BMC Pregnancy and Childbirth最新文献

Objective: This research analyzes the potential of long non-coding RNAs (lncRNAs) as markers in determining the necessity of antiviral treatment in pregnant women by examining alterations in the expression profile of serum lncRNAs in pregnant women with elevated hepatitis B viral load (HBVL) under antiviral and non-antiviral treatment regimens between the second trimester and delivery.

Methods: Serum was obtained from 6 s-trimester pregnant women with high HBVL and no intrauterine infection. Then, 3 of these women were randomly selected for antiviral treatment, with the remaining 3 women undergoing non-antiviral treatment as control. Serum samples were again collected from these 6 women before delivery. The expression profile of lncRNAs was analyzed with microarray technology, followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. The axes of hub lncRNA-miRNA-mRNA were identified based on the competing endogenous RNA (ceRNA) network.

Results: The expression profile of serum lncRNAs in pregnant women with high HBVL changed significantly from the second trimester of pregnancy until delivery under antiviral or non-antiviral treatment. The Venn diagram was utilized to screen out the jointly up-regulated and down-regulated lncRNAs in the serum of pregnant women under antiviral and non-antiviral treatment before delivery. Additionally, the KEGG pathway enrichment analysis results showed that lncRNAs might mediate the Hippo pathway in HBV infection. Based on the ceRNA network, 3 hub lncRNAs (CATG00000076041.1, LINC01310, and G014655) were found to potentially regulate the key gene TP73 in the Hippo pathway.

Conclusion: In this study, we retrieved co-differentially expressed lncRNAs in pregnant women with high HBVL under antiviral or non-antiviral treatment, which may be used as markers for evaluating whether pregnant women with high HBVL may be free of antiviral treatment. This study may provide a basis for preventing potential adverse effects of antiviral treatment on maternal and fetal health.

Background: Antenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.

Methods: This study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother's age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.

Results: The findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019-2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women's education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.

Conclusion: Despite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women's care experiences.

Background: The impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.

Methods: Singleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.

Results: After chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5-13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1-18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.

Conclusions: The rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.

Backgroud: Pregnancy is a state of increased metabolic demand, and poor maternal nutrition can exacerbate these changes, potentially increasing the risk of cardiometabolic disorders.This study is significant as it investigates the effect of high energy nutritional supplements on cardio metabolic risk markers in underweight primigravidas.

Methodology: A single blinded randomized controlled trial was conducted from April 2018- August 2019 among the Pakistani tertiary care facilities of Khyber Pakhtunkhwa. A total of thirty six participants were randomized into two groups receiving either high energy nutritional supplement 'MAAMTA' or Placebo. They were instructed to take Placebo/Supplement alongside to their regular prenatal care and food from their first antenatal visit till a week postnatally. Anthropometric measurements and blood samples for biochemical parameters insulinlevels, fasting blood glucose & lipid profile were taken at baseline visit, between 16 and 20 weeks gestation and a post natal visit.

Results: The two-way repeated measures ANOVA showed that there was a highly significant time effect on participant's Insulin level (F (1.8, 53.6) = 10.64, P < 0 0.000, ηp² = 0.269). A highly significant time effect on participant's insulin resistance (F (2, 68) = 8.116,P < 0 0.001, ηp² = 0.193) was also observed. There was a highly significant time effect on participant's LDL level as well (F (2, 68) = 11.82, P < 0 0.000, ηp² = 0.258).

Conclusion: Supplementation with high energy nutritional supplements may improve insulin levels and insulin sensitivity in underweight primigravidas.

Trial registration: https://www.

Clinicaltrials: gov ClinicalTrials.gov Identifier: ISRCTN 10088578. Registered on 27 March 2018. https://www.isrctn.com/ISRCTN10088578 .

Purpose: The purpose of this study was to examine the association between hygiene and sexual practices and the incidence of urinary tract infection (UTI) among Jordanian pregnant women.

Methods: The cross-sectional data were collected using self- administered survey from October 2018 to January 2019 in central Jordan. A total of 200 pregnant women completed the survey. All of them were married and aged between 18 and 45 years (M = 27.45; SD = 6.06). The measures used were demographics, social, hygiene and sexual practices.

Results: A significant association was found between the incidence of UTI and the educational level of husbands (p = 0.05), history of UTI in previous pregnancies (p = 0.02) and being in the second trimester of pregnancy (p = 0.02). Their sexual and hygiene practices also were significantly associated with the incidence of UTI.

Conclusion: History of UTI in previous pregnancies, hygiene and sexual practices are associated with increased incidence of UTI among Jordanian pregnant women. Appropriate strategies and techniques to promote health and preventive behaviors for pregnant women with UTI should be provided to improve the quality of life among pregnant women and reduces economic burdens on health care system.

Introduction: Our study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.

Methods: Data from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15-49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother's age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.

Results: Newborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.

Conclusion: Considering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby's body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Background: Improving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the "Communities in which Mothers and Newborns Thrive (COMONETH) project" in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.

Methods: We used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.

Results: A total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07-1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06-4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20-1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80-1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93-1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06-1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27-1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03-1.14).

Conclusions: The findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

Introduction: Mobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.

Methods: A qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.

Results: The current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.

Conclusion: mHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.

Trial registration: PROSPERO: CRD42023461425.

Background: Cesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined.

Methods: In this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes.

Results: From January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P < 0.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P < 0.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P < 0.05). However, these factors did not result in improved surgical success rates.

Conclusion: The classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment.

Background: Transmission of SARS-CoV-2 highlighting the importance of social distancing guidelines. Following a series of lockdowns and the widespread vaccination of the European population, many countries began to lift these restrictions. During this period, while some parents yearned for emotional support and family presence, others found that the solitude facilitated by the restrictions was beneficial for bonding and breastfeeding. In France, postnatal stays are generally longer than in other countries, and the limited availability of home-based follow-up care, combined with pandemic isolation measures, further complicated perspectives on visitation restrictions. Therefore, the objective of this study was to assess the satisfaction of mothers and caregivers regarding these visit restrictions in French maternity settings during the COVID-19 pandemic.

Methods: We conducted two multicentre descriptives surveys across five French maternity wards (three in Paris and two in Lyon) from June 1st to July 15th, 2021. Participants included mothers, selected based on criteria such as French-speaking, at-term birth (≥ 37 weeks), and hospitalisation with their newborn, as well as caregivers working in the postpartum units. Satisfaction with visitation restrictions was assessed using a four-point Likert scale, which was then dichotomised into "mostly satisfied" versus "mostly dissatisfied" for the analysis. Multivariable logistic regression models were used to identify factors associated with satisfaction.

Results: We analysed complete responses from 430 of the 2,142 mothers (20.1%) and 221 of the 385 caregivers (57.4%) who participated during the study period. The majority of mothers (68.8%, n = 296/430) and caregivers (90.5%, n = 200/221) declare themselves satisfied with the policy of restricting visits to maternity wards. The main source of mother's satisfaction came from a quieter stay, but they regretted the absence of their other children.

Conclusions: Maternity visit restriction policies were largely supported by mothers and caregivers, especially when partners and siblings were allowed. Revisiting these policies, along with the postpartum stay length, may improve care, though further evaluation in non-pandemic settings is needed.