Frontiers in global women's health最新文献

Objective: This retrospective study investigated the characteristics of endometrial polyps identified during incomplete abortion management and evaluated differences between these polyps and retained products of conception.

Methods: Patients with intrauterine retention within 4 months after abortion were enrolled in this study between January 2019 and December 2024. Twenty-six patients with pathologically confirmed endometrial polyps were included in the case group, while fifty-two patients with confirmed retained products of conception (RPOC) comprised the control group. The groups were matched in a 1:2 ratio based on gestational age (±1 week).

Results: Twenty-six study group patients were included; 69.2% (18/26) were nulliparous. Abortions occurred in gestational age of 6-14 weeks. No polyps were identified prior to subsequent surgical intervention. Hysteroscopy was performed on 24 women. In hysteroscopic cases, no endometrial polyp was larger than 2 centimeters in size. Compared with control group, the study group had lower gravidity (1 [0-3] vs. 2 [0-8], p = 0.025) and lower serum β-hCG levels (3.67 [0-799.1] mIU/ml vs. 21.08 [0-901.2] mIU/ml, p = 0.004). Ultrasonography indicated a lower rate of abundant blood flow (7.7% vs. 46.2%, p = 0.001) and smaller intrauterine volume (1.93 ± 2.55 cm³ vs. 5.42 ± 4.94 cm³, p = 0.001) in the study group. Additionally, the study group had a significantly longer interval from pregnancy termination to subsequent surgical intervention (51.5 ± 31.7 days vs. 38.2 ± 14.9 days, p < 0.001).

Conclusions: Endometrial polyps should be considered in stable women after abortion with intrauterine retention present with low blood flow on doppler, low β-hCG levels, and prolonged retention, especially in women with lower gravidity. Hysteroscopy is recommended for accurate diagnosis and proper management, preventing unnecessary treatment for presumed retained products of conception.

The climate finance architecture addresses mitigation, adaptation, and loss and damage for climate-resilient development. However, it fails to advance the debt-related injustices in climate financing that inflict economic and non-economic violence on women from the low- and middle-income countries (LMICs) and marginalized communities in the "Global North." Gender-based violence (GBV) is one dimension of climate injustices that becomes a risk multiplier to the lives of women, girls, and gender minorities across race, caste, abilities, and ethnicities. This article establishes the climate-resilient gender-responsive solutions to internalize gender-based violence prevention in the feminist economy of climate finance. Resultantly, the care economy under climate crises transforms family structures and relations beyond the neoclassical comprehension of micro and macroeconomics. This article takes a multisectoral approach to gender-responsive finance for climate crises. Moreover, it draws on gray literature from civil society organizations and think tanks addressing the majority of perspectives and academic articles across principles of feminist economics, climate financing, and gender-based violence.

Background: Nausea and vomiting in pregnancy (NVP) affect up to 85% of pregnant individuals, predominantly in the first trimester. While most cases are mild, moderate to severe NVP can significantly impair quality of life and require medical intervention. Besides, safety concerns often influence decision-making. This study examines the perceptions, concerns, and information-seeking behaviors of women in Germany regarding NVP and its treatment.

Methods: A nationwide cross-sectional online study was conducted from March 18-28, 2024, targeting pregnant individuals and mothers in Germany via the "Echte Mamas" online community. Participants completed an anonymous online questionnaire comprising 15 items covering sociodemographic data, NVP severity (using the PUQE-24 score for pregnant individuals currently suffering from NVP), treatment attitudes, and information-seeking behavior. Data were analyzed using descriptive statistics and subgroup analyses were performed to investigate differences in NVP severity.

Results: Among 506 respondents (completion rate: 83.9%), 81.9% reported experiencing NVP, with 40% reporting moderate, 30.6% mild and 29.4% severe symptoms. Hospitalization was required in 12.4% of cases, predominantly among those with severe NVP, with 76.3% of those receiving medication post-discharge. Participants primarily sought information from physicians (53.4%), the internet (50.6%), and midwives (44.5%), with more severe NVP prompting greater information-seeking behavior. Safety concerns dominated treatment preferences, with participants prioritizing drug approval (on-label prescription) for pregnancy and rapid symptom relief.

Conclusion: This study emphasizes the need for proactive communication from healthcare providers about safe and effective NVP treatments. Tailored, patient-centered strategies that address safety concerns and provide evidence-based guidance are essential for informed decision-making.

Background: Cultural beliefs and power relationships existing in family daily practices significantly influence the health behaviors and outcomes of pregnant women. The role of family hierarchy and shamanic practices in shaping maternal health behaviors. In rural Indonesian communities, limited access to education and health literacy among women and their families hinders informed decision-making, increasing the risk of maternal and neonatal complications and death. This study approach, informed by the Foucauldian view of power relationships within family dynamics, aimed to explore the cultural norms and daily practices that contribute to adverse pregnancy outcomes.

Method: A qualitative ethnographic study was conducted in Banjarnegara, Indonesia. Seventy participants-including pregnant women, their husbands, health cadres, and midwives-were recruited from three Public Health Centers (PHCs). Data collection involved 12 focus group discussions (FGDs), field observations, and in-depth semi-structured interviews. Data was analyzed by utilizing discourse analysis that highlighting communication and interactions of pregnant women with family members and health cadres who are assigend to support the women. This study was reported according to the COnsolidated criteria for REporting Qualitative Research (COREQ).

Results: Thematic using discourse analysis revealed three primary themes: 1) daily activities of pregnant women, 2) family hierarchy and power dynamics, and 3) cultural practices involving shamans during pregnancy. The most frequently coded subthemes were cultural food practices (48.6%); activity-related practices (37.1%); family dominance (28.6%); shamanic practices (15.7%); practices related to rest and sleep (14.3%); and lack of reproductive control (14.3%).

Conclusion: Pregnant women were often subject to culturally driven food taboos and restrictive physical routines, heavily influenced by family hierarchies and power relationships existing in their families-particularly mothers-in-law and husbands. These influences extended to decisions about reproductive health and prenatal care, sometimes leading to unplanned pregnancies and unsafe practices. The role of shamans, while culturally significant, poses risks when traditional methods conflict with scientific standards of care. Strengthening communication between healthcare providers and families, promoting culturally sensitive education, and empowering women through targeted interventions are essential to improving maternal and neonatal outcomes in these communities.

Background and aim: The novel coronavirus pandemic has notably affected the psychological health of antenatal women, heightening their vulnerability to stress and raising questions about the impact of vaccination and fetal health outcomes. This study aims to examine the relationship between stress, resilience, and social support among antenatal women in Jordan during the novel coronavirus pandemic.

Methodology: Using a cross-sectional approach, 434 antenatal women were surveyed in November 2021. Participants were recruited through digital platforms, including social media (Facebook and Instagram). Eligibility criteria were participants should be at least 18 years old, pregnant, living in Jordan, and proficient in English.

Results: The mean perceived stress score among participants was 24.3 ± 4.4, with nearly half (49.3%) experiencing difficulty focusing, 48.9% finding daily tasks stressful, and 45.9% having trouble falling asleep. The mean social support score was 39.3 ± 9.1; the highest-rated support item was having someone available to drive them to a doctor. Pearson correlation revealed a significant positive association between resilience and social support (r = 0.565, p < 0.01). Regression analysis identified later trimester, lack of insurance, and negative life changes during the pandemic as significant predictors of higher stress among pregnant women. These findings highlight that antenatal women in Jordan experienced considerable stress and moderate social support during the pandemic, and that social support is linked to higher resilience.

Conclusion: Antenatal women have experienced persistently high levels of anxiety and stress throughout the novel coronavirus pandemic. The mental health impacts are closely related to pandemic-driven factors such as isolation, interpersonal difficulties, and financial strain. Addressing these psychological outcomes and associated risk factors is essential before they worsen and impact both mothers and their unborn children.

The policy brief analyses program implementation gaps among Adivasi population in Southern Karnataka to support India's 'Anemia Mukt Bharat' and Karnataka's 'Anemia Mukt Poushtika Karnataka' initiatives which aims to improve anemia and nutrition status of the population This analysis is based on a Adivasi birth cohort. Preliminary results show higher underweight and anemia prevalence in Adivasi women than National Family Health Survey-5 estimates. A significant proportion of women also have thalassemia traits, suggesting a genetic predisposition. Given the burden of sickle cell disease and the undernutrition, an intersectoral approach is needed. A multistakeholder committee, including Adivasi women, experts from public health and nutrition, others are crucial to design culturally appropriate initiatives and prioritize hemoglobinopathy screening, ensuring effective strategies for this vulnerable population.

Introduction: Group antenatal care is a model where care is provided in groups of around 6-12 women/birthing people, integrating healthcare with information and learning in a participatory approach. There is international evidence of improved care experiences and outcomes; however, the approach (here called Pregnancy Circles) had not been trialled in the United Kingdom in the context of a universal health system with midwife-led care. We aimed to understand the experience of care and any mechanisms by which group care functions for the different people involved.

Method: This study comprised a qualitative process evaluation nested within a randomised controlled trial. The mixed qualitative methods used in this study included observations of care, interviews with participants, survey open-text responses and written feedback, and a review of relevant documents. Inductive thematic analysis was conducted using a framework of theorised mechanisms based on a realist review. The trial's clinical and psychosocial outcomes and lessons for implementation are reported elsewhere.

Results: We found a high level of concordance with the framework of mechanisms derived from the literature. The key mechanisms were social support and community building, a critical pedagogy (combining peer learning, an interactive and participatory approach, and health education), satisfaction and engagement with care, and the health professionals' satisfaction and development. Building on these, the empowerment of participants and midwives formed an overarching mechanism. Relational continuity and time for care were the key underpinning components.

Discussion: Pregnancy Circles address key deficits in contemporary maternity care, including the lack of time and relational or informational continuity of care, the lack of informed choice, and loss of opportunities to enhance empowerment through health knowledge, social support, and confidence in caring for one's own health, in decision-making, and in seeking support. Importantly, midwives felt that facilitating group care enhanced their professional satisfaction and development and collaboration across boundaries, features associated with service safety and resilience. Fidelity in terms of the midwives' skills and confidence in using a facilitative approach was important and was underpinned by continuity. Midwives' and women's empowerment were found to be mutually supportive rather than in tension. Scaling up Pregnancy Circles as a standard care option in the National Health Service may support positive care experiences; however, further research is needed to monitor the longer-term impact and service and public health implications.

Introduction: Stillbirth remains a major public health issue in low- and middle-income countries (LMICs). Ghana's 2021 stillbirth rate (21.4 per 1,000 births) exceeds the United Nations Sustainable Development Goal (SDG) target of 12 per 1,000 births by 2030. Unclean household cooking fuels have been associated with adverse pregnancy outcomes, including stillbirth. In Ghana, women conduct about 64% of household cooking, often in poorly ventilated settings with particulate levels above World Health Organization (WHO) guidelines. We assessed the association between household cooking fuel type and stillbirth among Ghanaian women.

Methods: We conducted a cross-sectional analysis using data from the 2022 Ghana Demographic and Health Survey. The sample included 10,654 women aged 15-49 years with ≥1 recorded pregnancy. The primary exposure was household cooking fuel (clean vs. unclean per WHO guidelines). Outcomes were (1) stillbirth, defined as fetal loss at ≥7 months' gestation, and (2) stillbirth rate per 1,000 total births. Survey-weighted bivariate screening (p < 0.05) identified candidate covariates for inclusion in multivariable, survey-weighted logistic regression models. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported. Given the cross-sectional design, estimates reflect associations, not causation.

Results: The overall stillbirth rate was 15.85 per 1,000 births. Unclean cooking fuel use was associated with 44% higher odds of stillbirth (AOR: 1.44; 95% CI: 1.05-1.99; p = 0.0258). Other factors associated with higher odds were age ≥30 years (AOR: 2.17; 95% CI: 1.59-2.95; p < 0.001), moderate-to-poor health (AOR: 1.78; 95% CI: 1.39-2.28; p < 0.001), and alcohol consumption (AOR: 1.43; 95% CI: 1.06-1.93; p = 0.0195).

Discussion: In this nationally representative sample, unclean cooking fuel use was associated with increased odds of stillbirth. Expanding access to clean fuels and leveraging antenatal care services for culturally responsive clean-energy counseling may help reduce stillbirth risk. Prospective studies with exposure monitoring are needed to establish temporality.

Objective: Endometriosis (EMT) is a prevalent gynecological disorder characterized by chronic pain, menstrual irregularities, and infertility. This study aims to evaluate the global burden of EMT from 1990 to 2021 and to project trends up to 2050.

Methods: Data from the Global Burden of Disease (GBD) 2021 database were utilized to analyze mortality, incidence, prevalence, and disability-adjusted life years (DALYs). Trends were assessed using age-standardized rates (ASR) and estimated annual percentage change (EAPC). Future burdens were projected using ARIMA and exponential smoothing models.

Results: In 2021, there were 3,447,126 new cases of EMT reported globally. The age-standardized incidence rate (ASIR) experienced a decline of 1.07% from 1990 to 2021, while the age-standardized prevalence rate (ASPR) decreased by 0.95%. The incidence of EMT peaked among women aged 20-24 years, whereas mortality rates increased with advancing age. Projections suggest that by 2050, EMT-related deaths will rise to 68 cases, and the number of disability-adjusted life years (DALYs) will increase to 2,260,948, despite ongoing declines in both ASIR and ASPR.

Conclusion: Although the incidence and prevalence rates of EMT are declining, the disease burden remains significant among women of reproductive age. The anticipated rise in mortality and disability-adjusted life years (DALYs) in the future underscores the necessity for targeted public health policies. This study provides evidence to inform global prevention strategies. Future research should investigate the effects of population aging and lifestyle changes on the burden of EMT.

Introduction: This study examined the impact of maternal adverse childhood experiences (ACEs) on their children's overall quality of life (QoL), focusing on the mediating role of maternal QoL and the moderating role of maternal self-esteem. Understanding these intergenerational pathways can provide valuable insights for designing interventions that promote family well-being.

Methods: A secondary data analysis was conducted using data from the 2018 National Child Life Experience Survey in South Korea. Participants included 930 mothers who had experienced at least one type of childhood adversity. A descriptive and correlational research design was employed, and statistical analyses were performed using the PROCESS macro to test mediation and moderation effects.

Results: Higher levels of maternal ACEs were significantly associated with lower QoL in both mothers and their children. Maternal QoL partially mediated this relationship, indicating that adverse childhood experiences affect children's well-being indirectly through maternal health. Moreover, maternal self-esteem moderated the negative effects of maternal ACEs on children's QoL, serving as a psychological protective factor.

Discussion: These findings highlight the critical importance of maternal psychological health in mitigating the intergenerational transmission of adversity. Strengthening maternal self-esteem and emotional well-being could buffer the negative impact of early adversity on families. Public health and nursing strategies that integrate mental health promotion and family-based interventions are essential to improve long-term outcomes for children in families affected by maternal ACEs.