Maternal health, neonatology and perinatology最新文献

Background: Research into probiotic use in pregnancy typically focuses on general probiotic strains. We instead investigated the relation between intake of ice cream with vaginal commensal probiotics (L. crispatus, L. gasseri, L. jensenii, L. rhamnosus GR-1; these may govern a stable microbiota and may carry beneficial functions in the vagina), throughout pregnancy, and the impact on gut and vaginal microbiomes, in women at high risk of preterm birth.

Methods: This was a randomised controlled feasibility trial where the impact on gut and vaginal microbiomes was assessed by using 16 S rRNA gene sequencing and qPCR. In total 43 pregnant women were randomized, with 29 assigned to the intervention group and 14 to the control group. Both groups provided vaginal and rectal swabs by self-sampling at gestational time points. Pregnancy outcomes were registered through hospital records, and ice cream adherence and study experience was recorded.

Results: We observed statistically significant gut and vaginal Lactobacillus increase during first half of pregnancy in all women with a continued increase in the second half in women compliant with the intervention. L. crispatus was found more often in the intervention group, and L. gasseri, L. jensenii and L. rhamnosus GR-1 in the ice cream could be recovered in both rectal and vaginal samples. Finally, vaginal Prevotella spp, as well as gut Gardnerella and Atopobium spp, significantly decreased upon intervention. Adherence to the intervention varied but gradually decreased throughout the study with 30.4% displaying excellent adherence in the first time period.

Conclusions: We conclude that vaginal commensal probiotics administered in ice cream can be an effective method of optimizing the vaginal and intestinal health in pregnant women at high risk of preterm birth when administered regularly. We give recommendations for future studies.

Trial registration: Clinicaltrials.gov registration number 18/27209. Date of registration 03/25/2019. Date of first enrolment 04/08/2019.

Background: Perinatal asphyxia remains a leading cause of neonatal morbidity and mortality in Ethiopia, yet comprehensive and up-to-date evidence on its incidence and associated risk factors is limited. Thus, this study was conducted to identify the epidemiology of perinatal asphyxia among newborns in Ethiopia: a systematic review and meta-analysis of incidence and risk factors.

Methods: This systematic review and meta-analysis was carried out based on a pre-written and registered protocol on International Prospective Register of Systematic Reviews (PROSPERO) registration number (CRD42024589974). A comprehensive search of databases was conducted from PubMed/Medline, Scopus, Web of Science, Science Direct, African Journal Online, Google Scholar, and the Wiley Online Library, Cochrane Library. Population, Intervention, Comparator, Outcome, Context, and Other factors (PICOCO) and Population, Intervention, Comparator, Outcome (PICO) framework was applied. Studies were screened, and their quality was assessed using the Newcastle-Ottawa Scale. Data were extracted into Excel and then exported to STATA version 17 for analysis. Subgroup analyses were performed to identify potential sources of heterogeneity, and meta-regression was conducted to examine the influence of study-level covariates on effect sizes. Publication bias was assessed visually using funnel plots for asymmetry and statistically using Egger's test.

Results: After removing 2,815 duplicates from the initial 4,740 collected studies, the pooled incidence of prenatal asphyxia in Ethiopia was 15% (95% Confidence Interval [CI]: 12-18%, p < 0.001). The most commonly identified pooled risk factors included lack of antenatal care visits (Adjusted Odds Ratio [AOR] = 1.60; 95% CI: 1.12-2.29), rural residence (AOR = 1.56; 95% CI: 1.18-2.07), low birth weight (AOR = 2.33; 95% CI: 1.53-3.54), antepartum hemorrhage (AOR = 2.09; 95% CI: 1.12-3.90), preterm birth (AOR = 2.21; 95% CI: 1.65-2.96), and neonatal Intensive Care Unit (ICU) admission (AOR = 1.88; 95% CI: 1.09-3.25).

Conclusion and recommendation: This systematic review and meta-analysis identified a high incidence of perinatal asphyxia in Ethiopia, with regional variations. Several key risk factors were found to be significantly associated with the condition. Addressing these factors is crucial for preventing birth asphyxia and improving neonatal outcomes.

Background: Smoking cessation during pregnancy is very important but few women succeed. Supporting change in identity (i.e. perceptions of "who I am") towards nonsmoking seems a promising route to smoking cessation. This study aimed to assess identity of participants of the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study and evaluate the group session on identity.

Methods: This prospective, uncontrolled, before-after study was conducted in The Netherlands in 2019-2021. In the SAFER pregnancy study, prepregnant and pregnant women participated in a maximum of six group sessions, one of them focused on identity, and received access to an online platform to support smoking cessation. Biochemically validated smoking cessation was rewarded with incentives with a total value up to 185 euros.

Results: Thirty-nine women participated in the intervention of whom twenty-one women in the identity session. Women who identified more strongly with other mothers ('mother group-identity') also identified more strongly with the group of non-smokers ('non-smoker group-identity'; r = 0.52, P < 0.001), and those who perceived themselves more strongly as smokers ('smoker self-identity') also identified more strongly with the group of smokers (r = 0.51, P < 0.001). Non-significant changes in identity were observed. Images about the ideal, non-smoking, future self were often related to 'relaxation and freedom', 'strength and pride' and 'motherhood'. The identity session was appreciated by participants and was felt to provide grounds for open and honest discussions about smoking in the context of being a mother.

Conclusions: Addressing non-smoker, smoker and mother identity may be a promising new route to improving interventions for smoking cessation around pregnancy. Effective interventions are needed to support identity in smoking cessation interventions, in order to help women quit smoking before and during pregnancy and to prevent postpartum relapse.

Trial registration: Netherlands Trial Register: NL7493. Date registered: 4 February 2019.

Background: This study aimed to determine whether donor oocyte versus autologous oocyte use is associated with adverse maternal or neonatal outcomes in singleton live births conceived using assisted reproductive technology.

Methods: This was a retrospective cohort study of singleton live births conceived using assisted reproductive technology and delivered within a tertiary-care university health system between January 2014 and August 2019. Multiple gestations and cases with missing data were excluded. Adverse maternal and neonatal outcomes were compared between live births conceived using donor versus autologous oocytes utilizing multivariate backwards-stepwise logistic regression to adjust for potential confounders. Data are presented as adjusted odds ratios (OR) with 95% confidence intervals (CI) with p <.05 considered statistically significant.

Results: Among 1,015 singleton gestations, 97 (9.6%) were conceived using donor and 918 (90.4%) using autologous oocytes. Women using donor oocytes were older (42.5y vs. 35.4y, p <.001), more likely to have pre-gestational diabetes (5.2% vs. 0.7%, p =.001), more likely to utilize fresh embryo transfers, (29.9% vs. 18.9%, p =.01) and less likely to utilize PGT-A (25.8% vs. 51.3%, p <.001). A greater odds of a 5-minute APGAR score < 7 was noted among the donor oocyte group (4.1% vs. 0.9%, OR 4.64 [95% CI 1.30-14.45]). There were no other significant differences in maternal or neonatal outcomes between the two groups.

Conclusions: In singleton gestations conceived using assisted reproductive technology, donor oocyte use does not appear to be associated with an increased risk of adverse maternal or neonatal outcomes. This may be reassuring for patients hoping to achieve a live birth through use of donor oocytes.

Background: Birth trauma is a complex concept that encompasses experiences spanning the perinatal period, from prenatal care to delivery and postpartum care. Despite NICU parents being a high-risk population, there are limited studies examining interpersonal trauma in the NICU. Our study sought to explore the perspectives of NICU families on contributors to birth trauma and assess concordance with NICU staff knowledge on traumatic births.

Methods: A multi-methods study was performed exploring the qualitative experience of postpartum parents with infants admitted to a level IV NICU. Each participant shared their prenatal, delivery, and postnatal experiences through a semi-structured, audio-recorded interview. Interviews were transcribed using HIPAA compliant software and verified by principal investigators for accuracy. Each principal investigator performed thematic analysis using the constant comparative method until saturation and consensus was reached. Additionally, NICU Staff completed an anonymous survey soliciting baseline knowledge and attitudes regarding birth trauma. Perspectives from birthing parents and medical staff were compared.

Results: Three themes contributing to birth trauma emerged among birthing parents (1) inadequate communication with the medical team (2) lack of support from trusted sources (3) fear of the unknown regarding their infants medical condition. While 96% of medical staff acknowledged that implicit bias and interpersonal trauma contribute negatively to healthcare disparities, when probed about real life examples, 50% of staff were unsure if they had personally witnessed such events. Majority of staff believed "deviation from birth plans", "prolonged hospitalization", and "treatment decisions" would be the primary contributors to patients' negative feelings about their birth. This was discordant with patient perspectives who frequently cited provider-patient interactions as the biggest contributor.

Conclusions and relevancy: Interpersonal interactions play a huge role in patients' perception of the birth experience. Despite this, good communication, access to support, and anticipatory guidance can be protective factors, but providers need more education to better understand birth trauma and how it can present. Trauma-informed care education among medical staff is needed to improve recognition of signs and symptoms of trauma responses and reduce re-traumatization of patients during the perinatal experience.

Background: There are expert-agreed upon malnutrition indicators for infants, but the meaningfulness of these indicators in hospitalized neonates is unknown.

Methods: Eighty-four term infants hospitalized in a level IV neonatal intensive care unit had body composition measurements and other anthropometric data extracted from the medical record. Linear regression using maximum likelihood estimation was performed to evaluate the relationship of malnutrition status (assessed at time of body composition assessment) with each body composition metric (body fat percent z-score, fat mass z-score, fat-free mass z-score) and with toddler body mass index (BMI) z-score. Linear regression was also performed to evaluate the relationship between each body composition metric and toddler BMI z-score.

Results: There was a statistically significant negative association between neonatal malnutrition diagnosis with a -0.83 change in fat-free mass z-score (95% CI -1.61 to -0.05, p = 0.04). There was no statistically significant association between body fat percent or fat mass and neonatal malnutrition diagnosis. There was no statistically significant relationship between each infant body composition metric and toddler BMI z-score in unadjusted linear regression models.

Conclusions: Neonatal malnutrition diagnosis is associated with lower fat-free mass in critically ill infants with a variety of conditions.

Background: While the birth of a newborn is often a moment of great joy, it can be overshadowed by life-threatening complications that endanger survival in the early days of life. Neonatal near-miss (NNM) cases are infants who survive severe complications, offer a valuable lens for evaluating the quality of neonatal care. Somalia continues to have one of the highest neonatal mortality rates globally, with about 37 deaths per 1,000 live births, highlighting significant gaps in maternal and child health services. This study aimed to identify the determinants of neonatal near miss among neonates admitted to SOS Mother & Child Hospital, Banadir, Somalia.

Methods: An unmatched case-control study was conducted at SOS Mother and Child Hospital in Banadir region from December 2024 to April 2025. A total of 243 neonatal near miss (NNM) cases and 730 healthy neonate controls were included. Cases were identified using pragmatic and management criteria from the Centro Latinoamericano de Perinatología (CLAP) criteria. For each case, three controls were randomly selected. Data were collected using structured questionnaire and record reviews and analyzed using SPSS v25. Logistic regression was employed to identify independent predictors of neonatal near miss.

Results: Significant predictors of neonatal near miss included lack of maternal (aOR: 2.61) and paternal education (AOR: 3.64), monthly household income below 100 USD (aOR: 2.82), short birth interval under 24 months (aOR: 1.97), lack of antenatal care (ANC) attendance (aOR: 6.25), history of stillbirth (aOR: 4.35), obstetric complications (aOR: 4.46), preterm or post-term birth (AOR: 1.89), prolonged labor (aOR: 3.58), home delivery (aOR: 4.76), maternal chronic illness (aOR: 3.37), male sex of the newborn (aOR: 1.86), and low birth weight (aOR: 9.34).

Conclusion & recommendation: Neonatal near miss remains a pressing public health concern in Somalia, influenced by socio-demographic, obstetric, and neonatal factors. Strengthening maternal education, promoting antenatal care, ensuring skilled birth attendance, and improving facility-based delivery services are essential to reducing neonatal complications and improving outcomes. Policymakers and humanitarian partners must prioritize investments in maternal and newborn health to address these preventable risks.