Alterations of the gut microbiota and fecal short-chain fatty acids in women undergoing assisted reproduction.

CONTEXT: The community structure of gut microbiota changes during pregnancy, which also affects the synthesis of short-chain fatty acids (SCFAs). However, the distribution of gut microbiota composition and metabolite SCFA levels are poorly understood in women undergoing assisted reproductive technology (ART). AIMS: To evaluate the changes in gut microbiota composition and metabolic SCFAs in women who received assisted reproduction treatment. METHODS: Sixty-three pregnant women with spontaneous pregnancy (SP) and nine with ART pregnancy were recruited to provide fecal samples. Gut microbiota abundance and SCFA levels were determined by 16S ribosomal RNA (rRNA) gene amplicon sequencing and gas chromatography-mass spectrometry (GC-MS). KEY RESULTS: The ART group showed decreased alpha diversity (the species richness or evenness in a sample). The principal coordinates analysis (a method of analysing beta diversity) showed significant difference in gut microbiota between the ART group versus the SP group (unweighted UniFrac distance, R 2 =0.04, P =0.003). Proteobacteria , Blautia and Escherichia-Shigella were enriched in the ART group, whereas the relative abundance of beneficial intestinal bacteria Faecalibacterium was lower than in the SP group. Different modes of conception were associated with several SCFAs (valeric acid (r =-0.280; P =0.017); isocaproic acid (r =-0.330; P =0.005); caproic acid (r =-0.336; P =0.004)). Significantly different SCFAs between the two groups were synchronously associated with the differential gut microbiota. CONCLUSIONS: The diversity and abundance of gut microbiota and the levels of SCFAs in women undergoing ART decreased. IMPLICATIONS: The application of ART shaped the microbial composition and metabolism, which may provide critical information for understanding the biological changes that occur in women with assisted reproduction.

Global analysis of the yeast knockout phenome.

Genome-wide phenotypic screens in the budding yeast Saccharomyces cerevisiae, enabled by its knockout collection, have produced the largest, richest, and most systematic phenotypic description of any organism. However, integrative analyses of this rich data source have been virtually impossible because of the lack of a central data repository and consistent metadata annotations. Here, we describe the aggregation, harmonization, and analysis of ~14,500 yeast knockout screens, which we call Yeast Phenome. Using this unique dataset, we characterized two unknown genes (YHR045W and YGL117W) and showed that tryptophan starvation is a by-product of many chemical treatments. Furthermore, we uncovered an exponential relationship between phenotypic similarity and intergenic distance, which suggests that gene positions in both yeast and human genomes are optimized for function.

Oral Microbiome, Mental Health, and Sleep Outcomes During the COVID-19 Pandemic: An Observational Study in Chinese and Korean American Immigrants.

COVID-19 is a systemic disease whose effects are not limited to the respiratory system. The oral microbiome (OM)-brain axis is of growing interest in understanding the broader, neuropsychiatric, impacts of the COVID-19 pandemic through a systems biology lens. In this context, mental health and sleep disturbance are often reported by Asian Americans. In a cross-sectional observational study design, we examined the associations of the oral microbiome with mental health among Asian Americans during the COVID-19 pandemic (between November 2020 and April 2021). Participants (n = 20) were adult Chinese and Korean American immigrants in Atlanta, Georgia, and primarily born outside the United States (60%) with a mean age of 34.8 years ±14 (standard deviation). Participants reported depressive symptoms, anxiety, and sleep disturbance, as measured by standard questionnaires. The OM was characterized by 16S rRNA V3-V4 gene using saliva. Depressive symptoms and anxiety were reported by 60% (n = 12) of participants, whereas 35% (n = 7) reported sleep disturbance. The α-diversity was significantly associated with depressive symptoms, and marginally with anxiety. Participants with depressive symptoms and anxiety had enriched Rothia and Scardovia, respectively, whereas those without symptoms had enriched Fusobacterium. Individuals with sleep disturbance had enriched Kingella. In conclusion, this study suggests significant associations of the OM diversity with certain mental health dimensions such as depressive symptoms and anxiety. Specific taxa were associated with these symptoms. The present observations in a modest sample size suggest the possible relevance of the OM-brain axis in studies of mental health during COVID-19.

Impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review.

OBJECTIVE: The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). INTRODUCTION: Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized. INCLUSION CRITERIA: This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included. METHODS: MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively. RESULTS: A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness. CONCLUSIONS: Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020151569.

Skin Microbiome and Treatment-Related Skin Toxicities in Patients With Cancer: A Mini-Review.

The human skin hosts millions of bacteria, fungi, archaea, and viruses. These skin microbes play a crucial role in human immunological and physiological functions, as well as the development of skin diseases, including cancer when the balance between skin commensals and pathogens is interrupted. Due to the linkages between inflammation processes and skin microbes, and viral links to skin cancer, new theories have supported the role a dysbiotic skin microbiome plays in the development of cancer and cancer treatment-related skin toxicities. This review focuses on the skin microbiome and its role in cancer treatment-related skin toxicities, particularly from chemotherapy, radiation therapy, and immunotherapy. The current literature found changes in the diversity and abundance of the skin microbiome during cancer treatments such as radiation therapy, including lower diversity of the skin microbiome, an increased Proteobacteria/Firmicutes ratio, and a higher abundance of pathogenic Staphylococcus aureus. These changes may be associated with the development and severity of treatment-related skin toxicities, such as acute radiation dermatitis, hand-foot syndrome in chemotherapy, and immunotherapy-induced rash. Several clinical guidelines have issued potential interventions (e.g., use of topical corticosteroids, phototherapy, and non-pharmaceutical skin care products) to prevent and treat skin toxicities. The effectiveness of these promising interventions in alleviating treatment-related skin toxicities should be further tested among cancer patients.

The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated Care in the NICU: A Qualitative Study.

OBJECTIVES: To conduct a needs assessment with families and their healthcare team to understand the impact of restrictive family presence policies in the neonatal intensive care unit (NICU) in response to COVID-19. BACKGROUND: In response to the COVID-19 pandemic, significant restrictive family presence policies were instituted in most NICUs globally intended to protect infants, families, and HCPs. However, knowledge on the impact of the stress of the pandemic and policies restricting family presence in the NICU on vulnerable neonates and their families remains limited. METHODS: Individuals were eligible to participate if they were a caregiver of an infant requiring NICU care or a healthcare provider (HCP) in the NICU after March 1, 2020. Semi-structured interviews were conducted using a virtual communication platform, and transcripts were analyzed using inductive thematic qualitative content analysis. RESULTS: Twenty-three participants were interviewed (12 families and 11 HCPs). Three themes emerged: (1) successes (family-integrated care, use of technology), (2) challenges (lack of standardized messaging and family engagement, impact on parental wellbeing, institutional barriers, and virtual care), and (3) moving forward (responsive and supportive leadership). CONCLUSIONS: Our findings highlight the significant impact of family restrictions on the mental well-being of families, physical closeness with parents, and empathetic stress to HCPs. Further study of potential long-term impact is warranted.

Do Single-Family Rooms Increase Parental Presence, Involvement, and Maternal Well-Being in Neonatal Intensive Care?

Objectives of this study were to determine whether single-family room (SFR) design enhances parental presence, involvement, and maternal well-being during neonatal intensive care hospitalization. An observational cohort including mothers of infants was randomly assigned to receive care in a tertiary-level open-bay (OB) (n = 35) or SFR (n = 36). Mothers were asked to complete daily diaries documenting parental presence, involvement in care, and questionnaires examining maternal well-being. Mother and father mean presence (standard deviation) was significantly higher in the SFR-17.4 (5.2) and 13.6 (6.8)-compared to OB-11.9 (6.3) and 4.6 (3.7) hours/day. Total time spent in care activities did not differ for mothers, except SFR mothers spent more time expressing breast milk (EBM). SFR fathers had greater involvement with care activities. There were no other significant differences. The SFR was associated with greater maternal presence, but not greater involvement in care activities except for EBM, nor improved maternal well-being. The SFR appears to have greater impact on fathers' involvement in care and comforting activities, although the amount of time involved remained quite low compared with mothers. Further studies examining ways to enhance parental involvement in the neonatal intensive care unit are warranted.

A co-design of clinical virtual care pathways to engage and support families requiring neonatal intensive care in response to the COVID-19 pandemic (COVES study).

BACKGROUND: In response to the COVID-19 pandemic, family presence restrictions in neonatal intensive care units (NICU) were enacted to limit disease transmission. This has resulted in communication challenges, negatively impacting family integrated care. AIM: To develop clinical care pathways to ensure optimal neonatal care to support families in response to parental presence restrictions imposed during the COVID-19 pandemic. METHODS: An agile, co-design process utilizing expert consensus of a large interdisciplinary team and focus groups and semi-structured interviews with families and HCPs were used to co-design clinical virtual care pathways. RESULTS: Three clinical virtual care pathways were co-designed: (1) building and maintaining relationships between family and healthcare providers; (2) awareness of resources; and (3) standardized COVID-19 messaging. Modifications were made to optimize uptake and utilization in the clinical areas. CONCLUSION: Clinical care virtual pathways were successfully co-designed to meet these needs to ensure more equitable family centered care.

Caregiver Presence and Involvement in a Canadian Neonatal Intensive Care Unit: An Observational Cohort Study.

BACKGROUND: Presence in the neonatal intensive care unit (NICU) is a vital step for caregivers initiating involvement, such as skin-to-skin contact, holding or singing/reading to their newborn. Little is known about caregiver presence and involvement in Canadian NICU's context by caregiver type (mother, father, other), and the association between maternal presence and key maternal and newborn characteristics. PURPOSE: The primary objective was to examine the presence and involvement of family caregivers in the NICU. The secondary objective was to examine the relationship between maternal presence and maternal and newborn characteristics. DESIGN AND METHODS: A prospective observational cohort study in an open bay setting of an Eastern Canadian NICU. Presence (physically present at the newborn's bedside) and involvement (e.g., skin-to-skin, singing/reading) were tracked daily by families in the NICU until discharge. Demographic information was also collected. RESULTS: Participants included 142 mothers and their newborns. Mothers were present 8.7 h/day, fathers were present 4.1 h/day, and other caregivers were present 1.8 h/day in the NICU in the first 34 days. Mothers were involved in care activities 50% of the time they were present in the NICU, whereas fathers and other caregivers were spending 20% and 6% of their time respectively. Regression identified maternal age, distance to home, parity, birthweight, and length of stay to be statistically significant variables related to maternal presence. CONCLUSIONS: There is variation in presence and involvement by caregiver type. Targeted interventions to maintain and increase mothers, fathers and other caregivers' presence and involvement in care throughout their stay in the NICU are recommended.

Influence of parity and infant age on maternal self-efficacy, social support, postpartum anxiety, and postpartum depression in the first six months in the Maritime Provinces, Canada.

BACKGROUND: After giving birth, women experience significant changes related to maternal self-efficacy and social support and are at risk of experiencing postpartum anxiety and depression. PROBLEM: No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context. AIM: To explore the relationship between parity and infant age on perceived maternal self-efficacy, social support, postpartum anxiety, and postpartum depression. METHODS: Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim. FINDINGS: A total of 561 women (56.5% primiparous, 55.1% infant 0-3 months) participated. There were significant main effects for both parity (P < .001) and age of infant (P < .001), but no significant interaction (P = .463). Primiparous women had lower maternal self-efficacy (P = .004) and higher postpartum anxiety (P = .000) than multiparous women. Women with younger infants had more perceived social support (P = .002). Women with older infants had higher levels of postpartum anxiety (P = .003) and depression (P = .000). DISCUSSION: The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six-week follow-up period. CONCLUSIONS: Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well-being and address postpartum needs.

Timing of maternal and neonatal mortality and morbidity in healthy women and newborns during the postnatal period: a systematic review protocol.

OBJECTIVE: To determine the timing of overall and cause-specific maternal and neonatal mortality and severe morbidity in healthy women and newborns during the postnatal period. INTRODUCTION: Despite significant focus on improving maternal and neonatal outcomes, many women and newborns continue to die or suffer negative health outcomes within the postnatal period. While the maternal and neonatal mortality and morbidity rates and causes are regularly updated, less is known on when they occur during the postnatal period. INCLUSION CRITERIA: This review will consider studies that include healthy women and newborns after birth to six weeks' and four weeks' postnatally, respectively, and includes data regarding time to death or complications. Studies that report solely on high risk women (eg, antenatal complications) or preterm or high-risk newborns will not be included in this review. METHODS: The search strategy will aim to locate both published and unpublished studies. After the initial search and removal of duplicates, titles and abstracts of all retrieved studies will be screened and the full text of selected reports will be assessed against the eligibility criteria. The reference list of all studies selected for critical appraisal will be screened for additional relevant studies/reports. Screening, critical appraisal, and data extraction will be completed by two independent reviewers. Findings from the studies/reports will be pooled in statistical meta-analysis or presented in narrative form including tables and figures. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020187341.

Quorum Sensing Behavior in the Model Unicellular Eukaryote Chlamydomonas reinhardtii.

Microbial communities display behavioral changes in response to variable environmental conditions. In some bacteria, motility increases as a function of cell density, allowing for population dispersal before the onset of nutrient scarcity. Utilizing automated particle tracking, we now report on a population-dependent increase in the swimming speeds of the photosynthetic unicellular eukaryotes Chlamydomonas reinhardtii and C. moewussi. Our findings confirm that this acceleration in swimming speed arises as a function of culture density, rather than with age and/or nutrient availability. Furthermore, this phenomenon depends on the synthesis and detection of a low-molecular-weight compound which can be transferred between cultures and stimulates comparable effects across both species, supporting the existence of a conserved phenomenon, not unlike bacterial quorum sensing, among members of this genus. The potential expansion of density-dependent phenomena to a new group of unicellular eukaryotes provides important insight into how microbial populations evolve and regulate "social" behaviors.

Impact of mobile health interventions during the perinatal period on maternal psychosocial outcomes: a systematic review.

OBJECTIVE: The objective of this review was to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries. INTRODUCTION: The perinatal period is an exciting yet challenging period for mothers that requires physical, emotional and social adjustment to new norms and expectations. In recent years, there has been an increase in the use of mHealth by new mothers who are seeking health information through online or mobile applications. While there have been systematic reviews on the impact of mHealth interventions on maternal and newborn health in low- and middle-income countries, the impact of these interventions on maternal psychosocial health outcomes in high-income countries remains uncertain. INCLUSION CRITERIA: This review considered studies of mHealth education interventions targeting mothers in high-income countries (as defined by the World Bank) during the perinatal period. Interventions must have started between the antenatal period (conception through birth) through six weeks postpartum. All experimental study designs were included. Outcomes included self-efficacy, social support, postpartum anxiety and postpartum depression. METHODS: PubMed, CINAHL, PsycINFO and Embase were searched for published studies in English on December 16, 2018. Gray literature was also searched for non-peer reviewed articles, including Google Scholar, mHealth intelligence and clinical trials databases. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI. All conflicts were solved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan. Where statistical pooling was not possible, findings were reported narratively. RESULTS: Of the 1,607 unique articles identified, 106 full-text papers were screened and 24 articles were critically appraised, with 21 included in the final review. Eleven were quasi-experimental and 10 were randomized controlled trials. The mHealth intervention approach varied, with text message and mobile applications being the most common. Length of intervention ranged from four weeks to six months. The topics of the mHealth intervention varied widely, with the most common topic being postpartum depression. Mothers who received an mHealth intervention targeting postpartum depression showed a decreased score on the Edinburgh Postnatal Depression Scale when measured post-intervention (odds ratio = -6.01, 95% confidence interval = -8.34 to -3.67, p < 0.00001). The outcomes related to self-efficacy, social support and anxiety showed mixed findings of effectiveness (beneficial and no change) across the studies identified. CONCLUSIONS: This review provides insight into the effectiveness of mHealth interventions targeting mothers in high-income countries in the perinatal period to enhance four psychosocial outcomes: self-efficacy, social support, anxiety and depression. Despite a wide variety of outcome measurements used, the predominant findings suggest that there are insufficient data to conclude that mHealth interventions can improve self-efficacy and anxiety outcomes. Potential benefits on social support were related to interventions targeting postnatal behaviors. Postpartum depression was the mostly commonly reported outcome. Findings related to the comparison of pre-post outcomes and intervention versus control demonstrated that mHealth interventions targeting postpartum depression were associated with a reduction in postpartum depression.

Parent-Targeted Education Regarding Infant Pain Management Delivered During the Perinatal Period: A Scoping Review.

All infants experience pain in early life from procedures. Parents recognize pain as a prevalent issue, reporting a strong desire for more information on infant pain. The aim of this study was to explore and map the current evidence of parent-targeted educational interventions about infant pain, delivered throughout the perinatal period. Records were identified in PubMed, CINAHL, EMBASE, and ERIC databases and hand searching recent publications in 3 relevant journals. Records in English that described or evaluated educational interventions on infant pain management aimed at parents during the perinatal period were eligible for review and those not related to pain or aimed at healthcare providers were excluded. Evaluation was completed following the Methodology for JBI Scoping Reviews and standardized critical appraisal instruments from the Joanna Briggs Institute. Initial search yielded 6946 records, with 9 included in analysis. Six studies were quantitative, 2 qualitative, and 1 mixed methods. Included interventions contained information about parent-led pain management strategies for infants in the neonatal intensive care unit (n = 4), full term (n = 4), or both (n = 1). Despite being an area of high concern for parents of newborns, few studies addressed parent-targeted education regarding infant pain. Future research examining the impact and efficacy of these interventions addressing parental and neonatal outcomes is warranted.

The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol.

OBJECTIVE: The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). INTRODUCTION: Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. INCLUSION CRITERIA: This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. METHODS: PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

Impact of mobile health (mHealth) interventions during the perinatal period for mothers in low- and middle-income countries: a systematic review.

OBJECTIVE: The primary objective of this review was to determine the impact of mother-targeted mobile health (mHealth) educational interventions available during the perinatal period in low- and middle-income countries (LMICs) on maternal and neonatal outcomes. INTRODUCTION: There has been significant growth of mHealth projects in LMICs. The use of mHealth interventions across the perinatal period offers the ability to share information with mothers about essential newborn care and to encourage mothers to attend perinatal clinics to obtain additional in-person support as needed. The impact of perinatal mHealth educational interventions on maternal behavior change and early neonatal mortality and morbidity outcomes in LMICs is unknown. INCLUSION CRITERIA: This review considered studies that included mHealth educational interventions targeting mothers living in LMICs during the antenatal or postnatal period using mobile devices. The intervention must have been initiated during the antenatal period (conception through birth) through six weeks postnatally. All experimental study designs were included. Outcomes included maternal knowledge, maternal self-efficacy, antenatal/postnatal care attendance and newborn early morbidity and mortality. METHODS: PubMed, Embase and CINAHL were searched on March 19, 2018 for studies published in English. The search was updated on June 7, 2018. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments. Quantitative data were extracted from included studies independently by two reviewers using a standardized data extraction tool. All conflicts were resolved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis. Where statistical pooling was not possible, the findings were reported narratively. RESULTS: A total of 1514 articles were screened, and 71 full-text papers were assessed for eligibility, with 23 articles critically appraised. Following appraisal, three articles were excluded due to poor quality. Of the 20 articles included, 16 were peer reviewed articles and four were gray literature reports. Eight papers targeted antenatal education, eight covered postnatal education and four covered both antenatal and postnatal education. Studies varied in terms of design, country, approach, frequency and content. Mothers who received an mHealth intervention attended a significantly greater number of antenatal care contacts (mean difference = 0.67, 95% confidence interval, 0.35 to 0.99, P = 0.0001) and were significantly more likely to have at least one postnatal care contact between six and eight weeks (odds ratio = 1.36, 95% confidence interval, 1.00 to 1.85, P = 0.05). Maternal knowledge, self-efficacy and neonatal mortality and morbidity were inconsistently reported across studies. CONCLUSIONS: mHealth education interventions are associated with increased maternal contact antenatally and postnatally in LMICs. Due to heterogeneity of studies among country of implementation, approach, frequency and content of the mHealth interventions, the impact on other maternal and neonatal outcomes is inconclusive. Future work using mHealth to target maternal education during the perinatal period should focus on standardization of content and outcome evaluations.

Impact of mHealth interventions during the perinatal period on maternal psychosocial outcomes: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries. INTRODUCTION: Mobile health (i.e. mHealth) is defined as the use of mobile devices to transmit health content and services. The use of mHealth to provide education and support to mothers is a growing field of health innovation. Mothers seek health information online during the postpartum period to learn about health concerns and get advice and support. Despite the potential benefits of mHealth, the potential impact on maternal psychosocial outcomes requires further evaluation. INCLUSION CRITERIA: The review will consider studies that include mHealth interventions targeting mothers in high-income countries. The mHealth education interventions must occur during the antenatal or postnatal period. This review will consider studies that compare the intervention to any comparators. Studies published in English from 2000 will be included. METHODS: The search strategy will aim to locate both published and unpublished studies. Following the search, all identified citations will be collated and duplicates removed. Titles and abstracts will be screened and full text of selected citations will then be assessed in detail against inclusion criteria. The results of the search will be reported in full in the final systematic review. Eligible studies will be critically appraised by two independent reviewers. Data extracted will include specific details about the interventions, populations, study methods and outcomes. Studies will be pooled in statistical meta-analysis or presented in narrative form including tables and figures.

Parent-targeted postnatal educational interventions in low and middle-income countries: A scoping review and critical analysis.

OBJECTIVES: To identify and map existing postnatal educational interventions targeting parents in low and middle-income countries. A secondary objective is to conduct a critical analysis of the strengths and limitations of the educational strategies used for parent-targeted postnatal education. Design & data sources: Using scoping review methodology, MedLine, CINAHL, and SCOPUS were searched in October 2017. REVIEW METHODS: All studies published after 2000 reporting on educational interventions that targeted parents from the period of birth to 6 weeks postnatally in low and middle-income countries were included. Studies were excluded if they targeted healthcare professionals or were community interventions that spanned antenatal to postnatal care. Title, abstract and full-text screening was conducted by two reviewers. RESULTS: We initially identified 9284 articles with 77 articles included after title, abstract and full-text screening. Most of the studies were quantitative (94%) with over half published after 2014. Most studies (61%) targeted a single newborn care education intervention, of which 75% targeted breastfeeding. Interventions used on average three different methods of implementation (e.g., verbal, written information, counselling). Interventions were provided in the hospital (76%), at home (23%), at a clinic/hospital (8%), and/or virtually through an eHealth intervention, including phone or text messages (12%). Maternal outcomes primarily included knowledge, self-efficacy, anxiety and stress while newborn outcomes primarily included exclusive breastfeeding, weight gain at follow-up, and morbidities. Positive changes were found to occur for reported maternal outcomes (89%) and newborn outcomes (56%). CONCLUSIONS: Parent-targeted education varied in terms of educational topics covered, method and location of intervention, and outcomes examined. While the best strategies of implementing postnatal education interventions to parents in low and middle-income countries is yet to be determined, evidence suggests that current interventions had a positive impact on parents' outcomes using a combined approach. Further work is needed to evaluate the impact on newborn outcomes and to identify the most effective methods and timing of the interventions.

Evaluation of Mobile Apps Targeted to Parents of Infants in the Neonatal Intensive Care Unit: Systematic App Review.

BACKGROUND: Parents of preterm infants increasingly use their mobile phone to search for health information. In a recent review, websites targeted toward parents with infants in the neonatal intensive care unit (NICU) were found to have poor to moderate quality educational material; however, there is a dearth of literature regarding mobile apps for NICU parents. OBJECTIVE: This study aimed to identify and evaluate apps targeting parents of infants in the NICU for quality of information, usability, and credibility. METHODS: We systematically searched the Apple App Store and Google Play using 49 key terms (eg, "preterm infant") from July 26 to August 18, 2017. English apps targeting NICU parents that cost less than $20 were included. Apps for health care professionals, e-books/magazines, or nonrelevant results were excluded. In total, 3 tools were used for evaluation: Mobile Application Rating Scale (MARS) to measure quality; Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV) to measure the app's content usability; and Trust it or Trash It to measure credibility. RESULTS: The initial search yielded 6579 apps, with 49 apps eligible after title and description screening. In total, 27 apps met the eligibility criteria with 9 apps available in both app stores; of those, the app with the most recent update date was chosen to be included in the analysis. Thus, 18 unique apps were included for final analysis. Using MARS, 7 apps (7/18, 39%) received a good score on overall quality (ie, 4.0 out of 5.0), with none receiving an excellent score. In addition, 8 apps (8/18, 44%) received a PEMAT-AV score between 51% and 75% on the understandability subscale, and 8 apps (8/18, 44%) scored between 76% and 100% on the actionability subscale. Trust It or Trash It deemed 13 apps (13/18, 72%) as trash for reasons including no identification of sources or lack of current information, with only 5 (5/18, 28%) deemed trustworthy. Reviewer's expert evaluation found 16 apps contained content that matched information provided by multiple sources; however, most apps did not meet other objective measurement items to support credibility. When comparing the MARS overall quality and subjective quality scores with trustworthiness of apps, there was no statistically significant difference. A statistically significant difference was found between the 2 MARS quality scores, indicating that, on average, apps were ranked significantly lower on subjective quality compared with overall quality measures. CONCLUSIONS: This evaluation revealed that of the available apps targeting NICU parents, less than half should be considered as acceptable educational material. Over two-thirds of the apps were found to have issues regarding credibility and just over a quarter were considered good quality. The apps currently available for NICU parents are lacking and of concern in terms of quality and credibility.

Learning to parent from Google? Evaluation of available online health evidence for parents of preterm infants requiring neonatal intensive care.

The study aim was to identify and evaluate the reliability and quality of online resources for parents of preterm infants seeking health information about their infant using the DISCERN tool and Health on Net code. An Internet search ( www.google.com ) was used to identify websites for parents of preterm infants on their infants' health and health issues. For each search, the top 100 "hits" were downloaded, yielding 1200 websites. After reviewing websites for exclusion criteria and duplicates, 197 websites remained and were analyzed. According to the DISCERN tool, the websites had a moderate reliability score (mean = 29.88, standard deviation = 4.88, range: 18-40), moderate treatment score (mean = 24.15, standard deviation = 5.79, range: 10-35), and moderate overall quality score (mean = 3.41, standard deviation = 0.89, range: 1-5). Only 24 (12.2%) websites had current Health on Net code approval and no other websites met full eligibility for certification. Overall, the reliability and quality of information available online to parents of preterm infants is lacking.