Maternal health, neonatology and perinatology最新文献

Introduction: Pregnancy-related AKI (PR-AKI), has profound maternal and fetal implications, including high mortality and long-term risks such as the development of chronic kidney disease (CKD). This systematic review aims to evaluate the burden of CKD owing to PR-AKI cases during follow-up in developing countries, particularly India.

Methods: A systematic search of PubMed, Embase, and Cochrane databases was performed for Indian studies published between 2000 and June 2024. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI, subsequent CKD, and dialysis dependency in Indian cohorts during follow-up. Details of etiology of PRAKI, and adverse fetal and maternal outcomes were also recorded. Only studies that provided follow-up kidney outcomes were considered.

Results: A total of 25 studies comprising 2,306 participants were included in the analysis. The incidence of PR-AKI ranged from 1 to 12% across different studies. Sepsis was the most common cause of PR-AKI, accounting for up to 78% of cases, followed by hypertensive disorders, obstetric haemorrhage, and tropical etiologies. Hemodialysis was required in 20-85% of patients. CKD development during follow-up was observed in 12.8-35% of cases, with up to 30% remaining dialysis-dependent. Maternal mortality ranged from 2.5 to 34%, while perinatal mortality reached as high as 67.3%. Pre-term delivery rates varied between 13.9% and 58%.

Conclusions: Up to one-third of PR-AKI patients may develop CKD and remain dialysis-dependent during follow-up. PR-AKI significantly impacts both maternal and fetal morbidity and mortality. Early prevention and prompt management by healthcare professionals are critical to improving outcomes in PR-AKI. Pregnancy-related acute kidney injury (PR-AKI) significantly affects maternal and fetal health, leading to high mortality and long-term complications such as chronic kidney disease (CKD). This systematic review, focusing on developing countries like India, evaluated the burden of CKD due to PR-AKI patients. The review analyzed Indian studies published between 2000 and June 2024, including 25 studies with 2,306 participants. PR-AKI incidence ranged from 1 to 12%, with sepsis being the leading cause in up to 78% of cases, followed by hypertensive disorders, obstetric hemorrhage, and tropical fevers. RRT was needed in 20-85% of patients, and 12.8-35% developed CKD during follow-up, with up to 30% remaining dialysis-dependent. Maternal mortality varied from 2.5 to 34%, while perinatal mortality reached 67.3%. The study emphasizes the critical need for early prevention timely intervention and need for long-term follow-up to reduce the high morbidity and mortality rates associated with PR-AKI.

Objective: To systematically identify and classify maternal and perinatal health outcomes reported in research conducted in the epidemic and pandemic context.

Study design and setting: We conducted a systematic review following Cochrane Methods. We searched MEDLINE, EMBASE, LILACS, SCI-EXPANDED, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO, AMED, ClinicalTrials.gov and ICTRP, between January 2015 and March 2023. Experimental, quasi-experimental, observational studies, phase IV trials, and post-marketing studies, published protocols and ongoing registered studies reporting maternal and perinatal health outcomes were included. Studies only reporting coverage of interventions, access to routine health services, clinical presentation of infectious diseases, and reviews were excluded. A sampling strategy was used for COVID-19 studies, due to their very high numbers. Outcome verbatims were extracted and categorized in unique outcome, and further classified into domains and subdomains. Frequency of outcome reporting was calculated.

Results: 94 maternal and pregnancy and 47 unique neonatal outcomes were identified, from a total of 917 and 657 verbatims, respectively, reported across 440 included studies. At least 20% of included studies reported maternal and pregnancy outcomes of mode of delivery (56.1%), stillbirth (33.0%), preterm birth (28.6%), hypertensive disorders of pregnancy (26.6%), and maternal death (20.7%). These outcomes were identified across all three types of studies identified (epidemiological, product development or post-authorization surveillance). Gestational age at birth (29.8%), congenital malformations of the nervous system (26.1%), birth weight (23.4%), neonatal admission to intensive care unit (23.2%), and neonatal death (19.1%) were the most frequently reported neonatal outcomes.

Conclusions: Our study provides the basis for developing a core outcome set to measure maternal and perinatal health during outbreaks, which would help improve data collection of harmonized data, data synthesis, and timely development of informed public health guidance and clinical care responding to the needs of pregnant women.

Background and objectives: Maternal nutrition indicated by fat and fat-free mass gains is a sensitive determinant of infant growth; however, there is a dearth of literature on the impact of specific body composition indicators on infant growth, especially from India. Thus, we aimed to study trends in body composition of pregnant women according to pre-pregnancy body mass index (BMI) through gestation and at birth and to evaluate the effect of maternal body composition changes on infant morphometry at birth.

Methods and material: We analyzed data on 268 pregnant women enrolled in a prospective observational longitudinal (MAI: Mother and Infant) cohort. Pregnant women and their infants were longitudinally measured for their anthropometry and women were measured for body composition and interviewed for socio-demography, diet, and physical activity once in each trimester during pregnancy. Pearson's correlation analysis and linear regression were performed to assess the relationship between maternal body composition and the infant's morphometry at birth. P-value < 0.05 was considered statistically significant.

Results: Among women belonging to underweight, normal, and overweight/obese BMI category, gestational weight gain (GWG%) and post-partum weight loss (%) were 27.5 ± 9.2, 21.7 ± 7.8, 16.9 ± 7.5 and - 10.1 ± 4.4, -8.7 ± 3.4, -7.3 ± 2.5 respectively. Fat (%) increased during pregnancy and decreased at childbirth (Underweight: 24.6 ± 4.0 vs. 29.7 ± 4.0 and 26.7 ± 3.9, normal: 32.5 ± 3.8 vs. 37.0 ± 3.7 and 34.3 ± 4.2, overweight/obese: 42.0 ± 4.1 vs. 45.5 ± 4.0 and 44.3 ± 4.6). Sedentary (r = 0.405), and light activity (r = 0.334), and dietary fat intake(r = 0.231) were correlated with fat%(p < 0.05 for all). Fat gain among women in underweight (B: 0.05, 95%CI: 0.005-0.09) and normal BMI category (B:0.04, 95%CI: 0.008-0.07), but not overweight/obese BMI category (B = 0.04, 95% CI: -0.01-0.09) was a significant predictor of infant birth weight.

Conclusion: Distinct BMI categories exhibited varying trends of change in fat percentage where women belonging to the underweight BMI category gained the highest fat% and lost most of it during childbirth as compared to those in the overweight/obese BMI category. An increase in fat among women in the underweight and normal but not overweight/obese BMI categories was associated with infant birth weight.

Importance: Following expansive legalization of cannabis in many parts of the United States, cannabis use in pregnancy has increased several fold. There is a pressing need to understand the maternal and neonatal outcomes associated with this exposure.

Objective: To quantify the maternal and neonatal outcomes of mothers using cannabis during pregnancy.

Data sources: We searched five databases for all relevant observational studies, from each database's inception until March 1st 2024.

Study selection: Two reviewers separately screened the studies in duplicate. Our initial search yielded 5184 studies, of which 51 (0.98%) were included in our qualitative synthesis.

Data extraction and synthesis: Our study adhered to PRISMA guidelines and independent extraction by two researchers was utilized. We used a 95% confidence interval and the random effects model, as there was significant heterogeneity between studies.

Results: The 51 included studies yielded a total population of 7,920,383 pregnant women. Cannabis consumption was associated with increased risks of low birth weight (RR = 1.69,95% CI = (1.34,2.14),P < 0.0001), small for gestational age (RR = 1.79,95% CI = (1.52, 2.1),P < 0.00001), major anomalies (RR = 1.81,95% CI = (1.48, 2.23),P < 0.00001), decreased head circumference (MD = -0.34,95% CI = (-0.57,-0.11),P = 0.004), birth weight (MD = -177.81,95% CI = (-224.72,-130.91),P < 0.00001), birth length (MD = -0.87,95% CI = (-1.15,-0.59),P < 0.00001), gestational age (MD = -0.21,95% CI = (-0.35,-0.08),P = 0.002), NICU admission (RR = 1.55,95% CI = (1.36,1.78),P < 0.00001), perinatal mortality (RR = 1.72,95% CI = (1.09,2.71),P = 0.02), and preterm delivery (RR = 1.39,95% CI = (1.23,1.56),P < 0.00001). Cannabis use was also associated with a decreased risk of gestational diabetes in pregnancy (RR = 0.64,95% CI = (0.55,0.75),P < 0.00001).

Conclusions: Inclusion of the latest published data continues to show worse maternal and neonatal outcomes for mothers using cannabis in pregnancy.

Background: There is a reverse J-shaped relation between newborn weight percentile and risk of perinatal mortality. Perinatal mortality itself is associated with severe maternal morbidity and mortality (SMM-M) around the index pregnancy, likely because the two share common etiologies, including placental dysfunction. We evaluated an infant's birthweight percentile and risk of its mother experiencing SMM-M.

Methods: This population-based cohort study was completed within a universal healthcare system in Ontario, Canada. Included were 2,203,490 singleton livebirths between 2002 and 2020. The study exposure was infant birthweight percentile for gestational age and sex. The 25th to 75th percentile served as the referent. The main outcome was SMM-M arising from 23 week's gestation up to 42 days postpartum. Multivariable modified Poisson regression generated relative risks (aRRs) and 95% confidence intervals (CI), adjusted for maternal age, income, rurality, pre-existing diabetes and hypertension.

Results: A J-shaped relation was seen between birthweight and risk of SMM-M. Relative to the 25th to 75th (15.0 per 1000 livebirths), the aRR of SMM-M was 1.27 (95% CI 1.21, 1.32) at 5th to < 10th, 1.40 (95% CI 1.28, 1.53) at 2nd to < 3rd, and 1.48 (95% CI 1.36, 1.62) at < 1st birthweight percentile. At higher birthweights, the aRR was 1.16 (95% CI 1.11, 1.21) at 90th to < 95th, 1.24 (95% CI 1.13, 1.36) at 95th to < 96th, and 1.73 (95% CI 1.60, 1.87) at > 99th percentile.

Conclusion: There is a J-shaped relation between infant birthweight and risk of its mother experiencing SMM-M, likely due to shared risk factors and a common pathogenesis.

Background: The transition to motherhood, known as matrescence and comparable to adolescence, involves significant changes across multiple life domains, impacting maternal identity and increasing the risk of psychopathology. Conventional maternal mental health interventions often emphasize crisis management over proactive resilience building. Psychoeducational programs designed to empower and support positive adaptation may offer a beneficial preventative approach. This pilot study evaluates the acceptability, relevance, and effectiveness of a matrescence-informed maternal health education program developed to enhance new mothers' understanding of the complex emotional and social challenges associated with the transition to motherhood.

Methods: This study evaluated a six-week, matrescence-informed maternal health education program delivered via Zoom. Eighteen participants (n = 18) attended weekly 75-minute sessions that included lectures, experiential exercises, and group discussions. Pre- and post-intervention surveys were administered to assess mindfulness, self-compassion, perceived stress, personal growth, and psychological well-being. Quantitative data were analyzed using paired t-tests to compare pre- and post-intervention scores, and qualitative responses were analyzed using thematic analysis to capture participant perceptions of the program's relevance and impact.

Results: The pilot program demonstrated improvements in select psychological measures. While overall mindfulness scores did not change, increases were noted in the subscales of observing, non-judgment, and non-reactivity. Self-compassion scores increased, and participants reported gains in areas such as personal strength, relationships, and spiritual development. Perceived stress and psychological well-being remained unchanged, though environmental mastery showed improvement. Qualitative responses described challenges related to physical and emotional challenges as well as identity shifts. Participants assessed the program to be relevant and useful in addressing the challenges of motherhood and in enhancing their awareness of the concept of matrescence.

Conclusions: Positive participant feedback suggests that matrescence-informed education may offer benefits to new mothers' understanding of their developmental transition and should be disseminated more widely to improve their awareness and literacy. The small sample size highlights the need for larger-scale studies, including randomized controlled trials and longitudinal follow-ups, to evaluate the program's potential in mitigating the risk of poor maternal mental health outcomes. Efforts should be made to reduce barriers to matrescence education and make it affordable and accessible to all.

Background: The neonatal period is the most vulnerable time for children under 5 years. Neonatal mortality contributes to almost one-half of all under-5 deaths. Developing one or more newborn danger signs increases the mortality risk in the first 28 days of life. Understanding maternal awareness of newborn danger signs is essential in promoting early newborn care-seeking for better outcomes. In Uganda, there is a paucity of evidence on maternal awareness of newborn danger signs (NDS) immediately after delivery. This study aimed to determine the level and factors associated with maternal awareness of NDS before discharge from the hospital.

Methods: This is a secondary analysis of baseline data from a hospital-based enhanced maternal education intervention conducted at a Tertiary Care and Teaching Hospital in Eastern Uganda. Maternal awareness of NDS was assessed by recording spontaneous maternal responses to the question, 'What are the danger signs of a newborn baby that you know? Women who mentioned ≥ 3 NDS were categorized as having a good awareness. Frequencies and percentages for all categorical variables were presented in tables and charts. Binary logistic regression analysis was used to determine the factors associated with awareness of NDS.

Results: The baseline survey enrolled 250 post-natal women. Only 14.0% of the participants had a good awareness of NDS. High body temperature/fever (73.6%) and poor breastfeeding/or failure to breastfeed (38.8%) were the commonly identified NDS. Hypothermia, cord sepsis (0.4%), skin pustules (1.6%), and convulsions (4.6%) were the least identified NDS. Mode of delivery (p = 0.039) and maternal age (p = 0.032) were significantly associated with maternal awareness of NDS.

Conclusions: Maternal awareness of newborn danger signs in the immediate post-delivery period is poor. The women do not know the majority of the NDS, and therefore, these signs can go undetected, delaying care-seeking and posing a risk for poor infant outcomes. Routine postnatal health education should focus on these danger signs while ensuring that younger mothers and women who deliver by cesarean section are given special attention during knowledge enhancement sessions.

Objectives: Poor prenatal health is of particular concern among minoritized individuals who may experience adverse social determinants of health contributing to the intergenerational transmission of health disparities. The purpose of this study was to investigate associations between psychosocial resources, and mental and physical health among a prenatal sample, and to explore if these relationships vary by race.

Methods: English-speaking pregnant individuals living in the United States were recruited using Centiment (n = 340). Participants completed a 121-item cross-sectional survey. We conducted a single- and multi-group structural equation model to test hypothesized relationships, and then investigated differences by pregnant White individuals versus Black, Indigenous, and People of Color (BIPOC).

Results: Our final single-group model exhibited good model fit (χ2 (43) = 99.07, p < .01, CFI = 0.97, SRMR = 0.04, and RMSEA = 0. 06 (0.05-0.08)). After controlling for demographic characteristics and social determinants of health, higher levels of mindfulness were statistically significantly related to lower anxiety and depression scores (both p < .01). Higher levels of social supports were statistically significantly related to lower anxiety scores. Scale measurement invariance was confirmed for the multi-group model and the structural model was statistically significantly different between pregnant White individuals and BIPOC in this sample (Δ χ2 (27) = 116.71, p < .01).

Conclusions: Identification of core components of psychosocial resource interventions, consideration of upstream structural determinants, mindfulness and valued-living (MVL)-based strategies, cultural adaptation, and an emphasis on resilience rather than psychopathology may result in improved prenatal health among pregnant individuals traditionally underrepresented in research.

Background: The enduring conflict in Somalia has precipitated significant humanitarian crises, including severely weakened health systems and poor health indicators. The situation has led to almost two million Somalis living abroad, often as refugees or asylum seekers in more high-resource settings in the Global North. To understand outcomes of care of pregnant women and their babies in host countries, this systematic review and meta-analysis aims to synthesise existing evidence on adverse maternal and perinatal outcomes among Somali migrant women compared to host populations.

Methods: We conducted a comprehensive search across multiple electronic databases, including PubMed, Scopus, CINAHL Plus, and the Directory of Open Access Journals, using tailored keyword combinations. No language or date restrictions were applied, and the search concluded on June 30, 2024. Following data extraction and quality assurance using the STROBE Checklist, we conducted a meta-analysis for outcomes with sufficient data, using a random-effects model to account for heterogeneity across populations. Subgroup analyses were conducted by host country, with heterogeneity assessed using I² and τ² statistics. Potential publication bias was evaluated through Egger's test and funnel plots. The results provide pooled estimates of maternal and perinatal outcomes.

Results: Across all databases, 116 articles were retrieved, with 17 meeting the eligibility criteria. From these articles, pregnancy-related data from 1978 to 2018 on 55,119 Somali migrant women and 5,190,459 women from the host population was extracted. Somali migrant women, compared to host populations, had significantly increased odds of emergency caesarean section (CS) (pooled OR 2.54, 95%CI: 2.22-2.86), non-progressing/induced labour (pooled OR 1.25, 95%CI: 1.19-1.31). Their babies had higher odds of small for gestational age (SGA) (pooled OR 2.03, 95%CI: 1.89-2.17), neonatal morbidity (pooled OR 1.51, 95%CI: 1.40-1.61), and neonatal mortality (pooled OR 1.39, 95%CI: 1.25-1.54). Conversely, Somali migrant women had lower odds of assisted instrumental delivery (OR 0.72, 95%CI: 0.66-0.78), post-partum depression (OR 0.27, 95% CI: 0.12-0.63), preterm birth (OR 0.92, 95%CI: 0.88-0.96), and low birth weight (OR 0.87, 95% CI: 0.80-0.94) compared to host populations.

Conclusion: Significant disparities in maternal and perinatal outcomes between Somali migrant women and host populations exist. Though more research is needed, available evidence points to the need for more culturally aware obstetric services that address the specific needs of Somali migrant women.