Awareness of urinary incontinence in pregnant women as a neglected issue: a cross-sectional study.

Background: Pregnancy and labor are independent risk factors for the development of urinary incontinence (UI). Although UI is common during pregnancy, it is a health problem mostly neglected by pregnant women. The high prevalence of UI in pregnancy and its effects on the postpartum period justifies the need to determine the knowledge and attitudes of pregnant women regarding the prevention and management of UI. It is necessary to increase the awareness of pregnant women about UI, educate, consultant, and integrate pelvic floor muscle training into prenatal care services. This study aims to determine the UI awareness of pregnant women and their knowledge and attitudes in this context. Methods: This cross-sectional study was conducted with 255 pregnant women in a university hospital in Turkey between March and September 2020. Data were collected using the Incontinence Knowledge Questionnaire (PIKQ) and Urinary Incontinence Attitude Scale (UIAS). Results: The UI prevalence was 51% during pregnancy. The mean score of PIKQ was 8.07±2.64, and only 6.3% of participants correctly answered all the questions regarding UI. The mean score of UIAS was 42.33±3.48. A positive correlation was found between UI knowledge and attitude score (r=0.35, p=0.00). Conclusions: The results showed that although UI is prevalent during pregnancy, pregnant women's knowledge of UI is poor. Nearly half of pregnant women need information. They tend to display positive attitudes towards UI, but not sufficient to improve their health-seeking behavior. Strategies should be developed to increase pregnant women's awareness of UI and to encourage them health-seeking behaviors for the prevention/management of UI during prenatal visits.

Experiences of antenatal care practices to reduce stillbirth: surveys of women and healthcare professionals pre-post implementation of the Safer Baby Bundle.

BACKGROUND: The Safer Baby Bundle (SBB) aimed to reduce stillbirth rates in Australia through improving pregnancy care across five elements; smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping in late pregnancy and decision making around timing of birth. We assessed experiences of women and healthcare professionals (HCPs) with antenatal care practices around the five elements. METHODS: A pre-post study design using online surveys was employed to assess change in HCPs awareness, knowledge, and frequency of performing recommended practices (22 in total) and women's experiences of care received related to reducing their chance of stillbirth. Women who had received antenatal care and HCPs (midwives and doctors) at services participating in the SBB implementation program in two Australian states were invited to participate. Surveys were distributed over January to July 2020 (pre) and August to December 2022 (post). Comparison of pre-post responses was undertaken using Fisher's exact, Pearson's chi-squared or Wilcoxon rank-sum tests. RESULTS: 1,225 women (pre-1096/post-129) and 1,415 HCPs (pre-1148/post-267, ≥ 83% midwives) completed the surveys. The frequency of HCPs performing best practice 'all the time' significantly improved post-SBB implementation across all elements including providing advice to women on side sleeping (20.4-79.4%, p < 0.001) and benefits of smoking cessation (54.5-74.5%, p < 0.001), provision of DFM brochure (43.2-85.1%, p < 0.001), risk assessments for FGR (59.2-84.1%, p < 0.001) and stillbirth (44.5-73.2%, p < 0.001). Practices around smoking cessation in general showed less improvement e.g. using the 'Ask, Advise and Help' brief advice model at each visit (15.6-20.3%, p = 0.088). Post-implementation more women recalled conversations about stillbirth and risk reduction (32.2-50.4%, p < 0.001) and most HCPs reported including these conversations in their routine care (35.1-83.0%, p < 0.001). Most HCPs agreed that the SBB had become part of their routine practice (85.0%). CONCLUSIONS: Implementation of the SBB was associated with improvements in practice across all targeted elements of care in stillbirth prevention including conversations with women around stillbirth risk reduction. Further consideration is needed around strategies to increase uptake of practices that were more resistant to change such as smoking cessation support. TRIAL REGISTRATION: The Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.

Effects of prenatal exercise interventions on maternal body composition: A secondary analysis of the FitMum randomized controlled trial.

The main objective of the study was to investigate the effects of prenatal exercise interventions on maternal body composition at 28 weeks gestation and 7-14 days after delivery. We also explored associations between physical activity (PA) per se and body composition. This study presents secondary outcomes of the FitMum randomized controlled trial, which included healthy inactive pregnant women at gestational age ≤ 15+0 weeks. They were randomized to structured supervised exercise training, motivational counselling on PA, or standard care. Maternal body composition was measured by doubly labeled water at 28 weeks gestation (n = 134) and by dual-energy X-ray absorptiometry scan 7-14 days after delivery (n = 117). PA, including moderate-to-vigorous-intensity PA (MVPA), active kilocalories, and steps, were measured continuously from inclusion to delivery by a wrist-worn activity tracker. One hundred fifty pregnant women were included with a median pre-pregnancy body mass index (BMI) of 24.1 (21.6-27.9) kg/m2. We found no differences between groups in fat mass, fat percentage or fat-free mass at 28 weeks gestation or 7-14 days after delivery. Visceral adipose tissue mass and bone mineral density measured 7-14 days after delivery did not differ between groups either. Linear regression analyses adjusted for pre-pregnancy BMI showed that a higher number of daily steps was associated with lower fat mass, fat percentage, and visceral adipose tissue mass at 28 weeks gestation and 7-14 days after delivery. Active kilocalories during pregnancy was positively associated with fat-free mass 7-14 days after delivery. Neither structured supervised exercise training nor motivational counselling on PA during pregnancy affected maternal body composition at 28 weeks gestation or 7-14 days after delivery compared to standard care. Interestingly, when adjusted for pre-pregnancy BMI, higher number of daily steps was associated with lower fat content during pregnancy and after delivery, whereas MVPA and active kilocalories were not. Trial registration: ClinicalTrials.gov; NCT03679130; 20/09/2018.

Encontro com Especialistas - Método Canguru: cuidado integral antes e após o nascimento

No Dia Internacional do Método Canguru, Encontro com Especialistas Sônia Venâncio, Coordenadora da Atenção à Saúde Integral da Criança e do Adolescente (CACRIAD/DGCI/SAPS/MS); Zeni Lamy, médica neonatologista, docente da UFMA; Sérgio Marba, médico neonatologista, docente da Unicamp; Mariana Bahia, assessora técnica da Coordenação de Atenção à Saúde da Mulher (COSMU/CGACI/DGCI/SAPS/MS); Celmário Brandão, Coordenador da Saúde do Homem (COSAH/CGACI/DGCI/SAPS/MS); Roseli Calil, médica neonatologista do Caism/Unicamp; e Mariane Curado Borges, Coordenação de Políticas de Aleitamento Materno da SES/DF.

Determinants and willingness to practice obstetric analgesia among women attending antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia: a cross-sectional study.

BACKGROUND: Labor pain is uniquely experienced and described by the woman giving birth, and it is often considered one of the most excruciating experiences for many women. This study aimed to evaluate factors associated with the willingness to receive labor analgesia among women attending the antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia in 2022. METHODS: An institution-based, cross-sectional study was conducted from January to March 2022. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data was entered in EpiData 4.2 and exported to SPSS version 20 for analysis. Both Bivariable and multivariable logistic regressions were conducted to determine factors associated with pregnant women's willingness to choose labor analgesia. Crude odds ratio (COR) and adjusted odds ratio (AOR) were computed to assess the association between variables. RESULTS: A total of 398 pregnant women have participated in the study with a response rate of 94%. Nearly 30%, (29.4%) of the pregnant women had a willingness to practice labor pain management. Being a housewife (AOR: 8.35, 95% CI: 2.07, 33.63). Women who live in urban (AOR: 2.60, 95% CI: 1.29, 5.29). Having had awareness about labor analgesia (AOR: 1.70, 95% CI: 1.00, 2.60) and the short duration of labor time (AOR: 1.84, 95% CI: 1.15, 2.96) were statistically significant with a willingness to practice labor analgesia. CONCLUSION: We conclude that the willingness of pregnant mothers' toward obstetric analgesia practice was low in the study area. Being a housewife, urban residence, awareness about labor analgesia, and short duration of labor were statistically significant with the willingness of the mothers to practice labor analgesia. To increase willingness to use labor analgesia, authorities should prioritize delivering health education on pain management choices to address concerns and promote effective methods and practices.

Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh.

Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study.

OBJECTIVE: To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN: A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING: Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS: Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS: The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS: Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

WHO antenatal care policy and prevention of malaria in pregnancy in sub-Saharan Africa.

BACKGROUND: The WHO 2016 antenatal care (ANC) policy recommends at least eight antenatal contacts during pregnancy. This study assessed ANC8 uptake following policy implementation and explored the relationship between ANC attendance and intermittent preventive treatment in pregnancy (IPTp) coverage in sub-Saharan Africa following the rollout of the World Health Organization (WHO) 2016 ANC policy, specifically, to assess differences in IPTp uptake between women attending eight versus four ANC contacts. METHODS: A secondary analysis of data from 20 sub-Saharan African countries with available Demographic Health and Malaria Indicator surveys from 2018 to 2023 was performed. The key variables were the number of ANC contacts and IPTp doses received during a participant's last completed pregnancy in the past two years. Pooled crude and multivariable logistic regression models were used to explore factors associated with attendance of at least four or eight ANC contacts as well as receipt of at least three doses of IPTp during pregnancy. RESULTS: Overall, only a small proportion of women (median = 3.9%) completed eight or more ANC contacts (ANC8 +). Factors significantly associated with increased odds of ANC8 + included early ANC attendance (AOR: 4.61: 95% CI 4.30-4.95), literacy (AOR: 1.20; 95% CI 1.11-1.29), and higher wealth quintile (AOR: 3.03; 95% CI 2.67-3.44). The pooled estimate across all countries showed a very slight increase in the odds of IPTp3 + among women with eight (AOR: 1.06; 95% CI 1.00-1.12) compared to those with four contacts. In all but two countries, having eight instead of four ANC contacts did not confer significantly greater odds of receiving three or more doses of IPTp (IPTp3 +), except in Ghana (AOR: 1.67; 95% CI 1.38-2.04) and Liberia (AOR: 1.43; 95% CI 1.18-1.72). CONCLUSION: Eight years after the WHO ANC policy recommendation, all countries still had sub-optimal ANC8 + coverage rates. This paper is a call to action to actualize the vision of the WHO and the global malaria community of a malaria free world. Policies to improve ANC and IPTp coverage should be operationalized with clear actionable guidance and local ownership. Study findings can be used to inform multi-level policy, programmatic, and research recommendations to optimize ANC attendance and malaria in pregnancy prevention, thus improving maternal and child health outcomes, including the reduction of malaria in pregnancy.

Prevalence and factors associated with unskilled childbirth attendance in Guinea: Analysis of the 2018 Demographic and Health Survey.

This study aimed to analyze the prevalence and factors associated with the unassisted delivery by qualified health personnel in the Republic of Guinea, based on data from the 2018 demographic and health survey. Multivariate logistic regression was used to identify the associated factors. The prevalence of unassisted delivery was 40.8%; it was 38.4% in rural areas and 2.3% in urban areas. Factors associated with this type of delivery included the performance of no ANC (ORa = 6.19 IC95%: [4.86 - 7.87], p<0.001) and those who had performed one to three ANC (ORa =1.75 IC95%: [1.49 - 2.05], p<0.001) the perception of the distance to the health institution as a problem (ORa =1.28 IC95%: [1.10 - 1.48], p<0.001), belonging to the poor wealth index (ORa = 2.77 IC 95%: [2.19 - 3.50], p<0.001) and average (ORa = 2.01 IC95%: [1.57 - 2.57], p<0.001), the fact of residing in the region of Faranah (ORa = 2.24 IC95%: [1.37 - 3.65], p<0.001) and rural areas (ORa = 4.15 IC95%: [3.10 - 5.56], p<0.001). Strengthening community awareness, making functional ambulances available to rural health centers and making prenatal care inputs available in health institutions would help to reduce the scale of unassisted deliveries in the Republic of Guinea.

Cette étude visait à analyser la prévalence et les facteurs associés à l'accouchement non assisté par un personnel de santé qualifié en Guinée, partant des données de l'enquête démographique et de santé de 2018. La régression logistique multivariée a servi à identifier les facteurs associés. La fréquence de l'accouchement non assisté était de 40.8% ; elle était de 38.4% en milieu rural et 2.3% en milieu urbain. Les facteurs associés à ce type d'accouchement comprenaient la réalisation d'aucune CPN (ORa =6.19 IC95% : [4.86 - 7.87], p<0.001) et celles qui avaient réalisées une à trois CPN (ORa =1.75 IC95% : [1.49 - 2.05], p<0.001) la perception de la distance pour la structure de santé comme un problème (ORa =1.28 IC95% : [1.10 - 1.48], p<0.001), l'appartenance à l'indice de richesse pauvre (ORa =2.77 IC95% : [2.19 - 3.50], p<0.001) et moyenne (ORa =2.01 IC 95% : [1.57 - 2.57], p<0.001), le fait de résider dans la région de Faranah (ORa =2.24 IC95% : [1.37 - 3.65], p<0.001) et rurale (ORa =4,15 IC 95% : [3,10 - 5,56], p<0,001). Le renforcement de la sensibilisation communautaire, la mise d'ambulances fonctionnelles à la disposition des centres de santé ruraux et rendre disponible les intrants de soins prénatals dans les structures sanitaires contribueraient serte à réduire l'ampleur des accouchements non assistés en Guinée.

Prenatal affective cognitive training to reduce the risk of postpartum depression (PACT): study protocol for a randomized controlled trial.

BACKGROUND: Postpartum depression (PPD) affects 30-50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD. METHODS: The study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum. DISCUSSION: The results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children. TRIAL REGISTRATION: ClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024.

The wonders of mind-body practices during pregnancy: A topical review.

This topical review provides an up-to-date overview of the latest advancements in mind-body therapies in the gynaecological research field. It explores the various mind-body practices and their multifaceted benefits for expectant mothers during the transformative phase of pregnancy, including physical, emotional, and psychological aspects. The research highlights the importance of these practices in promoting maternal and fetal well-being. Prenatal yoga is found to enhance physical health, reduce discomfort, and lower stress and anxiety levels, potentially leading to shorter labour durations. Meditation is revealed to reduce stress and anxiety while nurturing emotional resilience. Prenatal Pilates improves musculoskeletal health and prepares mothers for labour, emphasising controlled movements and breathing techniques. Breathing techniques prove to be helpful for pregnant women in effectively managing pain during labour. Acupressure and reflexology offer non-pharmacological pain relief for common discomforts. Tai Chi improves physical fitness, flexibility, and mental well-being. This brief review, using evidence available from pre-clinical studies in physiological gynaecology literature, demonstrates the role of mind-body practices in enhancing the pregnancy journey, emphasising their integration into daily routines to contribute to overall well-being. By selecting the right practice or combination, expectant mothers can experience an overall better pregnancy.

Intimate Partner Violence and its associated factors among pregnant women receiving antenatal care. A Bayesian analysis approach.

BACKGROUND: Intimate Partner Violence (IPV) is a major public health problem worldwide. In developing nations, including Ethiopia, the problem is under-reported and under-estimated. Therefore, this study attempts to assess intimate partner violence and its associated factors among pregnant women receiving antenatal care at public hospitals in Amhara region, Ethiopia. METHODS: A health facility-based cross-sectional study design was employed. A sample of 418 pregnant women was selected using random sampling technique from 1st May to 1st June 2021. IPV was measured using the World Health Organization (WHO) Multi-country study of violence against women assessment tool. Data were entered into Epi-data 3.1 and exported into Stata 17 for further analysis. A Bayesian multivariable logistic regression analysis was carried out from the posterior distribution, and an adjusted odds ratio (AOR) with a 95% credible interval (CrI) was used to declare statistically significant variables. RESULTS: The prevalence of any IPV among pregnant women was 31.3% [95% CrI 26.6%, 36.1%]. After adjusting a range of covariates, IPV during pregnancy was more likely among women whose husbands used substances [AOR = 4.33: 95% CrI 1.68, 8.95] and household decisions made by husbands only [AOR = 6.45: 95% CI 3.01, 12.64]. Conversely, pregnant women who attended primary [AOR = 0.47: 95% CrI 0.24, 0.81] and secondary [AOR = 0.64: 95% CrI 0.41, 0.92] educational levels, women who had four or more ANC visits antenatal care visits [AOR = 0.43: 95% CrI 0.25, 0.68], and women with no prior history of adverse birth outcomes [AOR = 0.48: 95% CI 0.27, 0.80] were less likely to experience IPV during pregnancy. CONCLUSION: The study revealed a relatively high prevalence of any IPV among pregnant women, with factors such as substance use by husbands and limited decision-making autonomy associated with increased IPV likelihood. Conversely, women with higher education levels, four and above antenatal care attendance, and no history of adverse birth outcomes showed a reduced likelihood of experiencing IPV during pregnancy. Therefore, targeted interventions to address substance use, empower women in decision-making, and promote education and healthcare access to mitigate IPV risk during pregnancy are recommended.

Assessment of women's needs and wishes regarding interprofessional guidance on oral health in pregnancy - a qualitative study.

BACKGROUND: Poor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women's positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy. METHODS: Sources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz. RESULTS: 25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic. CONCLUSION: Guidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

Integrated group antenatal and pediatric care in Haiti: A comprehensive care accompaniment model.

INTRODUCTION: The J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes. METHODOLOGY: We conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais. Quantitative data was collected retrospectively to compare dyads receiving J9 care to usual care. A secondary analysis of qualitative data described patient perspectives of J9 care. RESULTS: Antenatal care attendance was significantly higher among women in J9 (n = 524) compared to usual care (n = 523), with 490(93%) and 189(36%) having >4 visits, respectively; p <0.001, as was post-partum visit attendance [271(52%) compared to 84(16%), p<0.001] and use of post-partum family planning methods [98(19%) compared to 47(9%), p = 0.003]. Incidence of pre-eclampsia with severe features was significantly lower in the J9 group [44(9%)] compared to the usual care group [73(14%)], p <0.001. Maternal and neonatal mortality and low birth weight did not differ across groups. Cesarean delivery [103(20%) and 82(16%), p<0.001] and preterm birth [118 (24%)] and 80 (17%), p <0.001] were higher in the J9 group compared to usual care, respectively. In the qualitative analysis, ease of access to high-quality care, meaningful social support, and maternal empowerment through education were identified as key contributors to these outcomes. CONCLUSION: Compared to usual care, the J9 Plus maternal-child accompaniment model of care is associated with increased engagement in antenatal and postpartum care, increased utilization of post-partum family planning, and lower incidence of pre-eclampsia with severe features, which remains a leading cause of maternal mortality in Haiti. The J9 accompaniment approach to care is an empowering model that has the potential to be replicated in similar settings to improve quality of care and outcomes globally.

Antenatal care utilisation and receipt of its components in Nigeria: Assessing disparities between rural and urban areas-A nationwide population-based study.

INTRODUCTION: Antenatal care (ANC) is crucial for positive pregnancy outcomes, but it is underutilised in Nigeria, suggesting unmet needs, and potentially contributing to the country's high burden of maternal and neonatal mortalities. This study comprehensively assesses ANC utilisation and receipt of its components in Nigeria, focusing on disparities between rural and urban areas. METHODS: We used the data disaggregation approach to analyse the Nigeria Demographic and Health Survey 2018. We estimated ANC utilisation, assessed the receipt of ANC components, and identified factors associated with eight or more (≥ 8) ANC contacts nationally and across rural and urban residences. RESULTS: Nationwide, only 20.3% of women had ≥ 8 ANC contacts, with a significant disparity (P < 0.001) between urban (35.5%) and rural (10.4%) areas in Nigeria. The North-East region had the lowest ANC utilisation nationally (3.7%) and in urban areas (3.0%), while the North-West had the lowest in rural areas (2.7%). Nationally, 69% of mothers received iron supplements, 70% had tetanus injections, and 16% received medicines for intestinal parasites, with urban residents having higher proportions across all ANC components. Maternal and husband education, health insurance, and maternal autonomy were associated with increased ANC odds at the national, rural, and urban residences. However, differences exist, with all ethnicities having higher ANC odds than the Hausa/Fulanis in urban areas and the Yorubas demonstrating greater odds than other ethnicities in rural settings. Internet use was significant only in the national context, watching television only in urban settings, while maternal working status, wealth, birth type, religion, and radio listenership were significant in rural areas. CONCLUSION: Our study reveals significant disparities in ANC utilisation and components across Nigeria, with rural residents, particularly in northern regions, as well as socioeconomically disadvantaged and teenage mothers facing notable challenges. A multifaceted approach prioritising the interplay of intersectional factors like geography, socioeconomic status, education, religion, ethnicity, and gender dynamics is essential. Key strategies should include targeted interventions to promote educational opportunities, expand health insurance coverage, leverage internet and context-specific media, and foster socioeconomic empowerment, with priority for underserved populations.

Childbirth preparation and its facilitating and inhibiting factors from the perspectives of pregnant and postpartum women in Tabriz-Iran: a qualitative study.

BACKGROUND: The World Health Organization recognizes childbirth preparation as an essential component of antenatal care, as it plays a crucial role in reducing maternal mortality and improving women's childbirth experience. Countries worldwide have implemented various interventions to assist women in preparing for childbirth, based on their own resources. This study was conducted with the aim of exploring the perspectives of pregnant and postpartum women on childbirth preparation and the facilitating and inhibiting factors, in Tabriz, Iran. METHODS: This qualitative study was conducted with 25 participants, selected purposively among pregnant women in weeks 37 to 40 of gestation and postpartum women within 10 days to 6 weeks after childbirth. Data collection was done through semi-structured, in-depth individual interviews using an interview guide. The data was analyzed using content analysis method with conventional approach. RESULTS: The perspectives of pregnant and postpartum women regarding childbirth preparation revealed that factors such as maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial elements for effective childbirth preparation. Additionally, mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of childbirth methods were recognized as facilitators. On the other hand, insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan were identified as barriers. CONCLUSION: The findings highlight the multifaceted nature of childbirth preparedness, necessitating the involvement of families, the healthcare system, and the entire community. Utilizing the study results in strategic planning for pre-pregnancy, during pregnancy, and inter-pregnancy care can enhance childbirth preparedness and contribute to achieving Iran's population rejuvenation policy goals.

Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study.

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

An investigation of factors associated with antenatal care attendance in Gauteng in 2015.

BACKGROUND: Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS: This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealthTM. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS: The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION: The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.

The Association Between State-Level Prenatal Substance Use Policies and Rates of Maternal Mortality in the United States: A Legal Epidemiology Study.

Little research has explored relationships between prenatal substance use policies and rates of maternal mortality across all 50 states, despite evidence that prenatal substance use elevates risk of maternal death. This study, utilizing publicly available data, revealed that state-level mandated testing laws predicted maternal mortality after controlling for population characteristics.