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Addressing Maternal Morbidity and Mortality: Innovations in Antenatal and Postnatal Care

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 8041

Special Issue Editor

Dr. Ruth E. Zielinski

E-Mail Website
Guest Editor
Health Behavior and Biological Sciences Department, School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
Interests: maternal health; midwifery education; respectful maternity care; sexual health; group antenatal care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prior to the pandemic, there was progress in decreasing maternal mortality across the globe. However, the number of women dying from childbirth-related causes at 211 per 100,000 live births [1] is still three times higher than the goal set by the United Nation’s Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 by the year 2030. Unfortunately, populations that have the highest mortality have seen the least improvement [2]. In addition, the recent global pandemic has worsened and further increased the gap in maternal outcomes [3]. Nowhere is this truer than in the United States where the maternal mortality ratio has risen to an unacceptable rate of 34 per 100,000, far higher than other high-income countries [4]. In the United States, racial disparities in maternal mortality have increased such that black women die at a rate of 68.9 per 100,000 versus 26.1 for white women [4]. High-quality antenatal care that includes not only risk assessment but also education could decrease the risk of life-threatening complications. Because many of the deaths occur following birth, better care during the post-partum period is also essential for reducing maternal mortality and morbidity. To that end, this Special Issue includes innovations in antenatal and postnatal care that can be implemented in an effort to improve maternal outcomes globally.

References

  1. United Nations. Sustainable Development Goals. Available online: https://sdgs.un.org/goals (accessed on 30 March 2023).
  2. Graham, W.; Wood, S.; Byass, P.; Filippi, V.; Gon, G.; Virgo, S.; Chou, D.; Hounton, S.; Lozano, R.; Pattinson, R.; et al. Diversity and divergence: the dynamic burden of poor maternal health. 2016, 388, 2164–2175. Available online: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31533-1/fulltext?rss%3Dyes= (accessed on 30 March 2023).
  3. Chmielewska, B.; Barratt, I.; Townsend, R.; Kalafat, E.; van der Meulen, J.; Gurol-Urganci, I.; O'Brien, P.; Morris, E.; Draycott, T.; Thangaratinam, S.; et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob. Health. 2021, 9, E759–E772. doi: https://doi.org/10.1016/S2214-109X(21)00079-6.
  4. Government Accountability Office. MATERNAL HEALTH Outcomes Worsened and Disparities Persisted During the Pandemic, 2022. Available online: gao.gov/assets/gao-23-105871.pdf (accessed on 30 March 2023).

Dr. Ruth E. Zielinski
Guest Editor

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Keywords

  • maternal health
  • maternal mortality
  • antenatal care
  • postnatal care
  • group antenatal care
  • prenatal care
  • postpartum care

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Published Papers (4 papers)

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Research

10 pages, 1239 KiB  
Article
Knowledge, Acceptance, and Uptake of Family Planning: A Cluster Randomized Controlled Trial of Group Antenatal Care in Ghana
by Ruth Zielinski, Samia Abdelnabi, Georgina Amankwah, Vida A. Kukula, Veronica Apetorgbor, Elizabeth Awini, John Williams, Cheryl Moyer, Bidisha Ghosh and Jody R. Lori
Int. J. Environ. Res. Public Health 2024, 21(8), 1025; https://doi.org/10.3390/ijerph21081025 - 3 Aug 2024
Viewed by 1130
Abstract
The use of family planning (FP) methods significantly contributes to improved outcomes for mothers and their offspring. However, the use of FP remains low, particularly in low- and middle-income countries. A cluster randomized controlled clinical trial was implemented in Ghana, comparing group antenatal [...] Read more.
The use of family planning (FP) methods significantly contributes to improved outcomes for mothers and their offspring. However, the use of FP remains low, particularly in low- and middle-income countries. A cluster randomized controlled clinical trial was implemented in Ghana, comparing group antenatal care (ANC) with routine care. The group ANC intervention included eight meetings where the seventh group meeting incorporated information and discussion regarding methods of FP. Data collection occurred at five time points: baseline (T0), 34 weeks’ gestation (T1), 6–12 weeks post birth (T2), 5–8 months post birth, and 11–14 months post birth (T4). At T1, there was a significantly greater increase in the knowledge of FP methods as well as the intention to use FP after the birth among the intervention group. The uptake of FP was significantly higher in the intervention group for all post-birth timepoints except for T4 where the control group had significantly higher rates. The reasons for the diminishing effect are unclear. An increasing uptake of FP methods requires a multifaceted approach that includes increasing accessibility, knowledge, and acceptability as well as addressing societal and cultural norms. Full article
(This article belongs to the Special Issue Addressing Maternal Morbidity and Mortality: Innovations in Antenatal and Postnatal Care)
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13 pages, 329 KiB  
Article
Multiple Job Holding, Job Changes, and Associations with Gestational Diabetes and Pregnancy-Related Hypertension in the National Birth Defects Prevention Study
by Amel Omari, Miriam R. Siegel, Carissa M. Rocheleau, Kaori Fujishiro, Kristen Van Buren, Dallas Shi, A.J. Agopian, Suzanne M. Gilboa and Paul A. Romitti
Int. J. Environ. Res. Public Health 2024, 21(5), 619; https://doi.org/10.3390/ijerph21050619 - 14 May 2024
Cited by 1 | Viewed by 1468
Abstract
We used National Birth Defects Prevention Study data to investigate associations between working patterns shortly before and during pregnancy and gestational diabetes and pregnancy-related hypertension. We analyzed working patterns (multiple-job holders, job changers, single-job holders) during the three months before and during pregnancy [...] Read more.
We used National Birth Defects Prevention Study data to investigate associations between working patterns shortly before and during pregnancy and gestational diabetes and pregnancy-related hypertension. We analyzed working patterns (multiple-job holders, job changers, single-job holders) during the three months before and during pregnancy for 8140 participants who delivered a live-born child without a birth defect. “Multiple-job holders” worked more than one job simultaneously, “job changers” worked more than one job with no overlap, and “single-job holders” (referent) worked one job. We used multivariable logistic regression to estimate associations between working pattern and each outcome, adjusting for maternal age and educational attainment at delivery. We explored effect measure modification by household income, peak weekly working hours, and maternal race/ethnicity. Multiple-job holders had higher odds of gestational diabetes (adjusted odds ratio [aOR]: 1.5; 95% confidence interval [CI]: 1.1–2.1) and pregnancy-related hypertension (aOR: 1.5; 95% CI: 1.0–2.2) compared with single-job holders. Multiple-job holders with a household income of more than 30,000 USD per year, 32–44 peak weekly working hours, and from racial/ethnic minority groups had higher odds of gestational diabetes compared with single-job holders in respective categories. Detailed occupational information is important for studies of occupation and maternal health. Full article
(This article belongs to the Special Issue Addressing Maternal Morbidity and Mortality: Innovations in Antenatal and Postnatal Care)
15 pages, 786 KiB  
Article
Assessing the Quality and Coverage of Maternal Postnatal Care in Bangladesh: A Comparative Analysis of Quality Postnatal Care among Home and Facility Births
by Sabrina Sharmin Priyanka, Dibbya Pravas Dasgupta, Abu Yousuf Md Abdullah, Nazia Binte Ali, Hafeza Khatun and Sk Masum Billah
Int. J. Environ. Res. Public Health 2024, 21(3), 359; https://doi.org/10.3390/ijerph21030359 - 18 Mar 2024
Cited by 1 | Viewed by 2307
Abstract
Background: Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. Methods: This study included data from [...] Read more.
Background: Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. Methods: This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. Results: From 2010 to 2016, postnatal care coverage within 48 h of delivery by a qualified provider rose from 23% to 47%. Of the births, 94% were facility births that received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, type of birth attendant, delivery method, and financial readiness. Conclusion: Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. This study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC. Full article
(This article belongs to the Special Issue Addressing Maternal Morbidity and Mortality: Innovations in Antenatal and Postnatal Care)
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11 pages, 319 KiB  
Article
Prevalence of Maternal Fever and Associated Factors among Postnatal Women at Kawempe National Referral Hospital, Uganda: A Preliminary Study
by Hilda Ainebyona, Elizabeth Ayebare, Allen Nabisere and Melissa A. Saftner
Int. J. Environ. Res. Public Health 2024, 21(3), 316; https://doi.org/10.3390/ijerph21030316 - 8 Mar 2024
Cited by 1 | Viewed by 2520
Abstract
Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal fever could reduce severe outcomes, such as maternal mortality due to puerperal sepsis. The purpose of this cross-sectional [...] Read more.
Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal fever could reduce severe outcomes, such as maternal mortality due to puerperal sepsis. The purpose of this cross-sectional study was to determine the prevalence of and associated factors of postnatal fever among postnatal women at Kawempe National Referral Hospital. Three hundred postnatal women were recruited. Temperature measurements were conducted and a 29-item questionnaire was completed along with the extraction of health history from the medical records of the participants. The prevalence of maternal fever was 58/300 (19.3%). Multivariable analysis indicated that only four factors—HIV-positive status (AOR = 2.56; 95% CI = 1.02–6.37), labor complications (AOR = 6.53; 95% CI = 2.40–17.71), prolonged labor (AOR = 3.12; 95% CI = 1.11–8.87), and more than 24 h spent in postnatal care (AOR = 5.16; 95% CI = 2.19–12.16)—were found to be significantly associated with postnatal fever. The prevalence of postnatal maternal fever among postnatal women at Kawempe National Referral Hospital was higher than that in other reports in the literature. The factors significantly associated with maternal fever were HIV-positive status, complications during labor, prolonged labor, and more than 24 h spent in postnatal care. Health workers involved in the provision of labor and obstetric services must follow guidelines to assess fever and manage the underlying conditions causing it. Full article
(This article belongs to the Special Issue Addressing Maternal Morbidity and Mortality: Innovations in Antenatal and Postnatal Care)
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