The Equity Impact of Universal Home Visits to Pregnant Women and Their Spouses in Bauchi State, Nigeria: Secondary Analysis From a Cluster Randomised Controlled Trial.

BACKGROUND: Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits. PURPOSE: To examine equity of the intervention implementation and its pro-equity impact. RESEARCH DESIGN AND STUDY SAMPLE: The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women. ANALYSIS: We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels. RESULTS: Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors. CONCLUSIONS: The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.

Unveiling the Craving: A systematic review of pregnant women's desires for expert nutrition care in Australia.

PROBLEM: Poor nutrition during the antenatal period can contribute to adverse health outcomes for both mother and baby. BACKGROUND: Despite the importance of nutrition during pregnancy, there is limited research exploring the attitudes and experiences pregnant women possess towards nutrition care, particularly within the Australian context. Existing literature has indicated that pregnant women lack knowledge of and are not adhering to pregnancy related nutrition recommendations. Furthermore, although pregnant women rely on many health professionals for nutrition care, there are deficiencies in both the quality and quantity of care provided. AIM: The aim of this meta-aggregative review was to explore the experiences and attitudes pregnant women in Australia have towards nutrition care. METHODS: Meta-aggregation was used to synthesise qualitative studies. A search strategy was applied to four electronic databases in May 2023.The findings were extracted and synthesised via the JBI approach. FINDINGS: A total of 719 studies were identified in the initial database search with seven eligible studies included in the meta-aggregation. From 11 categories, three synthesised findings were developed: (i) approaches to nutrition care delivery matters, (ii) quality and quantity of nutrition care is insufficient, and (iii) pregnant women value nutrition care. CONCLUSION: This review highlights pregnant women's desires for better nutrition care in Australia, with current provision of nutrition care lacking in quality and quantity. Improved antenatal dietetics services and increased health professional nutrition training is necessary to address these concerns.

Connecting with fetus: The use of app-based fetal movement counting and experiences during pregnancy and birth.

BACKGROUND: Pregnant people are often introduced to fetal movement counting to monitor the health of their fetus. This study aims to examine the impacts of app-based fetal movement counting on experiences during pregnancy and birth. METHOD: This study used two types of secondary data including individual user's app use and their end of pregnancy survey data collected on the Count the Kicks (CTK) app. CTK is a free mobile app providing a virtual platform for pregnant people to conduct their daily kick counting. The study sample includes 1,147 pregnant people. Descriptive analyses were used to examine the number of kick counts using CTK and pregnant women's experiences with the app, their pregnancy, and childbirth. Bivariate analyses were used to examine the relationships between the frequency of kick counts and pregnant people's experience with their pregnancy and birth. Logistic regressions were used to model pregnant people's experiences: anxiety level related to their pregnancy and bonding with their baby. FINDINGS: The study found that there is inadequate compliance with daily fetal movement counting recommendations in third trimester among pregnant people. However, results showed that frequent use of fetal movement counting is associated with lower anxiety level related to their pregnancy, and more bonding with their baby. These positive pregnancy experiences are associated with healthy birth. CONCLUSION: To benefit from the impacts of fetal movement counting on positive pregnancy and birth experience, the app developers and public health agencies need to develop strategies to increase daily use of fetal movement counting.

Midwives' perceptions and experiences of recommending and delivering vaccinations to pregnant women following the Covid-19 pandemic: a qualitative study.

BACKGROUND: Pregnant women and their unborn babies are at an increased risk of hospitalisation, morbidity, and mortality from illness. However, uptake of influenza, pertussis and Covid-19 vaccinations offered during pregnancy is below the desired rate. This research aims to explore UK midwives' experiences of approaching and discussing vaccinations with pregnant women, and their perceived role in pregnant women's vaccination decisions. METHODS: Midwives in the West Midlands, UK were recruited via participating hospitals and midwife specific social media groups. Interviews were conducted remotely from April to July 2023 and analysed with a deductive codebook coding strategy using thematic analysis. FINDINGS: Semi-structured interviews were conducted with 16 midwives identifying the following key themes: Recommendations to have vaccinations reported on the contents of recommendations and how they are communicated; Messages and guidance included the importance of up-to-date informational needs for midwives to administer vaccinations and the barriers caused by uncertainty and conflicting messages about the Covid-19 vaccine during pregnancy; Delivery of vaccinations included the convenience of offering vaccinations during standard antenatal appointments; and Midwives' barriers explored the pandemic specific and other barriers midwives face in the administering of vaccinations. DISCUSSION: These findings contribute to the understanding of how midwives discuss the topic of vaccinations with pregnant women. This research highlights the importance for midwives to receive clear and consistent information. A strong emphasis on why vaccines are important when recommending to pregnant women in addition to standard information on the availability and timing may have a bearing in helping women to make informed decisions about accepting vaccinations.

Psychometric evaluation of the wijma delivery expectancy/experience questionnaire for pregnant women in Taiwan.

BACKGROUND: Fear of childbirth profoundly affects women's ability to cope during pregnancy and influences birth outcomes. In Taiwan, there's a lack of validated tools for assessing childbirth fear. OBJECTIVE: To evaluate the psychometric properties of the Taiwanese version of the Wijma delivery expectancy/experience questionnaire version A (WDEQ-A) in pregnant women. METHODS: We conducted a cross-sectional study with pregnant women, using the WDEQ-A and a Visual Analogue Scale to assess childbirth fear. We employed the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and Mindful Attention Awareness Scale to measure depressive symptoms, anxiety, and mindfulness, respectively. We evaluated internal consistency reliability and construct validity using exploratory factor analysis and Rasch analysis. Pearson correlations measured the association between childbirth fear and psychological variables. The receiver operating characteristic curve was used for determining the sensitivity and specificity indices. RESULTS: The WDEQ-A demonstrated excellent reliability (Cronbach's alpha = 0.93) and revealed a three-factor structure, including fear, lack of positive anticipation, and isolation. Rasch analysis supported the dimensionality of each of the three revised factors. The total score significantly correlated with depression (r = 0.56), anxiety (r = 0.19), and mindfulness (r = -0.40) (Ps < 0.001). The optimal cut-off for WDEQ-A was established at 55.5, with a sensitivity of 83 % and a specificity of 65 %. CONCLUSIONS: The Taiwanese version of WDEQ-A proved to be a reliable and valid tool for assessing fear of childbirth in pregnant women, demonstrating excellent psychometric properties. IMPLICATION FOR PRACTICE: These findings can assist midwives in Taiwan in identifying and promptly providing effective strategies for women experiencing a high fear of childbirth.

Effectiveness of psychosocial education program on postnatal depression, stress, and perceived maternal parenting self-efficacy among pregnant women in South India.

OBJECTIVE: This study aimed to evaluate the effect of a psychosocial education program on postnatal depression (PND), perceived stress, (PSS), and perceived maternal parenting self-efficacy (PMPSE). METHODS: A randomized controlled trial design was used with stratified block randomization. The sample size consisted of 128 pregnant women. The women in the experimental group were provided with a psychosocial education program along with standard care, and the control group received standard care with an information pamphlet. Post-test assessments (PND, PSS, and PMPSE) were performed at 1 week, 6 weeks, and 12 weeks after delivery in both groups. RESULTS: The result of the effect of the intervention on outcome variables on repeated measures ANOVA revealed that there was a positive statistically significant reduction in scores of postnatal depression [F (1, 119) = 18.832, p = 0 < 0.001] and perceived stress [F (1,119) = 22.488, p = < 0.001] and no statistically significant change in perceived maternal parenting self-efficacy in the experimental group [F (1,119) = 0.036, p = 0.850]. CONCLUSION: The psychosocial education program was found to be effective in reducing postnatal depression and stress related to pregnancy and childbirth to enable a smooth transition to motherhood. PRACTICE IMPLICATIONS: Given the benefits the program provides to women, this psychosocial education program could be incorporated into routine antenatal care for pregnant women.

Perspectives of physicians and doulas on shared decision-making and decision counseling in the treatment of pregnant women with opioid use disorders.

INTRODUCTION: Research about the application of shared decision-making (SDM) in the context of Medication Assisted Treatment (MAT) for pregnant women with opioid use disorder (OUD) is limited. The objectives of our study were to 1) examine facilitators of and barriers to SDM for the initiation of MAT in clinical practice and 2) evaluate the receptivity of clinicians and doulas involved in the care of women with OUD to the use of an online software application to facilitate SDM about MAT. METHODS: This qualitative study utilized semi-structured interviews with consenting physicians and doulas who provided care for pregnant women with OUD between November 2021 and May 2022. Participants were asked about factors influencing SDM in practice. In addition, the study asked participants about the feasibility of using the Jefferson Decision Counseling Guide© (JDCG) to educate pregnant women with OUD as to the benefits and risks of undergoing MAT versus no treatment and to help patients clarify their treatment preference. The study recorded the interview and transcribed it verbatim using Rev. transcription services. The study used thematic analyses to code the data and identify key barriers and facilitators of SDM and perceptions of the SDM tool. RESULTS: Nineteen participants completed interviews. The study identified several barriers to SDM including time constraints, lack of decision counseling tools at points of care, and patients presenting in an actively high state or withdrawing. Peer workers or other trained personnel, giving patients more time, and comfort in decision counseling are examples of facilitators identified by the participants of the study. Participants believed that the counseling tool could facilitate conversations with patients and should be integrated into the workflow. CONCLUSION: In this qualitative study, we identified several barriers and facilitators of SDM to initiate MAT for pregnant women with OUD. Our findings indicate that there are challenges and opportunities for healthcare systems to increase SDM in this marginalized patient population. Feedback from participants highlighted their receptivity to the use of SDM tools to facilitate meaningful conversations in various settings that can guide decision making about care.

Development of the Hiesho (sensitivity of hands or feet to cold) Care Practice Scale for pregnant women.

AIM: Evidence-based indicators are needed to increase the frequency of practicing care for hiesho, which can be a risk factor during childbirth. Such practice will lead to hiesho prevention. This study aimed to develop a Hiesho Care Practice Scale (HCPS) for pregnant women and examine its reliability and validity. METHODS: To develop a HCPS and examine its reliability and validity, we conducted a questionnaire-based survey among nurses who provide hiesho care for pregnant women in Japan. RESULTS: The analysis included 100 participants (recovery rate: 96%). Exploratory factor analysis produced four factors and 20 items. The model's fit indices obtained from the confirmatory factor analysis include goodness of fit of .80, adjusted goodness of fit of .75, comparative fit index of .88, and root mean squared error of approximation of .08. The correlation coefficients for the patient coaching skill evaluation scale for criterion-related validity test ranged from .23 to .51 (p < .01). Cronbach's α was .88, and intraclass correlation coefficient (ICC) was .81. CONCLUSIONS: The HCPS developed in this study consisted of four factors and 20 items, and its reliability and validity were verified. This scale enables the subjective and objective evaluation of hiesho care practice in the nursing profession. It may contribute to standardizing and developing improvement measures for hiesho care among pregnant women by nurses and midwives.

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.

Effectiveness of supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM) -intervention on self-efficacy in weight management in pregnant women: A quasi-experimental trial.

BACKGROUND: Half of women with overweight gain excessive weight during pregnancy. Perceived self-efficacy plays a significant role in adherence to healthy behaviours, especially in turning points of life, such as a pregnancy. OBJECTIVES: To assess the effectiveness of the Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM)-intervention in terms of improving self-efficacy in eating and physical activity and preventing excessive weight gain of pregnant women with overweight. The second aim was to evaluate the fidelity of the intervention implementation. METHODS: Pregnant women with overweight (N = 54) attending maternity clinics in Southwest Finland between 2021 and 2023, were recruited using convenience sampling. The SLIM-intervention included: health technology, motivational interviewing, feedback, and goal setting. The intervention was implemented in prenatal visits in maternity clinics continuing to 12 weeks postpartum. The change in self-efficacy was measured with Weight Efficacy Life-Style Questionnaire (score 0-180) and Self-Efficacy for Physical Activity Scale (score 5-25) with repeated measures in three timepoints. Data on weight were collected from patient records. RESULTS: The levels of self-efficacy were high throughout the study period and there were no significant changes in self-efficacy in eating (p= 0.650) or physical activity (p= 0.936). Most of the women (N = 9/10), whose gestational weight gain was within recommendations or less, managed to lose weight during the postpartum period (p < 0.001). CONCLUSIONS: Although the intervention was not effective in improving self-efficacy, the importance of recommended gestational weight gain on better postpartum weight management was highlighted. A long follow-up time was valuable for examination of changes over time and understanding trends, patterns, and outcomes of the study. REGISTRATION: The trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on March 17th, 2021.

Feelings and thoughts about life selection in pregnant women undergoing non-invasive prenatal testing in Japan.

The objective of this study was to conduct qualitative research by clarifying the thoughts of pregnant women undergoing non-invasive prenatal testing (NIPT) in Japan, to collect evidence to provide information and psychosocial support in genetic counseling (GC). We attempted to conduct qualitative research to provide support for GC and the society in relation to children with special needs, by clarifying the thoughts of pregnant women undergoing NIPT. Between January 2016 and December 2017, we administered an open-ended questionnaire to pregnant Japanese women undergoing NIPT to clarify their ethical views in relation to children with special needs. The target population included 754 pregnant women who described their feelings and thoughts about undergoing NIPT and about children with special needs. Pregnant women undergoing NIPT have a variety of various mixed feelings and concerns. We classified the feelings and thoughts of pregnant women who underwent NIPT into the following four primary categories (multiple classifications): (1) perception about people with special needs (18.0%); (2) relation between NIPT and life selection (22.3%); (3) attitudes towards undergoing NIPT (47.5%); and (4) negative feelings and thoughts about raising children with special needs (48.1%). Most pregnant women undergoing NIPT expressed negative feelings and raising children with special needs. These feelings and thoughts may be one of the reasons why pregnant women undergo NIPT. In GC, it is important to also provide wide information on the social support and the current situation in the actual life of children with special needs.

Vacinação protege crianças e gestantes contra a coqueluche

A coqueluche começa como um resfriado comum, com febre baixa, mal-estar geral, coriza e tosse seca. Gradualmente, a tosse se torna mais intensa, podendo causar vômito e dificuldade de respirar. Justamente por isso, crianças menores de seis meses são mais propensas a formas graves da doença, que podem evoluir para pneumonia, parada respiratória, convulsões e desidratação. Em 2024, o Brasil já registrou 13 óbitos pela doença, todos em crianças menores de um ano de idade.

A qualitative assessment of barriers to iron and folic acid supplementation among pregnant women in Botswana.

BACKGROUND: Antenatal iron and folic acid (IFA) supplementation remains an effective strategy in the prevention of maternal anemia and low birthweight and is universally recommended by WHO. However, uptake of IFA has varied globally due to challenges with acceptability, supply and distribution, counselling and knowledge, and access to health services. In Botswana, nearly one-third of pregnant women engaged in antenatal care do not receive IFA, despite it being standard of care. The objectives of this study were to assess knowledge of and barriers and facilitators to IFA supplementation before and during pregnancy. METHODS: We conducted qualitative interviews with two key stakeholder groups at two different levels-the individual level (pregnant women) and the service delivery level (health care providers). Here, we present results from interviews with pregnant women at two representative antenatal clinic sites in Botswana in 2022. RESULTS: Pregnant women were motivated to be healthy and were knowledgeable about the benefits of supplementation during pregnancy to mothers and their infants; however, women knew more about the benefits of iron than folic acid. Most women were in favor of receiving IFA supplementation prior to pregnancy and receiving fortified foods. Several key barriers were identified: lack of supplement availability in the clinics, poverty, side effects, number of tablets, and adherence. Approaches to overcome these barriers included improving supplement availability, improving health education, increasing supply of nutritious and fortified foods, backyard gardens, and increasing family and monetary support. CONCLUSIONS: Our study identified a need to 1) increase the availability of supplementation at antenatal clinics and 2) improve education regarding supplementation to include information about the benefits of folic acid and other micronutrients. Implementation research is needed to ascertain whether increasing supply and improving education could increase utilization of supplementation during pregnancy, with the ultimate goal of improving maternal and infant outcomes.

Effectiveness of moringa biscuit (Moringa oleifera) and snakehead fish (Channa striata) in improving the nutritional status of pregnant women with chronic energy deficiency.

The objective of this study was to analyse the effectiveness of moringa biscuits and snakehead fish in improving the nutritional status of pregnant women with chronic energy deficiency (CED). The study was a randomized control trial carried out in two stages. The first stage was carried out in 2020, while the second stage was implemented in 2021 in Sigi Regency, Central Sulawesi Province, Indonesia. Thirty pregnant women with CED were divided into two groups. Five pieces of biscuits (60g) were given every day for three months to women in the intervention group while the control group were given biscuits without moringa and snakehead fish. The analysis consisted of paired t-test statistics. The results showed that giving biscuits significantly improved the nutritional status of pregnant women with CED, with the mean body mass index Centre (BMI) having a value of (P 0.000). In contrast, the upper arm circumference did not differ between the intervention and control groups. (P 0.247). We conclude that the consumption of moringa and snakehead fish biscuits provides a higher average contribution of energy and nutrients in pregnant women with CED.

L'objectif de cette étude était d'analyser l'efficacité des biscuits au moringa et de la tête de serpent pour améliorer l'état nutritionnel des femmes enceintes souffrant de carence énergétique chronique (DEC). L'étude était un essai contrôlé randomisé réalisé en deux étapes. La première étape a été réalisée en 2020, tandis que la deuxième étape a été mise en œuvre en 2021 dans la régence de Sigi, dans la province centrale de Sulawesi, en Indonésie. Trente femmes enceintes atteintes de DEC ont été divisées en deux groupes. Cinq morceaux de biscuits (60 g) ont été donnés chaque jour pendant trois mois aux femmes du groupe d'intervention tandis que le groupe témoin a reçu des biscuits sans moringa ni poisson à tête de serpent. L'analyse consistait en des statistiques de test t appariées. Les résultats ont montré que donner des biscuits améliorait significativement l'état nutritionnel des femmes enceintes atteintes de DEC, l'indice de masse corporelle (IMC) moyen ayant une valeur de (P 0,000). En revanche, la circonférence du haut du bras ne différait pas entre les groupes d'intervention et témoin. (P0,247). Nous avons conclu que la consommation de biscuits au moringa et au poisson à tête de serpent apporte un apport moyen plus élevé en énergie et en nutriments chez les femmes enceintes atteintes de DEC.

The influence of sleep quality of pregnant women on the incidence of stunting in children: A literature review.

Lifestyle changes have significant impact on the pattern of sleep-in pregnant women. Irregular sleep patterns in pregnant women can lead to anaemia and disturbances in the formation of growth hormones, hence, causing interference in the progress and maturation of children, which includes increased potentials for stunted growth. This literature review aims to discuss the influence of the sleep quality of pregnant women on the incidence of stunting of newborns. The methodology in this study techniques is the result of a comprehensive literature review. The data for this study was obtained from three databases, namely Scopus, Google Scholar, and media articles, using specific criteria for inclusion and exclusion. The major findings suggest that pregnant women with suboptimal sleep quality leading to disruptions in haemoglobin and anaemia. This is attributable to a lack of Non-Rapid Eyes Movement (NREM) sleep phase, where the growth hormone is produced. We conclude that the quality of sleep-in pregnant women influences the incidence of stunting in children.

Les changements de mode de vie ont un impact significatif sur les habitudes de sommeil des femmes enceintes. Des habitudes de sommeil irrégulières chez les femmes enceintes peuvent entraîner une anémie et des perturbations dans la formation des hormones de croissance, provoquant ainsi des interférences dans la progression et la maturation des enfants, ce qui inclut un potentiel accru de retard de croissance. Cette revue de la littérature vise à discuter de l'influence de la qualité du sommeil des femmes enceintes sur l'incidence du retard de croissance des nouveau-nés. La méthodologie de cette étude technique est le résultat d'une revue complète de la littérature. Les données de cette étude ont été obtenues à partir de trois bases de données, à savoir Scopus, Google Scholar et d'articles médiatiques, en utilisant des critères spécifiques d'inclusion et d'exclusion. Les principales conclusions suggèrent que les femmes enceintes ont une qualité de sommeil sous-optimale, ce qui entraîne des perturbations du taux d'hémoglobine et de l'anémie. Cela est dû à un manque de phase de sommeil à mouvements oculaires non rapides (NREM), où l'hormone de croissance est produite. Nous concluons que la qualité du sommeil des femmes enceintes influence l'incidence du retard de croissance chez les enfants.

Knowledge, attitude, and practice of Iraqi pregnant women about maternal risk factors.

Maternal risk factors can lead to adverse pregnancy outcomes. These include extreme maternal age, short inter-pregnancy intervals, lack or inadequate prenatal care, smoking, and obesity. Good knowledge, positive attitude, and safe practice of women about these risk factors are important in improving pregnancy outcomes. To assess knowledge, attitude, and practice of pregnant mothers attending primary health centres, a cross-sectional study was conducted with 200 randomly selected pregnant women attending the Al-Qudus Family Medicine Primary Health Centre for antenatal care during the period June 2022 to February 2023. Direct interviews of the participants was carried out to obtain data using a structured questionnaire, and the data were tabulated and analyzed using SPSS software The mean age was 22.5 years, 78% of whom knew pregnancy beyond 35 years increases complication; 77% agreed that low maternal educational level has bad effect on pregnancy; 63% were aware of the bad effects of short interpregnancy intervals; while almost all women agreed that smoking has bad effect on pregnancy. About 82% had attitude of planning for pregnancy and frequent antenatal care visits; more than half had regular doctor visits with folic acid supplementation; while three quarters of the women took information from their families and relatives and half from doctors. We conclude that pregnant women in Al-Qudus Family Medicine Health centre, Iraq, have moderately to good knowledge of maternal risk factors.

Les facteurs de risque maternels peuvent entraîner des issues défavorables de la grossesse. Il s'agit notamment de l'âge maternel extrême, des intervalles inter-grossesse courts, du manque ou de l'insuffisance de soins prénatals, du tabagisme et de l'obésité. Une bonne connaissance, une attitude positive et une pratique sûre des femmes concernant ces facteurs de risque sont importantes pour améliorer les issues de la grossesse. Pour évaluer les connaissances, l'attitude et la pratique des mères enceintes fréquentant les centres de santé primaires, une étude transversale a été menée auprès de 200 femmes enceintes sélectionnées au hasard fréquentant le centre de santé primaire de médecine familiale Al-Qudus pour des soins prénatals pendant la période de juin 2022 à février 2023. Des entretiens directs avec les participantes ont été réalisés pour obtenir des données à l'aide d'un questionnaire structuré, et les données ont été tabulées et analysées à l'aide du logiciel SPSS. L'âge moyen était de 22,5 ans, dont 78 % savaient qu'une grossesse au-delà de 35 ans augmente les complications ; 77 % ont convenu que le faible niveau d'éducation de la mère a un effet négatif sur la grossesse ; 63 % étaient conscientes des effets néfastes des intervalles inter-grossesse courts ; tandis que presque toutes les femmes ont convenu que fumer a un effet négatif sur la grossesse. Environ 82 % des femmes avaient une attitude de planification de la grossesse et des visites fréquentes de soins prénatals ; plus de la moitié avaient des visites régulières chez le médecin avec supplémentation en acide folique ; tandis que les trois quarts des femmes se sont informées auprès de leur famille et de leurs proches et la moitié auprès de leur médecin. Nous concluons que les femmes enceintes du centre de médecine familiale Al-Qudus, en Irak, ont une connaissance moyenne à bonne des facteurs de risque maternels.

Social determinants of the mental health of pregnant women in Nepal: Stakeholder perspectives.

INTRODUCTION: Women during pregnancy are at a greater risk of experiencing poor mental health, which is one of the major global public health issues, and more so in many developing countries like Nepal, but limited evidence of research on this topic is evident. In this paper, we are focused on exploring the social determinants of the mental health of pregnant women in Nepal from the stakeholder perspectives. METHODS: This paper utilises eight stakeholder perspectives collected through open-ended in-depth interviews. All the interviews were analysed thematically using an inductive approach. RESULTS: This paper presents three major findings: Inadequate social support, Limited availability and accessibility of maternal health services, and Restricted socioeconomic and cultural context. The inadequate social support from family/relatives, neighbours, community and national policies such as maternity leave, alongside the absence of NGOs/INGOs support, put women at risk of poor mental health. In addition to the inadequate support, limited availability and accessibility of maternal health services potentially cause immense distress among pregnant women. Furthermore, in the context of a patriarchal society, the impact of socioeconomic and cultural context on pregnant women's mental health is also presented as a major determinant of poor mental health among pregnant women. CONCLUSION: Based on the findings, we conclude that pregnant women are at risk of poor mental health experiences in Nepal and recommend that promoting mental health among pregnant women needs a multifaceted approach that should be considered in all the policies and practices involved in promoting the mental health of pregnant women.

Psychometric Properties of the Persian Version of the Fear of Childbirth among Pregnant Women Attending Comprehensive Health Centers.

Introduction: One topic that has changed globally is fertility, which is influenced by factors such as the fear of childbirth, leading to the delay or avoidance of pregnancy. The global prevalence of fear of childbirth (FOC) has been reported to be 14%. The present study was designed and conducted to validate a questionnaire assessing fear of childbirth. Methods and Materials: Psychometric properties of the Persian version of the FOC questionnaire were assessed through six stages: translation, evaluation of content validity, assessment of face validity, examination of construct validity, analysis of discriminant validity, and determination of reliability. A panel of experts (n = 10) and pregnant women (n = 10) evaluated the questionnaire items for content and face validity, respectively. The questionnaire consisted of nine elements, including fears such as the fear of losing sexual pleasure/attractiveness, fear of pain during natural childbirth, fear of embarrassment, fear of harming the baby, fear of cesarean section, fear of maternal or infant death, fear of inadequate pain relief, and fear of bodily harm, totaling 40 questions. A cross-sectional study employing a random sampling method was conducted with 300 pregnant women to establish construct validity. Internal consistency was assessed using Cronbach's alpha and the McDonald's omega coefficients. Results: The average age of the women in the study was 35.39 years. The content validity ratio, content validity index, and impact score for FOC were 0.98, 0.98, and 3.54, respectively, indicating strong content and face validity. Exploratory factor analysis was conducted on the 40 items to assess construct validity, revealing that nine factors accounted for 76.18% of the cumulative variance. The fit indices (CFI = 0.97, TLI = 0.95, χ2/df = 4.20, RMSEA = 0.04) supported the model's validity in confirmatory factor analysis. The average variance extracted values exceeding 0.5 indicate good convergent validity of the factors. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega coefficients, which yielded values of 0.90 and 0.92, respectively. Conclusion and Discussion: Addressing the FOC as a public health concern necessitates targeted education. Therefore, it is essential to recognize these fears by utilizing a standardized tool to develop effective support strategies and suitable interventions to achieve this. This questionnaire serves as a novel instrument for evaluating the complex fear of childbirth. Its reliability and validity have been confirmed among Iranian women in the community, making it a valuable resource for identifying the concerns of pregnant women and formulating educational interventions tailored to these specific fears.

"Stop, pause and take a break": a mixed methods study of the longer-term outcomes of digital emotional wellbeing training for perinatal women.

BACKGROUND: Maternal psychological distress is related to poorer physical and mental health as well as child developmental problems. Interventions that optimise maternal mental health and wellbeing during the "first 1,000 days" of life should have wide-reaching benefits for the mother and her child. Digital mental health interventions (DMHIs) during this critical period have the potential to equip women with enhanced coping strategies that can be applied and maintained in daily life. This study aimed to understand uptake of DMHIs in pregnancy, and the extent participants apply intervention strategies 10-12 months post-participation in a pilot randomised controlled trial (RCT) comparing different digital programs. METHODS: A mixed methods triangulation approach was undertaken. We explored demographic data and psychological distress measures in the intervention groups and a comparison group that were offered the intervention but did not participate or did not meet the inclusion criteria based on gestational age (n = 525). Intervention participants (n = 54) were invited to undertake an interview up to 12 months post-intervention to understand ongoing skills application. Fifteen interviews were undertaken using a phenomenological approach to analyse the data. RESULTS: Baseline psychological distress results showed a significant difference between those who enrolled in the intervention, compared to those who did not, with higher psychological distress (combined), and stress and depression (sub-scale) scores for the intervention groups. Qualitative content analysis identified four main themes relating to long-term engagement: (1) Motivations to use skills; (2) Taking time for oneself; (3) Emotional support; and (4) Improving wellbeing (such as aids sleep and emotional impacts). Within each theme there were several sub-themes, including enablers or barriers to engagement. CONCLUSIONS: This study indicated that women who chose to enrol in DMHIs in pregnancy have greater psychological distress than those who chose not to participate. Many participants in this study continued to apply learnt skills in everyday life, such as breathing exercises. This implies that digital strategies may be effective and applicable longer-term to enable women to apply positive coping skills during critical child developmental periods. Ultimately, this will contribute to designing apps that sustain wellbeing and could be protective in preventing postnatal psychological distress. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number ( ACTRN12620000672954p ); (12/06/2020).