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BMJ Open Jul 2024The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more...
BACKGROUND
The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more sharply with time for mothers under the age of 20 years.
AIM
This study sought to explore the challenges experienced by adolescent mothers who visit the department of obstetrics and gynaecology of Korle Bu Teaching Hospital in Ghana.
METHOD
This study employed a qualitative phenomenology design and collected data from adolescent mothers. Data were gathered with the aid of a semistructured in-depth interview guide from 13 breastfeeding adolescent mothers. Data for the study were analysed using content analysis. The study was conducted at the obstetrics and gynaecology department of Korle Bu Teaching Hospital, Ghana.
FINDINGS
Two major themes were generated from the study to be the challenges that confront adolescent breastfeeding mothers, and they are maternal factors of breastfeeding barriers and societal factors of breastfeeding barriers. Subcategories were generated for both themes during the process.
CONCLUSION AND RECOMMENDATION
Training of pregnant adolescents during antenatal care visits on how to manage the inability to lactate, breastfeeding stress, painful and sore nipple, engorged breast, stigma from society will lessen their burden. Furthermore, training close family members and friends on how to be kind and support adolescent mothers during breast feeding is important. In-service training should be organised for health workers to enhance their knowledge and practice of approaching and guiding adolescent mothers on effective breast feeding and the provision of cubicles in public places where adolescent mothers can comfortably breastfeed.
Topics: Humans; Breast Feeding; Ghana; Female; Adolescent; Hospitals, Teaching; Mothers; Qualitative Research; Young Adult; Pregnancy; Infant, Newborn; Interviews as Topic; Pregnancy in Adolescence; Health Knowledge, Attitudes, Practice
PubMed: 38950996
DOI: 10.1136/bmjopen-2023-077504 -
BMJ Open Jul 2024Toxoplasmosis is a zoonotic parasitic disease caused by . It has a wide host range and is capable of vertical transmission in pregnant women, which may lead to...
BACKGROUND
Toxoplasmosis is a zoonotic parasitic disease caused by . It has a wide host range and is capable of vertical transmission in pregnant women, which may lead to undesirable pregnancy outcomes such as congenital malformations, miscarriage, premature birth and stillbirth. This study investigated the seroprevalence of infection among pregnant women attending the antenatal clinic at Namwala District Hospital in Southern Zambia.
METHODS
This was a cross-sectional study where blood was collected, and the serum was tested for IgG and IgM. A questionnaire was administered to participants on demographic characteristics and risk factors. Data were entered in Microsoft Excel and exported to STATA version 14 for analysis.
RESULTS
A total of 401 women were enrolled in the study from 3 March to 5 August 2021. The seroprevalence of IgG was 4.2% (n=17), while the seroprevalence of IgM was 0.7% (n=3). The median age was 27 (IQR: 24-30) years, and a larger proportion had primary-level education (n=223, 55.6%). The majority (81.6%) of the women were married. None of the risk factors investigated in this study were significant for infection.
CONCLUSION
There was a low seroprevalence of infection among pregnant women in the Namwala district of Southern Province, Zambia, and regular screening may not be warranted in this population. Continued research on toxoplasmosis is recommended to understand its epidemiology across Zambia.
Topics: Humans; Female; Zambia; Cross-Sectional Studies; Seroepidemiologic Studies; Adult; Pregnancy; Toxoplasmosis; Risk Factors; Toxoplasma; Young Adult; Immunoglobulin M; Antibodies, Protozoan; Pregnancy Complications, Parasitic; Immunoglobulin G; Prenatal Care
PubMed: 38950992
DOI: 10.1136/bmjopen-2024-084582 -
Acta Medica Portuguesa Jul 2024
Topics: Portugal; Humans; Primary Health Care; Abortion, Induced; Female; Forecasting; Pregnancy
PubMed: 38950621
DOI: 10.20344/amp.21673 -
Acta Medica Portuguesa Jul 2024
Topics: Humans; Female; Postpartum Hemorrhage; Pregnancy
PubMed: 38950610
DOI: 10.20344/amp.21684 -
Journal of Psychosomatic Obstetrics and... Dec 2024In the Netherlands adverse perinatal outcomes are also associated with non-medical factors which vary across geographical locations. This study analyses the presence of...
In the Netherlands adverse perinatal outcomes are also associated with non-medical factors which vary across geographical locations. This study analyses the presence of non-medical vulnerabilities in pregnant women in two regions with high numbers of psychosocial adversity using the same definition for vulnerability in both regions. A register study was performed in 2 regions. Files from women in midwife-led care were analyzed using a standardized case report form addressing non-medical vulnerability based on the Rotterdam definition for vulnerability: measurement A in Groningen (n = 500), measurement B in South-Limburg (n = 538). Only in South-Limburg a second measurement was done after implementing an identification tool for vulnerability (C (n = 375)). In both regions about 10% of pregnant women had one or more urgent vulnerabilities and almost all of these women had an accumulation of several urgent and non-urgent vulnerabilities. Another 10% of women had an accumulation of three or more non-urgent vulnerabilities. This study showed that by using the Rotterdam definition of vulnerability in both regions about 20% of pregnant women seem to live in such a vulnerable situation that they may need psychosocial support. The definition seems a good tool to determine vulnerability. However, without considering protective factors it is difficult to establish precisely women's vulnerability. Research should reveal whether relevant women receive support and whether this approach contributes to better perinatal and child outcomes.
Topics: Humans; Female; Pregnancy; Netherlands; Adult; Registries; Vulnerable Populations; Pregnant Women
PubMed: 38950574
DOI: 10.1080/0167482X.2024.2362653 -
The Journal of Clinical Investigation May 2024In utero gene editing (IUGE) is a potential treatment for inherited diseases that cause pathology before or soon after birth. Preexisting immunity to adeno-associated...
In utero gene editing (IUGE) is a potential treatment for inherited diseases that cause pathology before or soon after birth. Preexisting immunity to adeno-associated virus (AAV) vectors and Cas9 endonuclease may limit postnatal gene editing. The tolerogenic fetal immune system minimizes a fetal immune barrier to IUGE. However, the ability of maternal immunity to limit fetal gene editing remains a question. We investigated whether preexisting maternal immunity to AAV or Cas9 impairs IUGE. Using a combination of fluorescent reporter mice and a murine model of a metabolic liver disease, we demonstrated that maternal anti-AAV IgG antibodies were efficiently transferred from dam to fetus and impaired IUGE in a maternal titer-dependent fashion. By contrast, maternal cellular immunity was inefficiently transferred to the fetus, and neither maternal cellular nor humoral immunity to Cas9 impaired IUGE. Using human umbilical cord and maternal blood samples collected from mid- to late-gestation pregnancies, we demonstrated that maternal-fetal transmission of anti-AAV IgG was inefficient in midgestation compared with term, suggesting that the maternal immune barrier to clinical IUGE would be less relevant at midgestation. These findings support immunologic advantages for IUGE and inform maternal preprocedural testing protocols and exclusion criteria for future clinical trials.
Topics: Animals; Female; Dependovirus; Mice; Pregnancy; Gene Editing; Humans; Immunoglobulin G; CRISPR-Associated Protein 9; Genetic Vectors; Maternal-Fetal Exchange; Antibodies, Viral; CRISPR-Cas Systems; Fetus; Immunity, Maternally-Acquired
PubMed: 38950310
DOI: 10.1172/JCI179848 -
PloS One 2024The placenta is a transient organ critical for fetal development. Disruptions of normal placental functions can impact health throughout an individual's entire life....
BACKGROUND
The placenta is a transient organ critical for fetal development. Disruptions of normal placental functions can impact health throughout an individual's entire life. Although being recognized by the NIH Human Placenta Project as an important organ, the placenta remains understudied, partly because of a lack of non-invasive tools for longitudinally evaluation for key aspects of placental functionalities.
OBJECTIVE
Our goal is to create a non-invasive preclinical imaging pipeline that can longitudinally probe murine placental health in vivo. We use advanced imaging processing schemes to establish functional biomarkers for non-invasive longitudinal evaluation of placental development.
METHODOLOGY
We implement dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) and analysis pipeline to quantify uterine contraction and placental perfusion dynamics. We use optic flow and time-frequency analysis to quantify and characterize contraction-related placental motion. Our novel imaging and analysis pipeline uses subcutaneous administration of gadolinium for steepest slope-based perfusion evaluation, enabling non-invasive longitudinal monitoring.
RESULTS
We demonstrate that the placenta exhibits spatially asymmetric contractile motion that develops from E14.5 to E17.5. Additionally, we see that placental perfusion, perfusion delivery rate, and substrate delivery all increase from E14.5 to E17.5, with the High Perfusion Chamber (HPC) leading the placental changes that occur from E14.5 to E17.5.
DISCUSSION
We advance the placental perfusion chamber paradigm with a novel, physiologically based threshold model for chamber localization and demonstrate spatially varying placental chambers using multiple functional metrics that assess mouse placental development and remodeling throughout gestation.
CONCLUSION
Our pipeline enables the non-invasive, longitudinal assessment of multiple placenta functions from a single imaging session. Our pipeline serves as a key toolbox for advancing research in mouse models of placental disease and disorder.
Topics: Animals; Female; Pregnancy; Magnetic Resonance Imaging; Mice; Placenta; Uterine Contraction; Contrast Media; Mice, Inbred C57BL
PubMed: 38950083
DOI: 10.1371/journal.pone.0303957 -
PloS One 2024Maternal mortality is of global concern, almost 800 women die every day due to maternal complications. The maternal death surveillance and response (MDSR) system is one...
BACKGROUND
Maternal mortality is of global concern, almost 800 women die every day due to maternal complications. The maternal death surveillance and response (MDSR) system is one strategy designed to reduce maternal mortality. In 2021 Makonde District reported a maternal mortality ratio of 275 per 100 000 and only sixty-two percent of deaths recorded were audited. We evaluated the MDSR system in Makonde to assess its performance.
METHODS
A descriptive cross-sectional study was conducted using the CDC guidelines for evaluating public health surveillance systems. An Interviewer-administered questionnaire was used to collect data from 79 health workers involved in MDSR and healthcare facilities. All maternal death notification forms, weekly disease surveillance forms, and facility monthly summary forms were reviewed. We assessed health workers' knowledge, usefulness and system attributes.
RESULTS
We interviewed 79 health workers out of 211 workers involved in MDSR and 71 (89.9%) were nurses. The median years in service was 8 (IQR: 4-12). Overall health worker knowledge (77.2%) was good. Ninety-three percent of the deaths audited were of avoidable causes. Twelve out of the thirty-eight (31.6%) facilities were using electronic health records system. Feedback and documented shared information were evident at four facilities (21%) including the referral hospital. Nineteen (67.9%) out of 28 maternal death notification forms were completed within seven days and none were submitted to the PMD on time.
CONCLUSION
The MDSR system was acceptable and simple but not timely, stable and complete. Underutilization of the electronic health system, work load, poor documentation and data management impeded performance of the system. We recommended appointment of an MDSR focal person, sharing audit minutes and improved data management.
Topics: Humans; Female; Zimbabwe; Cross-Sectional Studies; Maternal Death; Maternal Mortality; Pregnancy; Adult; Health Personnel; Surveys and Questionnaires; Population Surveillance
PubMed: 38950042
DOI: 10.1371/journal.pone.0301929 -
PloS One 2024Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains... (Review)
Review
BACKGROUND
Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care.
METHODS AND FINDINGS
This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers' experiences with abortion stigma and (2) Providers' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care.
CONCLUSIONS
The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.
Topics: Humans; Abortion, Induced; Female; Pregnancy; Health Personnel; Social Stigma; Attitude of Health Personnel
PubMed: 38950040
DOI: 10.1371/journal.pone.0303601 -
PloS One 2024Mental health issues and parenting difficulties in the perinatal period are common, and have significant negative impacts on individuals, families, and broader society....
BACKGROUND
Mental health issues and parenting difficulties in the perinatal period are common, and have significant negative impacts on individuals, families, and broader society. Community-based peer support programs might be an effective adjunct to standard mental health interventions in perinatal mental health issues, specifically where low-cost interventions are required, or access to professional care is limited.
METHODS
A systematic review will be undertaken. Searches will be conducted on four electronic databases (Pubmed, Embase, Cinahl, and PsycINFO), using terms related to perinatal mental health and peer support. Literature will be screened by title and abstract and then by full text. Selected studies will be evaluated using the Quality Assessment with Diverse Studies (QuADS) tool. Data relevant to community-based perinatal peer support intervention characteristics and outcomes will be extracted, and synthesised narratively.
DISCUSSION
This review will contribute to the existing evidence about perinatal mental health peer support, by synthesising information about community-based interventions specifically. The findings will be used to inform the design, implementation, and evaluation of a community-based perinatal mental health peer support program in urban and rural/remote hospital and health services in Australia.
TRIAL REGISTRATION
Systematic review registration: CRD42023451568.
Topics: Humans; Systematic Reviews as Topic; Peer Group; Pregnancy; Female; Perinatal Care; Social Support; Mental Health
PubMed: 38950030
DOI: 10.1371/journal.pone.0303277