is not well documented that might help in design effective interventions applicable during armed conflict. Thus, this study aimed to assess maternal health service utilization and bridge the gap in healthcare provision and support during conflict.. Methods: A community-based cross-sectional survey was conducted among mothers of children under the age of 1 year in six accessible zones of Tigray from August 4–20, 2021. The study participants were selected through a random sampling method. The study was conducted during the armed conflict where the access to health services was limited due to the damaged and looted health facilities. A descriptive study was used to characterize the study population and data were presented using proportions and percentages. A Chi-square test was used for categorical variables and a P-value of 0.05 was considered significant.. Results: A total of 4,381 participants were included in the study. Modern contraceptives were used by 1002 (22.9%) of women, and injectable contraceptives were the most common method used by 472 (47.1%) women. Likewise, only 830 (36.5%),1956 (47.1%), and 623 (15.0%) respondents reported the use of optimal antenatal care (ANC), skilled delivery, and postnatal care (PNC) in the first 24 h by mothers, respectively. About 34% of women received comprehensive abortion care services. Most delivery services took place in hospitals. Residence has shown a significant difference in using maternal health services at p-value < 0.001. Conclusion: The conflict in Tigray has had a profound impact on maternal health services, resulting in a significant disruption that is disproportionately high in rural areas. Immediate action is required to provide access to lifesaving interventions for basic maternal health services. The timely initiation of these services is crucial in addressing the pressing needs of pregnant women and their infants. By implementing comprehensive and targeted interventions, we can mitigate the potential long-term consequences and ensure that maternal health services are effectively reinstated. [ABSTRACT FROM AUTHOR]

Background/Objectives: Resources to cope with maternity and women's participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women's knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken's V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken's V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context. [ABSTRACT FROM AUTHOR]

Background: The continuum of maternal health care ensures consistency in the delivery of care from pregnancy to the postnatal period. It recommends a minimum of 4 antenatal visits, skilled birth attendance, and 42 days of postnatal care. This approach helps reduce maternal deaths. The aim of this study was to estimate the proportion of women who had completed the different stages of the continuum of maternal health care (four antenatal visits, given birth under the care of qualified personnel, and received postnatal care within 42 days of delivery). Methods: This was a cross-sectional analytical study conducted in the five communes of Conakry, using a two-stage cluster sampling for data collection. Results were described using medians and percentages. The proportions of women in the continuum of care, and at the different stages of this continuum, have been weighted. Multivariate logistic regression was used to identify the factors associated with non-completion of the different stages of the maternal health care continuum among the women included in this study. Results: We found that 26.9% of women had completed all stages of the maternal health care continuum, while 73.1% had not. While 56.7% received four antenatal visits, only 29.5% delivered under the care of a qualified healthcare professional. Key factors associated with discontinuity were not attending school (AOR 1.825: 1.594-2.089), unemployment (AOR 4.588: 3.983-5.285), having two or more living children (AOR 1.890: 1.016-1.296), and not receiving a free Long-Lasting Insecticidal Net at the first Antenatal Care. Conclusion: Maternal care discontinuity is a major issue in Guinea. The country's Health Development Plan had set an expected level for maternal care which has not been met as of 2022. The completeness of care is influenced by various factors, including individual socio-demographic characteristics and factors related to the organization, availability, and quality of health services. To reduce maternal and child mortality rates, it is essential to improve interpersonal communication during antenatal care, ensure the availability of quality health services, and conduct a national study on maternal health service quality and maternal satisfaction. This will help establish a proper continuum of care for mothers and children. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence is more common in polygynous couples than monogamous couples, but the extent that this association is modified by the husband's alcohol consumption is unknown. The objectives of this study are: (1) To describe the extent to which polygyny is associated with self-reported experience of intimate partner violence among women receiving postpartum care; (2) To describe the extent to which the mentioned association is modified by the husband's alcohol consumption. Methods: We conducted a hospital-based cross-sectional study among women age 18 years or older receiving postpartum care at 8 public hospitals in 3 provinces in Northern and Northeastern Thailand using self-administered questionnaires. We analyzed data using descriptive statistics, logistic regression, and stratified analyses. Results: A total of 1207 women agreed to participate in the study, 8% of whom reported that their husbands practiced polygyny. Women in a polygynous relationship were more likely than women in monogamous relationships to experience intimate partner violence (11.7% vs. 3.6%, Adjusted OR = 2.23; 95% CI = 0.94, 5.26). The prevalence of intimate partner violence was relatively low in both groups among women whose husbands did not drink (2.9% vs. 0%, Adjusted OR = N/A), and very high in both groups among those whose husbands binge-drank (46.2% vs. 20.8%, Adjusted OR = 9.54; 95% CI = 1.10, 82.54). However, the Breslow-Day Test of Homogeneity suggested that there was no statistically significant effect modification (p-value = 0.259). Conclusion: Stakeholders in intimate partner violence should consider both alcohol use (particularly binge-drinking) and polygyny as risk factors for intimate partner violence. However, caveats regarding study design, misclassification and potential information bias, and lack of generalizability should be considered in the interpretation of the study findings. [ABSTRACT FROM AUTHOR]

LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth. [ABSTRACT FROM AUTHOR]

Introduction: Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity. Methods: Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time. Results: In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was −0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = −0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05). Discussion: Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance. Significance: Women with overweight/obesity during pregnancy are at an increased risk of adverse cardiometabolic profiles and future development of type 2 diabetes and cardiovascular disease. Hispanic women are disproportionately affected by cardiometabolic disorders but have largely been excluded from lifestyle intervention studies. Although providing a lifestyle intervention to Hispanic women with overweight/obesity resulted in no significant differences in postpartum cardiometabolic biomarkers, women who articipated in vigorous activity, regardless of their assigned intervention arm, had favorable changes in insulin resistance biomarkers. These findings suggest that the intensity of physical activity may be important for improving postpartum cardiometabolic biomarkers among high-risk, Hispanic women. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is a common mental health condition that affects women in a silent and covert way and is not clearly visible to the community or to health care providers. Untreated PPD has significant and long-term consequences on the mother and their child. This study aims to assess the risk of postpartum depression among women in the Emirate of Abu Dhabi and its determinants. Method: This is a questionnaire-based cross-sectional study conducted at primary healthcare centers in the Emirate of Abu Dhabi. The target population is women visiting the well-child vaccination clinics for their infants' vaccination. The questionnaire used consisted of socio-demographic characteristics, important histories such as obstetric, medical, and social histories, and the Edinburgh Post Partum depression scale EPPS. EPPS is a validated tool used to evaluate the probability of postpartum depression. Results: The probability of postpartum depression for women visiting the well child care clinics in the Emirate of Abu Dhabi during the study period was 35%, One-third. 10% had high risk, 7% had moderate risk, and 18% had mild risk. Using logistic and linear regression, there was an association identified between postpartum depression risk and the presence of weight concern and employment status OR 5.499(2.618–11.548) and OR 0.483 (0.246–0.951), respectively (P < 0.005). From the total sample, 3.7% responded quite often or sometimes to the question of having the intention to harm themselves. Conclusion: EPDS is recommended to be used routinely to screen women in the postnatal period. This high prevalence of risk of postpartum depression in the UAE (One in three women) calls for a well-prepared healthcare system and community. Healthcare providers need to be prepared with better knowledge, practice, and management strategies to care for these women, for early identification and management. Further studies should be undertaken to achieve effective strategies to reduce the incidence of this condition. Significance: Successful strategies for the prevention of postpostpartum depression and its early prevention and management are dependent on good research studies. This study revealed that the prevalence is almost one-third among women attending the well-baby clinics in Abu Dhabi with important associations identified. These findings call for action research aiming to prevent the condition or mitigate its impact on women, families, and the community. [ABSTRACT FROM AUTHOR]

Background: Mothers must acquire the knowledge and skills needed to fulfill their responsibilities and take care of themselves and their babies. Purpose: This study aimed to examine the effects of online baby care education and postpartum counseling based on Meleis' transition theory on mothers' readiness for baby care and breastfeeding. Method: This randomized controlled trial was conducted between May 2022 and May 2023 at the pregnancy followup outpatient clinic of a state hospital. The study sample consisted of 102 pregnant women (52 in the intervention group, 50 in the control group). Results: The mean scores of the intervention group compared to the control group were significantly higher immediately after birth and at 1, 2, and 3 months postpartum. Change over time was significantly higher in repeated measurements of National Institute of Child Health and Human Development scale scores of the intervention and control groups (P=0.001). In the first 24 hours, mothers in the intervention group breastfed more successfully than those in the control group (P<0.001). Mothers in the intervention group exclusively breast fed at a significantly higher rate immediately and at 1, 2, and 3 months postpartum compared to the control group (P<0.001). A statistically significant difference was noted in mean infant height and weight in the intervention group compared to the control group (P<0.05). Conclusion: Theory-based online education initiated during pregnancy and counseling continued up to 3 months postpartum positively affected the mothers' abilities to care for their infants. Mothers who received education and counseling breastfed their babies more successfully on the first day and breast fed exclusively at a higher rate in the first 3 months. [ABSTRACT FROM AUTHOR]