Frontiers in global women's health最新文献

Objectives: Anemia in pregnancy has been a topic of interest for researchers due to its potential impact on various adverse pregnancy outcomes. This study aims to explore the relationship between anemia and adverse pregnancy outcomes such as preterm birth, low birth weight, and maternal mortality.

Methods: We conducted both a systematic review and a meta-analysis on the associations between anemia during pregnancy and adverse pregnancy outcomes. We searched Chinese databases (CNKI, Wanfang, CBM, VIP) and English ones (Cochrane Library, PubMed, Embase, Web of Science). Two researcher-authors independently assessed study quality with the Newcastle-Ottawa Scale. After extracting data, we analyzed heterogeneity and used a random-effects model for higher heterogeneity and a fixed-effects model for low heterogeneity in the meta-analysis while also systematically synthesizing and narratively describing findings in the systematic review.

Results: A total of 31 cohort studies were included. Meta-analysis showed that the risk of postpartum hemorrhage [RR [95% CI], 2.76 [1.63, 4.66]], premature rupture of membranes (PROM) [1.94 (1.26, 3.00)], preterm delivery [1.51 (1.33, 1.72)], low birth weight (LBW) [1.40 (1.19, 1.63)], cesarean section[1.33 (1.02, 1.74)], gestational hypertension[1.28 (1.14, 1.44)] and neonatal asphyxia[1.21 (1.07, 1.37)] was higher in the group of anemia in pregnancy than in the control group.

Conclusion: Maternal anemia is associated with an increased risk of seven adverse pregnancy outcomes: postpartum hemorrhage, PROM, preterm delivery, LBW, cesarean section, gestational hypertension and neonatal asphyxia. Appropriate nutritional supplementation and screening for anemia before and during pregnancy are recommended to improve maternal health and manage adverse pregnancy outcomes.

Background: Unplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers.

Methods: A prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables.

Results: The study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p < 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p < 0.001), and those who were primiparous (p < 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p < 0.001, 95% CI 0.401-0.603) according to the Edinburgh Postpartum Depression Scale.

Conclusions: The findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.

Introduction: Estimating a reliable gestational age (GA) is essential in providing appropriate care during pregnancy. With advancements in data science, there are several publications on the use of artificial intelligence (AI) models to estimate GA using ultrasound (US) images. The aim of this meta-analysis is to assess the accuracy of AI models in assessing GA against US as the gold standard.

Methods: A literature search was performed in PubMed, CINAHL, Wiley Cochrane Library, Scopus, and Web of Science databases. Studies that reported use of AI models for GA estimation with US as the reference standard were included. Risk of bias assessment was performed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Mean error in GA was estimated using STATA version-17 and subgroup analysis on trimester of GA assessment, AI models, study design, and external validation was performed.

Results: Out of the 1,039 studies screened, 17 were included in the review, and of these 10 studies were included in the meta-analysis. Five (29%) studies were from high-income countries (HICs), four (24%) from upper-middle-income countries (UMICs), one (6%) from low-and middle-income countries (LMIC), and the remaining seven studies (41%) used data across different income regions. The pooled mean error in GA estimation based on 2D images (n = 6) and blind sweep videos (n = 4) was 4.32 days (95% CI: 2.82, 5.83; l ²: 97.95%) and 2.55 days (95% CI: -0.13, 5.23; l ²: 100%), respectively. On subgroup analysis based on 2D images, the mean error in GA estimation in the first trimester was 7.00 days (95% CI: 6.08, 7.92), 2.35 days (95% CI: 1.03, 3.67) in the second, and 4.30 days (95% CI: 4.10, 4.50) in the third trimester. In studies using deep learning for 2D images, those employing CNN reported a mean error of 5.11 days (95% CI: 1.85, 8.37) in gestational age estimation, while one using DNN indicated a mean error of 5.39 days (95% CI: 5.10, 5.68). Most studies exhibited an unclear or low risk of bias in various domains, including patient selection, index test, reference standard, flow and timings and applicability domain.

Conclusion: Preliminary experience with AI models shows good accuracy in estimating GA. This holds tremendous potential for pregnancy dating, especially in resource-poor settings where trained interpreters may be limited.

Systematic review registration: PROSPERO, identifier (CRD42022319966).

Background: This is the first study to combine both the women's preferences, impacts, and satisfaction during their labour and delivery experience and their companions for their role and impacts. Previously published papers examined either the preferences of pregnant women or those of their companions, which are few. Women's preferences, impacts, and satisfaction with their companions during labour and delivery were evaluated in this study.

Methods: This cross-sectional observational study was conducted between June 2022 and April 2024. As part of this study, labouring women as well as their companions were interviewed separately face-to-face in a private place, and all answers were kept anonymous and confidential. We evaluated each category separately based on two separate sections.

Results: This study included a total of 444 labouring women and an equal number of companions, with mean ages of 32.25 years and 42.66 years, respectively. The majority of women and companions were housewives with college degrees. Among companions, mothers and husbands were the most preferred, and they were typically present from admission to discharge. Among women who had companions, 84.1% reported feeling calmer and more comfortable. 91.9% of companions supported women with encouraging words, and 92.6% perceived their support as highly beneficial to the women. Women expressed 94.8% satisfaction with the medical staff and 87.6% satisfaction with hospital services, while companions reported 96.6% and 74.8% satisfaction with the medical staff and hospital services, respectively.

Conclusions: Labouring women appreciated and valued the presence of companions during childbirth as they had positive impacts. Mothers are the most preferred companions and preferred to be present from admission until discharge. Most companions support their labouring women by encouraging wards. Labouring women and companions were satisfied with the medical team and services provided to them. The presence and role of companions during the childbirth process are crucial and warrant emphasis.

Freebirth (intentionally giving birth without doctors or midwives present) is a taboo and stigmatised birthing decision. In this study, 16 women who had freebirthed their babies in the UK were interviewed, and the data was analysed using the voice-centred relational method (VCRM). This methodology produces a range of outputs, including I-Poetry. Previous scholars have noted the difficulty in presenting results from VCRM research and have devised varied and creative ways of subverting these obstacles. Uniquely, this article relies on the theories of Joseph Campbell, Arthur Frank, and Kim Hudson to present women's freebirth accounts as both Quest Narratives and Heroine Journeys. The article outlines the theoretical underpinnings of the Heroine's Journey and demonstrates its use with women's freebirth accounts as they pertain to the joy of undisturbed physiological birth.

Introduction: Women with inflammatory arthritis (IA) face significant challenges throughout preconception, pregnancy, and postpartum phases, including concerns about disease management and medication safety. The Reproductive Rheumatology care pathway at Erasmus University Medical Center integrates specialized care from rheumatologists and specialized nurses to address both medical, nursing, practical and emotional needs during these phases. This study evaluates patient satisfaction, identifies unmet needs, and explores opportunities for enhancing support within this integrated care model.

Methods: This was a cross-sectional study. We designed a customized questionnaire for women 18 years and older who were treated following the Reproductive Rheumatology care pathway and had given birth between 2019 and 2021. These women were invited to fill in the questionnaire. The survey assessed satisfaction with care, challenges experienced, and information needs across preconception, pregnancy, and postpartum phases. Descriptive statistics and paired t-tests were used for data analysis.

Results: Participants reported high satisfaction with care, rating rheumatologists an average of 8.8/10 and specialized nurses 9.2/10. While 78.9% experienced no major issues, some faced problems such as managing disease flares and difficulties around conception. Information needs varied by phase: preconception needs focused on medication safety and fertility, while pregnancy and postpartum concerns included disease management and emotional support. Specialized nurses were pivotal in offering personalized care and practical advice.

Conclusion: The integrated Reproductive Rheumatology care pathway effectively supports women with IA through their reproductive journey. Despite high satisfaction, improvements could be made in personalized care and addressing challenges related to confidence and help acceptance. Future research should investigate the long-term impact of such care pathways on reproductive outcomes and patient well-being.

Background: A systematic review has reported that paternal involvement is beneficial in reducing social, behavioural and psychological problems in children. However, little research has investigated factors associated with the attainment of paternity leave.

Objective: The objective of this study was to explore fathers' perceptions of the factors associated with taking paternity leave.

Participants and setting: Overall, 21 in-depth interviews were conducted with fathers to obtain information on their perceptions of paternity leave. We also conducted key informant interviews with four supervisors at companies to understand their opinions on paternity leaves and ensure that the implications of this study are relevant at workplaces.

Methods: Thematic analysis was adopted to analyse the data. Deductive coding was conducted based on previous studies on paternity leave, followed by inductive coding and modification of the initial codes. The final codes were organised based on the social-ecological model.

Results: Themes associated with taking paternity leave included fathers' career aspirations, fathers' commitment to supporting infants or mothers, mothers' or infants' need for fathers' involvement, colleagues' outlook on paternity leaves, fathers' work schedules or responsibilities, support from relatives, paternity leave policies, and trends toward fathers' involvement. The supervisors mentioned themes related to paternity leave from the broader perspective of long-term effects and impact on the organisation.

Conclusions: This study revealed fathers' perceptions regarding the factors associated with taking paternity leave. The results may provide useful information on how to create an environment in which fathers can easily take paternity leave.

Introduction: Effective use of the partograph is crucial in identifying abnormal labor (prolonged and obstructed labor) and taking appropriate actions. However, in Ethiopia, the prevalence of obstructed labor is much higher at 11.8% and contributes to 14.4% of the total maternal deaths due to underutilization of the partograph by obstetric caregivers. Although a previous systematic review and meta-analysis (SRMA) had been conducted, they were not representative on a national level as they included a limited number of studies and did not evaluate the current prevalence of partograph utilization beyond July 2019. Since then, there have been inconsistent studies assessing the proportion of partograph utilization and its associated factors. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of partograph utilization and its associated factors in Ethiopia.

Method: Comprehensive literature searches were conducted in PubMed, Google Scholar, and HINARI from 1 September 2013 to 23 October 2023. A random-effects model was used to estimate pooled prevalence and adjusted odds ratio. Stata (version 11.0) was used to analyze the data. Cochrane I ² statistics were computed to assess heterogeneity among studies. A subgroup analysis was done based on the study region to minimize underlying heterogeneity. Funnel plot and Eggers test were conducted to assess publication bias.

Result: Overall, 661 articles were retrieved, and finally, 23 studies were included in this systematic review, including 7,649 participants. The pooled prevalence of partograph utilization was 54.92% (95% CI: 43.38-66.45). The subgroup analysis showed that partograph utilization was highest in the Dire Dawa region and lowest in the Amhara region. Factors such as partograph training [adjusted odds ratio (AOR) = 3.63, 95% CI: 2.57-5.25], good knowledge about partograph (AOR = 2.63, 95% CI: 1.62-4.26), a favorable attitude toward partograph (AOR = 1.95, 95% CI: 1.35-2.82), partograph availability (AOR = 0.89, 95% CI: 2.24-6.61), and being in the midwifery profession (AOR = 0.09, 95% CI: 1.78-5.25) were significantly associated with partograph utilization.

Conclusion: The pooled prevalence of partograph utilization in Ethiopia was low. Partograph training, good knowledge about partograph, favorable attitude toward partograph, partograph availability in the health facility, and being in the midwifery profession were significantly associated with partograph utilization.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier (CRD42023475818).

Background: Respectful maternity care is care organized for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth. However, in many healthcare settings in Ethiopia, the standard practice of respectful obstetric care is not the norm, and a significant proportion of health professionals view patients merely as cases and do not show compassion.

Objectives: To assess respectful maternity care and associated factors among mothers who gave birth at public health institutions in Debre Tabor town, Northwest Ethiopia from December 1, 2023, to January 30, 2024.

Methods: An institution-based cross-sectional study was conducted using qualitative and quantitative data collection methods. Three hundred seventy participants were selected for quantitative analysis using systematic random sampling, while eight were chosen for the qualitative study through purposive sampling. The quantitative data were coded and entered into Epi Data version 4.6, then exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. Adjusted odds ratios with 95% confidence intervals were computed to determine the significance level. Thematic analysis was used for the qualitative data.

Results: The proportion of respectful maternity care was 34.1% (95%CI: 29.4, 39.2) cesarean delivery [AOR = 3.45, 95%CI: 1.60, 7.42]. Daytime delivery [AOR = 3.14, 95%CI: (1.59, 6.18)] and less than or equal to 1 day stay in a healthcare facility [AOR = 3.03, 95%CI: (1.51, 6.08)] were positively associated with respectful maternity care. Inadequate equipment and supplies, shortage of staffing, and lack of accountability were barriers to providing respectful maternity care.

Conclusions: The proportion of respectful maternity care was low. Therefore, health institutions and other stakeholders should support and strengthen monitoring and evaluation mechanisms for maternal and neonatal healthcare providers and enhance education and constant support for women during their pregnancy and childbirth. Additionally, adequate access to basic equipment and supplies should be given due attention to ensure respectful maternity care.

Background: Globally, Africa has the highest HIV, cervical cancer and schistosomiasis prevalence. Female Genital Schistosomiasis (FGS) is hypothesized to be associated with HIV and cervical atypia. Young women aged 15 and above, constituting almost 3 million of the South African population, have limited health care access and are at risk for this triad of diseases. Urinary HPV DNA analysis is a non-invasive sampling method that can assist in evaluating risk among this population. This study compared the analysis of HPV DNA in urine and cervico-vaginal lavage (CVL) samples to cytology Pap smear, Schistosoma microscopy and HIV results.

Methods: In this cross-sectional study, 235 young women aged 16 years and older from rural high schools in KwaZulu-Natal participated. HPV DNA analysis was done in urine and CVL samples. Pap smears were analysed for squamous cell atypia and urine microscopy was used for the identification of Schistosoma ova.

Results: Urinary schistosomiasis was reported in 49 (20.9%) and HIV detected in 49 (20.4%). Urinary and CVL HPV DNA was found in 147 (62.6%) and 177 (75.3%) respectively. Any atypia was detected cytologically among 173 (73.6%). The following associations were found using the Pearson Chi-Square and a Likelihood Ratio test: (a) between HIV positive status and urinary HPV DNA positive cases on both the urine (X ² = 5.007; p-value = 0.025) and (X ² = 4.264; p-value = 0.039) and between HIV positive status and CVL HPV DNA tests respectively (X ² = 5.165; p-value = 0.023) and (X ² = 4.321; p-value = 0.015), and (b) among urine HPV DNA and the CVL HPV DNA tests, where (X ² = 52.966; p-value = 0.001) and (X ² = 50.716; p-value = 0.001). Urine HPV DNA showed a sensitivity of 75.7% and specificity of 77.6% relative to the CVL HPV DNA. There was no statistical association between urinary schistosomiasis and HPV or with any atypia.

Conclusion: Urine has the potential of being optimized as an alternative and possibly more acceptable sample for HPV detection among young adolescent populations at risk in comparison to CVL samples. An integrated targeted intervention incorporating Schistosoma in addition to HPV and HIV testing needs consideration among young women in this age group from endemic areas.