Search Results (581)

Background/Objectives: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy associated with adverse maternal and neonatal outcomes. Data on GDM in Central Asian populations remain limited. This study aimed to identify factors associated with GDM and evaluate selected obstetric outcomes among pregnant women in Kazakhstan. Methods: A retrospective case–control study based on medical record data was conducted among 256 pregnant women, including 106 women with GDM and 150 women with normal glucose tolerance. GDM was diagnosed using a 75 g oral glucose tolerance test according to the International Association of Diabetes and Pregnancy Study Groups criteria. Demographic, clinical, anthropometric, laboratory, and obstetric data were obtained from medical records. Multivariable logistic regression was used to identify factors statistically associated with GDM. Obstetric outcomes were compared using unadjusted analyses. Results: Women with GDM were older than controls (31.6 ± 5.8 vs. 28.6 ± 5.3 years, p < 0.001) and had a higher pre-pregnancy body mass index (BMI) (29 [25–33] vs. 26 [23–29] kg/m², p < 0.001). Thyroid-stimulating hormone levels were also higher in the GDM group (p = 0.026). In multivariable analysis, pre-pregnancy obesity (adjusted OR 4.54, 95% CI 2.08–9.91; p < 0.001) and educational level (overall p = 0.001) remained associated with GDM, whereas maternal age was not independently associated after adjustment. Hypertension (24.5% vs. 2.0%; p < 0.001), eclampsia (3.8% vs. 0%; p = 0.028), cesarean delivery (52.8% vs. 28.0%; p < 0.001), and fetal macrosomia (21.7% vs. 12.0%; p = 0.037) were more frequent among women with GDM. No significant difference was observed in neonatal birth weight. Conclusions: Pre-pregnancy obesity and educational level were independently associated with GDM. Women with GDM more frequently experienced hypertensive complications, cesarean delivery, and fetal macrosomia; however, these findings were based on unadjusted analyses and should be interpreted cautiously. Further multicenter prospective studies are needed to confirm these findings in Central Asian populations. Full article

Parental education, as institutionalized family cultural capital, is significantly associated with children’s academic performance. Using provincial-level academic quality monitoring data, this study employs hierarchical linear models and path analysis to examine how parental education levels and matching patterns relate to urban primary school students’ academic performance. Key findings: Higher overall parental or paternal education is positively associated with performance; however, maternal education exhibits an inverted U-shaped relationship. Compared to both parents non-highly-educated families, students perform significantly better when both parents are highly educated or when fathers are highly educated and mothers are not, but significantly worse in families where the mother is highly educated while the father is not. Path analysis indicates that the negative association in mother-hypergamy families is partly statistically associated with reduced paternal learning involvement, which in turn is related to heightened academic pressure and poorer outcomes. The study suggests that the lower academic performance observed in mother-hypergamy families may be partly associated with reduced paternal learning involvement, highlighting the importance of family educational configuration and balanced co-parenting dynamics. These findings suggest that the association between parental education and children’s academic performance is not straightforward. While consistent with cultural reproduction and family investment perspectives, the detrimental effect of the mother-hypergamy pattern highlights the importance of family configuration and points to the potential roles of role conflict, co-parenting dynamics, and expectation-pressure mechanisms that warrant direct empirical investigation in future research. Full article

Background: Neonates and young infants are susceptible to vaccine-preventable diseases because of immature immune responses and delayed acquisition of vaccine-induced protection. As household members and caregivers are a major source of exposure, international organizations recommend cocooning, i.e., vaccination of susceptible individuals who are in regular contact with infants, to provide complementary indirect neonatal protection. To evaluate cocooning implementation, we assessed influenza and pertussis vaccination uptake among mothers and close contacts of hospitalized neonates and identified factors associated with vaccine uptake. Methods: Mothers of neonates hospitalized in a Neonatal Intensive Care Unit (NICU) between 1 January 2022 and 31 December 2024 were invited to complete a structured questionnaire. Mothers reported their own vaccination status and that of the neonate’s close contacts. Associations between maternal characteristics and vaccine uptake were examined using logistic regression. Results: In total, 405 mothers participated. Influenza vaccination uptake was 47.6% among mothers, and at least one adult close contact was vaccinated in 53.6% of families. Pertussis vaccination uptake was 40.5% among mothers, and at least one adult close contact was vaccinated in 32.3% of families. The most frequently reported reason for non-vaccination was low perceived need among unvaccinated mothers (74.1% for influenza and 83.4% for pertussis) and among families with incompletely vaccinated adult close contacts (81.8% for influenza and 89.7% for pertussis). In multivariable analyses, higher maternal education was associated with increased uptake of both influenza (OR 2.36, 95% CI: 1.47–3.80, p < 0.001) and pertussis vaccination (OR 4.25, 95% CI 2.02–8.94, p < 0.001), whereas younger maternal age (≤25 years) was associated with lower influenza vaccine acceptance (OR 0.24, 95% Cl: 0.1–0.60, p = 0.002). Conclusions: Vaccination uptake among mothers and adult close contacts of NICU-admitted neonates was suboptimal for both influenza and pertussis vaccines. Targeted counseling before delivery, reinforced during maternity or NICU hospitalization as a catch-up opportunity, and system-level implementation measures aligned with the dominant barrier of low perceived need are needed to strengthen cocooning in this high-risk population. Full article

Background: Gestational anemia represents a major public health challenge in Peru, with a national prevalence ranging from 20% to 27.9%; however, the northern regions remain insufficiently studied. This study aimed to explore the multidimensional structure of clinical and sociodemographic characteristics among pregnant women with gestational anemia treated in northern Peru. Methods: A cross-sectional study was conducted among 70 pregnant women diagnosed with gestational anemia and treated at the Chicama micro-network in the La Libertad region during 2024. Sociodemographic, territorial, reproductive, and nutritional variables were obtained from medical records. Principal Component Analysis for Categorical Data (CATPCA) was applied to identify multidimensional patterns associated with anemia severity. Results: The CATPCA identified a two-dimensional structure explaining 38.47% of the total variance. Dimension 1 (sociodemographic–territorial profile; 22.55%) included health facility (−0.925), educational level (0.887), maternal age (0.878), and district of origin (−0.871). Dimension 2 (reproductive–biological profile; 15.91%) included number of previous pregnancies (0.909), interpregnancy interval (0.909), and body mass index classification (0.589). Multivariate profiles showed that mild anemia (n = 49) was predominantly associated with pregnant women younger than 20 years, lower educational attainment, and rural settings. In contrast, moderate/severe anemia (n = 21) was more frequently associated with women aged 20–35 years, secondary or higher educational attainment, and urban healthcare settings, contrary to the conventional expectation that higher educational attainment acts as a protective factor against anemia. Additionally, mild anemia was associated with multiparity and overweight/obesity, whereas moderate/severe anemia was linked to primiparity and normal BMI. Conclusions: Gestational anemia in northern Peru follows a two-dimensional pattern in which sociodemographic and territorial characteristics showed greater explanatory contribution than reproductive–biological factors. Distinct anemia severity profiles were identified, highlighting the need for context-specific prenatal care strategies and targeted public health interventions. Full article

Background/Objectives: The aim of this study was to examine the discrepancy between nutrition-related knowledge (NRK) and nutrition-related practice (NRP) among 1440 Polish school-aged students (10–18 years), according to BMI status, and to identify factors associated with this discrepancy. Methods: This cross-sectional study was conducted via the CAWI method using an author-developed, non-validated questionnaire. Questions assessing NRK and NRP were thematically aligned and referred to the recommendations of the Polish Healthy Eating and Lifestyle Pyramid for Children and Adolescents (aged 4–18 years). Results: Students with excess weight scored significantly lower in nutritional knowledge (NRK: 46%) and practices (NRP: 30%) than those with underweight or normal weight (NRK: 52–53%, NRP: 33–34%). Higher NRK was associated with older age, female sex, larger urban residence (for students with overweight and obesity), and higher maternal/legal guardian education level (for students with normal/underweight body weight). Better NRP was associated with higher NRK and higher physical activity, while rural or small-town living was positively associated with healthier dietary practices and maintenance of normal BMI. Conclusions: The present study confirms that nutritional knowledge is a necessary but insufficient condition for shaping appropriate dietary behaviors among adolescents with different BMI statuses; lifestyle factors, practical food-related skills—including self-assessment of knowledge and adherence to dietary recommendations—and the broader environmental context plays a crucial role. These findings highlight the need for targeted nutrition education programs that expand not only knowledge but also practical skills among students. Full article

Background: Congenital infections included in the TORCH complex remain an important cause of fetal and neonatal morbidity and mortality, being associated with miscarriage, intrauterine growth restriction, congenital malformations, neurological impairment, and long-term developmental sequelae. Prenatal serological screening may contribute to the early identification of maternal infections and facilitate preventive and therapeutic interventions. However, data regarding the utilization of TORCH screening and associated socio-demographic determinants in Romania remain limited. Objective: This study aimed to evaluate the self-reported uptake of prenatal serological testing for one or more infections included in the TORCH complex, particularly Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV), and syphilis, and to identify socio-demographic, obstetrical, and prenatal care-related factors associated with TORCH testing among pregnant women in Romania. Materials and Methods: A cross-sectional observational study was conducted using an online self-administered questionnaire completed by 1301 pregnant women from Romania. Data collection was performed between August 2022 and March 2023 through digital platforms, including social media and pregnancy-related forums. The primary outcome was self-reported performance of serological testing for at least one TORCH-related infection during pregnancy. Associations between explanatory variables and TORCH testing were evaluated using chi-square tests and multivariable binary logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: Overall, 75.6% of participants reported undergoing serological testing for at least one infection included in the TORCH complex during pregnancy, while 49.3% reported a complete TORCH panel. The most frequently reported investigations were for Toxoplasma gondii (92.8%) and rubella virus (89.9%), whereas HSV testing was less commonly reported (42.5%). Lower educational level was the strongest independent factor associated with reduced likelihood of TORCH testing (adjusted OR = 0.08; 95% CI: 0.03–0.19; p < 0.001) (adjusted OR—aOR). Unemployment status (aOR = 0.70; 95% CI: 0.50–0.99; p = 0.045) and multiparity (aOR = 0.62; 95% CI: 0.49–0.77; p < 0.001) were also associated with lower testing uptake. In contrast, participation in prenatal education programs was associated with increased likelihood of TORCH testing (aOR = 1.37; 95% CI: 1.04–1.80; p = 0.024). The number of prenatal consultations was not independently associated with testing uptake. Conclusions: The uptake of prenatal serological screening for congenital infections (assessed using an expanded Romanian panel that includes hepatitis B and HIV in addition to the classical TORCH agents) in Romania appears to be influenced predominantly by socio-educational and behavioral factors rather than by the quantitative utilization of prenatal care services alone. Given the online recruitment strategy and the predominantly urban and highly educated sample, the reported uptake rates may overestimate population-level coverage. Significant inequalities in access to preventive prenatal investigations were observed, particularly among women with lower educational and socio-economic status. Strengthening prenatal education programs and improving equitable access to standardized prenatal screening may contribute to optimizing congenital infection prevention and maternal–fetal health outcomes. Full article

Background/Objectives: Postpartum depression (PPD) is a significant public health issue, particularly in high-risk pregnancies where medical complexities increase maternal vulnerability. This study aimed to determine the prevalence of PPD in a high-risk parturient population and to explore factors associated with PPD using a telepsychiatry-based longitudinal follow-up model. Methods: This longitudinal pilot study followed 58 women who met high-risk pregnancy criteria at a university hospital in Turkey. Initial assessments were conducted face-to-face within 72 h post-delivery, followed by telepsychiatric evaluations at the first and second months postpartum. PPD was diagnosed via structured clinical interviews based on DSM-5 criteria, supplemented by the Edinburgh Postnatal Depression Scale (EPDS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Logistic regression was used to explore factors associated with PPD. Results: The cumulative prevalence of PPD during the first two postpartum months was 32.7%: 13 participants (22.4%) were diagnosed at month 1, and 6 additional new-onset cases (10.3%) were identified at month 2. In the exploratory multivariable logistic regression model, low marital satisfaction (OR = 26.13, p = 0.005), lower postpartum MSPSS total scores (OR = 0.90, p < 0.001), the presence of a fetal anomaly (OR = 15.10, p = 0.043), and a lower spousal education level (OR = 17.19, p = 0.014) were associated with PPD. However, these estimates should be interpreted cautiously because of the limited number of PPD events and wide confidence intervals. Notably, comorbid medical conditions and stressful life events during pregnancy did not remain significant in the final model. Conclusions: The observed PPD prevalence in this selected high-risk cohort was higher than previously reported general-population estimates. Psychosocial factors, particularly marital satisfaction and perceived social support, showed strong associations with PPD in this pilot cohort. A fetal anomaly may also represent an important clinical risk marker, but this finding requires confirmation in larger samples. A telepsychiatry-based follow-up model appears feasible for postpartum mental health assessment in this vulnerable group and may help support the early identification of PPD. Full article

Background/Objectives: Early childhood is an important period when growth and adiposity patterns emerge and may persist into later childhood. Children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) face elevated obesity risk. We characterized BMI-for-age z-score (BMIz) trajectories from 24 to 60 months and their child-, caregiver-, and household-level correlates. Methods: This was a secondary analysis of the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2) public-use dataset. We analyzed 5,583 BMIz observations from 2,247 dyads; adjusted models used 4,314 observations from 1,738 children. Linear mixed-effects models tested individual, interpersonal, and household predictors. Restriction and pressure-to-eat were lagged, time-varying exposures. Results: Mean BMIz was elevated at all waves (0.46 to 0.56). Obesity prevalence rose from 15.4% to 18.5%. Unconditionally, BMIz was stable from 24 to 48 months and rose by 60 months. Adjusted models linked higher BMIz to higher birth weight, Hispanic or Latino ethnicity, birth complications, maternal overweight or obesity, paternal overweight, prenatal smoking, adolescent maternal age, and lower maternal education. Male sex was associated with lower BMIz. Prior-wave restriction was associated with higher, and pressure to eat with modestly lower, subsequent BMIz. Household indicators showed no independent association. Conclusions: Caregiver and perinatal characteristics and feeding practices were the most consistent modifiable correlates of late-preschool BMIz. These observational, complete-case findings warrant caution. The 48–60-month window may be a promising period to target for WIC-based obesity prevention. Full article

Background/Objectives: Anemia in early childhood remains a key global health issue due to its impact on growth and development. While biological determinants of anemia have been extensively studied, parenting styles remain unexplored. This study aimed to examine the association between parenting styles, anemia, and developmental outcomes among under-five children. Methods: From February to March 2026, a cross-sectional study was carried out in Bandung, Indonesia, involving children aged 6–59 months who visited the Pasirkaliki Primary Health Centre. Anemia was confirmed by laboratory testing, defined as a hemoglobin level ≤ 11 g/dL. The Parenting Styles and Dimensions Questionnaire was used to assess parenting styles, while the Pre-Screening Developmental Questionnaire was used to examine child development. Statistical analyses were performed using the Mann–Whitney U test, Chi-square test or Fisher’s exact test, and logistic regression analysis. Results: One hundred and ninety-three subjects were included in the analysis, among which 20.2% were anemic, with a significantly higher proportion among children aged below 24 months (p < 0.001). Permissive parenting was significantly more common among children with anemia and was associated with higher odds of anemia (aOR = 10.31; 95% CI: 3.92–27.10). Children with anemia had significantly higher odds of developmental delay (aOR = 19.49; 95% CI: 6.46–58.84), after adjustment for child age, maternal education, and family income. Conclusions: Permissive parenting was associated with anemia, while anemia was associated with increased odds of developmental delay in under-five children, highlighting the importance of considering not only biological but also psychosocial factors in early child health interventions. Full article

This study examines how mothers raising children with disabilities in American Samoa experience the processes of seeking diagnosis, navigating special education, and advocating for services within an insular rural context. American Samoa, an unincorporated U.S. territory located 2600 miles from Hawaiʻi with a population under 50,000, represents a case of what we term insular rurality—a condition in which the structural disadvantages of rurality are intensified by oceanic isolation, territorial governance, and colonial history. Data were collected through three focus groups with fifteen mothers whose children hold a range of disability diagnoses, with a card sort activity at the outset of each session serving as an idiographic anchor to protect individual voice within the group format. Analysis followed Interpretative Phenomenological Analysis adapted for focus groups (IPA-FG), proceeding from line-by-line exploratory noting through Personal Experiential Themes and Group Experiential Themes within each focus group case to cross-case convergence and divergence analysis, interpreted through the Fonofale model of Pacific wellness. Findings reveal two overarching themes: systemic invalidation, in which mothers encountered deficit-based assumptions, stagnant educational goals, and institutional disengagement; and parent peer support as the primary infrastructure, in which mothers became de facto experts, built community-driven solutions, and envisioned more inclusive futures. Technology emerged as a contradictory force—valuable for parent learning but largely ineffective for children’s remote therapy. These findings suggest how workforce shortages and geographic isolation create conditions in which maternal advocacy becomes a systems-level necessity rather than a personal choice. Implications for rural education policy, IDEA implementation in U.S. territories, and culturally grounded family support are discussed. Full article

Objectives: This study aims to assess the acceptance of vaccinations among pregnant women, particularly against influenza, pertussis, COVID-19, and RSV, and to identify factors influencing their willingness to get vaccinated. It also seeks to evaluate the impact of the COVID-19 pandemic on maternal attitudes and behaviors regarding vaccination. Methods: The analysis involved a review of existing literature and studies to evaluate the level of vaccine acceptance among pregnant women before and after the COVID-19 pandemic. Factors contributing to vaccine hesitancy, including misinformation, lack of knowledge, and the influence of healthcare professionals, were examined. Results: The findings indicated that, despite scientific evidence supporting the safety and efficacy of vaccines during pregnancy, public concerns remain about their impact on the developing fetus. The outbreak of the COVID-19 pandemic has increased awareness of the risk of infectious diseases, but at the same time, its impact on vaccination rates among pregnant women is ambiguous and geographically diverse. Misinformation and decreased access to healthcare during the pandemic negatively affected vaccine uptake. Trustworthy information provided by healthcare professionals emerged as a key factor in promoting vaccine acceptance. Conclusions: To improve vaccination rates among pregnant women, it is essential to provide clear, evidence-based information through healthcare professionals, particularly those directly caring for pregnant women. Educational campaigns should address concerns calmly and without judgment, emphasizing the safety and benefits of vaccinations. Enhanced access to healthcare and vaccinations, along with strategic information dissemination, can significantly improve vaccine acceptance during pregnancy. Lessons learned from past pandemics should be incorporated into the development of healthcare strategies aimed at implementing recommended vaccinations for pregnant women in the future. Full article

This study investigates the “competence–performance gap” between cognitive ability (measured by the WISC-IV) and actual adaptive performance (measured by the ABAS-II) in children with autism spectrum disorder (ASD), and examines the moderating role of family environment, specifically parental education levels. We applied Latent Profile Analysis (LPA) to cross-sectional data from 3246 children with ASD (aged 6–16 years). The analysis identified three distinct cognitive–adaptive subgroups: the Balanced High-Functioning group (33%), the Classic Mismatch group (44%), and the Cognitively Vulnerable group (23%). Notably, the Classic Mismatch group was characterized by adaptive performance that significantly trailed cognitive potential. Multinomial logistic regression revealed that maternal education—but not paternal education—significantly predicted a child’s likelihood of being in the “Balanced High-Functioning” group. This moderating effect was especially pronounced during the school-age years. These findings highlight the critical role of environmental factors in the translation of intellectual potential into practical social adaptive functioning, providing theoretical support for targeted family-based interventions. Full article

Migrant mothers experience high levels of acculturative stress while raising children in a new cultural environment. Such stress can negatively impact parenting behaviors and child development. This study draws on the Family Stress Model and ecocultural theory to examine the mediating role of mindful parenting and the moderating effects of multicultural sensitivity and social support in the relationship between acculturative stress and the social skills of young children (aged 1–7 years) of migrant mothers. Validated self-report measures were used to collect data from 338 migrant mothers residing in South Korea. The PROCESS Macro was used to analyze the data and examine the moderated mediation model. Maternal education, household income, spouse’s country of origin, and reason for migration were controlled. The results indicated that acculturative stress was associated with reduced social skills in young children due to diminished mindful parenting, which exhibited a significant mediating effect. Furthermore, multicultural sensitivity and social support each showed significant moderating effects on the respective pathways. These findings suggest that providing mindful parenting support and fostering culturally and socially supportive environments for migrant mothers can enhance the social competencies of their young children. Full article

Socioeconomic inequities are associated with longer length of hospital stay (LOS) and clinical severity in children. This retrospective cross-sectional study analyzes health inequalities and area-level deprivation, focusing on hospitalization indicators, in a suburban pediatric population in Portugal. Pediatric admissions to a local general hospital were analyzed for LOS and admission to intensive care unit (ICU), as well as their relation to socioeconomic factors, over an 8-year period (2014 to 2021), using population-averaged models. Area-level inequalities were measured for the population ranked by civil parishes’ European Deprivation Index. 8016 admissions were included. Health inequalities associated with socioeconomic deprivation were observed, with concentration curves above the diagonal for LOS and admission to ICU and located in urban and densely populated civil parishes. Neonatal age showed the highest mean LOS ratio (MR = 2.29, 95% CI 1.96; 2.67, p < 0.001) and ICU admission odds (OR = 9.25, 95% CI 4.84; 17.68, p < 0.001). Mean LOS ratio was significantly higher for Black ethnicity (MR = 1.19; 95% CI 1.10; 1.28, p < 0.001) and lower maternal education. Odds of admission to ICU was significantly higher for male gender (OR = 1.25, 95% CI 1.01; 1.55, p = 0.048) and mother’s unskilled occupation (OR = 1.66, 95% CI 1.09; 2.53, p = 0.019). Paternal manual skilled occupation demonstrated 17% higher mean LOS ratio (p < 0.001) and 51% higher odds of admission to ICU (p = 0.019). Public policies must be culturally competent and target socioeconomic and geographical deprivation. Full article

Introduction: Prelacteal feeding, the practice of giving newborns substances other than breast milk within the first few days of life, remains a common yet harmful practice in many low- and middle-income countries, including Ethiopia. No evidence in Ethiopia indicates that mHealth can help improve prelacteal feeding. This study aimed to evaluate the effect of mobile health (mHealth) intervention on reducing prelacteal feeding practices and improving antenatal care (ANC) and postnatal care (PNC) utilization among mothers in South Ethiopia. Methods: A cluster-randomized controlled trial (CRT) was conducted in rural areas of South Ethiopia. A total of 20 clusters were selected using simple random sampling for intervention (mHealth) and control groups, each containing 340 women. Mothers in the intervention group received automated weekly SMS messages and reminders on exclusive breastfeeding, prelacteal feeding risks, ANC, and PNC. Mothers were only selected if they could read, write, and use mobile phones. Results: The mHealth intervention significantly reduced prelacteal feeding practice (AOR = 0.19, 95% CI: 0.06–0.58); p < 0.05). Higher ANC visits related to decreased prelacteal feeding (AOR = 0.28, 95% CI: 0.21–0.39; p < 0.001). The log count of ANC visit increased by 0.14 among intervention groups (IRR = 1.15, 95% CI: 1.06–1.25; p < 0.001). The PNC time was delayed 2.05 days among controls (β = −2.05, 95% CI: −2.66–−1.42; p < 0.001). Maternal and partner education, postnatal time, and ANC visits influenced prelacteal feeding. Conclusions: This finding might suggest that mHealth can reduce prelacteal feeding practices and improve maternal healthcare behaviors such as ANC attendance and timely PNC. These findings highlight the potential of mobile health interventions in promoting healthy maternal and infant practices in rural settings, where healthcare access is limited. Further research is needed to explore the long-term impacts of such interventions on maternal and child health outcomes. Multi-level analysis reduced variability. However, an unexplained variance could be reduced by including more cluster-level variables. Full article