Search Results (226)

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, food security, barriers, and facilitators with the practice of exclusive breastfeeding. Methods: Cross-sectional study with 566 women who had prenatal care and gave birth at the National Institute of Perinatology (Mexico City) between 2021 and 2024. Surveys were administered on breastfeeding practices, food insecurity, barriers, and facilitators of exclusive breastfeeding in mothers. In addition, sociodemographic information, medical history (prepregnancy conditions and complications), gestational weight gain, and neonatal outcomes were recorded. Results: Of the 566 women, only 43.6% practiced exclusive breastfeeding, with a median duration of 4 months. Exclusive breastfeeding was more frequent in young, stay-at-home mothers with lower educational attainment and in those with food insecurity, who also tended to delay the introduction of complementary foods until after six months. Prepregnancy risk conditions (OR 1.56, 95% CI 1.06–2.30) and multiparity (OR 1.64, 95% CI 1.08–2.49) increased the risk of non-exclusive breastfeeding. Conversely, food insecurity (OR 0.40, 95% CI 0.20–0.78) and counseling from healthcare personnel (OR 0.09, 95% CI 0.01–0.51) showed a protective effect. The analysis also showed that paid employment (OR 4.68, 95% CI 1.65–13.21), the perception of low milk production (OR 6.45, 95% CI 2.95–14.10), maternal illness/medication (OR 3.91, 95% CI 1.36–11.28), and fatigue (OR 4.67, 95% CI 1.36–11.28) increased the probability of non-exclusive breastfeeding. Conclusions: In Mexico, the promotion of exclusive breastfeeding faces challenges, especially in mothers who begin pregnancy with significant chronic conditions such as diabetes, hypertension, obesity, advanced maternal age, and hypothyroidism, among others. Healthcare personnel should provide personalized advice to each woman from the prenatal stage on strategies to achieve and maintain exclusive breastfeeding. Full article

This article describes a case study of the partnership between Healthy Birth Initiatives, a community-based organization (CBO) and Black-led public health nurse home visiting program, and the maternal health division of the Providence Health System located in the Pacific Northwest. This study’s purpose was to explore the formation, significance, and impact of this partnership from the perspectives of staff and leadership members from both organizations. We conducted a case study through qualitative interviews with staff, participant observation, and debrief of leadership meetings. We completed a hybrid deductive–inductive thematic analysis of the data, followed by member checking with study participants and other key interest holders. Key facilitators of the CBO–health system partnership included the vital role of leaders in prioritizing the partnership; health system willingness to incorporate new information from the CBO to improve care; and health system utilization of resources to institutionalize changes that emerged from this partnership. Challenges to the CBO–health system partnership included CBO resource limitations; fragmented referral processes and information sharing; and the persistence required to nurture the relationship without formalized roles. This study contributes to the literature by offering staff perspectives on how a CBO–health system partnership formed, successes, early lessons learned, and practical suggestions for how to develop stronger alignment to provide culturally responsive patient-centered care to Black families. Full article

Background/Objectives: Using healthcare vouchers mitigates the financial burdens of low-income individuals, therefore enhancing mothers’ satisfaction and encouraging service utilization. In Yemen, reducing financial barriers results in marked improvement in reproductive health services utilization for mothers and their newborns. Such financial strain can be addressed through reproductive health vouchers, which reduce out-of-pocket expenses of family planning, pregnancy, birth, postnatal care and neonatal care. This study compares the Safe Motherhood and Family Planning Voucher Program in the Lahj governorate to the non-voucher program in the Abyan governorate in terms of enhancement of reproductive healthcare accessibility and use. Methods: This facility-based, quantitative, comparative, cross-sectional study was conducted in the Lahj governorate, which supports the Safe Motherhood and Family Planning Voucher Program, and the Abyan governorate, which does not. Results: The voucher-supported program has greatly improved mothers’ satisfaction, access, and use of all reproductive health services by covering transportation, covering lodging during hospitalization, and providing free reproductive treatments. Compared to Abyan mothers, Lahj governorate mothers more frequently used rental vehicles (paid for by the voucher program) and free reproductive health services (p-value < 0.001). Lahj governorate mothers (who used the vouchers) used family planning, prenatal care, facility-based delivery, home delivery by competent birth staff, cesarean section, postnatal care, and neonatal care more frequently than Abyan governorate mothers. A health institution which supported the Safe Motherhood and Family Planning Voucher Program (SMHFPVP) provided prenatal care (98.5%), competent birth services (99.0%), and modern contraceptive use (92.3%)—oral contraceptive pills, implants, injectables, contraceptive patches, vaginal rings, and intrauterine devices—for mothers who were interviewed and attended the targeted HFs in the Lahj governorate, compared with (77.6%), (80.3%), and (67.8%), respectively, for mothers in Abyan governorate who were not supported by the SMHFPVP. This study demonstrates substantially higher satisfaction levels among voucher-using mothers in the Lahj governorate compared to those in the Abyan governorate, across all satisfaction domains and overall satisfaction scores. Conclusions: This study found that women without access to maternal health vouchers experienced worse prenatal, natal, and postnatal care and were less satisfied with healthcare services compared with women who used vouchers. Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Background: Exposure to secondhand smoke (SHS) during pregnancy has been linked to adverse maternal and perinatal outcomes. Preterm birth is one of the most critical complications. However, the evidence of an association between SHS exposure and preterm birth remains inconclusive. Objectives: our aim was to identify the prevalence of exposure to secondhand smoke among pregnant women and investigate the association between exposure to SHS and preterm birth. Methods: A cross-sectional study was conducted in Madinah, Saudi Arabia, from October to December 2024. A self-administered questionnaire was distributed among women in the postnatal ward to assess sociodemographic and pregnancy-related variables and exposure to SHS. Results: A total of 469 women were included in the study. About 33.7% of the women reported that their husbands currently smoked tobacco, with 51% smoking indoors; 21% of the women did not impose smoking restrictions at home. Pregnant women exposed to SHS had more than twice the odds of preterm birth compared to unexposed women (OR = 2.09; 95% CI: 1.06–4.13; p = 0.03). Conclusions: SHS exposure increased the risk of preterm birth among pregnant women in Madinah. These findings emphasize the essential need for preventive strategies to diminish SHS exposure in residential and public environments. Full article

Cross-sectional research suggests associations between enrichment and cognitive skills in toddlerhood. There are no prospectively designed longitudinal studies that investigate the link between early home literacy activities and subsequent mechanisms that explain the putative cognitive benefits. This study tests long-term associations between toddler literacy enrichment and later student engagement across key academic transitions, from kindergarten to the end of high school. Using the Quebec Longitudinal Study of Child Development (QLSCD) population-based birth cohort data, we examined whether parent-reported experiences of shared reading, looking at picture books or illustrated stories, and pretend writing at age 2 years predict later teacher- and self-reported student engagement at ages 6, 12, and 17 years. The results from multiple regression models, stratified by sex and adjusted for pre-existing and concurrent child and family characteristics, revealed significant associations between early literacy enrichment and later engagement. For boys and girls, literacy enrichment in toddlerhood predicted increases in classroom engagement from kindergarten to the end of high school. These findings highlight the lasting influence of early literacy exposure on subsequent learning-related behaviors, both in and beyond the classroom. They underscore the importance of promoting enrichment in early childhood as a family strategy toward individual readiness to learn, a cornerstone of crystalized intelligence. Full article

Background/Objectives: Breastfeeding multiple birth infants (MBIs) poses unique challenges that require tailored support; however, research on these mothers’ experiences is limited. This study explored the breastfeeding journeys of Australian mothers of MBIs, highlighting barriers, facilitators, and support needs. Methods: Data were collected via an online survey (May–August 2024) and included quantitative data on breastfeeding initiation, duration, and challenges, as well as qualitative insights into mothers’ experiences. Thematic analysis was used to identify key themes, and statistical analyses were used to compare breastfeeding outcomes by parity. Results: While most mothers (87%) had an antenatal intention to breastfeed, they faced barriers such as latching difficulties (56%), inadequate milk supply (49%), and sore nipples (47%). Preterm births (58%) and neonatal unit admissions delayed the breastfeeding initiation. Most mothers (99%) used electric breast pumps to boost milk supply (68%) and enable expressed breast milk feeding by other caregivers (65% of mothers). While 72% were satisfied with hospital breastfeeding support and some mothers received excellent hands-on support, others felt neglected due to busy staff or conflicting advice. Mothers frequently reported that breastfeeding guidance was geared toward singletons, leaving them unprepared for the challenges of feeding multiples. Mothers’ suggestions for improving care included specialised guidance, better access to lactation support, and in-home practical support to alleviate the burden of feeding and expressing. Additionally, mothers reported that healthcare professionals should be trained to offer practical, non-judgemental support to help mothers navigate the elaborate challenges of breastfeeding MBIs. Conclusions: This study underscores the need for early postpartum support and tailored guidelines to enhance MBI breastfeeding outcomes and maternal-infant well-being. Full article

Aboriginal and Torres Strait Islander ways of knowing, being and doing have fostered physical, social, and emotional wellbeing for millenia, forming a foundation of strength and resilience. However, colonisation, systemic violence and discrimination—including the forced removal of Aboriginal and Torres Strait Islander children, which continues today—have disrupted this foundation, leading to compounding cycles of intergenerational and complex trauma. The enduring impact of intergenerational and complex trauma is exemplified in increasing proportions of Aboriginal and Torres Strait Islander children being removed from their families and involved in the child protection and youth justice system—which represents a national crisis. Despite this crisis, the national response remains insufficient. To address these urgent issues, over 200 predominantly Aboriginal and Torres Strait Islander stakeholders, participated in Gathering the Seeds Symposium, the inaugural meeting for the Replanting the Birthing Trees project held in Perth in April 2023. This meeting marked the beginning of a public dialogue aimed at Closing the Gap by advancing community-led strategies to break cycles of trauma and foster cycles of nurturing, recovery, and wellbeing for Aboriginal and Torres Strait Islander parents and children across the first 2000 days. We outline critical shortcomings in the current child protection and youth justice systems, and the urgent need for child wellbeing reform. Importantly we highlight recommendations made in submissions in 2023 to two key Australian inquiries—the National Early Years Strategy and the Human Rights Commission inquiry into out of home care and youth justice systems. We argue that structural reforms and culturally safe and skillful care for parents experiencing trauma and violence is a serious gap, and a national priority. The first 2000 days represents a critical window of opportunity to transform cycles of trauma into cycles of healing. It is time to ‘replant the birthing trees’ and ensure that all Aboriginal and Torres Strait Islander babies and families can have the best possible start to life through comprehensive models of care grounded in recognition of the right to self-determination and culture. Full article

Background: Exposure to household air pollution (HAP) is one of the primary risk factors for acute lower respiratory infection (ARI) morbidity and mortality among children in low-income settings. This study aimed to examine the relative contribution of residing in deprived neighbourhoods and exposure to HAP on the occurrence of ARI among children using data from the 2014–2015 Chad Demographic and Health Survey (DHS). Methods: We applied multilevel modelling techniques to survey data of 2882 children from 372 communities to compute the odds ratio (OR) for the occurrence of ARI between children of respondents exposed to clean fuels (e.g., electricity, liquid petroleum gas, natural gas, and biogas) and respondents exposed to polluting fuel (e.g., kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, and animal dung). Results: The results showed that children exposed to household polluting fuels in Chad were 215% more likely to develop ARI than those not exposed to household air pollution (OR = 3.15; 95% CI 2.41 to 4.13). Further analysis revealed that the odds of ARI were 185% higher (OR = 2.85; 95% CI 1.73 to 4.75) among children living in rural residents and those born to teenage mothers (OR = 2.75; 95% CI 1.48 to 5.15) who were exposed to household polluting fuels compared to their counterparts who were not exposed. In summary, the results of the study show that the risk of ARI is more common among children who live in homes where household air-polluting cooking fuel is widely used, those living in rural areas, those living in socioeconomically deprived neighbourhoods and from the least wealthy households, and those born to teenage mothers in Chad. Conclusions: In this study, an independent relative contribution of variables, such as HAP from cooking fuel, neighbourhood deprivation, living in rural areas, being from a low-income household, having a mother who is a manual labourer worker, and being given birth to by a teenage mother, to the risk of ARI among children is established. Full article

As global urbanisation is rising and public health challenges intensify, this systematic review is conducted at a critical time to explore and explain the associations between the parameters of green environments and nuanced adaptive neuroplasticity in the human brain to advance the development of health-focused sustainable cities and buildings in line with the concept of neurosustainability. This review includes studies involving participants of all ages and genders, with no restrictions on health conditions, exposed to green environments regardless of built environment comparisons. A systematic search of Scopus, PubMed, and Web of Science identified relevant studies published up to November 2024. The risk of bias was assessed using the PEDro scale and ROBINS-I domains, and data were analysed narratively due to heterogeneity. Twenty-three studies were included, conducted across the USA, UK, Germany, Spain, Bulgaria, the Netherlands, Japan, and South Korea. Findings reveal that green environments are associated with positive, region-specific brain changes across the lifespan, surprisingly from before birth to late adulthood. While forests showed more significant effects than blue spaces or urban green spaces, residential greenness emerged as a consistently effective exposure, especially within a 300–500 m buffer around home addresses, provided that sky visibility is present. Notably, no studies have examined green architecture or biophilic interiors, although they are more proximal, are associated with greater exposure time, have antagonistic effects, and may potentially limit sky visibility, highlighting a key gap for future research. Limitations include heterogeneity in exposure definitions, methodologies, and targeted brain regions. Still, this review offers a novel synthesis, providing insight into how greening the built environment may sustain not only the planet but also the plasticity of the brain. This review is registered with INPLASY (INPLASY2024110103) and forms part of a doctoral research project funded by the Cambridge Trust in partnership with the Jameel Education Foundation. Full article

Experiences of out-of-home care (placement in foster-family care or residential care) and parental death in childhood are known risk factors for premature all-cause mortality. However, it remains unclear whether parental death during placement moderates the association between out-of-home care and mortality, particularly when considering the timing and duration of placement. Longitudinal register data from 10 Swedish birth cohorts (n = 948,483) were analyzed. Around 2.5% (n = 23,628) had out-of-home care experience during ages 0–19. Sex-specific Cox proportional hazard regression models assessed associations between experience of out-of-home care (categorized by timing and duration), parental death, and premature all-cause mortality (ages 20–47). Both men and women with out-of-home care experience displayed increased risk of premature all-cause mortality, as did those who experienced parental death before age 20. However, statistical interaction analyses revealed no moderating effect of parental death on the association between placement and premature all-cause mortality. Compared to non-placed individuals, parental death during placement in out-of-home care did not further increase the risk of premature mortality across placement groups. Possible reasons include strong attachments within the out-of-home care setting or reduced stress towards biological parents. Further research is needed to explore the complex dynamics of parental loss within out-of-home care populations. Full article

Background: Acute diarrheal disease remains a leading cause of childhood morbidity and mortality, particularly among children under five. Despite being preventable and treatable, cultural, socioeconomic, and familial factors influence home management. This study examined how these factors shape childhood diarrhea care in Ecuador. Objective: To analyze maternal, child, and household characteristics associated with diarrhea management in children under five years of age using data from the 2018 Ecuadorian National Health and Nutrition Survey (ENSANUT). Methods: This cross-sectional study applied logistic regression models to assess the influence of various factors on diarrhea management practices. Results: Maternal education, ethnicity, child’s age, household size, and urban or rural residence significantly influenced diarrhea management. Households with 4–6 persons (OR = 1.584, p < 0.05) and 7–9 persons (OR = 2.006, p < 0.05) had higher odds of receiving medical care. However, the child’s sex, birth order, maternal marital status, and socioeconomic status were not significant predictors. Conclusions: Although most children received some form of healthcare, disparities persisted, particularly in education level, ethnicity, and rural residence. These findings highlight the need for targeted maternal health literacy programs, culturally tailored interventions, and improved water-security initiatives to enhance diarrhea management and reduce inequities in care. Full article

When a child is placed in out-of-home care, parents must adapt their parenting to a unique situation governed by Child Welfare Services (CWS). Contact arrangements between parents and children are particularly important, as they provide the primary opportunity for parents to maintain a meaningful connection and participate in their children’s lives. This article explores how mothers with migration experiences navigate their motherhood when it is regulated by the CWS in Norway. Drawing on semi-structured interviews and a photo-elicitation task with eight birth mothers, the study sheds light on how they perceive and talk about staying connected with their children living in out-of-home care during contact visits. Three themes were identified through a narrative-inspired thematic analysis: (1) mothers’ active efforts to organise meaningful contact visits for their children; (2) their struggles to maintain family cohesion and belonging; and (3) the constraints they face in their emotional care work due to regulated and limited contact. These findings illustrate how contact visits function as an essential but also challenging space for motherhood. We argue that by recognising mothers’ perspectives, resources, and challenges during the limited and regulated contact visits, CWS can offer more culturally sensitive and supportive parental follow-up. Full article

Background: Pregnant women are likely to experience depression due to various factors. Hypnobirthing is a non-invasive therapy that can be used to treat depression during pregnancy. This study aims to systematically review the effect of hypnobirthing on antenatal depression. Methods: This study employs a systematic review following PRISMA guidelines. Articles were retrieved from PubMed, ScienceDirect, the Cochrane Library, Google Scholar, and hand searches. Articles were included for review if they met the following inclusion criteria: (1) published in the last ten years (2014–2024); (2) the articles published in English; (3) article types are original research articles and reviews; (4) the full text can be retrieved; and (5) the findings of the selected articles should discuss the effect of hypnobirthing or hypnosis for birth. Articles were critically appraised using Joanna Briggs Institute tools. Results: The initial search yielded 7603 records; nine studies met the inclusion criteria for systematic review, and four studies for meta-analysis. The articles were analyzed, and findings were presented in narrative ways and categorized into three themes: the effect of therapy, the administration of the therapy, and the mechanism of the therapy. The therapy was performed by different methods, involving hypnosis, daily relaxation, progressive muscle relaxation, breathing exercises, the J-breathing technique, meditation, visualization, and ego strengthening. Additionally, participants were encouraged to do self-practice at home and were followed up by personal visits, phone calls, or text messages. Conclusions: The majority of the studies found that hypnobirthing ameliorated antenatal depression, despite the variation in initial administration and the duration of therapy. Further research is needed to standardize therapy protocols and explore long-term outcomes. Full article