G. Justus Hofmeyr, Mandisa Singata-Madliki, Sara Della Ripa, Andrew D. Weeks
The global impact of life-saving medical devices is directly related to their availability. Access may be limited by cost, availability, or lack of information regarding effectiveness and safety. Addressing the inequity in access requires concerted effort from device developers, the research community, global agencies and professional organisations. We discuss, with examples, three strategies to promote equity: low-cost, purpose-built innovation, improvisation and off-label use. First, developing simple, safe and low-cost innovative devices can be an effective way of increasing global access. For example, the BabySaver Kit facilitates intact-cord neonatal bedside resuscitation. Re-usability is an important design feature for both cost and environment, exemplified by the MaternaWell tray for blood loss monitoring after birth. A second strategy is improvisation using commonly available hospital items. This can extend device availability into settings where purpose-designed devices are unavailable or unaffordable. Examples include the use of condoms or glove balloons for uterine balloon tamponade (UBT) to treat postpartum haemorrhage (PPH), elastic catheters for uterine tourniquet, and plastic tubing for posterior axilla sling traction in shoulder dystocia. However, the lack of systematically developed evidence and governance approvals can lead to wide variation in training, technique, and device specifications. Finally, some of these quality issues are addressed by using approved medical devices ‘off-label.’ However, they can have similar problems of variation in technique and depend on the uncoordinated efforts of researchers and clinicians to generate an evidence base. Examples include the Foley catheter for labour induction and the Levin stomach tube for suction tube uterine tamponade for PPH. WHO has pathways to facilitate global access to important public health device innovations. Global agencies and professional organisations also have a major role to play in providing co-ordination, platforms for data sharing, practice guidelines, instructions for use on off-label devices and robust data on their safety and effectiveness.
{"title":"Achieving Equitable Access to Obstetric Devices Through Innovation, Improvisation and Off-Label Use","authors":"G. Justus Hofmeyr, Mandisa Singata-Madliki, Sara Della Ripa, Andrew D. Weeks","doi":"10.1111/1471-0528.70058","DOIUrl":"10.1111/1471-0528.70058","url":null,"abstract":"<p>The global impact of life-saving medical devices is directly related to their availability. Access may be limited by cost, availability, or lack of information regarding effectiveness and safety. Addressing the inequity in access requires concerted effort from device developers, the research community, global agencies and professional organisations. We discuss, with examples, three strategies to promote equity: low-cost, purpose-built innovation, improvisation and off-label use. First, developing simple, safe and low-cost innovative devices can be an effective way of increasing global access. For example, the BabySaver Kit facilitates intact-cord neonatal bedside resuscitation. Re-usability is an important design feature for both cost and environment, exemplified by the MaternaWell tray for blood loss monitoring after birth. A second strategy is improvisation using commonly available hospital items. This can extend device availability into settings where purpose-designed devices are unavailable or unaffordable. Examples include the use of condoms or glove balloons for uterine balloon tamponade (UBT) to treat postpartum haemorrhage (PPH), elastic catheters for uterine tourniquet, and plastic tubing for posterior axilla sling traction in shoulder dystocia. However, the lack of systematically developed evidence and governance approvals can lead to wide variation in training, technique, and device specifications. Finally, some of these quality issues are addressed by using approved medical devices ‘off-label.’ However, they can have similar problems of variation in technique and depend on the uncoordinated efforts of researchers and clinicians to generate an evidence base. Examples include the Foley catheter for labour induction and the Levin stomach tube for suction tube uterine tamponade for PPH. WHO has pathways to facilitate global access to important public health device innovations. Global agencies and professional organisations also have a major role to play in providing co-ordination, platforms for data sharing, practice guidelines, instructions for use on off-label devices and robust data on their safety and effectiveness.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"1903-1909"},"PeriodicalIF":4.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beth Malory, Louise Nuttall, Alexander E. P. Heazell
Objective
To conduct a pilot study evaluating the acceptability of pregnancy loss nomenclature among people with recent lived experience and make recommendations for UK mass communication.
Design
Electronic internet-based questionnaire.
Setting
UK.
Population or Sample
Service users who accessed UK healthcare for > 1 experience(s) of pregnancy loss between 2021 and 2024 (n = 391).
Methods
Descriptive and inferential statistics.
Main Outcome Measures
Acceptability ratings for pregnancy loss nomenclature used diagnostically in UK healthcare settings.
Results
Much nomenclature currently in use in UK pregnancy loss care was rated ‘unacceptable’ by a majority of study participants. Spontaneous abortion, incompetent cervix, and cervical incompetence were among the terminology rated as ‘unacceptable’ by > 80.0% of the respondents rating terms for the process of loss. In contrast, pregnancy loss and ectopic pregnancy were rated ‘acceptable’ by > 80.0% of respondents. As nomenclature for pregnancy loss outcomes, products, contents of the womb/uterus, and tissue were rated ‘unacceptable’ by > 80.0% of respondents. Baby and ‘their given name’ were rated ‘acceptable’ by > 80.0% of respondents across all gestational age brackets. Some terminology elicited mixed acceptability ratings.
Conclusions
Some pregnancy loss nomenclature attracted consensus acceptability or unacceptability ratings for respondents. The data inform evidence-based recommended alternatives, which should be adopted for mass communications relating to pregnancy loss.
{"title":"Acceptable Nomenclature for Pregnancy Loss Care: A Cross-Sectional Observational Survey","authors":"Beth Malory, Louise Nuttall, Alexander E. P. Heazell","doi":"10.1111/1471-0528.70057","DOIUrl":"10.1111/1471-0528.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To conduct a pilot study evaluating the acceptability of pregnancy loss nomenclature among people with recent lived experience and make recommendations for UK mass communication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Electronic internet-based questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Service users who accessed UK healthcare for > 1 experience(s) of pregnancy loss between 2021 and 2024 (<i>n</i> = 391).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive and inferential statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Acceptability ratings for pregnancy loss nomenclature used diagnostically in UK healthcare settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Much nomenclature currently in use in UK pregnancy loss care was rated ‘unacceptable’ by a majority of study participants. <i>Spontaneous abortion, incompetent cervix</i>, <i>and cervical incompetence</i> were among the terminology rated as ‘unacceptable’ by > 80.0% of the respondents rating terms for the process of loss. In contrast, <i>pregnancy loss</i> and <i>ectopic pregnancy</i> were rated ‘acceptable’ by > 80.0% of respondents. As nomenclature for pregnancy loss outcomes, <i>products, contents of the womb/uterus</i>, and <i>tissue</i> were rated ‘unacceptable’ by > 80.0% of respondents. <i>Baby</i> and ‘their given name’ were rated ‘acceptable’ by > 80.0% of respondents across all gestational age brackets. Some terminology elicited mixed acceptability ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Some pregnancy loss nomenclature attracted consensus acceptability or unacceptability ratings for respondents. The data inform evidence-based recommended alternatives, which should be adopted for mass communications relating to pregnancy loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"471-479"},"PeriodicalIF":4.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariana Tome, Aimée A. K. Lovers, Lawrence Impey, Jane E. Hirst, Antoniya Georgieva
<div> <section> <h3> Background</h3> <p>Admission cardiotocography (CTG) remains widely used to assess the fetal condition at the onset of labour in low-risk pregnancies, despite international guidelines recommending against its routine use and advocating intermittent auscultation (IA) instead.</p> </section> <section> <h3> Objective</h3> <p>To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies.</p> </section> <section> <h3> Search Strategy</h3> <p>PubMed and the Cochrane Library were searched from inception to April 2025.</p> </section> <section> <h3> Selection Criteria</h3> <p>Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses.</p> </section> <section> <h3> Data Collection and Analysis</h3> <p>Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 from the Cochrane Library. Random-effects meta-analysis generated relative risks (RRs), and the quality of the evidence was evaluated using GRADE.</p> </section> <section> <h3> Main Results</h3> <p>Five RCTs (16 341 pregnant women) were included. Admission CTG was associated with significantly higher use of continuous electronic fetal heart rate (FHR) monitoring (RR 1.23, 95% CI: 1.05–1.44, <i>I</i><sup>2</sup> = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86–1.37, <i>I</i><sup>2</sup> = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96–1.40, <i>I</i><sup>2</sup> = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90–1.19, <i>I</i><sup>2</sup> = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91–1.27, <i>I</i><sup>2</sup> = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62–1.54, <i>I</i><sup>2</sup> = 13%). Evidence certainty was rated moderate for most outcomes.</p> </section> <section> <h3> Conclusions</h3> <p>Routine admission CTG in low-risk term pregnancies demonstrated no improvement in maternal or neonatal outcomes. Previous concerns regarding increased caesarean delivery rates appear overstated. These findings support current recommendations favouring IA over routine admission CTG in low-risk pregnancies. Future research should
{"title":"Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis","authors":"Mariana Tome, Aimée A. K. Lovers, Lawrence Impey, Jane E. Hirst, Antoniya Georgieva","doi":"10.1111/1471-0528.70047","DOIUrl":"10.1111/1471-0528.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Admission cardiotocography (CTG) remains widely used to assess the fetal condition at the onset of labour in low-risk pregnancies, despite international guidelines recommending against its routine use and advocating intermittent auscultation (IA) instead.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effect of admission CTG compared with IA upon admission on maternal and neonatal outcomes in low-risk term pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>PubMed and the Cochrane Library were searched from inception to April 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised controlled trials (RCTs) comparing admission CTG with IA in low-risk, term pregnancies with singleton fetuses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 from the Cochrane Library. Random-effects meta-analysis generated relative risks (RRs), and the quality of the evidence was evaluated using GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Five RCTs (16 341 pregnant women) were included. Admission CTG was associated with significantly higher use of continuous electronic fetal heart rate (FHR) monitoring (RR 1.23, 95% CI: 1.05–1.44, <i>I</i><sup>2</sup> = 95%). No significant differences were found for caesarean section (RR 1.09, 95% CI: 0.86–1.37, <i>I</i><sup>2</sup> = 49%), fetal blood sampling (RR 1.16, 95% CI: 0.96–1.40, <i>I</i><sup>2</sup> = 44%), instrumental deliveries (RR 1.06, 95% CI: 0.90–1.19, <i>I</i><sup>2</sup> = 38%), neonatal intensive care unit (NICU) admission (RR 1.07, 95% CI: 0.91–1.27, <i>I</i><sup>2</sup> = 0%), or Apgar score < 7 at 5 min (RR 0.97, 95% CI: 0.62–1.54, <i>I</i><sup>2</sup> = 13%). Evidence certainty was rated moderate for most outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Routine admission CTG in low-risk term pregnancies demonstrated no improvement in maternal or neonatal outcomes. Previous concerns regarding increased caesarean delivery rates appear overstated. These findings support current recommendations favouring IA over routine admission CTG in low-risk pregnancies. Future research should","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"375-390"},"PeriodicalIF":4.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the long-term morbidity experienced by women with a history of severe maternal morbidity (SMM).
Design
Prospective population-based cohort study.
Setting
A tertiary medical centre.
Population
All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM.
Methods
SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics.
Main Outcome Measures
Long-term incidence of morbidities and hospitalisations.
Results
A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03–7.90 and 2.17; 95% CI: 1.24–3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10–3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36–3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06–23.13).
Conclusions
Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.
{"title":"Long-Term Maternal Health Outcomes Following Severe Maternal Morbidity: A Cohort Study","authors":"Itamar Gothelf, Israel Yoles, Danielle Ben-Ayoun, Majdi Imterat, Asnat Walfisch, Tamar Wainstock","doi":"10.1111/1471-0528.70055","DOIUrl":"10.1111/1471-0528.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the long-term morbidity experienced by women with a history of severe maternal morbidity (SMM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A tertiary medical centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Long-term incidence of morbidities and hospitalisations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03–7.90 and 2.17; 95% CI: 1.24–3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10–3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36–3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06–23.13).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"454-462"},"PeriodicalIF":4.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dorothea Geddes-Barton, Raph Goldacre, Serena Luchenski, Chelsea Daniels, Rhiannon D′Arcy, Marian Knight, Nicola Vousden
Objective
To explore whether women experiencing homelessness during pregnancy have higher risks of adverse pregnancy outcomes compared to housed women.
Design
Population-based retrospective cohort study using national electronic hospital records.
Setting
Maternity services across English NHS hospitals.
Population
Women giving birth at gestational age ≥ 24 weeks from January 1, 2013 to March 31, 2023.
Methods
Data were obtained from the English National Hospital Episode Statistics Admitted Patient Care database. Poisson regression models compared outcomes for women identified as homeless to housed women, adjusting for age, parity, ethnicity, year and pre-existing medical conditions.
Main Outcome Measures
Severe maternal morbidity (SMM), preterm birth (< 37 and < 34 weeks), and low birth weight (< 2500 g).
Results
Among 3 349 601 women giving birth, 3301 (0.1%) experienced homelessness. Rates and adjusted risk ratios (aRR) comparing homeless to housed women were: SMM 2.5% versus 1.6% (aRR 1.28, 95% CI 1.02–1.59); preterm birth 11.8% versus 5.9% (aRR 1.88, 95% CI 1.69–2.08); and small for gestational age 9.0% versus 4.8% (aRR 1.56, 95% CI 1.38–1.76). Stratified by ethnicity, White homeless women had the highest risk for preterm birth and small for gestational age, while Asian homeless women showed the greatest risk for SMM, compared to White housed women.
Conclusions
Homelessness recorded during pregnancy or at birth is associated with poorer maternal and infant outcomes. Interventions focusing on housing stability are key. Future research should explore housing dynamics beyond homelessness, including frequent moves and overcrowding, requiring detailed perinatal housing data.
目的探讨怀孕期间无家可归的妇女是否比住在家里的妇女有更高的不良妊娠结局风险。设计基于人群的回顾性队列研究，使用国家电子医院记录。英国NHS医院的产科服务设置。人口2013年1月1日至2023年3月31日，胎龄≥24周分娩的妇女。方法数据来自英国国家医院事件统计住院患者护理数据库。泊松回归模型比较了被确定为无家可归的妇女和有房妇女的结果，调整了年龄、性别、种族、年龄和先前的医疗条件。主要结局指标：重度产妇发病率（SMM）、早产（< 37周和< 34周）和低出生体重（< 2500 g）。结果在3 349 601名分娩妇女中，有3301名（0.1%）无家可归。无家可归妇女与有房妇女的比率和调整风险比（aRR）分别为：SMM 2.5% vs 1.6% (aRR 1.28, 95% CI 1.02-1.59)；早产11.8%对5.9% (aRR 1.88, 95% CI 1.69-2.08)；胎龄小的为9.0%，胎龄小的为4.8% （aRR 1.56, 95% CI 1.38-1.76）。按种族划分，白人无家可归妇女早产和胎龄小的风险最高，而亚裔无家可归妇女与白人无家可归妇女相比，患SMM的风险最高。结论怀孕期间或出生时的无家可归记录与较差的母婴结局有关。以住房稳定为重点的干预措施是关键。未来的研究应探索住房动态超越无家可归，包括频繁移动和过度拥挤，需要详细的围产期住房数据。
{"title":"Maternal and Infant Outcomes for Women Experiencing Homelessness Before and During Pregnancy: A Retrospective Cohort Study","authors":"Dorothea Geddes-Barton, Raph Goldacre, Serena Luchenski, Chelsea Daniels, Rhiannon D′Arcy, Marian Knight, Nicola Vousden","doi":"10.1111/1471-0528.70050","DOIUrl":"10.1111/1471-0528.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore whether women experiencing homelessness during pregnancy have higher risks of adverse pregnancy outcomes compared to housed women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based retrospective cohort study using national electronic hospital records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Maternity services across English NHS hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women giving birth at gestational age ≥ 24 weeks from January 1, 2013 to March 31, 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the English National Hospital Episode Statistics Admitted Patient Care database. Poisson regression models compared outcomes for women identified as homeless to housed women, adjusting for age, parity, ethnicity, year and pre-existing medical conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Severe maternal morbidity (SMM), preterm birth (< 37 and < 34 weeks), and low birth weight (< 2500 g).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3 349 601 women giving birth, 3301 (0.1%) experienced homelessness. Rates and adjusted risk ratios (aRR) comparing homeless to housed women were: SMM 2.5% versus 1.6% (aRR 1.28, 95% CI 1.02–1.59); preterm birth 11.8% versus 5.9% (aRR 1.88, 95% CI 1.69–2.08); and small for gestational age 9.0% versus 4.8% (aRR 1.56, 95% CI 1.38–1.76). Stratified by ethnicity, White homeless women had the highest risk for preterm birth and small for gestational age, while Asian homeless women showed the greatest risk for SMM, compared to White housed women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Homelessness recorded during pregnancy or at birth is associated with poorer maternal and infant outcomes. Interventions focusing on housing stability are key. Future research should explore housing dynamics beyond homelessness, including frequent moves and overcrowding, requiring detailed perinatal housing data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2265-2274"},"PeriodicalIF":4.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyrillus S. Shohdy, Loay Kassem, Boules Gabriel, Emad Barsoum, Tamer Elnahas, Hamdy A. Azim
<p>Identification of patients with homologous recombination deficiency (HRD) is crucial for the better management of patients with epithelial ovarian cancer (EOC) [<span>1</span>]. In limited-resource countries, there is a shortage of HRD testing outcomes due to costly testing, substandard infrastructure and lack of expert know-how [<span>2</span>].</p><p>We conducted a multicentre registry study aiming to evaluate the feasibility and outcomes of in-house HRD testing for patients with EOC in Egypt (Figure 1A). From 2019 to 2022, 589 consecutive patients with a median age of 56 years (range 20–86), from five cancer centres across Egypt, had undergone a successful HRD testing. The study was approved by the Institutional Review Board at Dar El Salam Cancer Centre (Ministry of Health and Population—Egypt).</p><p>HRD testing included <i>BRCA1/2</i> tumour mutation status (t<i>BRCA1/2</i>) and genomic scar score (GSS) status. Briefly, for each FFPE sample submitted, DNA extraction was performed using QIAamp DNA Mini kit (QIAGEN). Then, appropriate libraries preparation according to the manufacturer's protocol with the AmoyDx HRD Panel (Amoy Diagnostics Co. Ltd.) and sequencing was performed using the Illumina NextSeq500 system (Illumina). A custom hybridisation capture panel that targets 27 000 SNPs distributed across the genome was used to infer the GSS. Patients with <i>BRCA1/2</i> mutations or GSS ≥ 50 (i.e., GSS-positive) were considered HRD-positive as previously validated [<span>3</span>] (Figure 1A).</p><p>GSS-positive tumours were detected in 198 (33.6%) of our patients while t<i>BRCA1/2</i> mutations were detected in 113 (19.2%) (Figure 1B). Collectively, 241 patients (41%) were diagnosed as HRD-positive EOC at a median turnaround time of 13 days (range 8–26 days).</p><p>We examined the contribution of the GSS score and t<i>BRCA1/2</i> status to the overall HRD positivity (Figure 1B). In total, 128 patients (21.7%) were positive due to a positive GSS score alone without identified t<i>BRCA1/2</i> mutations. Meanwhile, 43 (7.3%) were HRD-positive due to having <i>BRCA1/2</i> mutations with a negative GSS score. Expectedly, the majority (62%) of patients with <i>BRCA</i> mutations had a positive GSS score, and the majority (80.7%) of patients with <i>BRCA</i> variants of uncertain significance (VUS) were GSS-negative (Figure 1B).</p><p>There was no significant difference in HRD-positive rate in younger age (< 50-year-old) compared to older (63 (38.2%) vs. 178 (42%), <i>p</i> = 0.42) neither in the rate of GSS-positive (51 (30.9%) vs. 147 (34.7%), <i>p</i> = 0.38). However, we identified a significant trend for increasing the rate of HRD-positive across age categories with the highest at age category 40 to < 60 years and lowest at under 40 years (46% vs. 24%, <i>p</i><sub>trend</sub> = 0.034) (Figure 1C).</p><p>We also examined the differences among <i>BRCA1</i>/2 mutations in relation to the GSS score. Intriguingly, patients with <i>BRCA1<
{"title":"Homologous Recombination Deficiency Testing in Women With Ovarian Cancer: An Egyptian Multicentre Study","authors":"Kyrillus S. Shohdy, Loay Kassem, Boules Gabriel, Emad Barsoum, Tamer Elnahas, Hamdy A. Azim","doi":"10.1111/1471-0528.70052","DOIUrl":"10.1111/1471-0528.70052","url":null,"abstract":"<p>Identification of patients with homologous recombination deficiency (HRD) is crucial for the better management of patients with epithelial ovarian cancer (EOC) [<span>1</span>]. In limited-resource countries, there is a shortage of HRD testing outcomes due to costly testing, substandard infrastructure and lack of expert know-how [<span>2</span>].</p><p>We conducted a multicentre registry study aiming to evaluate the feasibility and outcomes of in-house HRD testing for patients with EOC in Egypt (Figure 1A). From 2019 to 2022, 589 consecutive patients with a median age of 56 years (range 20–86), from five cancer centres across Egypt, had undergone a successful HRD testing. The study was approved by the Institutional Review Board at Dar El Salam Cancer Centre (Ministry of Health and Population—Egypt).</p><p>HRD testing included <i>BRCA1/2</i> tumour mutation status (t<i>BRCA1/2</i>) and genomic scar score (GSS) status. Briefly, for each FFPE sample submitted, DNA extraction was performed using QIAamp DNA Mini kit (QIAGEN). Then, appropriate libraries preparation according to the manufacturer's protocol with the AmoyDx HRD Panel (Amoy Diagnostics Co. Ltd.) and sequencing was performed using the Illumina NextSeq500 system (Illumina). A custom hybridisation capture panel that targets 27 000 SNPs distributed across the genome was used to infer the GSS. Patients with <i>BRCA1/2</i> mutations or GSS ≥ 50 (i.e., GSS-positive) were considered HRD-positive as previously validated [<span>3</span>] (Figure 1A).</p><p>GSS-positive tumours were detected in 198 (33.6%) of our patients while t<i>BRCA1/2</i> mutations were detected in 113 (19.2%) (Figure 1B). Collectively, 241 patients (41%) were diagnosed as HRD-positive EOC at a median turnaround time of 13 days (range 8–26 days).</p><p>We examined the contribution of the GSS score and t<i>BRCA1/2</i> status to the overall HRD positivity (Figure 1B). In total, 128 patients (21.7%) were positive due to a positive GSS score alone without identified t<i>BRCA1/2</i> mutations. Meanwhile, 43 (7.3%) were HRD-positive due to having <i>BRCA1/2</i> mutations with a negative GSS score. Expectedly, the majority (62%) of patients with <i>BRCA</i> mutations had a positive GSS score, and the majority (80.7%) of patients with <i>BRCA</i> variants of uncertain significance (VUS) were GSS-negative (Figure 1B).</p><p>There was no significant difference in HRD-positive rate in younger age (< 50-year-old) compared to older (63 (38.2%) vs. 178 (42%), <i>p</i> = 0.42) neither in the rate of GSS-positive (51 (30.9%) vs. 147 (34.7%), <i>p</i> = 0.38). However, we identified a significant trend for increasing the rate of HRD-positive across age categories with the highest at age category 40 to < 60 years and lowest at under 40 years (46% vs. 24%, <i>p</i><sub>trend</sub> = 0.034) (Figure 1C).</p><p>We also examined the differences among <i>BRCA1</i>/2 mutations in relation to the GSS score. Intriguingly, patients with <i>BRCA1<","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2304-2306"},"PeriodicalIF":4.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Human Touch in Writing: What Distinguishes Human- and Artificial Intelligence-Written Manuscripts?","authors":"Shigeki Matsubara","doi":"10.1111/1471-0528.70051","DOIUrl":"10.1111/1471-0528.70051","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"532-533"},"PeriodicalIF":4.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Excessive bleeding after childbirth, known as postpartum haemorrhage (PPH), remains a leading cause of maternal mortality worldwide. Of the estimated 260,000 maternal deaths in 2023, nearly 45,000 were attributable to PPH [<span>1</span>]. In October 2023, the World Health Organization (WHO) and several partners launched the <i>Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030</i>, a unifying strategy to galvanise action across PPH research, norms, implementation, and advocacy [<span>2</span>]. The Roadmap called on governments, funders, academia, professional societies, industry and innovators, women's groups and civil society to accelerate action for PPH priorities. While this call to action has mobilised the global community toward a more proactive PPH agenda, persistent implementation gaps, systemic inequities, and geopolitical stressors continue to limit progress. To spotlight PPH as a preventable cause of maternal death, a World PPH Day was proposed as an annual global advocacy activity to keep Roadmap objectives on track [<span>3</span>]. As we approach 5 October 2025, the inaugural World PPH Day, the maternal health community is uniting behind a renewed call to action. This commentary reflects on progress since the launch of the Roadmap, highlights lessons from country experiences, and outlines why urgent, coordinated action is necessary to realise its promise.</p><p>Global maternal mortality has declined by 41% between 2000 and 2023 [<span>4</span>]. Reductions in deaths from PPH have contributed significantly to this progress. Yet gains remain uneven. While high-income countries have seen dramatic declines, women in sub-Saharan Africa and South Asia continue to die at disproportionately high rates from PPH, despite availability of effective preventive, diagnostic and treatment measures. These deaths reflect systemic weaknesses, including overburdened health systems, fragile supply chains, and poor quality or inconsistent availability of essential medicines that leave providers unprepared for emergencies.</p><p>Proven solutions to PPH have failed to gain traction due to persistent gaps in policy and programme implementation that are compounded by inadequate domestic funding. Quality-assured essential PPH medicines such as uterotonics, tranexamic acid (TXA), and iron supplements; trained providers; and functional emergency response systems, including blood transfusion facilities, are still not readily available in many high-burden countries. Global stressors such as geopolitical instability, shrinking development funding, climate shocks, and persistent gender inequalities exacerbate these vulnerabilities. In fragile and conflict-affected settings, women face the highest risks, as skilled birth attendance, life-saving PPH commodities and emergency obstetric care are often inaccessible [<span>4</span>].</p><p>Since its launch, the PPH Roadmap has catalysed progress across four strategic areas: research, norms and standards,
{"title":"World Postpartum Haemorrhage Day: Renewing the Global Call to End Deaths From Postpartum Haemorrhage","authors":"PPH Roadmap Advocacy Working Group","doi":"10.1111/1471-0528.70007","DOIUrl":"10.1111/1471-0528.70007","url":null,"abstract":"<p>Excessive bleeding after childbirth, known as postpartum haemorrhage (PPH), remains a leading cause of maternal mortality worldwide. Of the estimated 260,000 maternal deaths in 2023, nearly 45,000 were attributable to PPH [<span>1</span>]. In October 2023, the World Health Organization (WHO) and several partners launched the <i>Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030</i>, a unifying strategy to galvanise action across PPH research, norms, implementation, and advocacy [<span>2</span>]. The Roadmap called on governments, funders, academia, professional societies, industry and innovators, women's groups and civil society to accelerate action for PPH priorities. While this call to action has mobilised the global community toward a more proactive PPH agenda, persistent implementation gaps, systemic inequities, and geopolitical stressors continue to limit progress. To spotlight PPH as a preventable cause of maternal death, a World PPH Day was proposed as an annual global advocacy activity to keep Roadmap objectives on track [<span>3</span>]. As we approach 5 October 2025, the inaugural World PPH Day, the maternal health community is uniting behind a renewed call to action. This commentary reflects on progress since the launch of the Roadmap, highlights lessons from country experiences, and outlines why urgent, coordinated action is necessary to realise its promise.</p><p>Global maternal mortality has declined by 41% between 2000 and 2023 [<span>4</span>]. Reductions in deaths from PPH have contributed significantly to this progress. Yet gains remain uneven. While high-income countries have seen dramatic declines, women in sub-Saharan Africa and South Asia continue to die at disproportionately high rates from PPH, despite availability of effective preventive, diagnostic and treatment measures. These deaths reflect systemic weaknesses, including overburdened health systems, fragile supply chains, and poor quality or inconsistent availability of essential medicines that leave providers unprepared for emergencies.</p><p>Proven solutions to PPH have failed to gain traction due to persistent gaps in policy and programme implementation that are compounded by inadequate domestic funding. Quality-assured essential PPH medicines such as uterotonics, tranexamic acid (TXA), and iron supplements; trained providers; and functional emergency response systems, including blood transfusion facilities, are still not readily available in many high-burden countries. Global stressors such as geopolitical instability, shrinking development funding, climate shocks, and persistent gender inequalities exacerbate these vulnerabilities. In fragile and conflict-affected settings, women face the highest risks, as skilled birth attendance, life-saving PPH commodities and emergency obstetric care are often inaccessible [<span>4</span>].</p><p>Since its launch, the PPH Roadmap has catalysed progress across four strategic areas: research, norms and standards, ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"201-204"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olga Kazakova, Kyriaki Kosidou, Samir Cedic, Michaela Granfors, Viktor H. Ahlqvist, Cecilia Magnusson
Objective
To determine risks of caesarean section (CS) and instrumental deliveries, including CS on individual request, in birthing people with mental disorders, overall and according to indications (i.e., Robson group).
Design
Register-based total population study.
Setting
Record-linkage of administrative and health data registers.
Population
A total of 178,069 people with a delivery during 2014–2020 in Stockholm County.
Methods
Mental disorders in birthing people were identified from health care registers as at least one recorded diagnosis according to ICD-10, and categorised as non-psychotic mood and anxiety disorders, severe, psychotic neurodevelopmental, and other mental disorders. Binary and multinomial regression analyses were used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI), overall and stratified by Robson group.
Main Outcome Measures
Overall mode of delivery (non-instrumental vaginal, instrumental vaginal, elective and emergency CS) and CS on individual request (yes/no).
Results
In total, 143 483 individuals were included in the analysis. Among them, 10.06% had elective caesarean section (CS), 10.89% non-elective CS, 5.61% instrumental delivery, and 5.70% CS on maternal request. The adjusted odds ratio of elective CS (aOR 1.54, 95% CI 1.49–1.60), emergency CS (aOR 1.24, 95% CI 1.20–1.28), and CS on request (aOR 2.05, 95% CI 1.96–2.14) was increased among birthing people with mental disorders. The associations were of similar magnitudes regardless of the type of mental disorder, but particularly pronounced among nulliparous birthing people with full-term, single, cephalic delivery (Robson group 1–2).
Conclusions
Mental disorders in birthing people are associated with an increased risk of caesarean section, both overall and on birthing person request. There may be unmet needs for obstetric care in birthing people with mental disorders.
目的确定精神障碍分娩人群（即Robson组）总体上和按指征进行剖宫产（CS）和器械分娩（包括个人要求的CS）的风险。基于设计登记的总人口研究。设置记录-管理和健康数据寄存器的链接。人口2014-2020年期间，斯德哥尔摩县共有178069人分娩。方法根据ICD-10，从卫生保健登记册中确定分娩人群的精神障碍为至少一项记录诊断，并将其分类为非精神病性情绪和焦虑障碍、严重、精神病性神经发育障碍和其他精神障碍。采用二元和多项回归分析估计校正优势比（aOR）， 95%置信区间（95% CI），总体和Robson组分层。主要结局指标：总体分娩方式（非器械阴道、器械阴道、选择性和紧急宫颈穿刺）和个人要求的宫颈穿刺（是/否）。结果共纳入143,483人。其中择期剖宫产占10.06%，非择期剖宫产占10.89%，器械分娩占5.61%，应产妇要求剖宫产占5.70%。在有精神障碍的分娩人群中，选择性CS （aOR 1.54, 95% CI 1.49-1.60）、紧急CS （aOR 1.24, 95% CI 1.20-1.28）和要求CS （aOR 2.05, 95% CI 1.96-2.14）的调整优势比增加。无论精神障碍的类型如何，这种关联都是相似的，但在足月、单次、头位分娩的无产人群中尤其明显（Robson组1-2）。结论产妇的精神障碍与剖宫产的风险增加有关，无论是总体上还是应产妇的要求。精神障碍产妇的产科护理需求可能未得到满足。
{"title":"Mode of Delivery and Request for Caesarean Section in Birthing People With Mental Disorders: A Register-Based Total Population Study","authors":"Olga Kazakova, Kyriaki Kosidou, Samir Cedic, Michaela Granfors, Viktor H. Ahlqvist, Cecilia Magnusson","doi":"10.1111/1471-0528.70032","DOIUrl":"10.1111/1471-0528.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine risks of caesarean section (CS) and instrumental deliveries, including CS on individual request, in birthing people with mental disorders, overall and according to indications (i.e., Robson group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Register-based total population study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Record-linkage of administrative and health data registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 178,069 people with a delivery during 2014–2020 in Stockholm County.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mental disorders in birthing people were identified from health care registers as at least one recorded diagnosis according to ICD-10, and categorised as non-psychotic mood and anxiety disorders, severe, psychotic neurodevelopmental, and other mental disorders. Binary and multinomial regression analyses were used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI), overall and stratified by Robson group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Overall mode of delivery (non-instrumental vaginal, instrumental vaginal, elective and emergency CS) and CS on individual request (yes/no).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 143 483 individuals were included in the analysis. Among them, 10.06% had elective caesarean section (CS), 10.89% non-elective CS, 5.61% instrumental delivery, and 5.70% CS on maternal request. The adjusted odds ratio of elective CS (aOR 1.54, 95% CI 1.49–1.60), emergency CS (aOR 1.24, 95% CI 1.20–1.28), and CS on request (aOR 2.05, 95% CI 1.96–2.14) was increased among birthing people with mental disorders. The associations were of similar magnitudes regardless of the type of mental disorder, but particularly pronounced among nulliparous birthing people with full-term, single, cephalic delivery (Robson group 1–2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mental disorders in birthing people are associated with an increased risk of caesarean section, both overall and on birthing person request. There may be unmet needs for obstetric care in birthing people with mental disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"422-431"},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Caroline Bank, Janet Catov, Jiqiang Wu, Lynn M. Yee, David M. Haas, Rebecca McNeil, Jessica Pippen, Hyagriv N. Simhan, Uma Reddy, Robert M. Silver, Lisa Levine, George Saade, Judith Chung, Courtney D. Lynch, William A. Grobman, Kartik K. Venkatesh
<div> <section> <h3> Objective</h3> <p>To examine whether neighbourhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI) in early pregnancy, was associated with severe maternal morbidity (SMM) at delivery hospitalisation.</p> </section> <section> <h3> Design</h3> <p>A prospective multi-site observational cohort.</p> </section> <section> <h3> Setting</h3> <p>A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study (nuMoM2b) across eight United States (US) sites from 2010 to 2013.</p> </section> <section> <h3> Study Design</h3> <p>Participant residential address in the first trimester was geocoded at the US census-tract level to calculate the ADI, a standardised metric of neighbourhood socioeconomic disadvantage. We used modified Poisson regression with robust error variance and adjusted for individual-level covariates: age, pre-pregnancy body mass index, chronic hypertension, and pregestational diabetes to examine the association between the ADI [modelled in quartiles from the least (quartile 1, Q1, reference) to the most (Q4) disadvantage] and SMM. Differences in the association between ADI and SMM by self-reported race and ethnicity as a social construct were evaluated with effect modification via an interaction term in the adjusted model.</p> </section> <section> <h3> Main Outcomes</h3> <p>SMM, based on the US Centers for Disease Control and Prevention definition, and secondarily, SMM without transfusion.</p> </section> <section> <h3> Results</h3> <p>Among 9588 nulliparas, 2.3% (<i>n</i> = 221) experienced any SMM and 0.5% (<i>n</i> = 48) experienced non-transfusion SMM. Individuals living in the most disadvantaged neighbourhoods (Q4) were more likely to experience SMM compared with those in the least disadvantaged neighbourhoods (Q1) (3.4% vs. 2.1%; aRR 1.73; 95% CI: 1.17, 2.58). This association was also significant for non-transfusion SMM (1.0% vs. 0.3%; aRR: 2.82; 95% CI 1.15, 6.93). Individuals who self-identified as non-Hispanic Black were more likely to experience SMM than non-Hispanic White individuals (3.9% vs. 2.1%; <i>p</i> < 0.001). There was no evidence of effect modification by self-reported race and ethnicity (interaction <i>p</i> > 0.05).</p> </section> <section> <h3> Conclusion</h3>
{"title":"Neighbourhood Socioeconomic Disadvantage and Severe Maternal Morbidity: Secondary Analysis of a Prospective Cohort","authors":"T. Caroline Bank, Janet Catov, Jiqiang Wu, Lynn M. Yee, David M. Haas, Rebecca McNeil, Jessica Pippen, Hyagriv N. Simhan, Uma Reddy, Robert M. Silver, Lisa Levine, George Saade, Judith Chung, Courtney D. Lynch, William A. Grobman, Kartik K. Venkatesh","doi":"10.1111/1471-0528.70024","DOIUrl":"10.1111/1471-0528.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether neighbourhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI) in early pregnancy, was associated with severe maternal morbidity (SMM) at delivery hospitalisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective multi-site observational cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study (nuMoM2b) across eight United States (US) sites from 2010 to 2013.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Participant residential address in the first trimester was geocoded at the US census-tract level to calculate the ADI, a standardised metric of neighbourhood socioeconomic disadvantage. We used modified Poisson regression with robust error variance and adjusted for individual-level covariates: age, pre-pregnancy body mass index, chronic hypertension, and pregestational diabetes to examine the association between the ADI [modelled in quartiles from the least (quartile 1, Q1, reference) to the most (Q4) disadvantage] and SMM. Differences in the association between ADI and SMM by self-reported race and ethnicity as a social construct were evaluated with effect modification via an interaction term in the adjusted model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>SMM, based on the US Centers for Disease Control and Prevention definition, and secondarily, SMM without transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 9588 nulliparas, 2.3% (<i>n</i> = 221) experienced any SMM and 0.5% (<i>n</i> = 48) experienced non-transfusion SMM. Individuals living in the most disadvantaged neighbourhoods (Q4) were more likely to experience SMM compared with those in the least disadvantaged neighbourhoods (Q1) (3.4% vs. 2.1%; aRR 1.73; 95% CI: 1.17, 2.58). This association was also significant for non-transfusion SMM (1.0% vs. 0.3%; aRR: 2.82; 95% CI 1.15, 6.93). Individuals who self-identified as non-Hispanic Black were more likely to experience SMM than non-Hispanic White individuals (3.9% vs. 2.1%; <i>p</i> < 0.001). There was no evidence of effect modification by self-reported race and ethnicity (interaction <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2256-2264"},"PeriodicalIF":4.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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