The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals.

Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.

Identifying common conditions of pregnancy for women, including women from culturally and linguistically diverse backgrounds, at an Australian hospital: A survey.

PROBLEM: Research that explores the prevalence and range of treatments sought for common conditions of pregnancy is limited, particularly for culturally and linguistically diverse (CALD) women. BACKGROUND: During pregnancy, physical and psychological conditions affect participation in the home, workplace, and community. However, treatment options may be limited, particularly for CALD women. AIM: To establish the prevalence of physical and psychological conditions experienced during pregnancy, and ascertain treatments options sought by women attending a hospital in a multicultural area of Sydney (Australia), including medical, allied health and complementary medicines. METHODS: A cross-sectional survey of pregnant women attending an outpatient antenatal clinic (July-December 2019). The survey was conducted in the most common language groups, English, Arabic and traditional Chinese (inclusive of Cantonese and Mandarin). Univariate and bivariate analysis was conducted. FINDINGS: A total of 154 women participated. CALD women most frequently reported lower-back pain (41.5 %), constipation (34 %), nausea (28 %), and anxiety (7.5 %) . English-speaking women reported lower-back pain (43.5 %), difficulty sleeping (37 %), severe tiredness (35 %), and anxiety (15.8 %), and were more likely to seek treatment (p < 0.01). Practitioners most consulted were massage therapists, physiotherapists, community nurses and counsellors. Doctors were least consulted overall. CONCLUSIONS: Pregnant women most commonly reported lower-back pain, however conditions were reported and treated less frequently by CALD women, including psychological conditions. It is vital that women can access hospital-based treatment for common physical and psychological conditions of pregnancy. The implication for clinicians is to establish routine asking, adequate care provision and referral to culturally safe and appropriate services.

Assistência pré-natal às usuárias de substâncias psicoativas: dificuldades elencadas pelos profissionais da saúde / Prenatal care for users of psychoactive substances: difficulties listed by health professionals / Atención prenatal a consumidoras de sustancias psicoactivas: dificultades mencionadas por los profesionales de la salud

Objetivo: conhecer as dificuldades elencadas pelos profissionais de saúde na assistência pré-natal às usuárias de substâncias psicoativas. Método: estudo qualitativo, exploratório-descritivo, realizado nas mídias sociais, com profissionais da área da saúde que realizam atendimento pré-natal. A coleta de dados ocorreu de novembro de 2022 a janeiro de 2023 por meio de questionário eletrônico. Os dados foram analisados por meio da análise temática. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados: os profissionais destacam o déficit de conhecimento para abordar este público em específico. A abordagem superficial e condenatória do uso de substâncias pelas políticas públicas corrobora para que os profissionais se sintam preparados em parte para atender essas gestantes. Considerações finais: a capacitação dos profissionais é necessária para superar práticas condenatórias e retrógradas de cuidado que focam unicamente a abstinência; como também, o investimento na capacitação acerca da rede de atenção à saúde, buscando ampliar sua visibilidade e utilização.

Objective: understanding the difficulties listed by health professionals in prenatal care for users of psychoactive substances. Method: this is a qualitative, exploratory-descriptive study carried out on social media with health professionals who provide prenatal care. Data was collected from November 2022 to January 2023 using an electronic questionnaire. The data was analyzed using thematic analysis. Protocol approved by the Research Ethics Committee. Results: the professionals highlight the lack of knowledge to deal with this specific public. The superficial and condemnatory approach to substance use by public policies contributes to making professionals feel partly prepared to deal with these pregnant women. Final considerations: the training of professionals is necessary to overcome condemnatory and retrograde care practices that focus solely on abstinence; and investment in training about the health care network, seeking to increase its visibility and use.

Objetivo: conocer las dificultades mencionadas por los profesionales de la salud en la atención prenatal de las consumidoras de sustancias psicoactivas. Método: estudio cualitativo, exploratorio-descriptivo, realizado en redes sociales, con profesionales de la salud que brindan atención prenatal. La recolección de datos se llevó a cabo de noviembre de 2022 a enero de 2023 a través de un cuestionario electrónico. Los datos se analizaron mediante análisis temático. El protocolo fue aprobado por el Comité de Ética en Investigación. Resultados: los profesionales destacan que les falta el conocimiento para atender a este público específico. El abordaje superficial y condenatorio del consumo de sustancias por parte de las políticas públicas contribuye a que los profesionales se sientan parcialmente preparados para atender a esas gestantes. Consideraciones finales: es necesario capacitar a los profesionales para superar las prácticas asistenciales condenatorias y retrógradas que se centran únicamente en evitar el consumo; e invertir en capacitación sobre la red de atención de salud, para ampliar su visibilidad y uso.

Factors associated with attendance to and completion of prenatal care visits in Colombia among urban-residing Venezuelan refugee and migrant women.

Between 2015 and 2023, 7.3 million Venezuelans have been displaced globally. We aimed to assess uptake of and factors associated with prenatal care among Venezuelan refugees and migrants in Colombia. We analyzed data from a cross-sectional survey of 6,221 urban-residing adult Venezuelans who were displaced to Colombia between 2015 and 2022. Analyses were restricted to 917 women aged 18-49 years who reported at least one pregnancy and delivered in Colombia; of these, 564 (61.5%) women completed ≥4 prenatal care visits in their most recent pregnancy. We used general linear models with negative binomial regression to identify associations and estimate the adjusted prevalence ratios (aPrR) of variables associated with completing ≥4 prenatal care visits during last complete pregnancy (WHO's pre-2016 recommendations). Having an irregular migration status was independently associated with a 12% lower likelihood (aPrR:0.88, 95%CI:0.78-0.99; p = 0.028) of completing ≥4 prenatal care visits compared to women with a regular status. Participants who reported an experience of denial of prenatal care at some point while Colombia (n = 135; 15.2%) were 42.8% less likely (aPrR:0.57, 95%CI:0.45-0.73; p < 0.001) to complete ≥4 prenatal care visits than those with no reported denial of care. Urban area of residence was also independently associated with prenatal care, while there was no evidence of association with educational attainment, literacy levels, or year of migration. Prenatal care attendance is suboptimal among Venezuelan refugees and migrants, particularly those with an irregular migration status, despite that prenatal care became officially available in 2018 to all Venezuelans in Colombia regardless of migration status. Reducing barriers to prenatal care by ensuring Venezuelan refugees and migrants are aware of available care, are supported in navigating the health system, and by preventing discrimination and stigma in the health facility are critical to ensuring the health and wellbeing of displaced people, their children, and the surrounding community.

Nutritional Knowledge and Practices of Low-Income Women During Pregnancy: A Qualitative Study in Two Oaxacan Cities.

Background: Adequate dietary intake is critical for healthy pregnancies. Recent changes in social services in Mexico, coupled with high levels of food insecurity, call into question whether expecting women of the lowest socioeconomic status are able to meet their dietary and nutritional needs in this changing context. The aim of this study was to explore the nutritional practices, education and received and employed among women during their pregnancy. Methods: Guided by Ecological Systems Theory and an Intersectionality Framework, this qualitative study was carried out in Oaxaca City and Puerto Escondido, in Oaxaca, a Mexican state with high levels of food insecurity. Women who had at least one child in the past five years and had lived in Oaxaca for the past five years were eligible to participate. Twenty-five women participated in semi-structured in-depth interviews conducted between June and December of 2023. A grounded theory approach was used for coding. NVivo was used for coding and analyses. Results: Five key themes emerged linked to individual-level characteristics and the multiple social identities related to the social support for nutritional knowledge and practices among low-income Oaxacan women during pregnancy: 1) Life experiences, sociodemographic, and health characteristics that influence nutritional practices and knowledge during pregnancy; 2) Female family members as a primary source of nutritional knowledge and food support; 3) Support from other members of women's social networks; 4) Medical guidance for nutrition during pregnancy; and 5) Quality and gaps in the broader health care system and social services. These themes highlight how women's own experiences and social identities and the different interpersonal and community-level environments, particularly those of mothers and grandmothers and health care providers, interact and shape women's nutritional knowledge and practices, such as foods and nutritional supplements consumed, during pregnancy. Conclusion: Nutritional knowledge and practices during pregnancy are impacted by multiple social identities women have and different factors at the individual, group, and structural level. Future research and programming that use multi-level approaches (considering the individual and the family and other social influences) are needed to address the gaps in nutrition that women in Oaxaca go through during the prenatal period.

Micronutrient intakes in a young antenatal population-10-year Retrospective survey at a Sydney hospital clinic.

AIM: Nutritional requirements are increased in young people to support growth, and this is particularly critical when pregnancy occurs within young age groups. The aim was to describe nutritional intakes (with particular emphasis on iron and calcium) and selected pregnancy outcomes, in a young antenatal population aged 14-24 years. METHOD: A retrospective audit was conducted using 404 records from a young parents' antenatal clinic which included prepregnancy body mass index (BMI), pregnancy weight gain, baby birth weight, nutritional biochemistry, and dietitian assessment of iron and calcium intakes and supplement use. Age groups were compared (adolescents aged 14-18 years versus older 19-24 years clients), and regression analysis was used to explore potential predictors of birth outcomes. RESULTS: There was no difference in prepregnancy body mass index for age, pregnancy weight gain, baby birth weight or outcomes, between the age groups. Based on food group serves, intakes were inadequate for iron in 82% of clients and for calcium in 72%. Iron status declined in both groups during the pregnancy, while adolescents had less adequate calcium intake (p = 0.0001). Supplement use was more common in clients with poor iron (p = 0.015) or vitamin D status (p < 0.0001). CONCLUSION: Iron and calcium intakes were inadequate in this nutritionally vulnerable population. Further research would be beneficial to identify effective interventions to improve nutrition in this cohort.

The impact of group antenatal care on newborns: Results of a cluster randomized control trial in Eastern Region, Ghana.

BACKGROUND: Maternal recognition of neonatal danger signs following birth is a strong predictor of care-seeking for newborn illness, which increases the odds of newborn survival. However, research suggests that maternal knowledge of newborn danger signs is low. Similarly, maternal knowledge of optimal newborn care practices has also been shown to be low. Since both issues are typically addressed during antenatal care, this study sought to determine whether group antenatal care (G-ANC) could lead to improvements in maternal recognition of danger signs and knowledge of healthy newborn practices, as well as boosting postnatal care utilization. METHODS: This cluster randomized controlled trial of G-ANC compared to routine individual antenatal care (I-ANC) was conducted at 14 health facilities in Ghana, West Africa, from July 2019 to July 2023. Facilities were randomized to intervention or control, and pregnant participants at each facility were recruited into groups and followed for the duration of their pregnancies. 1761 participants were recruited: 877 into G-ANC; 884 into I-ANC. Data collection occurred at enrollment (T0), 34 weeks' gestation to 3 weeks postdelivery (T1) and 6-12 weeks postpartum (T2). Comparisons were made across groups and over time using logistic regression adjusted for clustering. RESULTS: Overall, knowledge of newborn danger signs was significantly higher for women in G-ANC, both in aggregate (13-point scale) and for many of the individual items over time. Likewise, knowledge of what is needed to keep a newborn healthy was higher among women in G-ANC compared to I-ANC over time for the aggregate (7-point scale) and for many of the individual items. Women in G-ANC were less likely to report postnatal visits for themselves and their babies within 2 days of delivery than women in I-ANC, and there was no difference between groups regarding postnatal visits at one week or 6 weeks after birth. CONCLUSION: This study illustrates that group ANC significantly improves knowledge of newborn danger signs and healthy newborn practices when compared to routine care, suggesting that the impact of G-ANC extends beyond impacts on maternal health. Further research elucidating care pathways for ill newborns and maternal behaviors around healthy newborn practices is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04033003, Registered: July 25, 2019 Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ .

The Trajectory and Influencing Factors of Fear of Childbirth in Third Trimester Primiparas: A Prospective Longitudinal Study.

BACKGROUND: Maternal fear of childbirth fluctuates throughout pregnancy. However, no studies have investigated the changing characteristics and influencing factors of fear of childbirth. AIMS: This study aimed to identify the trajectory patterns of fear of childbirth in third-trimester primiparas and to examine the factors influencing these patterns. METHODS: This study followed the STROBE checklist for observational research. A prospective longitudinal design was employed, using the Intolerance of Uncertainty Scale, Childbirth Self-Efficacy Inventory and Childbirth Attitudes Questionnaire as primary measures. Data were collected from 226 primiparous women at 28-29 weeks, 32-33 weeks, 36-37 weeks and 39-41 weeks of gestation. Growth mixture modelling (GMM) was fitted using Mplus 8.3 software to analyse the trajectory of fear of childbirth. Logistic regression was conducted to identify the factors influencing these trajectories. RESULTS: The results revealed heterogeneity in the trajectory of fear of childbirth, which could be categorised into six groups: a normal group without fear, a group with no initial fear but increased fear later, a group with mild fear that decreased, a group with mild fear that worsened, a mild fear stable group and a moderate fear stable group. Logistic regression showed that intolerance of uncertainty, childbirth self-efficacy and childbirth preference were the primary factors influencing these trajectories (p < 0.05). CONCLUSIONS: This study highlights the varying trajectories of fear of childbirth in third-trimester primiparas. Different categories of fear emerge, each following a distinct path of change. Healthcare providers can use this information to create individualised interventions, addressing specific concerns and influencing factors at various stages, to support the psychological well-being of primiparas during the perinatal period. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Healthcare providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow-up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self-efficacy and ultimately alleviate fear. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT STATEMENT: This study is of great interest to health care providers, suggesting that health care providers should be vigilant about primiparas' awareness of and response to childbirth fear. This study shows that the fear of childbirth often begins to increase or decrease between 32 and 33 weeks of gestation. Screening and interventions should thus be initiated during this period, with follow-up mechanisms in place. Providers should also assess primiparas' capacity to cope with childbirth fear, offering targeted guidance and education to reduce uncertainty, enhance childbirth self-efficacy and ultimately alleviate fear.

Evaluating Prenatal Care Compliance and Barriers to Prenatal Care Among Pregnant Individuals in Forsyth County, North Carolina.

Background: Individuals who gave birth from May 2021 through July 2021 at Atrium Health Wake Forest Baptist (AHWFB) Hospital were surveyed to identify barriers to prenatal care (PNC), assess adequacy of PNC, and examine how these measures relate to race, ethnicity, and income. Methods: A survey was administered to 200 individuals giving birth at AHWFB. Eligibility included English- or Spanish-speaking, aged 18 years or older, and a gestational age of 35 weeks or greater at delivery. Primary outcomes included PNC receipt and PNC barriers. Stratification by race, ethnicity, and income were also evaluated. Results: PNC receipt rates were 81%, 87%, and 88% in the first 28 weeks, between 28 and 36 weeks, and after 36 weeks, respectively, with 76% of individuals receiving adequate PNC throughout pregnancy. Non-White or Hispanic participants experienced lower PNC rates in the first 28 weeks, and participants reporting an annual household income of less than $20,000 experienced lower PNC rates throughout pregnancy. While 19% of participants reported at least one barrier to PNC, the number of barriers reported did not differ based on race, ethnicity, or income. However, it was found that participants who reported at least one barrier were less likely to receive PNC throughout pregnancy. Limitations: This study was limited by convenience sampling and the potential for recall bias. Conclusions: Although race, ethnicity, and income were not associated with the number of reported barriers, they did impact the likelihood of receiving adequate PNC. As self-reported race/ethnicity in our study likely served as a proxy for racism and race-based discrimination, future research should more formally investigate the role of structural racism in the receipt of PNC.

Unveiling Macrosomia Risks of Non-Diabetic Women: Insights from Second Trimester Maternal Lipid Profiles.

BACKGROUND: Macrosomia, characterized by excessive fetal growth, is common in infants born to women with pre-gestational diabetes and gestational diabetes mellitus (GDM). However, macrosomia, which leads to birth-related maternal and fetal complications and metabolic complications in the adolescence of the affected fetuses, also occurs in the pregnancies of non-diabetic women. This study aims to identify the association between second-trimester lipid profiles and macrosomia in non-diabetic pregnant women to aid in early diagnosis. METHODS: This retrospective cohort study included 8,956 patients who delivered at a tertiary care center between 2017 and 2019. Exclusion criteria encompassed pre-existing diabetes, GDM, preeclampsia (PE), intrahepatic cholestasis of pregnancy, obesity, fetal chromosomal or genetic abnormalities, tobacco, alcohol, or drug use affecting lipid metabolism. Participants were divided into two groups: 621 with macrosomia and 873 controls. Second trimester maternal lipid profiles and demographic variables such as age, pregnancy week, and gender were assessed. RESULTS: In the study cohort, maternal age (P=0.002), gestational week (P=0.003), and cesarean section rate (P<0.001) were higher in the macrosomic group. High-density lipoprotein-cholesterol (HDL-C) was significantly lower, while total cholesterol (TC), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) were significantly higher in the macrosomic group (P<0.001). Univariate analysis revealed positive associations between second-trimester TG (OR 1.023, 95% CI: 1.020‒1.033, P<0.001), TC (OR 1.023, 95% CI: 1.016‒1.030, P<0.001) and LDL-C (OR 1.036, 95% CI: 1.018-1.054, P<0.001) with macrosomia and a negative association with HDL-C (OR 0.954, 95% CI: 0.923‒0.976, P<0.001). However, after adjusted multivariable logistic analysis, only TG remained statistically significantly associated with macrosomia (OR 1.054, 95% CI: 1.033‒1.076, P<0.001). CONCLUSION: Our study emphasizes the importance of early recognition and prevention of macrosomia. Structured prospective studies are needed to enhance macrosomia prediction and implement preventive measures, such as dietary modifications. These strategies will be crucial in preventing birth-related complications and long-term health risks, including diabetes, obesity, and cardiovascular diseases, associated with macrosomia.

Content of Selected Nutrients and Potential Contaminants in Prenatal Multivitamins and Minerals: an Observational Study.

BACKGROUND: Increasing consumer reliance on prenatal multivitamins and minerals (PMVMs) underscores the importance of ensuring their quality and safety. Adequate choline and iodine intakes during pregnancy are crucial for fetal development, yet discrepancies between labeled and actual content in PMVM products pose significant health risks. Additionally, the potential presence of toxic heavy metals, such as arsenic, lead, and cadmium, raises concerns about potential adverse health effects. OBJECTIVE: Evaluate nonprescription and prescription PMVMs regarding choline and iodine content as well as arsenic, lead, and cadmium. METHODS: This observational study evaluated a convenience sample of nonprescription and prescription PMVM products from online retailers and local retail pharmacies. Products were analyzed using liquid chromatograph mass spectrometry for choline and inductively coupled plasma mass spectrometry for iodine, arsenic, lead, and cadmium. Choline and iodine actual amounts were compared with reported label amounts and contaminant amounts were compared with United States Pharmacopeia (USP) standards. RESULTS: In total, 32 nonprescription and 15 prescription PMVM products were analyzed. Choline amounts were reported on 12/47 (25.6%) products including 5 (41.7%) within 20% of the claimed amount, 2 (16.7%) over the claimed amount by >20%, and 5 (41.7%) under the claimed amount by >20%. Iodine amounts were reported on 25/47 (53.2%) products including 4 (16.0%) within 20% of the claimed amount, 20 (80.0%) under the claimed amount by >20%, 1 (4.0%) over the claimed amount by >20%. Amounts of arsenic, lead, and cadmium above USP purity limits were found in 7 (14.9%), 2 (4.3%) and 13 (27.7%) PMVMs, respectively. CONCLUSIONS: Current PMVM labels are misleading with the potential to harm pregnant persons and fetuses through omission or inaccurate content of essential nutrients and inclusion of heavy metals. Regulation is needed, and the Food and Drug Administration needs sufficient authority and staffing to oversee these dietary supplements.

Obesity-related maternal complications during the COVID-19 pandemic.

Objectives: To compare gestational weight gain (GWG) during pregnancy and obesity-related maternal morbidity between three months of the first year of the COVID-19 pandemic and three months of the previous year. Methods: A retrospective comparative study was conducted in a tertiary university-affiliated hospital. GWG, obesity rates and pregnancy complications were compared between the time periods. Results: Among women with class I obesity, GWG was higher during the pandemic (n = 1071) than the previous year (n = 1194): 11.16 vs. 8.69 kg, p = 0.04. Women during the pandemic compared to the previous year were less likely to be diagnosed with gestational diabetes (odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47-0.91, p = 0.01) or hypertensive disorders of pregnancy (OR = 0.63, 95% CI 0.35-1.0, p = 0.05) after adjustment for parity, mode of conception and advanced maternal age. Conclusions: Gestational weight gain increased during the pandemic, yet rates of obesity-related complications were notably fewer. This is likely attributed to decreased detection consequent to limited antenatal care.

Seroprevalence of Toxoplasma gondii and Associated Risk Factors in Pregnant Women in Araçatuba, São Paulo, Brazil: A Multi-Level Analysis.

This study assessed the seroprevalence of Toxoplasma gondii and risk factors among 428 pregnant women attending Basic Health Units (BHUs) in Araçatuba, São Paulo, Brazil. The seroprevalence was 55.14%, indicating high exposure to the parasite in this population. Using a multi-level logistic regression model, this study analyzed these predictors to determine their association with a higher seropositivity rate, with BHUs included as a random factor. Predictors associated with higher seropositivity included older age (36-45 years), with a 71.64% prevalence in this group, and multiparity (61.65%). Women with lower educational levels were also more likely to be infected, with 59.46% seropositivity recorded among those who had only completed elementary school. Despite identifying several risk factors, no significant correlation was found between undercooked meat consumption or contact with soil and infection. These findings highlight the need for targeted public health interventions, particularly for educating high-risk groups about toxoplasmosis prevention, such as safe food handling and avoiding raw dairy products. Additionally, BHUs play a critical role in early detection and prevention. These units are important for providing healthcare access and preventive education for vulnerable populations. Given the high seroprevalence, this study underscores the urgency of implementing prenatal screening and educational programs to reduce the risks of congenital toxoplasmosis in this region.

Association between sleep quality and weight gain in pregnancy: a cross-sectional study.

INTRODUCTION: There are grounds for the hypothesis that poor sleep quality, regardless of the pre-gestational nutritional status, is a risk factor for inadequate gestational weight gain. OBJECTIVE: To investigate the association between sleep quality and insufficient or excessive gestational weight gain in Brazilian pregnant women without gestational complications and monitored in public prenatal care units. METHODS: This is a cross-sectional study nested within a cohort study that reviewed pregnant women's mental health, sleep, and nutritional outcome. Data collection was carried out from May 2018 to June 2019 through face-to-face and telephone interviews and consultation of pregnant women's medical records. Sleep quality was assessed using the Mini-sleep Questionnaire. The pregnancy weight gain was measured based on the Institute of Medicine's recommendations. Univariate and multivariate Poisson regression analysis was used for the two outcomes: insufficient or excessive weight gain, using pregnant women with adequate weight gain as the reference category. Associations were considered significant when p < 0.05. RESULTS: The prevalence of severe sleep disorders was high: 63.4% of pregnant women experienced this condition. Severe sleep disorders enhanced independently the risk of insufficient gestational weight gain (PR = 2.40; 95% CI = 1.06-5.42, p = 0.035). There was no association between sleep disorders and excessive gestational weight gain. CONCLUSION: The hypothesis that poor sleep quality influences gestational weight gain was confirmed. Severe sleep disorders, a highly prevalent condition, significantly increased the prevalence of insufficient gestational weight gain, yet it was not associated with excessive weight gain. Thus, educational actions should be included in the preconception and prenatal periods, in order to encourage the adoption of habits that favor sleep quality, an intervention that may have positive effects in reducing insufficient gestational weight gain.

Center M Pilot Trial: Integrating Preventive Mental Health Care in Routine Prenatal Care.

INTRODUCTION: Perinatal depression is a leading cause of preventable US maternal morbidity and mortality. Although Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) is highly effective, it faces significant scalability challenges. Center M, a brief, group-based, mindfulness-based cognitive behavioral therapy (CBT) intervention, is an adaptation of MBCT-PD designed to overcome these challenges. The purpose of this pilot study was to evaluate Center M's preliminary acceptability, feasibility, mechanisms of action, and efficacy. METHODS: In this mixed-methods pilot study, data were collected from 99 pregnant people at 3 time points: preintervention, postintervention, and 6-weeks postpartum (Clinical Trials no. NCT06525922). Participants engaged in 4 one-hour, weekly group telehealth Center M sessions facilitated by social workers. Participants strengthened mindfulness CBT skills using home practice materials between group sessions. Data included self-report measures evaluating depressive symptoms, mindfulness skills, and emotion regulation. Satisfaction was assessed via focus groups or surveys. RESULTS: Depressive symptoms significantly decreased preintervention to postintervention (Patient Health Questionnaire-8 score: preintervention mean [SD] 5.02 [3.52], postintervention mean [SD] 4.23 [2.84]; P = .03), and mindfulness capacity significantly increased preintervention to 6 weeks postpartum (Five Facets of Mindfulness Questionnaire score: preintervention mean [SD] 125.56 [18.68], 6 weeks postpartum mean [SD] 130.10 [17.15]; P = .004). Linear regression analyses indicate that higher mindfulness at 6 weeks postpartum significantly predicted fewer depression symptoms at 6 weeks postpartum (ß, -0.07; 95% CI, -0.123 to -0.021, R2 = 0.22; P = .006). Reduction in the use of maladaptive emotion regulation was significantly associated with decreased depressive symptoms at 6 weeks postpartum (ß, 0.21; 95% CI, 0.048 to 0.376, R2 = .21; P = .012). Qualitative themes indicated high Center M acceptability and appeal. DISCUSSION: Our findings support the feasibility, acceptability, and appeal of Center M. Results suggest Center M may be effective in reducing depression and enhancing mindfulness skills. Future research must confirm these initial findings to more widely address Center M implementation capacity and sustainability.

Development and Testing of the Comprehensive Prenatal Care Index: Relationship With Preterm Birth and Small for Gestational Age Across Racial and Ethnic Groups.

INTRODUCTION: Preterm birth and small for gestational age (SGA) are significant public health concerns in the United States, with pronounced disparities across racial and ethnic groups. Traditional prenatal care adequacy indices have limitations in fully capturing their multifaceted nature. Our study introduces the Comprehensive Prenatal Care Index (CPCI) to provide a more holistic assessment of prenatal care by integrating key elements of prenatal counseling and health promotion. METHODS: This cross-sectional study used the Pregnancy Risk Assessment Monitoring System 2016-2021 data. The CPCI was developed based on a comprehensive literature review, incorporating components such as timing, frequency, and content of prenatal visits. The index was validated using Item Response Theory (IRT) and compared with the Kotelchuck and Kessner Indices. RESULTS: The study included 139,181 pregnant women. The CPCI demonstrated strong internal consistency (Cronbach's α, 0.75; ω total, 0.81). IRT analysis confirmed the index's ability to capture variability in the quality of prenatal care, with item difficulty parameters ranging from -2.93 to +2.10. CPCI scores were significantly associated with reduced odds of adverse birth outcomes. Adequate CPCI care was linked to a 63% reduction in the odds of preterm birth among non-Hispanic White women, with similar reductions observed in Hispanic women (odds ratio [OR], 0.59) and Asian women (OR, 0.38). For SGA, adequate care was protective among non-Hispanic White (OR, 0.86) and Hispanic women (OR, 0.82) but showed mixed results in other groups. DISCUSSION: The CPCI provides a more inclusive measure of the quality of prenatal care compared with traditional indices. The study's findings suggest a significant role of comprehensive prenatal care in reducing adverse birth outcomes and addressing racial and ethnic disparities. Future research should focus on refining the CPCI and exploring its applicability in diverse populations to inform targeted and culturally sensitive prenatal care strategies.

Access and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic.

Objective: To compare access and suitability of antenatal care between years 2020 and 2022 among postpartum individuals at a Hospital in Florianopolis, and evaluate factors associated with antenatal suitability. Methods: Observational, cross-sectional, and quantitative study carried out in 2022. Collected data were compared with the database of a previous similar study carried out in the same setting in 2020. Data were extracted from medical records and prenatal booklets, in addition to a face-to-face questionnaire. Adequacy was measured using the Carvalho and Novaes index and health access was qualitatively evaluated. Socio-demographic and antenatal variables were analyzed. A statistical significance level of 0.05 was considered. Open-ended questions were categorized for analysis. Results: 395 postpartum individuals were included. Antenatal care was adequate for 48.6% in 2020 and 69.1% in 2022. Among the barriers to access, 56% reported difficulty in scheduling appointments and/or exams and 23% complained of reduced healthcare staff due to strikes, COVID-19, among others. Adequate antenatal care was associated with being pregnant in 2022, being referred to high-risk units (PNAR), and not reporting difficulties in access. Also, it was associated with twice the chance of investigation for gestational diabetes (GDM) and syphilis. Conclusion: The 2022 post-vaccination period showed higher antenatal adequacy. The main difficulty for postpartum individuals was scheduling appointments and/or exams. Having antenatal care in 2022, no reports of difficulty in access, and follow-up at a high-risk unit were associated with antenatal adequacy.

A cost-minimisation population-based analysis of telehealth-integrated antenatal care.

Background: In response to the COVID-19 pandemic, Victoria's largest maternity service provider implemented a telehealth-integrated antenatal care (ANC) schedule for high- and low-risk pregnancies. The program has been maintained since March 2020. Given ever-increasing healthcare costs, economic evaluation is crucial to ensure value and guide ongoing use. Methods: The aim of the study was to perform a cost-minimisation analysis of telehealth integrated ANC compared to conventional in-person ANC, from the hospital and patient perspectives. We hypothesised that the costs associated with telehealth integrated ANC would be less than in-person ANC. We generated propensity score matched pre- and post-telehealth cohorts from women with a singleton pregnancy who received ANC and birthed at Monash Health from 1 Jan 2018-22 Mar 2020 (pre-telehealth), and 20 Apr 2020-31 Dec 2021 (post-telehealth). Data were extracted from electronic medical and finance records. We assigned costs for all Monash Health outpatient, inpatient, and emergency department episodes to calculate mean cost per birth. Patient travel costs were estimated based on distance residing from hospital. Findings: Matched pre- and post-telehealth cohorts of n = 13,534 each were created. There were no significant differences in stillbirth, pre-eclampsia, severe maternal morbidity, or death. There was a AU$133 (0.98%, 95% CI [-0.17%, 2.16%]) increase in cost per birth in the post-telehealth cohort. This was driven by increased hospital costs (AU$340 or 2.64% increase, [1.44%, 3.86%]), due to a 4.78% increase in antenatal inpatient episodes and 3.51% increase in outpatient appointments post-telehealth. Increased care complexity was noted in the post-telehealth period with increased rates of gestational diabetes, caesarean birth, and specialty-led care (p-values all <0.0001). In contrast, patient costs of accessing healthcare fell significantly from AU$562 pre-telehealth to AU$355 post-telehealth (difference -AU$207 (-36.81%, [-37.46%, -36.16%]). Interpretation: Telehealth supported the provision of a greater volume of antenatal care to more complex pregnancies, while maintaining safety and quality of care, for only a minimal cost increase to health funders and substantial cost savings to patients. This finding provides reassurance regarding the financial viability of telehealth-integrated antenatal care. Funding: None.

Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis.

For decades, iron-folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government-run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (n = 19), family members (n = 18) and midwives (n = 18) and three in-depth interviews with maternal and child health chiefs (n = 3) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife-patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services.