Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes.

PURPOSE: Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. METHODS: This is a cohort study including all women delivering in Scottish hospitals between 01/01/2005 and 31/12/2018, using national healthcare databases. The primary exposure was intensive care unit (ICU) admission, while secondary exposures included high dependency unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth, and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. RESULTS: Of 762,918 deliveries, 1449 (0.18%) women were admitted to ICU, most commonly due to post-partum hemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations [24.5% (n = 299) vs 8.9% (n = 68,029)]. This association persisted after confounder adjustment (HR 1.93, 95% confidence interval [CI] 1.33, 2.81, p < 0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR 40.06, 95% CI 24.04, 66.76, p < 0.001), stillbirth (OR 12.31, 95% CI 7.95,19.08, p < 0.001) and neonatal critical care admission (OR 6.99, 95% CI 5.64,8.67, p < 0.001) after confounder adjustment. CONCLUSION: Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimizing long-term post-partum care may benefit maternal critical illness survivors.

The impact of maternal intrahepatic cholestasis during pregnancy on the growth trajectory of offspring: a population-based nested case‒control cohort study.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse fetal outcomes, yet its influence on offspring growth remains unclear. Our study dynamically tracks growth rates in children from ICP and healthy mothers and investigates the link between maternal liver function and developmental abnormalities in offspring. METHOD: Our case‒control study involved 97 women with ICP and 152 with uncomplicated pregnancies nested in a cohort of their offspring, including 50 from the ICP group and 87 from the uncomplicated pregnancy group. We collected pediatric growth and development data, with a maximum follow-up duration of 36 months. Stratified analyses of children's height, weight, and head circumference were conducted, and Spearman's rank correlation was applied to examine the relationships between maternal serological markers and pediatric growth metrics. RESULT: Maternal liver and renal functions, along with serum lipid profiles, significantly differed between the ICP and normal groups. In the ICP group, the offspring showed elevated alanine aminotransferase (ALT), direct bilirubin (DBIT), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (APOB) levels. Notably, the length-for-age z score (LAZ), weight-for-age z score (WAZ), and head circumference-for-age z score (HCZ) were lower in ICP offspring compared with those from normal pregnancies within the 1- to 12-month age range (P < 0.05). However, no significant differences in LAZ, weight-for-length z score (WLZ), BMI-for-age z score (BAZ), or HCZ were observed between groups in the 13- to 36-month age range. Maternal maximum lactate dehydrogenase (LDH) and total bile acids (TBA) levels during pregnancy were inversely correlated with LAZ and WAZ in the first year. Furthermore, offspring of mothers with ICP exhibited a greater incidence of stunting (24% vs. 6.9%, P = 0.004) and abnormal HCZ (14% vs. 3.7%, P = 0.034). CONCLUSIONS: Growth disparities in offspring of ICP-affected pregnancies were most significant within the 1- to 12-month age range. During this period, maximum maternal LDH and TBA levels were negatively correlated with LAZ and WAZ values of offspring. The observation of similar growth rates between ICP and control group offspring from 13 to 36 months suggested catch-up growth in the ICP group.

Investigating the association between metabolic syndrome conditions and perinatal mental illness: a national administrative claims study.

BACKGROUND: Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women. METHODS: This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high blood pressure, high triglycerides, or low HDL (1-year prior to delivery); perinatal comorbidities (9-months prior to and 4-month postpartum); and mental disorder (1-year prior to and 1-year post-delivery). Additionally, demographics and the number of days until mental disorder diagnosis were evaluated in this cohort. The analysis included descriptive statistics and multivariable logistic regression. MetS-C, perinatal comorbidities, and mental disorder were assessed using the International Classification of Diseases, Ninth, and Tenth Revision diagnosis codes. RESULTS: 372,895 deliveries met inclusion/exclusion criteria. The prevalence of MetS-C was 13.43%. Multivariable logistic regression revealed prenatal prevalence (1.64, CI = 1.59-1.70) and postpartum incident (1.30, CI = 1.25-1.34) diagnosis of mental health disorder were significantly higher in those with at least one MetS-C. Further, the adjusted odds of having postpartum incident mental illness were 1.51 times higher (CI = 1.39-1.66) in those with 2 MetS-C and 2.12 times higher (CI = 1.21-4.01) in those with 3 or more MetS-C. Young women (under the age of 18 years) were more likely to have an incident mental health diagnosis as opposed to other age groups. Lastly, time from hospital discharge to incident mental disorder diagnosis revealed an average of 157 days (SD = 103 days). CONCLUSION: The risk of mental disorder (both prenatal and incident) has a significant association with MetS-C. An incremental relationship between incident mental illness diagnosis and the number of MetS-C, a significant association with younger mothers along with a relatively long period of diagnosis mental illness highlights the need for more screening and treatment during pregnancy and postpartum.

Psychological status of pregnant women during the omicron pandemic outbreak in China.

BACKGROUND: Pregnant women faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of pregnant women and to provide appropriate resources and support to mitigate their effects. METHOD: By using the convenience sampling approach, a total of 401 pregnant women from two hospitals of different grades in two cities were included in the survey. The cross-sectional survey was conducted by basic characteristics, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Insomnia Severity Index (ISI) and self-made questionnaire. RESULTS: Insomnia affected 207 participants (51.6%), depression affected 160 participants (39.9%) and anxiety affected 151 participants (37.7%). Moreover, pregnant women in provincial capital city were more likely to experience anxiety, depression and insomnia than those in county-level city (P < 0.01). Pregnant women's anxiety, depression and insomnia were positively correlated with the severity of COVID-19 infection (P < 0.05). However, COVID-19 infection had no appreciable impact on maternal demand for termination of pregnancy and cesarean section (P > 0.05). CONCLUSION: Pregnant women frequently suffer from anxiety disorder, depression and insomnia as a result of the omicron pandemic in China. During this period, the community and medical professionals should provide more psychological counseling, conduct health education and offer virtual prenatal care to pregnant women (particularly in the provincial capital city).

Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study.

BACKGROUND: Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications. OBJECTIVE: Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy. METHODS: A time-stratified case-crossover design with conditional logistic regression was performed on ∼206,000 psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated. RESULTS: Each 5°C increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days. CONCLUSIONS: For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.

Systematic review and meta-analysis: Evaluating the influence of intrahepatic cholestasis of pregnancy on obstetric and neonatal outcomes.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a serious liver conditions that negatively impacts obstetric and neonatal outcomes. Elevated levels of bile acid, particularly glycine conjugate, may compromise blood flow and cause functional hypoxia-ischemia. AIMS: This meta-analysis aims to assess the association between ICP and key pregnancy outcomes including emergency caesarian sections (C-sections), preeclampsia, hemorrhage, preterm birth, small for gestational age, admission rate to neonatal intensive care union (NICU), gestational age, and stillbirth. MATERIALS AND METHODS: Literature search across five databases (PubMed, Embase, Web of Science) was done to detect relevant studies published up until June 2023. Meta-analysis of the identified studies was done using a random-effects model, and the results presented as Odds ratio (OR). RESULTS: A literature search identified 662 studies. Of them, 21 met the inclusion criteria. There was a significant association between ICP and odds of C-section (OR: 1.42, p <0.001), preeclampsia (OR: 2.64, p <0.001), NICU admission (OR: 2.1, p <0.001), and pre-term birth (OR: 2.64, p <0.001). ICP was not associated with postpartum hemmorhage (OR: 1.31, p = 0.13), small for gestational age (OR: 0.87, p = 0.07), stillbirth (OR: 1.49, p = 0.29). CONCLUSIONS: Our results confirm the adverse effects of ICP on co-existing pregnancy complications, obstetric and neonatal outcomes. ICP in associated with severe complications including increased rates of preeclampsia, emergency C-sections, preterm births, l gestational periods and higher rates of NICU admissions. These results may assist healthcare professionals in formulating comprehensive care guidelines for expectant mothers and newborns.

Relationship between increased maternal serum free human chorionic gonadotropin levels in the second trimester and adverse pregnancy outcomes: a retrospective cohort study.

BACKGROUND: A retrospective cohort study was conducted to collect the data of pregnant women who received hospital delivery in Hangzhou Women's Hospital from January 2018 to December 2020, and who participated in the second trimester (15-20+6 weeks) of free beta human chorionic gonadotropin (free ß-hCG). And the study was conducted to explore the relationship between maternal serum free ß-hCG and adverse pregnancy outcomes (APO). METHODS: We retrospectively analyzed the clinical data of 1,978 women in the elevated maternal serum free ß-hCG group (free ß-hCG ≥ 2.50 multiples of the median, MoM) and 20,767 women in the normal group (0.25 MoM ≤ free ß-hCG < 2.50 MoM) from a total of 22,745 singleton pregnancies, and modified Poisson regression analysis was used to calculate risk ratios (RRs) and 95% confidence intervals (CI) of the two groups. RESULTS: The gravidity and parity in the elevated free ß-hCG group were lower, and the differences between the groups were statistically significant (all, P < 0.05). The risks of polyhydramnios, preeclampsia, and hyperlipidemia, were increased in women with elevated free ß-hCG levels (RRs: 1.996, 95% CI: 1.322-3.014; 1.469, 95% CI: 1.130-1.911 and 1.257, 95% CI: 1.029-1.535, respectively, all P < 0.05), intrauterine growth restriction (IUGR) and female infants were also likely to happen (RRs = 1.641, 95% CI: 1.103-2.443 and 1.101, 95% CI: 1.011-1.198, both P < 0.05). Additionally, there was an association between elevated AFP and free ß-hCG levels in second-trimester (RR = 1.211, 95% CI: 1.121-1.307, P < 0.001). CONCLUSIONS: APOs, such as polyhydramnios, preeclampsia, and hyperlipidemia, were increased risks of elevated free ß-hCG levels, IUGR and female infants were also likely to happen. Furthermore, there was an association between elevated AFP levels and elevated free ß-hCG levels in second-trimester. We recommend prenatal monitoring according to the elevated maternal serum free ß-hCG level and the occurrence of APO.

Extreme weather events and maternal health in low-income and middle-income countries: a scoping review.

BACKGROUND: Despite global efforts to improve maternal health and healthcare, women throughout the world endure poor health during pregnancy. Extreme weather events (EWE) disrupt infrastructure and access to medical services, however little is known about their impact on the health of women during pregnancy in resource-poor settings. OBJECTIVES: This review aims to examine the current literature on the impact of EWE on maternal health to identify the pathways between EWE and maternal health in low-income and middle-income countries to identify gaps. ELIGIBILITY CRITERIA: Studies were eligible for inclusion if they were published before 15 December 2022 and the population of the studies included pregnant and postpartum women (defined at up to 6 weeks postpartum) who were living in low-income and middle-income countries. The exposure of the included study must be related to EWE and the result to maternal health outcomes. SOURCES OF EVIDENCE: We searched the literature using five databases, Medline, Global Health, Embase, Web of Science and CINAHL in December 2022. We assessed the results using predetermined criteria that defined the scope of the population, exposures and outcomes. In total, 15 studies were included. CHARTING METHODS: We identified studies that fit the criteria and extracted key themes. We extracted population demographics and sampling methodologies, assessed the quality of the studies and conducted a narrative synthesis to summarise the key findings. RESULTS: Fifteen studies met the inclusion criteria. The quantitative studies (n=4) and qualitative (n=11) demonstrated an association between EWE and malnutrition, mental health, mortality and access to maternal health services. CONCLUSION: EWE negatively impact maternal health through various mechanisms including access to services, stress and mortality. The results have demonstrated concerning effects, but there is also limited evidence surrounding these broad topics in low-resource settings. Research is necessary to determine the mechanisms by which EWE affect maternal health. PROSPERO REGISTRATION NUMBER: CRD42022352915.

Neonatal therapy after maternal central neurotropic drug exposure-a retrospective cohort study.

OBJECTIVE: Evaluation of neonatal morbidity after maternal central neurotropic drug exposure. METHODS: Retrospective single-center level-III neonatology cohort analysis of neonates after CND from 2018 to 2021. Control group of neonates born to mothers without CND cared for at the maternity ward. RESULTS: Significantly more frequent therapy need of neonates with CND [OR 23 (95% CI: 7.8-62); RR 14 (95% CI: 5.4-37); p < 0.01]. Neonates after CND had lower Apgar-scores LM 1 [CND 8.1; CG 8.6; p < 0.05]; LM 5 [CND 9; CG 9.7; p < 0.01]; LM 10 [CND 9.6; CG 9.9; p < 0.05]. The first symptom occurred in 95.35% within 24 h (mean: 3.3 h). CND group showed significantly more often preterm delivery [OR 3.5; RR 3.2; p < 0.05], and especially cumulative multiple symptoms [OR 9.4; RR 6.6; p < 0.01] but no correlation to multiple maternal medication use (p = 0.3). CONCLUSIONS: Neonates exposed to CND are at increased risk for postnatal therapy, often due to multiple symptoms. Neonates should be continuously monitored for at least 24 h.

Validation of a modified obstetric comorbidity index for prediction of postpartum adverse events including fetal morbidity - a retrospective cohort study from Qatar.

BACKGROUND: The Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity. METHODS: Data from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM. RESULTS: The median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1-3 versus median 0, IQR: 0-2; p < 0.001). The incidence of CFM was 11.3%. The incidence of low APGAR score, HIE and NICU admission was nearly 1 in 1000. Around 5% of the babies had fetal distress in labour and low UA pH. For every 1 unit increase in OBCMI score, the odds of SMM increased by 44% (OR 1.44 95% CI 1.30-1.59; p < 0.001; AUC 0.66), and CFM increased by 28% (OR 1.28 95% CI 1.15-1.42; p < 0.001; AUC 0.61). A cut-off score of 4 had a high specificity (> 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively. CONCLUSION: The OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.

Risk factors for maternal near-miss in an undeveloped province in south-central China, 2012-2022.

OBJECTIVE: To explore the risk factors for maternal near-miss (MNM) using the WHO near-miss approach. METHODS: Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM. RESULTS: Our study included 780,359 women with 731,185 live births, a total of 2461 (0.32%) MNMs, 777,846 (99.68%) non-MNMs, and 52 (0.006%) maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23-3.50). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). Results of multivariate logistic regression analysis showed risk factors for MNM: maternal age > = 30 years old (aOR > 1, P < 0.05), unmarried women (aOR = 2.21, 95%CI: 1.71-2.85), number of pregnancies > = 2 (aOR > 1, P < 0.05), nulliparity (aOR = 1.51, 95%CI: 1.32-1.72) or parity > = 3 (aOR = 1.95, 95%CI: 1.50-2.55), prenatal examinations < 5 times (aOR = 1.13, 95%CI: 1.01-1.27), and number of cesarean sections was 1 (aOR = 1.83, 95%CI: 1.64-2.04) or > = 2 (aOR = 2.48, 95%CI: 1.99-3.09). CONCLUSION: The MNM ratio was relatively low in Hunan Province. Advanced maternal age, unmarried status, a high number of pregnancies, nulliparity or high parity, a low number of prenatal examinations, and cesarean sections were risk factors for MNM. Our study is essential for improving the quality of maternal health care and preventing MNM.

Admission indications, initial diagnoses, Interventions, and patient outcomes within the sole obstetric high-dependency unit in Ethiopia.

BACKGROUND: Obstetric high-dependency care offers holistic care to critically ill obstetric patients while maintaining the potential for early mother-child bonding. Little is known about the obstetric high-dependency unit (HDU) in Ethiopia. Therefore, the objective of the study was to review the admission indications, initial diagnoses, interventions, and patient outcomes in the obstetric high-dependency unit at St.Paul's Hospital. METHODS: A retrospective observational study was carried out at St. Paul's Hospital in Addis Ababa, Ethiopia, between September 2021 and September 2022, targeting patients in the obstetric high-dependency unit during pregnancy or with in 42 days of termination or delivery. A checklist was used to compile sociodemographic and clinical data. Epidata-4.2 for data entry and SPSS-26 for data analysis were employed. Chi-square tests yielded significant results at p < 0.05. RESULT: Records of 370 obstetric patients were reviewed and analyzed. The study enlisted participants aged 18 to 40, with a mean age of 27.6 ± 5.9. The obstetric high-dependency unit received 3.5% (95% CI, 3.01-4.30) of all obstetric admissions. With the HDU in place, only 0.42% of obstetric patients necessitated adult intensive care unit (ICU) admission. The predominant motive behind HDU admissions (63.2%) was purely for observation. Hypertensive disorders of pregnancy (48.6%) and obstetric hemorrhage (18.9%) were the two top admission diagnoses. Ten pregnant mothers (2.7%) were admitted to HDU: 2 with antepartum hemorrhages, and 8 with cardiac diseases. Maternal mortality and transfer to the ICU were both 1.4 per 100 HDU patients. CONCLUSION: Our study found that the most frequent indication for admission to the HDU was just for observational monitoring. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two leading admission diagnoses. Expanding HDUs nationwide is key for mitigating the ICU burden from obstetric admissions. Strategies for early prenatal screening, predicting preeclampsia, and addressing postpartum hemorrhage should be reinforced. Future studies should focus on a broader array of factors affecting fetomaternal outcomes in such a unit.

Determinants of severe maternal outcome in Keren hospital, Eritrea: An unmatched case-control study.

BACKGROUND: In the past few decades, several studies on the determinants and risk factors of severe maternal outcome (SMO) have been conducted in various developing countries. Even though the rate of maternal mortality in Eritrea is among the highest in the world, little is known regarding the determinants of SMO in the country. Thus, the aim of this study was to identify determinants of SMO among women admitted to Keren Provincial Referral Hospital. METHODS: A facility based unmatched case-control study was conducted in Keren Hospital. Women who encountered SMO event from January 2018 to December 2020 were identified retrospectively from medical records using the sub-Saharan Africa maternal near miss (MNM) data abstraction tool. For each case of SMO, two women with obstetric complication who failed to meet the sub-Saharan MNM criteria were included as controls. Bivariate and multivariate logistic regression analyses were employed using SPSS version-22 to identify factors associated with SMO. RESULTS: In this study, 701 cases of SMO and 1,402 controls were included. The following factors were independently associated with SMO: not attending ANC follow up (AOR: 4.53; CI: 3.15-6.53), caesarean section in the current pregnancy (AOR: 3.75; CI: 2.69-5.24), referral from lower level facilities (AOR: 11.8; CI: 9.1-15.32), residing more than 30 kilometers away from the hospital (AOR: 2.97; CI: 2.29-3.85), history of anemia (AOR: 2.36; CI: 1.83-3.03), and previous caesarean section (AOR: 3.49; CI: 2.17-5.62). CONCLUSION: In this study, lack of ANC follow up, caesarean section in the current pregnancy, referral from lower facilities, distance from nearest health facility, history of anaemia and previous caesarean section were associated with SMO. Thus, improved transportation facilities, robust referral protocol and equitable distribution of emergency facilities can play vital role in reducing SMO in the hospital.

Fecal incontinence risk factors and pregnancy.

MATERIALS AND METHODS: We conducted an analysis on 231 pregnant women. A proctologist examined the patients three times: in the 1st trimester (within the first 15 weeks), in the 3rd trimester (29-40 weeks), and 12 months after childbirth. RESULTS: The total number of fecal incontinence observations among women included in the study was 66 cases (28.6%), detected at the final visit. Risk factors for fecal incontinence with a high probability were age over 36 years (P = 0.001), low physical activity (P = 0.034), three or more pregnancies resulting in childbirth (P = 0.022), history of hemorrhoids (P = 0.027), perianal discomfort on the first visit (P = 0.045), and constipation on the first visit (P = 0.006). Factors such as being overweight, marital status, education, living conditions, living area, and infant size did not have significance for fecal incontinence. DISCUSSION: Pregnancy- and obstetric-related risk factors contributing to fecal incontinence are multifactorial, including factors such as multiple childbirths with trauma to the pelvic muscles or anal sphincter muscles, chronic constipation, age, and vaginal deliveries. However, currently, there is no clear concept for the prevention of fecal incontinence in pregnant women. CONCLUSION: The prevalence of fecal incontinence among pregnant women is 12.9%, which increases to 28.6% one year after childbirth. The most common complaint was involuntary passage of intestinal gas. Risk factors for fecal incontinence with a high probability included being over 36-years old, low physical activity, three or more pregnancies resulting in childbirth, a history of hemorrhoids, perianal discomfort, and constipation in the 1st trimester of pregnancy.

Antenatal depression among pregnant mothers in Afghanistan: A cross-sectional study.

BACKGROUND: Approximately one in five pregnant women experience antenatal depression globally. The purpose of the present study was to estimate the prevalence of antenatal depression and explore its relationship between various demographic variables, recent sexual engagement, and recent adverse life events among pregnant Afghan women. METHODS: A cross-sectional survey study was carried out between January, 2023 and April 2023 among 460 women aged 15-45 years who were recruited using convenience sampling from Herat province (Afghanistan). Logistic regression models were utilized to explore the relationship between antenatal depression and socio-demographic characteristics among the participants. RESULTS: The prevalence of antenatal depression symptoms was 78.5%. Multiple regression analysis indicated that antenatal depression was significantly associated with (i) being aged 30-45 years (AOR: 4.216, 95% CI: 1.868-9.515, p = .001), (ii) being of low economic status (AOR:2.102, 95% CI: 1.051-4.202, p = .036), (iii) not being employed (AOR: 2.445, 95% CI:1.189-5.025, p = .015), (iv) not having had sex during the past seven days (AOR: 2.335, 95% CI: 1.427-3.822, p = .001), and (v) not experiencing a traumatic event during the past month (AOR:0.263, 95% CI: 0.139-0.495, p < .001). CONCLUSION: The present study provides insight into the factors associated with the high prevalence of antenatal depression among pregnant Afghan women (e.g., demographic variables, recent adverse life events, and recent sexual engagement). It highlights the urgency of addressing antenatal depression in Afghanistan and provides a foundation for future research and interventions aimed at improving the mental health and well-being of pregnant women in the Afghan context.

Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study.

BACKGROUND: Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS: We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS: Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION: Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.

Prenatal depression among pregnant women attending public health facilities in Babile district, Eastern Ethiopia: a cross-sectional study.

BACKGROUND: Depression during pregnancy is a significant health concern that can lead to a variety of short and long-term complications for mothers. Unfortunately, there is a lack of information available on the prevalence and predictors of prenatal depression in rural eastern Ethiopia. This study assessed prenatal depression and associated factors among pregnant women attending public health facilities in the Babile district, Eastern Ethiopia. METHOD: An institution-based cross-sectional study was conducted among 329 pregnant women attending Babile District Public Health Facilities from November 1 to December 30, 2021. Bivariable and multivariable logistic regression were used to identify factors associated with prenatal depression. The adjusted odds ratio (AOR) with a 95% confidence interval was used to report the association, and the significance was declared at a p-value < 0.05. RESULTS: The prevalence of prenatal depression was 33.1% (95% CI = 28.0%, 38.2%). A lower income (AOR = 3.85, 95% CI = 2.08, 7.13), contraceptive use (AOR = 0.53, 95% CI = 0.28, 0.98), unintended pregnancy (AOR = 2.24, 95% CI = 1.27, 3.98), history of depression (AOR = 5.09, 95% CI = 2.77, 9.35), poor social support (AOR = 5.08, 95% CI = 2.15, 11.99), and dissatisfied marriage (AOR = 2.37, 95% CI = 1.30, 4.33) were the factors associated with increased prenatal depression among pregnant women. CONCLUSIONS: One in every three pregnant women in rural eastern Ethiopia had prenatal depression. Monthly income, contraceptive use, pregnancy intention, history of depression, social support, and marriage satisfaction status were the determinants of prenatal depression. Preventing unintended pregnancies by encouraging women to utilize modern contraceptive methods is essential for mitigating and controlling the risks and burdens of prenatal depression and its negative consequences.

Factors associated with the occurrence of maternal deaths in the West Region between 2020 - 2022: case control study.

WHO defines maternal mortality as any death of a woman occurring during pregnancy or within 42 days of its termination or after delivery. Our aim was to study the factors associated with the occurrence of maternal deaths in the West Region of Cameroon between 2020 and 2022. This was a case-control study. Cases consisted of maternal deaths that occurred during the study period. The controls for their part were made up of women who normally gave birth in the same health facilities from which the cases came and during the same period as the cases. The only exposure criterion being the status of death. The data useful for our investigation were collected respectively with the investigation sheets, audit reports and via interviews with the heads of the health facilities where the maternal deaths occurred with a view to considerably reducing information bias. Analysis were done with IBM-SPSS 25 and RStudio 2023.03.0. The West Region of Cameroon recorded 161 maternal deaths between 2020 and 2022. 67% of them were housewives. The most frequently identified causes were haemorrhage (ante-, per- and post-partum), followed far behind by complications and sepsis, with respective 42.2%, 12.4% and 10.6%. Slightly more than one child out of 10 had an abnormal presentation. Nearly 50% had a short labor (less than 10 hours), the partograph was used in 38% of the women, and the GATP practiced in 50.1% of them. Abnormal presentation of the fetus (aOR = 2.7 (95% CI: 1.4 - 5.1), p=0.002), failure to use the partograph (aOR = 4.4 (95% CI: 2 .6 - 7.4), p<0.001), the fact of not having an economic activity (aOR = 1.7 (95% CI: 1.0 - 2.7), p = 0.033), the fact of having taken less than 2 doses of VAT ( aOR = 2.8 (95% CI: 1.8 - 4.4), p<0.001) and the absence of practice of GATP (aOR = 1.6 (CI 95%: 1.0 - 2.6), p=0.040) were identified as factors that significantly favored the occurrence of maternal deaths. Several factors negatively influence the occurrence of maternal deaths in the West Region. Operational strategies such as continuous training of maternity ward staff, and the establishment of systematic maternal death audits and review meetings should be implemented to reduce and control these risk factors.

Association between urinary arsenic species and vitamin D deficiency: a cross-sectional study in Chinese pregnant women.

Background: An increasing number of studies suggest that environmental pollution may increase the risk of vitamin D deficiency (VDD). However, less is known about arsenic (As) exposure and VDD, particularly in Chinese pregnant women. Objectives: This study examines the correlations of different urinary As species with serum 25 (OH) D and VDD prevalence. Methods: We measured urinary arsenite (As3+), arsenate (As5+), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) levels and serum 25(OH)D2, 25(OH)D3, 25(OH) D levels in 391 pregnant women in Tianjin, China. The diagnosis of VDD was based on 25(OH) D serum levels. Linear relationship, Logistic regression, and Bayesian kernel machine regression (BKMR) were used to examine the associations between urinary As species and VDD. Results: Of the 391 pregnant women, 60 received a diagnosis of VDD. Baseline information showed significant differences in As3+, DMA, and tAs distribution between pregnant women with and without VDD. Logistic regression showed that As3+ was significantly and positively correlated with VDD (OR: 4.65, 95% CI: 1.79, 13.32). Meanwhile, there was a marginally significant positive correlation between tAs and VDD (OR: 4.27, 95% CI: 1.01, 19.59). BKMR revealed positive correlations between As3+, MMA and VDD. However, negative correlations were found between As5+, DMA and VDD. Conclusion: According to our study, there were positive correlations between iAs, especially As3+, MMA and VDD, but negative correlations between other As species and VDD. Further studies are needed to determine the mechanisms that exist between different As species and VDD.