Special Issue "Women's Reproductive and Maternal Health"

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

Deadline for manuscript submissions: 31 December 2019.

Special Issue Editor

Prof. Dr. Johanne Sundby
E-Mail Website
Guest Editor
Department of Community Medicine and Global Health, The University of Oslo, Oslo, Norway
Interests: maternal and reproductive health services; newborn and women's reproductive health; quality of care

Special Issue Information

Dear Colleagues,

This issue will have a broad focus on women’s health, but especially its role in reproduction, pregnancy and childbirth. Contraceptive use, abortion services and issues of abuse and violence are welcome. Articles that discuss quality of care for women, dignity and respect for women, women’s sexuality and women’s reproductive mental health are also welcome. We are also looking for articles that provide an overview of women’s reproductive health in specific settings, for specific groups or specific services. Articles with policy relevance are important.

Prof. Dr. Johanne Sundby
Guest Editor

Manuscript Submission Information

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Keywords

  • Women’s health
  • Reproductive and sexual health
  • Contraception
  • Maternal health
  • Violence and abuse
  • Quality of care
  • Dignity and respect

Published Papers (22 papers)

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Open AccessArticle
Mothers’ Subjective Well-Being after Having a Second Child in Current China: A Case Study of Xi’an City
Int. J. Environ. Res. Public Health 2019, 16(20), 3823; https://doi.org/10.3390/ijerph16203823 - 10 Oct 2019
Abstract
The introduction of the two-child family planning policy in China calls for a study of the response of mothers’ subjective well-being after the birth of a second child. Generally focusing on Western countries, previous studies suggested that a series of factors could influence [...] Read more.
The introduction of the two-child family planning policy in China calls for a study of the response of mothers’ subjective well-being after the birth of a second child. Generally focusing on Western countries, previous studies suggested that a series of factors could influence the response, but insufficient attention has been paid to the relative importance of these factors so far. Based on survey data from mothers of two children in the Xi’an metropolitan area, Shaanxi Province, China, our study indicates that the important factors associated with mothers’ life satisfaction after having a second child were, in general, common to Western countries and China. There were also two factors somewhat unique to China: positive adjustment (i.e., becoming happier) by firstborn children (average age, 6 years old) following a sibling’s birth, predicted enhanced life satisfaction for mothers; additionally, mothers who had both a son and a daughter reported the highest increase in life satisfaction, while mothers who had two sons reported the lowest increase. Socioenvironmental constraints (i.e., parenting pressure and work–family conflict) had a larger association with mothers’ life satisfaction than individual ideational factors (e.g., family orientation and fertility desire). These findings suggest that fertility-friendly policies and convenient family intervention institutions are needed to alleviate potential undesirable consequences and improve maternal life quality following a second childbirth so that the two-child policy can be a success. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Unmet Need for Family Planning among Urban and Rural Married Women in Yangon Region, Myanmar—a Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(19), 3742; https://doi.org/10.3390/ijerph16193742 - 04 Oct 2019
Abstract
Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for [...] Read more.
Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for family planning (FP) among urban and rural married women in Myanmar and their demand for and satisfaction with FP. A cross-sectional survey using adapted Demographic and Health surveys questions was conducted in south and north Yangon from September 2016 to November 2016. A total of 1100 currently married women of 18–49 years participated. The contraceptive prevalence was 67.2% in total, 63% urban, and 70% rural. About 19.4% (95% CI: 16.7%–22.4%) of the studied women had an unmet need for FP, significantly higher in urban than rural women (22.6% versus 16.6%). Rural women also showed significant lesser odds (adjusted OR: 0.63; 95% CI: 0.461–0.849) of unmet need than the urban counterparts. About 86% of the women had demand for contraception and 77% of them satisfied their demand. The study population revealed a fairly good contraceptive coverage; however, a considerable proportion of women had an unmet need for FP, especially the urban women. The demand for contraception is increasing, and contraceptive services need to expand coverage to marginalized groups in order to reduce the risk of unsafe abortions. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Adequacy of Nutrients Intake among Jordanian Pregnant Women in Comparison to Dietary Reference Intakes
Int. J. Environ. Res. Public Health 2019, 16(18), 3440; https://doi.org/10.3390/ijerph16183440 - 17 Sep 2019
Abstract
Objective: Maternal nutrition is considered an important pillar in the pregnancy outcomes for both mother and infant. A mother’s malnutrition and inadequate nutrient intake is associated with many undesirable pregnancy outcomes. Hence, assessing the nutritional status of the mother in the early stages [...] Read more.
Objective: Maternal nutrition is considered an important pillar in the pregnancy outcomes for both mother and infant. A mother’s malnutrition and inadequate nutrient intake is associated with many undesirable pregnancy outcomes. Hence, assessing the nutritional status of the mother in the early stages of the pregnancy and preventing any inadequacy can preclude many health problems for both mother and infant. Therefore, this study aimed to assess the adequacy of nutrient intakes among Jordanian pregnant women as compared to their corresponding dietary reference intakes (DRIs). Methods: This cross-sectional study was conducted at a major University Hospital in Jordan. Three hundred pregnant women were invited to participate in the study and 286 agreed to participate. Fifty pregnant women were enrolled at week 9, then 96 pregnant women were at week 20 and 137 pregnant women were at week 30 of pregnancy. The participants completed the interview-based demographic questionnaire, pregnancy physical activity questionnaire, and quantitative food frequency questionnaire (FFQ). Results: The mean energy intake was 2768.9 ± 767.8 kcal/day and it was significantly higher in the 3rd trimester (p < 0.05). Women in the 3rd trimester consumed significantly more protein, carbohydrates, and sugar than women in the 1st and 2nd trimesters (p < 0.05). The pregnant women in the 3rd trimester consumed more sodium than women in the 1st and 2nd trimesters (p < 0.05). The vitamin K intake was significantly (p = 0.045) lower in the 2nd trimester than the 1st and 3rd trimesters. The calcium intake was significantly higher in the 3rd trimester than the 1st and 2nd trimesters (p = 0.021). The total micronutrient (vitamins B1, B2, B3, B6, B12, and D, calcium, and iron) intakes derived from dietary supplements and food sources throughout the 3 trimesters was significantly higher in the 3rd trimester than the 1st and 2nd trimesters (p < 0.05). The vitamin D, calcium, and iron intakes had the most significant increases between the 1st and 3rd trimesters (p < 0.001), while folic acid intake was significantly higher in the 1st trimester than the 2nd and 3rd trimester (p < 0.001). Most women exceeded the tolerable upper intake level (UL) for sodium in all trimesters, while 82% of women exceeded the UL of folic acid in the 1st trimester and from the supplement, not the diet. Conclusion: While the intake of some nutrients from food alone remains below the DRIs in the diets of pregnant women, the intake of other nutrients is above the UL. Raising the awareness of pregnant women about their diet and how a supplement intake can reduce the risk of inadequate intake for many micronutrients and improve their pregnancy outcomes is of great importance. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Psychosocial Profile and Reproductive Decisions of Women Undergoing Pregnancy Termination for Medical Reasons—A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(18), 3413; https://doi.org/10.3390/ijerph16183413 - 14 Sep 2019
Abstract
Background: The study aims to define the profile of women who decide to exercise their right to terminate a pregnancy and their future reproductive plans. Methods: Patients found eligible for termination for medical reasons between 2014 and 2016 were asked to complete an [...] Read more.
Background: The study aims to define the profile of women who decide to exercise their right to terminate a pregnancy and their future reproductive plans. Methods: Patients found eligible for termination for medical reasons between 2014 and 2016 were asked to complete an anonymous survey consisting of sixty questions examining the determinants of the decision to terminate a pregnancy. In total, 150 completed surveys were returned (62.5%). Results: Environmental factors, such as age, education, place of residence, marital status and financial status did not affect the decision-making process. The majority of the respondents were females under 35 years of age (71.3%). In most cases, the pregnancies had been planned and long-awaited (62.7%). The study also indicated that 22.6% of the patients who had been against abortion changed their mind when they encountered problems themselves. In addition, 20% of them changed their views on the acceptability of abortion. Termination had an impact on the participants future reproductive plans. Eighteen percent of the patients said they were definitely not planning more pregnancies. The majority (84.09%) of these women said that the reason was the traumatic experiences related to their pregnancy. Conclusions: The personal experience of a pregnancy termination procedure changed women’s opinions about pregnancy termination and modified further reproductive plans. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark
Int. J. Environ. Res. Public Health 2019, 16(18), 3396; https://doi.org/10.3390/ijerph16183396 - 13 Sep 2019
Abstract
Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey [...] Read more.
Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Changes in the Prevalence of Induced Abortion in the Floating Population in Major Cities of China 2007–2014
Int. J. Environ. Res. Public Health 2019, 16(18), 3305; https://doi.org/10.3390/ijerph16183305 - 09 Sep 2019
Abstract
Objective: Our aim was to assess the changes in induced abortion in different migrant groups in China between 2007 and 2014 and the contraceptive methods used prior to induced abortion. Methods: The studies of two population-based cross sections were conducted in urban China, [...] Read more.
Objective: Our aim was to assess the changes in induced abortion in different migrant groups in China between 2007 and 2014 and the contraceptive methods used prior to induced abortion. Methods: The studies of two population-based cross sections were conducted in urban China, involving 9146 sexually active migrant women. Within the selected sociodemographic subgroups, the changes in the percentage of women who had induced abortions, the proportion of pregnancies ending in induced abortions, the causes of induced abortions, and the methods of contraception were identified. A chi-squared test was used to calculate the differences in induced abortion in the subgroups. Results: Between 2007 and 2014, in the study groups from the major cities of China, the percentage of sexually active migrant women who had induced abortions increased 10.1%, from 21.8% to 24.0%. The proportion of pregnancies ending in induced abortions increased 23.7%, from 21.5% to 26.6%. Both of the aforementioned statistics increased significantly within most of the selected sociodemographic subgroups, especially in the 18–19 and 45–49 age groups. Over 50% of pregnancies were aborted in the cohabiting group, although this figure declined by 12.3% over the course of the seven-year study period. Contraceptive failure was the primary cause of induced abortion, although its contribution to induced abortion declined from 51.3% to 42.4%. The proportion of women not using contraception prior to induced abortion increased from 30.9% to 41.2%. Conclusion: The prevalence of induced abortion is high and continues to increase among sexually active migrant women in China. An increasing trend is forecasted over the next few decades. Special attention should be paid to the younger cohort of migrant women, especially 18–19-year-olds, and unmarried cohabitants, who are increasingly seeking induced abortions. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women
Int. J. Environ. Res. Public Health 2019, 16(14), 2590; https://doi.org/10.3390/ijerph16142590 - 20 Jul 2019
Abstract
Eswatini is one of the countries in the African continent where post-partum sexual abstinence is practiced. Beside scarcity of research exploring sexual abstinence in Eswatini, there are only a few studies that explore post-partum abstinence across HIV-positive and negative women in sub-Saharan Africa. [...] Read more.
Eswatini is one of the countries in the African continent where post-partum sexual abstinence is practiced. Beside scarcity of research exploring sexual abstinence in Eswatini, there are only a few studies that explore post-partum abstinence across HIV-positive and negative women in sub-Saharan Africa. The study explored the practice of post-partum sexual abstinence in Swazi women and examined how cultural beliefs influence and promotes the perpetuation of the practice. The study population consisted of post-partum women who were selected, using purposive sampling. Thematic approach was used for data analysis. Despite feeling that the period for post-partum, sexual abstinence was long; the participants adhered to the practice as prescribed by their culture. Nevertheless, they felt that the practice is imposed on women only because while they are observing post-partum abstinence, their partners get to sleep with other sexual partners. They raised concerns that the practice increases the risk of acquiring HIV and sexually transmitted infections. There is an element of coercion to the practice of post-partum abstinence, the myths and misconceptions around the early resumption of sexual intercourse forces the practice on women. At the family and community level, the discussions to change the way sexual abstinence is viewed and practiced are crucial. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
The Use of Disposable Tampons as Visual Biofeedback in Pelvic Floor Muscle Training
Int. J. Environ. Res. Public Health 2019, 16(12), 2143; https://doi.org/10.3390/ijerph16122143 - 17 Jun 2019
Cited by 1
Abstract
Background: Urinary incontinence represents a complex problem which commonly affects women and influences their physical, mental and social wellbeing. The objective was to determine the effect of pelvic floor muscle training using a tampon as visual biofeedback. Methods: A non-randomized clinical [...] Read more.
Background: Urinary incontinence represents a complex problem which commonly affects women and influences their physical, mental and social wellbeing. The objective was to determine the effect of pelvic floor muscle training using a tampon as visual biofeedback. Methods: A non-randomized clinical trial involving 60 women >18 years of age, both with, and without, urinary incontinence. All women exercised with a program involving visual biofeedback using disposable tampons at home for three months. The compliance rate was 76.8 ± 24.1 An electromyographic assessment of the pelvic floor was performed and assessments of the impact of the exercise program. Results: 54.5% of women without incontinence and 81.6% of women incontinence reported improvements (p = 0.041). In both groups, there was increased quality life (p > 0.05). The women without incontinence experienced greater improvement in the quality of their sexual relations (Pre 6.8 ± 1.4–Post 7.2 ± 1.0). Conclusions: After the intervention, a high percentage of women showed a statistically significant improvement in their symptoms. The participants reported an increase in quality of life and the women without incontinence reported an improvement in quality of their sexual relations. Our findings suggest that visual BFB for training the PFM may be beneficial for women with or without incontinence. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Maternal Body Mass Index and Gestational Weight Gain and Their Association with Pregnancy Complications and Perinatal Conditions
Int. J. Environ. Res. Public Health 2019, 16(10), 1751; https://doi.org/10.3390/ijerph16101751 - 17 May 2019
Abstract
This study aimed to evaluate the impact of selected pregnancy pathologies statistically depending on overweight/obesity and excessive maternal weight gain during pregnancy on women who gave birth in the years 2013–2015 at the Second Department of Gynecology and Obstetrics at the University Hospital [...] Read more.
This study aimed to evaluate the impact of selected pregnancy pathologies statistically depending on overweight/obesity and excessive maternal weight gain during pregnancy on women who gave birth in the years 2013–2015 at the Second Department of Gynecology and Obstetrics at the University Hospital in Bratislava, Slovakia. In a retrospective study, we analyzed data gathered from the sample, which consisted of 7122 women. Our results suggest a statistically significant, higher risk for the groups of women with overweight and obesity and gestational hypertension (adjusted odds ratio (AOR) = 15.3; 95% CI 9.0−25.8 for obesity), preeclampsia (AOR = 3.4; 95% CI 1.9−6.0 for overweight and AOR = 13.2; 95% CI 7.7−22.5 for obesity), and gestational diabetes mellitus (AOR = 1.9; 95% CI 1.2−2.9 for overweight and AOR = 2.4; 95% CI 1.4−4.0 for obesity). A higher incidence of pregnancies terminated by cesarean section was observed in the group of obese women. Gestational weight gain above IOM (Institute of Medicine) recommendations was associated with a higher risk of pregnancy terminated by C-section (AOR = 1.2; 95% CI 1.0−1.3), gestational hypertension (AOR = 1.7; 95% CI 1.0−2.7), and infant macrosomia (AOR = 1.7; 95% CI 1.3−2.1). Overweight and obesity during pregnancy significantly contribute to the development of pregnancy pathologies and increased incidence of cesarean section. Systematic efforts to reduce weight before pregnancy through prepregnancy dietary counseling, regular physical activity, and healthy lifestyle should be the primary goal. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Can Forum Play Contribute to Counteracting Abuse in Health Care? A Pilot Intervention Study in Sri Lanka
Int. J. Environ. Res. Public Health 2019, 16(9), 1616; https://doi.org/10.3390/ijerph16091616 - 08 May 2019
Abstract
Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and [...] Read more.
Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and prevent obstetric violence is limited. We developed a training intervention using a participatory theatre technique called Forum Play inspired by the Theatre of the Oppressed for health providers in Sri Lanka. This paper assesses the potential of the training method to increase staff awareness of obstetric violence and promote taking action to reduce or prevent it. We conducted four workshops with 20 physicians and 30 nurses working in three hospitals in Colombo, Sri Lanka. Participants completed a questionnaire before and three-to-four months after the intervention. At follow-up, participants more often reported that they had been involved in situations of obstetric violence, indicating new knowledge of the phenomenon and/or an increase in their ability to conceptualise it. The intervention appears promising for improving the abilities of health care providers to recognise obstetric violence, the first step in counteracting it. The study demonstrates the value of developing further studies to assess the longitudinal impacts of theatre-based training interventions to reduce obstetric violence and, ultimately, improve patient care. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Long-Acting Reversible Contraception Uptake and Associated Factors among Women of Reproductive Age in Rural Kenya
Int. J. Environ. Res. Public Health 2019, 16(9), 1543; https://doi.org/10.3390/ijerph16091543 - 01 May 2019
Cited by 1
Abstract
In the last two decades, the use of short-acting methods of contraception has driven the increase of contraceptive use in Kenya. We assessed the factors associated with uptake of long-acting reversible contraception by women seeking family planning services in public health facilities in [...] Read more.
In the last two decades, the use of short-acting methods of contraception has driven the increase of contraceptive use in Kenya. We assessed the factors associated with uptake of long-acting reversible contraception by women seeking family planning services in public health facilities in Kakamega County, Kenya. A mixed methods cross-sectional study through client exit surveys among 423 women seeking family planning services was done at 12 public health facilities in Kakamega County. Twelve in-depth interviews with health care providers from the study facilities further explored practices in provision of long-acting reversible contraception (LARC). Among women initiating contraceptive use, LARC method utilization was 20.6%. Women’s tertiary education level, Protestant Christian religion, age at first birth, and having no desire for more children were significantly associated with utilization of LARC. Structural factors including shortage of human resource, provider bias and lack of adequate skills on provision of services were identified as key barriers to uptake of long-acting reversible contraception services. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Metabolite Changes in Maternal and Fetal Plasma Following Spontaneous Labour at Term in Humans Using Untargeted Metabolomics Analysis: A Pilot Study
Int. J. Environ. Res. Public Health 2019, 16(9), 1527; https://doi.org/10.3390/ijerph16091527 - 30 Apr 2019
Abstract
The mechanism of human labour remains poorly understood, limiting our ability to manage complications of parturition such as preterm labour and induction of labour. In this study we have investigated the effect of labour on plasma metabolites immediately following delivery, comparing cord and [...] Read more.
The mechanism of human labour remains poorly understood, limiting our ability to manage complications of parturition such as preterm labour and induction of labour. In this study we have investigated the effect of labour on plasma metabolites immediately following delivery, comparing cord and maternal plasma taken from women who laboured spontaneously and delivered vaginally with women who were delivered via elective caesarean section and did not labour. Samples were analysed using ultra high-performance liquid chromatography-tandem mass spectrometry. Welch’s two-sample t-test was used to identify any significant differences. Of 826 metabolites measured, 26.9% (222/826) were significantly altered in maternal plasma and 21.1% (174/826) in cord plasma. Labour involves changes in many maternal organs and poses acute metabolic demands in the uterus and in the fetus and these are reflected in our results. While a proportion of these differences are likely to be secondary to the physiological demands of labour itself, these results present a comprehensive picture of the metabolome in the maternal and fetal circulations at the time of delivery and can be used to guide future studies. We discuss potential causal pathways for labour including endocannabinoids, ceramides, sphingolipids and steroids. Further work is necessary to confirm the specific pathways involved in the spontaneous onset of labour. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Distribution and Dietary Predictors of Urinary Phthalate Metabolites among Pregnant Women in Shanghai, China
Int. J. Environ. Res. Public Health 2019, 16(8), 1366; https://doi.org/10.3390/ijerph16081366 - 16 Apr 2019
Cited by 2
Abstract
The exposure of pregnant women to phthalates is a major concern due to their adverse effect on developmental outcomes. Diet is an important pathway for exposure to phthalate compounds. Nevertheless, studies on dietary exposure of pregnant women to phthalates in China are limited. [...] Read more.
The exposure of pregnant women to phthalates is a major concern due to their adverse effect on developmental outcomes. Diet is an important pathway for exposure to phthalate compounds. Nevertheless, studies on dietary exposure of pregnant women to phthalates in China are limited. We aimed to assess the distribution and dietary predictors of phthalate exposure among pregnant women in China. We measured the levels of 10 urinary phthalate metabolites using high-performance liquid chromatography coupled with tandem mass spectrometry in 210 pregnant women as part of the 2015 China National Chronic Disease and Nutrition Survey in Shanghai. We assessed the urinary specific gravity-adjusted phthalate metabolite levels along with potential demographic and dietary predictors. Multivariable linear regression analysis was used to examine the relationship between each potential demographic variable and dietary predictor and urinary phthalate metabolites. Seven urinary phthalate metabolites were detected in >95% of pregnant women. The geometric mean (GM) of urinary phthalate biomarker values were highest for monobutyl phthalate (GM: 25.29 ng/mL) and monoisobutyl phthalate (GM:11.18 ng/mL). Multivariate regression analysis indicated that a lower educational level was associated with elevated urinary phthalate metabolite levels. Edible seaweed consumption had a positive correlation with urinary monoethyl phthalate and monoisobutyl phthalate levels, and the total molar sum of Di-(2-ethylhexyl) phthalate metabolites. These findings offer important data on the dietary exposure to phthalates in pregnant Chinese women and suggest interventions to improve food safety. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Prevent Mother-to-Child Transmission (PMTCT) Programs and Enhancement of Maternal Healthcare Infrastructure to Improve Early Detection of Maternal Syphilis in Shanghai, China
Int. J. Environ. Res. Public Health 2019, 16(6), 1002; https://doi.org/10.3390/ijerph16061002 - 20 Mar 2019
Abstract
This study aimed to compare the screening and diagnosis of maternal syphilis in Shanghai between the national and municipal prevent mother-to-child transmission (PMTCT) of syphilis policies, and then to assess whether PMTCT programs and enhancing healthcare infrastructure could bring about an early detection [...] Read more.
This study aimed to compare the screening and diagnosis of maternal syphilis in Shanghai between the national and municipal prevent mother-to-child transmission (PMTCT) of syphilis policies, and then to assess whether PMTCT programs and enhancing healthcare infrastructure could bring about an early detection of maternal syphilis. Detection of maternal syphilis was initiated in 2001 and then scaled-up in 2011 along with the enhancement of antenatal healthcare infrastructure. The initial five-year periods of municipal and national PMTCT policies were defined as the “exploring period” (2002–2006) and the “comprehensive period” (2011–2015). The demographic and gestational weeks (GW) of syphilis screening and diagnosis were analyzed to identify the factors affecting early detection. During the study period, maternal syphilis screening increased from 83,718 in 2002 to 243,432 in 2015. Of the 1,894,062 pregnant women screened, 1526 and 2714 participants were diagnosed with maternal syphilis in 2002–2006 and 2011–2015, respectively. The average age of diagnosis was 28.36 years and non-residents accounted for 71.1%. In the comprehensive period, more women received early syphilis screening (14.0% vs. 10.8%) and diagnosis (13.3% vs. 7.3%) within 12 GWs compared with the exploring period. Significantly, early detection grew during 2011–2015, which was not seen in the exploring period. Multivariate analysis revealed a greater possibility for infected women to be diagnosed within 16 GWs (OR = 2.76) in the comprehensive period, but those who were non-residents and unemployed were less likely to receive early detection. In conclusion, early detection of maternal syphilis has been remarkably improved. More emphasis is required on the development of pro-vulnerable policies and the implementation of tailored health education to improve the accessibility of routine antenatal care and awareness of syphilis prevention. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Policymakers’ Perspectives Towards Developing a Guideline to Inform Policy on Fetal Alcohol Spectrum Disorder: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(6), 945; https://doi.org/10.3390/ijerph16060945 - 15 Mar 2019
Cited by 2
Abstract
Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current [...] Read more.
Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Impact of Socio-Economic Factors and Health Information Sources on Place of Birth in Sindh Province, Pakistan: A Secondary Analysis of Cross-Sectional Survey Data
Int. J. Environ. Res. Public Health 2019, 16(6), 932; https://doi.org/10.3390/ijerph16060932 - 15 Mar 2019
Cited by 1
Abstract
Medical facility birth with skilled birth attendance is essential to reduce maternal mortality. The purpose of this study was to assess the demographic characteristics, socio-economic factors, and varied health information sources that may influence the uptake of birth services in Pakistan. We used [...] Read more.
Medical facility birth with skilled birth attendance is essential to reduce maternal mortality. The purpose of this study was to assess the demographic characteristics, socio-economic factors, and varied health information sources that may influence the uptake of birth services in Pakistan. We used pooled data from Maternal-Child Health Program Indicator Survey 2013 and 2014. Study population was 9719 women. Generalized linear model with log link and a Poisson distribution was used to identify factors associated with place of birth. 3403 (35%) women gave birth at home, and 6316 (65%) women gave birth at a medical facility. After controlling for all covariates, women’s age, number of children, education, wealth, and mother and child health information source (doctors and nurses/midwives) were associated with facility births. Women were significantly less likely to give birth at a medical facility if they received maternal-child health information from low-level health workers or relatives/friends. The findings suggest that interventions should target disadvantaged and vulnerable groups of women after considering rural-urban differences. Training non-health professionals may help improve facility birth. Further research is needed to examine the effect of individual information sources on facility birth, both in urban and rural areas in Pakistan. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Anti-Müllerian Hormone Gene Polymorphism is Associated with Clinical Pregnancy of Fresh IVF Cycles
Int. J. Environ. Res. Public Health 2019, 16(5), 841; https://doi.org/10.3390/ijerph16050841 - 08 Mar 2019
Abstract
The aim of this study was to examine the effects of single-nucleotide polymorphisms (SNPs) in the anti-Müllerian hormone (AMH) and AMH type II receptor (AMHRII) genes on in vitro fertilization (IVF) outcomes. In this prospective cohort study, we genotyped the AMH 146 T [...] Read more.
The aim of this study was to examine the effects of single-nucleotide polymorphisms (SNPs) in the anti-Müllerian hormone (AMH) and AMH type II receptor (AMHRII) genes on in vitro fertilization (IVF) outcomes. In this prospective cohort study, we genotyped the AMH 146 T > G, AMHRII −482 A > G and AMHRII IVS1 +149 T > A variants in 635 women undergoing their first cycle of controlled ovarian stimulation for IVF. DNA was extracted from the peripheral blood of all participants, and the SNPs were genotyped by real-time polymerase chain reaction. The distributions, frequencies of genes, and correlation with clinical pregnancy of IVF were analyzed. The AMH 146 T > G G/G genotype in women was associated with a lower clinical pregnancy rate (T/T: 55.0%, T/G: 51.8%, G/G: 40.0%; p < 0.05). Women with the AMH 146 T > G GG genotype were half as likely to have a clinical pregnancy compared with women with TT genotypes (OR = 0.55, 95% CI: 0.34–0.88, p = 0.014). With multivariate analysis, the AMH 146 T > G GG genotype remains as a significant independent factor to predict clinical pregnancy (p = 0.014). No significant difference was found between AMHRII polymorphisms and clinical pregnancy outcomes of IVF. In conclusion, our results show that AMH 146 T > G seems to be a susceptibility biomarker capable of predicting IVF pregnancy outcomes. Further studies should focus on the mechanism of these associations and the inclusion of other ethnic populations to confirm the findings of this study. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
Open AccessArticle
Trends and Determinants of Antenatal Care Service Use in Ethiopia between 2000 and 2016
Int. J. Environ. Res. Public Health 2019, 16(5), 748; https://doi.org/10.3390/ijerph16050748 - 01 Mar 2019
Cited by 1
Abstract
Antenatal care (ANC) services are an essential intervention for improving maternal and child health worldwide. In Ethiopia, however, ANC service use has been suboptimal, and examining the trends and factors associated with ANC service use is needed to inform targeted maternal health care [...] Read more.
Antenatal care (ANC) services are an essential intervention for improving maternal and child health worldwide. In Ethiopia, however, ANC service use has been suboptimal, and examining the trends and factors associated with ANC service use is needed to inform targeted maternal health care interventions. This study aimed to investigate the trends and determinants of ANC service utilisation in Ethiopia for the period ranging from 2000 to 2016. This study draws on the Ethiopia Demographic and Health Survey data for the years 2000 (n = 7928), 2005 (n = 7276), 2011 (n = 7881) and 2016 (n = 7558) to estimate the trends in ANC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the study factors and ANC service utilisation. Over the sixteen-year period, the proportion of Ethiopian women who received the recommended four or more ANC visits increased from 10.0% (95% confidence interval (95% CI: 8.7–12.5%) in 2000 to 32.0% (95% CI: 29.4–34.3%) in 2016. Similarly, the proportion of women who received one to three ANC visits increased from 27.0% (95% CI: 23.6–30.7%) in 2000 to 62.0% in 2016 (95% CI: 60.4–67.3%). Multivariate analyses showed that higher maternal and paternal education, higher household wealth status, urban residency and previous use of a contraceptive were associated with ANC service use (1–3 and 4+ ANC visits). The study suggests that while Ethiopian pregnant women’s engagement with ANC services improved during the millennium development goal era (2000–2015), recommended ANC use remains suboptimal. Improving the utilisation of ANC services among pregnant women is essential in Ethiopia, and efforts should focus on vulnerable women. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Women’s Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania
Int. J. Environ. Res. Public Health 2019, 16(3), 481; https://doi.org/10.3390/ijerph16030481 - 07 Feb 2019
Cited by 2
Abstract
Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions [...] Read more.
Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15–49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women’s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
Effectiveness of a Novel Continuous Doppler (Moyo) Versus Intermittent Doppler in Intrapartum Detection of Abnormal Foetal Heart Rate: A Randomised Controlled Study in Tanzania
Int. J. Environ. Res. Public Health 2019, 16(3), 315; https://doi.org/10.3390/ijerph16030315 - 24 Jan 2019
Cited by 1
Abstract
Background: Intrapartum foetal heart rate (FHR) monitoring is crucial for identification of hypoxic foetuses and subsequent interventions. We compared continuous monitoring using a novel nine-crystal FHR monitor (Moyo) versus intermittent single crystal Doppler (Doppler) for the detection of abnormal FHR. Methods: [...] Read more.
Background: Intrapartum foetal heart rate (FHR) monitoring is crucial for identification of hypoxic foetuses and subsequent interventions. We compared continuous monitoring using a novel nine-crystal FHR monitor (Moyo) versus intermittent single crystal Doppler (Doppler) for the detection of abnormal FHR. Methods: An unmasked randomised controlled study was conducted in a tertiary hospital in Tanzania (ClinicalTrials.gov Identifier: NCT02790554). A total of 2973 low-risk singleton pregnant women in the first stage of labour admitted with normal FHR were randomised to either Moyo (n = 1479) or Doppler (1494) arms. The primary outcome was the proportion of abnormal FHR detection. Secondary outcomes were time intervals in labour, delivery mode, Apgar scores, and perinatal outcomes. Results: Moyo detected abnormal FHR more often (13.3%) compared to Doppler (9.8%) (p = 0.002). Time intervals from admission to detection of abnormal FHR were 15% shorter in Moyo (p = 0.12) and from the detection of abnormal FHR to delivery was 36% longer in Moyo (p = 0.007) compared to the Doppler arm. Time from last FHR to delivery was 12% shorter with Moyo (p = 0.006) compared to Doppler. Caesarean section rates were higher with the Moyo device compared to Doppler (p = 0.001). Low Apgar scores (<7) at the 1st and 5th min were comparable between groups (p = 0.555 and p = 0.800). Perinatal outcomes (fresh stillbirths and 24-h neonatal deaths) were comparable at delivery (p = 0.497) and 24-h post-delivery (p = 0.345). Conclusions: Abnormal FHR detection rates were higher with Moyo compared to Doppler. Moyo detected abnormal FHR earlier than Doppler, but time from detection to delivery was longer. Studies powered to detect differences in perinatal outcomes with timely responses are recommended. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Open AccessArticle
The Effect of Prenatal Stress, Proxied by Marital and Paternity Status, on the Risk of Preterm Birth
Int. J. Environ. Res. Public Health 2019, 16(2), 273; https://doi.org/10.3390/ijerph16020273 - 18 Jan 2019
Abstract
Uncertainty and insecurity in the relationship between the mother and father of a child are responsible for heightened maternal stress, which can lead to preterm birth (PTB). Different intensities of prenatal stress (proxied by four levels of marital status linked with the presence [...] Read more.
Uncertainty and insecurity in the relationship between the mother and father of a child are responsible for heightened maternal stress, which can lead to preterm birth (PTB). Different intensities of prenatal stress (proxied by four levels of marital status linked with the presence or absence of paternal data on birth records) were defined as the Marital-Father Data index. We assessed the impact of those varying intensities of prenatal stress on PTB with respect to parity among a group of Polish mothers residing in Krakow (N = 87,916). We found a pattern across the adjusted risk ratios (RR) of preterm birth that ordered these estimates in an increasing trend towards higher risk, beginning with the group of married mothers with father data present (baseline), through the groups of legitimizing marriages—married after conception with father data present (RR = 1.1; 95% Confidence Intervals (CI) 1.0–1.2) and unmarried mothers with father data present (RR = 1.3; 95% CI 1.2–1.5) to the group of unmarried mothers with father data absent (RR = 1.9; 95% CI 1.7–2.2). The adjusted p for the linear trend between Marital-Father Data index and PTB was less than 0.001. The adjusted effect of perceived prenatal stress differed with respect to parity (confirmed by statistically significant interactions between Marital-Father Data index levels and parity), with a higher magnitude of this effect noted among multiparous versus primiparous women. Low paternal involvement and support during pregnancy may negatively affect PTB risk and this effect may differ in relation to parity status. More attention should be paid to maternal pregnancy stress, especially of multiparous mothers, to decrease the risk of unfavorable birth outcomes. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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Review

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Open AccessReview
Management of Endocrinopathies in Pregnancy: A Review of Current Evidence
Int. J. Environ. Res. Public Health 2019, 16(5), 781; https://doi.org/10.3390/ijerph16050781 - 04 Mar 2019
Cited by 1
Abstract
Pregnancy in women with associated endocrine conditions is a therapeutic challenge for clinicians. These disorders may be common, such us thyroid disorders and diabetes, or rare, including adrenal and parathyroid disease and pituitary dysfunction. With the development of assisted reproductive techniques, the number [...] Read more.
Pregnancy in women with associated endocrine conditions is a therapeutic challenge for clinicians. These disorders may be common, such us thyroid disorders and diabetes, or rare, including adrenal and parathyroid disease and pituitary dysfunction. With the development of assisted reproductive techniques, the number of pregnancies with these conditions has increased. It is necessary to recognize symptoms and correct diagnosis for a proper pharmacotherapeutic management in order to avoid adverse side effects both in mother and fetus. This review summarizes the pharmacotherapy of these clinical situations in order to reduce maternal and fetal morbidity. Full article
(This article belongs to the Special Issue Women's Reproductive and Maternal Health)
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