Reproductive Health最新文献

Background: The global incidence of infertility is increasing, and infertility has become an important medical and social issue. With the widespread application of in vitro fertilization-embryo transfer (IVF-ET) technology, the mental health problems of patients undergoing this treatment have gradually attracted widespread attention. The purpose of this study was to explore the relationships among the level of hope, the fertility quality of life and negative emotions of patients who underwent IVF-ET treatment for the first time to provide a scientific basis for subsequent psychological support interventions.

Methods: This study was a cross-sectional survey conducted at the Reproductive Medicine Center of Renmin Hospital of Wuhan University. From February 2023 to October 2023, 1425 patients who received IVF-ET treatment for the first time participated in the questionnaire survey. The survey content included the General Information Questionnaire, the Fertility Quality of Life (FertiQoL) Questionnaire, and the Herth Hope Index (HHI). Pearson correlation analysis was used to examine the relationships among the level of hope, fertility quality of life, and negative emotions.

Results: The survey included 805 women and 620 men representing 603 couples. The level of hope in patients undergoing IVF-ET treatment for the first time was positively correlated with fertility quality of life (r = 0.247, P < 0.01), and the level of hope was negatively correlated with negative emotions (stress: r = - 0.135, P < 0.01; anxiety: r = - 0.105, P < 0.01; depression: r = - 0.189, P < 0.01). Fertility quality of life was negatively correlated with negative emotions (stress: r = - 0.609, P < 0.01; anxiety: r = - 0.533, P < 0.01; depression: r = - 0.591, P < 0.01). Among couples undergoing IVF-ET treatment for the first time, the husband's level of hope (r = 0.131, P < 0.01), fertility quality of life (r = 0.372, P < 0.01), and negative emotions (stress: r = 0.181, P < 0.01; anxiety: r = 0.163, P < 0.01; depression: r = 0.210, P < 0.01) were positively correlated with those of his wife.

Conclusions: In patients undergoing their first IVF-ET treatment, there is a significant correlation among hope, fertility quality of life, and negative emotions. Moreover, within couples, the levels of hope, fertility quality of life, and negative emotions of husbands and wives mutually influence each other. Enhancing the level of hope in this population is conducive to alleviating negative emotions and improving their fertility quality of life. The mutual influence of spouses should not be overlooked in clinical practice, and psychological support for both partners should be emphasized.

Background: Most maternal deaths are preventable by accessing essential maternity healthcare services. However, maternal mortality rates remain high in Ethiopia partly due to only a few women using a complete Continuum of Maternal Healthcare Services (CMHS). This study aims to assess trends and contributors for complete CMHS utilization in Ethiopia.

Methods: Ethiopian Demography and Health Survey (EDHS) 2011-2019 data were used to assess the trends of complete CMHS utilization. A total weighted sample of 10,768 women (3333 in 2011, 4590 in 2016, and 2845 in 2019) were included in the analysis. A logit-based multivariate decomposition analysis was undertaken to assess the change in the proportion of complete CMHS utilization and its contributors between 2011 and 2019.

Results: In Ethiopia, trends of complete CMHS utilization among women increased from 9.6% (95% CI 8.4, 10.9) in 2011 to 29.9% (95% CI 27.3, 32.6) in 2019. In the decomposition analysis, 60.6% of the difference in the proportion of complete CMHS utilization was explained by the differences in the composition of women's characteristics, and 39.4% was attributed to coefficients of characteristics. As such, equalizing the number of women who attended school at secondary level or higher, had television, initiated antenatal care (ANC) visits in the first trimester, were aware of pregnancy-related complications, delivered by caesarean section for their most recent childbirth, were from poorer households, gave urine and blood samples during pregnancy in 2019-2011 levels, would reduce the differences between 2011 to 2019 in complete CMHS utilization. In contrast, equalizing the number of women from richer (higher) household wealth categories in 2019-2011 levels would increase the 2011-2019 gaps in complete CMHS utilization.

Conclusion: While progress has been made, complete CMHS utilization was low in Ethiopia. Differences in the composition of characteristics and effect of coefficients had a substantial contribution to the change in complete CMHS utilization between 2011 and 2019. Adopting a multi-faceted approach that considers the unique challenges within the country, including women's education, wealth status, and quality of care, will improve CMHS utilization. Empowering women through education can enhance their decision-making ability regarding their own health.

Background: Endometriosis is a benign and chronic gynecological estrogen-dependent condition. Research findings have highlighted its impact on different aspects of women's lives. Enhancing quality of life and supporting the well-being of those affected is advised. Yet, none of the conducted studies have taken action toward these objectives. Therefore, the present study will be conducted with the aim of "Designing adaptation tool for endometriosis".

Methods/design: The method used in this study is an exploratory mixed-method study. The study will consist of two phases, starting with a qualitative phase followed by a quantitative phase. Upon approval Ethics Code from the endometriosis clinic at Imam Reza Hospital in Mashhad, Iran. The research will involve women of reproductive age diagnosed with endometriosis. In-depth and semi-structured interviews with open-ended questions will be conducted. The research aims to explore the experiences of women with endometriosis in adapting to the condition, utilizing qualitative content analysis with an approach based on the "ROY adaptation model." Sampling will be purposive until data saturation is achieved. Data analysis will follow the suggested steps using Elo Kingas' method and MAXQDA20 software. Tool design will involve an inductive approach (informed by qualitative findings) and a comparative method (based on literature review) to develop and refine tool items.

Discussion: This study is the first to employ a mixed-method approach in developing an adaptation tool for endometriosis. It uncovers underlying issues in the attitudes of patients, medical staff, and healthcare providers, offering insight into factors that can enhance the health and quality of life of affected women. The research findings can inform the creation of a relevant strategy for policymakers, planners, and healthcare professionals to better address the needs of women impacted by endometriosis. Ethical code: IR.MUMS.NURSE.REC.1403.069.

Background: Stigma is the experience of feeling different from socially accepted norms which can lead to personal devaluation or fear of disapproval from others. For men and women experiencing infertility, stigma has been associated with psychological distress, feelings of otherness in relation to people with children, and selective disclosure with others about their infertility challenges. However, there are few studies which examine how infertility stigma and being open with others are related to depressive symptoms and meaning in life for men and women diagnosed with infertility.

Methods: Participants experiencing infertility were recruited for this cross-sectional study during November 2023-January 2024 via announcements on infertility discussion listservs and social media accounts. Four-hundred fifty-eight women and 89 men completed an online survey. Participants were primarily from the United States (81%), followed by Europe, Canada, and Australia/New Zealand. Participants completed validated and reliable measures of infertility stigma, openness with others, depressive symptoms and meaning in life.

Results: Hierarchical regression models explained substantial variance (adjusted R-squared) for depressive symptoms (41% men; 27% women), search for meaning in life (12% men; 14% women), and presence of meaning in life (19% men; 25% women). For both men and women, higher personal infertility stigma was significantly related with higher depressive symptoms and search for meaning. For both men and women, higher openness with others about infertility was significantly associated with lower levels of depressive symptoms and greater presence of meaning.

Conclusions: The current findings support prior research indicating a significant association between infertility stigma and depressive symptoms and adds to the infertility literature by offering new insights into the relationships between stigma, openness with others, and meaning in life. Health care providers can use these findings to assist individuals and couples in reducing infertility stigma through collaborative conversations that reduce feelings of personal failure. Providers can also help those with infertility challenges to reduce psychological distress and increase meaning in life through accessing existing social networks and expanding social connections with others in ways that facilitate support.

Background: Mirroring other developed countries globally, the birth rate has decreased in Finland in recent years. The effects of a fear of childbirth (FOC) and psychiatric disorders on the likelihood of having more than one child remain relatively unstudied. This study aims to assess the influence of FOC, psychiatric disorders, and the mode of first delivery on the likelihood of the second birth among primiparous women.

Methods: Data were collected from the Medical Birth Register, the Hospital Discharge Register, and Statistics Finland census data. We used the t-test to compare continuous variables and the chi-square test or test for relative proportions to compare categorical variables. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) using the Cox regression analysis.

Results: Altogether, 317 219 women delivering their first child in 2006-2016 met the inclusion criteria, 216 521 of whom (68.3%) had their second birth during that time. A total of 11 108 (3.5%) of women were diagnosed with FOC during their first pregnancy, 34 381 (10.8%) women were diagnosed with a psychiatric disorder before or during their first pregnancy and 10 331 (3.3%) women received a new diagnosis of a psychiatric condition following the first birth. Between 2006-2021, the second child was born to 47.5% of women with FOC (n = 5276), 56.8% of women with a psychiatric disorder before or during their first pregnancy (n = 19 540), 53.4% of women receiving a psychiatric diagnosis after their first delivery (n = 5514) and 70.2% of women without either of these diagnoses (n = 191 572). Women with FOC had a 22% lower likelihood of the second birth [aHR 0.78 (95% CI 0.76-0.80)] compared to women without FOC. A psychiatric disorder before or during the first pregnancy decreased the likelihood of the second birth by 28% [aHR 0.72 (95% CI 0.71-0.73)] and by 51% (aHR 0.49 (95% CI 0.48-0.50)] with a psychiatric disorder following a first birth compared with women without a diagnosed psychiatric disorder. Among all women, a caesarean section as the mode of a first delivery reduced the likelihood of the second birth.

Conclusion: FOC and psychiatric disorders are associated with a low birthrate following the first delivery. Caesarean section as the mode of delivery decreases the likelihood of the second birth among women with FOC and psychiatric disorders.

Background: Exposure to sunlight aids in the body's production of vitamin D, guards against rickets, and treats newborn jaundice. In Ethiopia, the magnitude of sunlight exposure practice varies across studies. Thus, this study aimed to estimate the pooled practices and factors associated with sunlight exposure of infants among mothers in Ethiopia.

Methods: Electronic search was carried out using databases (PubMed, HINARI, Science Direct, electronic databases, and Google Scholar) for relevant articles published from January 1, 2010, to March 27, 2024. The screening process was carried out in accordance with PRISMA guidelines. Articles conducted in English and quantitatively expressed were considered in this review. The quality assessment of included articles was evaluated using the Newcastle-Ottawa Scale. Data analysis was carried out using STATA-14 version software. I2 statistics and Egger's test were used to evaluate heterogeneity and publication bias, respectively. The pooled prevalence with a 95% confidence interval (CI) of the meta-analysis utilizing the random effect model was displayed using forest plots, and adjusted odds ratio (AOR) was utilized to quantify the association.

Results: 1171 records, 13 studies were included in the meta-analysis with 5190 study participants that fulfill the inclusion criteria, and all the included studies were cross-sectional in design. The pooled prevalence of sunlight exposure practice among mothers in Ethiopia was 45.38% CI (38.36, 52.4). Good sunlight-related knowledge (AOR; 1.61, 95% CI 1.3, 1.98), maternal formal education (AOR; 1.35, 95% CI 1.08, 1.69), housewife (AOR; 0.7, 95% CI 0.51, 0.95), and husband formal education (AOR; 1.29, 95% CI 1.07, 1.56) were significantly associated with good sunlight exposure practice.

Conclusion: The pooled prevalence of good sunlight exposure practice among mothers in Ethiopia was low. Good sunlight-related knowledge, being a housewife, and maternal and husband formal education were the factors that were associated with good sunlight exposure practice. Thus, the government needs to cater further assistance and initiate greater information circulation and follow-up to improve the situation.

Objectives: The research objectives were to identify and synthesise prevailing definitions and indices of resilience in maternal, newborn, and child health (MNCH) and propose a harmonised definition of resilience in MNCH research and health programmes in low- and middle-income countries (LMICs).

Design: Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building.

Participants: Mothers, new-borns, and children living in low- and middle-income countries were selected as participants.

Outcomes: Resilience as defined by the authors was deduced from the studies.

Results: Twenty-two out of 76,566 cited studies published between 2006 and 2010 were included in the review. Thirteen (59.1%) examined maternal resilience, and nine (40.9%) examined newborn and child health resilience; most of the included studies were quantitative (n = 17; 81%). Seven studies defined 'resilience' in the context of maternal health, most of which described the term at the individual level. 'Maternal resilience' was measured using validated scales in five studies; another five defined newborn and child resilience. Only one reviewed study used maternal characteristics to identify newborn and child resilience. The synthesised consensus definition of 'maternal, newborn, and child resilience' is 'A woman's ability to prevent or adapt to significant and challenging circumstances including threats, tragedy, and trauma to herself during pregnancy, childbirth, and puerperium and to her neonates or children five years or younger'.

Conclusion: The information identified was limited but included a few definitions of resilience in MNCH and an index of child resilience in LMICs. The proposed definition is useful for MNCH programme implementation and interventions in LMICs. Scoping review registration: The protocol for this review was registered in the open science framework at the registered address ( https://osf.io/jt6nr ).

Background: Today, the screening of fetal abnormalities during pregnancy is used as one of the components of the prenatal care worldwide, and many abnormalities are detected by ultrasound during pregnancy. On the other hand, the possibility of an abnormality in the fetus causes worry and anxiety in pregnant women. Therefore, the present study was conducted with the aim of determining the relationship between worry and anxiety with the general health status of pregnant women at risk of diagnosing fetal abnormalities.

Methods: This descriptive-analytical cross-sectional study was conducted on 275 pregnant women with a gestational age of 16 to 18 weeks. They were referred by health centers, midwives, or gynecologists to determine fetal abnormalities according to the national guidelines of Iran for ultrasound scan anomalies. Pregnancy imaging was performed in Bojnurd city between April and December 2023. The data collection tools included a pregnancy-personal characteristics questionnaire, Goldberg general health standard questionnaire, Cambridge anxiety, and Spielberger anxiety scales. Data were analyzed using descriptive statistics tests, Pearson's correlation coefficient, and generalized linear models (GLM). A significance level of p < 0.05 was considered statistically.

Results: The average age of the participants was 28.13 ± 6.17 years. The average total score of general health was 15.49 ± 7.14, while the average total worry and anxiety scores were 16.81 ± 11.74 and 45.12 ± 6.06, respectively. A positive and significant correlation was observed between general health and worry (r = 0.374), as well as between general health and anxiety (r = 0.160). Additionally, based on the test of generalized linear models, education (beta coefficient = - 3.208 and p = 0.008) and type of pregnancy (beta coefficient = - 2.323 and p = 0.029) were related to general health.

Conclusion: The present findings demonstrate a relationship between the general health and worry and anxiety levels of pregnant women at risk of abnormality diagnosis. Pregnant women who are anxious and worried tend to have lower general health levels. Understanding this relationship between worry, anxiety, and the general health of pregnant women can provide useful information to policymakers and health planners to improve the health of expectant mothers.

Trials were inconsistent while reporting findings on the benefits of the intermittent regimen. Recent conclusive evidence to show overall effect was limited. This review compared intermittent and daily iron folic acid supplementation (IFAS) on pregnancy outcomes. Protocol is registered at Prospero with registration number CRD42023409161. The major data sources searched were PubMed/Medline, Hinari, and Google Scholar. The process was reported using a PRISMA flow diagram. The included studies were trials with English language reports. The population was pregnant women. The intervention was an intermittent oral iron folic acid regimen, and the control was a daily regimen. The outcome measures were blood hemoglobin level, side effects, and medication adherence. The GRADE approach and Cochrane collaboration tool were used in the quality evaluation. The selected trials were narrated for basic characteristics and major findings. The standardized mean difference was used for continuous outcomes and the relative risk for binary outcomes. A sensitivity analysis was performed to report the robustness of the estimate. Twenty-two trials were selected for analysis. The quality of the evidence ranges from high to very low. Maternal blood hemoglobin levels were different between the intermittent and daily groups (mean difference (MD), - 0.24 g/dl; 95%CI, - 0.35, - 0.12). However, either early initiation or frequently intermittent regimen in the subgroup analysis showed no difference in hemoglobin levels. Intermittent regimens had lower gastric side effects (relative risk (RR), 0.27; 95%CI, 0.11, 0.69) and better medication adherences (relative risk (RR), 1.6; 95%CI, 1.34, 1.91). There was no clear evidence of a difference in anaemia incidence between the groups (relative risk (RR), 1.09; 95%CI, 0.77, 1.54). The overall level of hemoglobin in pregnancy was different between the groups. However, anaemia incidence was similar. The combined results suggest the intermittent regimen had better benefits in pregnancy than daily.

Background: Over one-third of the global stillbirth burden occurs in countries affected by conflict or a humanitarian crisis, including Afghanistan. Stillbirth rates in Afghanistan remained high in 2021 at over 26 per 1000 births. Stillbirths have devastating physical, psycho-social and economic impacts on women, families and healthcare providers. Data on the risks and causes of stillbirths are critical to target prevention measures and are currently lacking. This study aimed to use routine health facility data to examine the socio-demographic, maternal, fetal, and obstetric characteristics associated with stillbirth.

Methods: This was a hospital-based case-control study of births at the maternity units of the three tertiary care referral hospitals in Kabul, Afghanistan between March-September 2021. Cases were defined as stillbirths that occurred at 22 weeks or later in pregnancy while live births occurring after each case were selected as controls. Multivariable logistic regression was used to explore factors associated with stillbirth after performing multiple imputation to impute missing data for independent variables.

Results: A total of 497 cases (stillbirths) and 1069 controls (live births) were included in the analysis. Factors independently associated with stillbirth while adjusting for maternal age and baby's sex were: being referred from another facility which increased the odds of stillbirth by over three times (aOR 3.24; 95% CI 1.17, 8.85) compared to those who were not referred; being born extremely preterm (< 28 weeks) (aOR 13.98; 95% CI 7.44, 26.27), very preterm (28-31 weeks) (aOR 3.91; 95% CI 2.73, 5.62), and moderate to late preterm (32-36 weeks) (aOR 2.32; 95% CI 1.60, 3.37) compared to term babies; and being small-for-gestational age (aOR 1.70; 95% CI 1.10, 2.64) compared to those that were average size for gestational age. Placental abruption also increased the odds of stillbirth by two times (aOR 2.07; 95% CI 1.37-3.11).

Conclusions: Improving the detection and management of preterm births, and small-for-gestational age babies through improvements in antenatal care attendance and quality will be important for future stillbirth prevention in Afghanistan. More research is needed to understand referral delays and contributing factors to increased risk among referrals. Strengthening routine data quality for stillbirths is imperative for improved understanding and prevention of stillbirths.