Search Results (157)

Background/Objectives: Food insecurity (FI) affects a substantial proportion of pregnant individuals in the United States and varies across geographic contexts. Rural and urban communities differ in food access, socioeconomic conditions, and environmental exposures, yet how these differences relate to maternal biology remain misunderstood. Methods: This study examined associations between FI, geographic context, and metabolic, nutritional, and inflammatory biomarkers among pregnant participants in the Southeastern United States (SE-US) using data from the All of Us (AoU) Research Program. Survey, clinical, and laboratory data were integrated with ZIP3-level geographic and food environment indicators. Analyses were conducted using biomarker-specific complete-case cohorts and multivariable regression models. Results: This study found that FI was more prevalent among rural participants than urban participants. However, in the overall cohort, FI was associated with higher body mass index, higher non-fasting glucose, higher C-reactive protein, and lower high-density lipoprotein cholesterol. Pregnant food-insecure participants also exhibited lower concentrations of vitamin B12, albumin, vitamin D, and folate, while ferritin did not differ. Stratified analyses demonstrated variability in these associations by urbanicity, with stronger and more consistent differences observed in urban populations and fewer significant differences in rural settings. Conclusions: Limitations of this study include potential residual confounding, EHR-related selection bias, exposure misclassification, and limited generalizability. Despite the limitations, recent self-reported household FI, assessed at enrollment and referring to the preceding 12 months, was associated with differences in several metabolic and nutritional biomarkers, with patterns varying by geographic context. Further longitudinal research is needed to clarify these associations and inform targeted interventions. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Perinatal mental health remains a critical global challenge, with maternal mortality, preterm birth, and persistent disparities in care contributing to adverse outcomes for mothers. In addition, mental health difficulties in the perinatal period are associated with poorer developmental outcomes for young children and impose an economic burden on societies. Addressing these issues requires innovative approaches that can complement traditional clinical practices. Artificial intelligence (AI) has emerged as a powerful tool with the potential to transform perinatal care by enabling early risk prediction, personalised interventions, and scalable support systems. However, there are no existing reviews on use of AI across different stages of perinatal mental health. We conclude with a call to action for clinicians, researchers, policymakers, and technology developers to collaborate on a consensus framework that ensures ethical, safe, and equitable integration of AI into perinatal care. Full article

Child malnutrition remains a critical global health challenge, yet most existing studies rely on static risk estimates and overlook the spatial–temporal nature of environmental exposures and localized socioeconomic disparities. To address this gap, we integrated Earth observation-derived environmental indicators, geolocated conflict events, socioeconomic variables, and child health outcomes, and applied a Fixed Effects Two-Stage Least Squares Spatial Durbin Error Model (FE-2SLS-SDEM). We found distinct hotspots of joint vulnerability, where areas experiencing both high conflict intensity and recurrent droughts show significantly higher rates of childhood stunting. High conflict intensity, drought severity, diarrheal prevalence, and inadequate sanitation significantly increase stunting, while maternal and paternal education, improved sanitation, economic development (proxied by nighttime light intensity), and agricultural productivity reduce it. Among these determinants, female education demonstrated the most pronounced inverse relationship with childhood stunting. Additionally, exposure to both drought severity and high conflict intensity independently and in combination worsens childhood stunting not only within affected regions but also in nearby localities. Our results underscore the urgency of geographically targeted, multisectoral, and action-oriented policies aimed at strengthening community and health system capacities to mitigate the converging risks of climate change and conflict on child malnutrition. Full article

Persisting ethnic disparities in pre-eclampsia (PE), cardiovascular disease (CVD), and maternal mortality call for a paradigm shift in how ethnicity is understood as a risk factor for PE. Starting from a migrant perspective, we argue that the transgenerational experience of maternal stress within shared, yet dynamic ecosocial contexts can be linked to core pathophysiological features of PE. A growing body of evidence suggests how a vicious cycle of chronic maternal stress, cardiovascular dysfunction, placental ER stress, and endothelial dysfunction may serve as a catalyst for the transmission of altered cardiovascular and neuro-endocrine stress reactivity patterns across generations, with a seemingly important role for foetal programming and epigenetics. As these alterations in stress reactivity patterns have in turn been associated with an increased risk of PE and CVD later in life, the resulting transgenerational chain reaction may ultimately allow for ethnic disparities in PE to be traced back to historic, stressful moments in the shared ecosocial contexts of ethnic minority women. Reconceptualising ethnicity as a proxy for the stratified and embodied experience of transgenerational maternal stress within its unique ecosocial contexts, rather than a stand-alone, non-modifiable risk factor, will therefore open new directions for future research, clinical care, and policy interventions aimed at advancing maternal health equity. Full article

Maternal anemia and prenatal exposure to neurotoxic metals are widespread in low- and middle-income countries and may affect early childhood development. In Suriname, where mercury contamination from artisanal gold mining and social disparities coexist, we examined associations between maternal anemia, prenatal exposure to mercury (Hg), lead (Pb), manganese (Mn), selenium (Se), and cadmium (Cd), and early neurodevelopment. The study included 755 pregnant women and 644 children (10–26 months) from the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort. Maternal anemia was defined using WHO criteria for Hb, metals were measured in maternal blood, and child development was assessed using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III-NL). Analyses used non-parametric tests, correlations, and multivariable regression. Anemia, though common (34%), was not independently associated with cognitive, language, motor, or social–emotional outcomes. However, iron status was not directly measured; therefore, the absence of an observed association should not be interpreted as evidence that maternal iron deficiency is unrelated to early neurodevelopment. Pb showed the most consistent associations, with higher prenatal levels predicting poorer cognitive, motor, and language scores. Hg demonstrated weaker but significant negative associations with several domains, while Mn and Cd showed limited direct effects. Interaction analyses suggested a potential modifying role of Se in certain metal-neurodevelopment associations; however, these findings require confirmation in future studies. Overall, these results suggest that prenatal exposure to neurotoxic metals and sociodemographic disparities may be important contributors to variation in early neurodevelopment in this population, but causal inferences cannot be made from this cross-sectional analysis. Full article

Background: Maternal mortality remains a major global health challenge, disproportionately affecting black and Indigenous women. Hypertensive disorders of pregnancy and postpartum hemorrhage are the leading direct causes of maternal death. Artificial intelligence (AI) tools have emerged as potential strategies for predicting these complications, yet concerns persist about their equity and validation across racial groups. Methods: A rapid review was conducted in five databases, PubMed, EMBASE, Web of Science, Scopus and LILACS, to synthesize recent evidence on the use of AI for preventing maternal mortality due to hypertension and postpartum hemorrhage. Studies published in the last five years that included racial or ethnic data were selected and analyzed narratively. Results: Ten studies met the inclusion criteria, showing high predictive accuracy of AI models (AUROC often >0.95) for severe maternal outcomes. However, few models incorporated racial variables or underwent external validation in racially diverse or low-resource populations. Evidence suggests that unrepresentative datasets may perpetuate or exacerbate existing health inequities. Conclusions: AI demonstrates strong technical performance in predicting maternal complications but limited equity in application. Broader racial representation, external validation, and ethical governance are essential for ensuring that AI-based tools reduce rather than reinforce racial disparities in maternal mortality. Full article

Background: Immigrant communities and first-generation immigrants in the United States face persistent disparities in maternal health outcomes. These inequities are shaped by intersecting structural conditions, including socioeconomic exclusion, language barriers, cultural differences, and institutional constraints documented in prior research. Methods: This narrative review examined 28 peer-reviewed studies published between 2010 and 2024 that applied an intersectional framework to maternal health research focused on immigrant communities in the United States. Studies were identified through PubMed, Scopus, Web of Science, and Google Scholar. The review analyzed how each study conceptualized, designed, and interpreted maternal health in these populations. Results: Seven recurring themes were identified: barriers to and access to care; gaps in clinical guidance; limitations in health data and surveillance; immigration-related policy context; health system influences; intersectional vulnerability across subgroups; and the role of individual- and community-level supports. Conclusions: The literature highlights the importance of community-based strategies, Medicaid policy considerations, and culturally responsive care in addressing maternal health disparities among immigrant communities. Advancing birth equity will require coordinated efforts across healthcare systems, public health programs, and policy environments. Full article

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes. Full article

Maternal hemorrhage (MH) remains a leading preventable cause of maternal health, yet global disparities on its burden remain poorly quantified. Using the Global Burden of Disease 2021 data, we analyzed global, regional, and national trends in age-standardized maternal mortality ratio (ASR_MMR) attributed to MH from 1990 to 2021. We applied Joinpoint regression, age–period–cohort modeling, inequality indices and frontier analysis. This descriptive–analytical ecological study is based on modeled secondary data. Globally, the proportion of ASR_MMR attributed to MH declined from 33.31% in 1990 to 24.52% in 2021 (relative reduction: 24.24%). ASR_MMR attributed to MH consistently declined, with an estimated annual percentage change (EAPC) of −3.17 (95% UI: −3.42, −2.91). In 2021, Central and West Africa countries reported ASR_MMR attributed to MH exceeding 300 per 100,000 live births, while the Caribbean experienced a temporary increase. ASR_MMR attributed to MH was strongly inversely correlated with the socio-demographic index (SDI). Absolute inequality (slope index of inequality) narrowed by 49.4%, while relative inequality (concentration index) increased by approximately 27.5%. Countries with the largest negative deviations from the frontier included Somalia, the Central African Republic, Chad, Nigeria, and Afghanistan. While substantial global progress has been made, socioeconomic inequities continue to drive persistent disparities in MMR attributed to MH. Policies must not only address average reductions but also the widening relative gap between advantaged and disadvantaged populations. Full article

The incidence of cancer during pregnancy is rising, yet scientific understanding and clinical management remain underdeveloped. Delayed diagnoses, limited therapeutic options, and lack of safety data exacerbate the clinical challenges of treating cancer during pregnancy. Further, the biology of gestational cancers is poorly understood due to the scarcity of model systems and mechanistic studies. This manuscript presents a multidisciplinary perspective from a group of researchers and clinicians to evaluate the current state of pregnancy-associated cancers, identify unmet clinical and biological questions, and propose strategies to improve diagnosis, treatment, and maternal–fetal outcomes. Full article

The United States faces a worsening maternal mortality crisis that starkly contrasts with trends in other high-income nations. Maternal mortality rates (MMRs) have more than doubled over the past two decades, rising from 9.65 deaths per 100,000 live births in 1999–2002 to 23.6 in 2018–2021, with approximately 700 deaths annually. Black and American Indian/Alaska Native women experience maternal mortality rates two to three times higher than their White counterparts, reflecting persistent structural inequities rather than biological differences. This narrative review synthesizes current evidence on the underlying drivers of racial inequities in maternal mortality and evaluates evidence-based interventions and policy strategies to address these disparities. A comprehensive literature review between 2000 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies examining clinical, social, and structural determinants of maternal health outcomes, as well as evidence-based interventions and maternal health policy. Targeted searches of policy reports and grey literature were also performed to identify relevant policy initiatives and system-level interventions. Key contributors to disparities include underlying health conditions, postpartum mental health inequities, provider shortages, and limited access to postpartum care, with pregnancy-associated breast cancer (PABC) representing a less common but clinically significant risk factor that warrants further investigation in the context of racial inequities. Structural racism and socioeconomic disparities further exacerbate inequities through differential access to care, treatment bias, and barriers to healthcare utilization. System-level challenges, including workforce shortages, maternity care deserts, and the absence of federally mandated paid maternity leave, disproportionately impact marginalized populations. Although policy initiatives such as Medicaid postpartum coverage extensions, the Maternal Health Momnibus Act, and Maternal Mortality Review Committees represent important progress, they remain insufficient without broader structural reform. Evidence-based interventions, including midwife- and doula-led care, community-based peer support, and culturally tailored mental health programs, demonstrate measurable improvements in maternal outcomes. Outcomes of this review highlight the need for a comprehensive, equity-centered approach to reducing maternal mortality disparities, emphasizing structural reform, expanded access to care, strengthened data systems, and community-driven solutions. Full article

The United States faces a maternal health crisis marked by stark racial disparities. Although doula support has emerged as an evidence-based intervention to improve perinatal outcomes by addressing social determinants of health, its integration into healthcare systems remains limited. This qualitative study, informed by phenomenological principles, examined multi-level experiences, perceived barriers, and perceived facilitators of integrating doula services into perinatal care systems and their intersection with health equity goals. We conducted 17 semi-structured interviews with 20 participants across Nebraska and Tennessee, including doulas, midwives, physicians, Medicaid administrators, and public health professionals, and analyzed data using reflexive thematic analysis guided by the Socio-Ecological Model. Three themes emerged: the integration paradox, an overarching theme capturing tensions between doula independence and healthcare system demands for standardization, including divergent views on practice models, provider dynamics, and certification; sustainable financing as the prevailing barrier, encompassing grant limitations, private pay inequities, absent Medicaid reimbursement, and the need for cost-effectiveness evidence; and cultural concordance as the prevailing facilitator, including cultural matching, addressing social determinants, and lived experience as motivation. Sustainable doula integration requires reconciling system demands for standardization with the relational, culturally responsive characteristics that define effective care, through Medicaid reimbursement pathways and policy reforms developed in partnership with doula communities. Full article

Objective: This study aimed to estimate the trends, projections, and determinants of standalone and coexisting forms of malnutrition (CFM) at the global, regional, national, and individual level among children under five in low- and middle-income countries (LMICs). It also assessed the projection trajectory towards the 2030 global nutrition targets (GNTs) for child growth including stunting, wasting, obesity, and CFM. Methods: Data from 48 LMICs were analyzed using the Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). Children with complete anthropometry were included for national- and individual-level descriptive analyses. Projected prevalence of each form of malnutrition, including CFM, was calculated using the Annual Rate of Change. Inferential analyses employed generalized linear regression models with two-way interaction terms to identify determinants of each malnutrition type. Findings: By 2030, 22 of 48 LMICs are projected to achieve the GNT of stunting, wasting, and obesity, that is up from 10 countries currently, while Yemen and Zimbabwe are expected to remain off-track. Stunting is the most prevalent form, affecting 42 countries, with nine nations projected to have over 50% of children affected by a form of malnutrition. Wasting, obesity, and CFM are rising in several countries. Maternal education and household wealth were the strongest determinants, with children of uneducated mothers and from poorest households at the highest risk. Inequalities are narrowing slowly by 1–2% per year, and marked regional disparities persist. Conclusions: Many LMICs are off-track to meet child-growth targets when CFM is considered alongside standalone indicators. The government and global health partners must strengthen nutrition surveillance systems and equity-focused policies and programs to routinely capture CFM and prevent as well as manage all forms of malnutrition at the national and individual levels. Full article

Background/Objectives: Racial and ethnic disparities in cesarean birth and labor management persist in the United States, including among individuals considered low risk. Understanding variation in labor progression and cesarean indications within low-risk nulliparous, term, singleton, vertex (NTSV) births may help clarify potential contributors to inequities. This study examined differences in cesarean rates, cesarean indications, and labor duration by race and ethnicity in a low-risk NTSV cohort. Methods: We conducted a retrospective secondary analysis of electronic medical record data from 13,231 low-risk NTSV births within a Midwestern academic health system. Multivariable logistic regression models were used to evaluate the likelihood of cesarean birth and cesarean indications by race and ethnicity, adjusting for maternal age, gestational age, body mass index, insurance type, and labor onset. Linear regression models examined differences in first-stage, second-stage, and total labor duration. Interaction terms assessed whether associations varied by labor onset. Results: The overall cesarean rate was 29%. Absolute cesarean rates were higher among non-Hispanic Black and Hispanic individuals compared with non-Hispanic White individuals; however, these differences were not statistically significant after adjustment. Labor duration differed significantly by race and ethnicity. Non-Hispanic Black and Hispanic individuals experienced longer median first-stage and total labor durations compared with non-Hispanic White individuals; however, second-stage duration was markedly shorter among non-Hispanic Black individuals. Among induced labors resulting in cesarean birth, non-Hispanic Black and Hispanic individuals had increased odds of cesarean for early arrest of dilation, although these findings should be interpreted as hypothesis-generating, given data limitations in labor onset documentation. Body mass index was positively associated with likelihood of cesarean. Conclusions: In this low-risk NTSV cohort, adjusted cesarean rates did not differ significantly by race or ethnicity; however, differences in labor duration and cesarean indication were observed. These findings underscore the importance of continued investigation into labor management practices and structural contributors to obstetric inequities. Full article