Search Results (100)

Background/Objective: Maternal immunization is highly recommended, particularly in developed countries. However, its awareness among pregnant women in Japan remains low. This study aimed to assess the awareness and attitudes toward maternal immunization among pregnant women in Japan and to identify the factors that may promote its acceptance. Methods: We conducted a cross-sectional questionnaire survey among pregnant women attending antenatal checkups at nine facilities in Kanagawa Prefecture, Japan, from August 2024 to January 2025. The survey assessed knowledge and intention regarding maternal immunization for influenza, pertussis, respiratory syncytial virus (RSV), and group B streptococcus (GBS) as well as attitudes toward vaccination costs and information sources. Results: Overall, 523 respondents were included in this study. The overall awareness of maternal immunization was 16%. Willingness to receive vaccinations during pregnancy was reported for influenza (68%), pertussis (58%), RSV (59%), and GBS (71%). A common reason for vaccine hesitancy included uncertainty about its effects on the fetus. The key factors associated with vaccine acceptance were higher educational attainment and prior knowledge of maternal immunization. Regarding costs, most respondents were willing to pay up to JPY 5000 (approximately USD 35). The most frequently prioritized sources were explanations from physicians, followed by explanations from midwives. Conclusions: Despite low awareness, vaccination intention was comparable to that reported in other countries. Points that may contribute to improved vaccine uptake were also identified. These findings may lead to the prevention of infectious diseases in newborns and infants in Japan and possibly improve public health. Full article

Background/Objectives: Embryo selection in IVF is traditionally based on morphology, yet many high-quality embryos fail to implant. Preimplantation genetic testing for aneuploidy (PGT-A) using next-generation sequencing (NGS) has been proposed to improve selection by identifying euploid embryos. However, its effectiveness in women of advanced maternal age remains unclear due to limited randomized data. This pilot trial assessed the feasibility of a full-scale RCT comparing PGT-A to morphology-based selection in women aged 35–42. Methods: This single-centre, two-arm parallel RCT (NCT05009745) enrolled women aged 35–42 undergoing IVF/ICSI with ≥3 good-quality day-3 embryos. Participants were randomized (1:1) to either embryo selection by morphology with fresh transfer or PGT-A with frozen transfer of a single euploid embryo. Allocation concealment was achieved via a secure web-based randomization platform; patients and clinicians were unblinded, but the biostatistician remained blinded. The primary outcome was feasibility of recruitment, randomization, and adherence. Results: Between June 2021 and January 2023, 138 women consented (recruitment rate: 55.8%, 95% CI: 49.7–62.0%) and 100 were randomized. Protocol adherence was 94%. Barriers to recruitment included preference for private PGT-A (19%) or fresh transfer (6%). Among biopsied embryos, 51.4% were euploid and 6.6% low-level mosaic. Intention-to-treat analysis showed no significant differences between PGT-A and control groups in clinical pregnancy rate (50% vs. 40%), live birth rate (50% vs. 38%), or miscarriage rate (12% vs. 8%). Cumulative live birth rate after up to three SETs was 72% vs. 52%, respectively (p > 0.05). No multiple pregnancies occurred. Conclusions: RCTs of PGT-A in older women are feasible. A multicentre design with broader inclusion criteria could improve recruitment and allow better assessment of clinical benefit. Full article

Background/Objectives: Obesity during pregnancy is strongly related to increased insulin resistance, and subsequent development of metabolic syndrome-like disorders, such as glucose intolerance, pre-eclampsia, as well as preterm birth, and cesarean delivery. Nutrition can influence the evolution of glycemic response and may help improve adverse pregnancy outcomes and long-term complications. The main objective of the Nutritional Intervention during Gestation and Offspring Health (NIGOHealth) randomized clinical trial (ClinicalTrials.gov Identifier: NCT02285764) was to investigate the potential effects of a low glycemic index/slow digesting (LGI/SD) carbohydrate product on maternal glycemia (glucose AUC at 27⁺⁰–28⁺⁶ weeks; maternal fasting blood glucose (MFBG) at 34⁺⁰–36⁺⁰ weeks), and neonatal body composition. Methods: Obese pregnant women were randomized: 230 in the intervention group (IG), who consumed two servings of an LGI/SD study product daily from 15 weeks of pregnancy until delivery, and 102 participants in the Standard of Care (SOC) group. Results: When analyzing baseline characteristics, significant differences were found in glucose metabolic parameters with higher values for IG than for the SOC group, compromising the group’s comparability. Despite this, a statistical analysis was conducted (intention-to-treat analysis/evaluable cohort): no differences were detected regarding maternal blood glucose AUC at 27⁺⁰–28⁺⁶ weeks, nor for MFBG at 34⁺⁰–36⁺⁰ weeks. Nonetheless, HbA1c (%) at 34⁺⁰–36⁺⁰ weeks was significantly lower in the IG vs. the SOC group (5.26 ± 0.03, 5.31 ± 0.04, p = 0.007) after adjusting for baseline conditions. Conclusion: This result might suggest a potential effect of the intervention on Evaluable participants. However, it should be taken with caution, due to the limitations of the study. More RCTs should be carried out to explore the effects of LGI/SD products on glycemic response in obese pregnant women. Full article

The assessment of the ovarian reserve is important in patients with fertility intent. The anti-Müllerian hormone (AMH) serum level is a useful ovarian reserve marker. Endometriosis is a benign disease with three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep endometriosis (DE). Endometriosis is linked with infertility; however, the exact impact of endometriosis and endometriosis surgery on AMH levels is less clear. This narrative review examines how different endometriosis phenotypes and related surgeries affect AMH levels as well as explores whether pre- and post-surgical AMH can predict the reproductive outcomes in women seeking pregnancy. The evidence suggests that OMA is linked to reduced AMH values and a higher AMH decline rate over time. OMA cystectomy causes further a reduction in AMH, which, however, tends to recover postoperatively. Non-excisional surgery for OMA spares the ovarian parenchyma; however, an at least temporary decline in AMH is observed. The effect is likely smaller than that of cystectomy. Non-thermal methods of hemostasis following cystectomy are likely superior in terms of AMH. The AMH levels before OMA cystectomy appear to be positively correlated with the postoperative probability of pregnancy, particularly spontaneous conception, but not livebirth rates. Preoperative AMH levels are also predictive of the risk of diminished ovarian reserve (DOR). Similarly, postoperative AMH levels and the rate of AMH decline at 1 year after OMA cystectomy appear to be predictive of fertility outcomes. SUP likely has little (if any) impact on AMH levels. DE reduces AMH levels, and a further reduction following surgery is anticipated. However, a reduction in AMH values should not be interpreted as a decline in the patient’s reproductive potential. Further research should focus on the extra-ovarian locations of endometriosis and their impact on AMH values. Full article

Interpersonal violence involves intentional physical harm or force with psychological effects, influenced by interpersonal and societal factors. Health systems play a vital role in detecting and addressing such violence, requiring improved training and surveillance. Our hospital established a registry of suspected violence cases reported by healthcare professionals to enhance understanding, prevention strategies, and recognition of violence types and risk factors. Since 2009, all admitted patients suspected of experiencing violence were included, regardless of age or gender. Data from 2009 to 2022 covered demographics, violence details, medical interventions, and legal actions. Among 1284 patients, 83.4% were seen in the emergency department, with women comprising 80.8%, and with a mean age of 33.19 years. Reports of violence rose from 1.9% in 2009 to 16.9% in 2022. Risk factors included pregnancy [5.6%], age below 18 or over 80 [18.9%], disability [10.2%], and psychiatric conditions [11.3%]. Perpetrators were known in 56.8% of cases, mainly intimate partners [25.2%], with 29.4% of victims living with the aggressor. Doctors were primary reporters, and injury reports were issued in 65.5% of cases. Violence types included physical [44.5%], sexual [22.4%], psychological [13.3%], and economic [12.5%], with 36.3% of cases involving multiple types. Routine hospital screening and trained staff can improve victim support and enable injury prevention programs. Full article

Background/Objectives: The primary aim of the study was to investigate the self-reported behavior and practice of healthcare professionals (midwives and obstetricians) regarding physical activity during the second and third trimesters of pregnancy. The secondary goal of the study was to highlight sociodemographic and professional characteristics affecting the aforementioned behavior. Methods: The study was of cross-sectional design and was conducted between January 2022 and March 2023 with the participation of 235 midwives and obstetricians working in public and private facilities in the region of Attica, Greece. The participants completed a demographic characteristics form as well as a questionnaire structured to serve the aim of the study. Eight independent models of multivariate analyses of variance were performed. Results: Among the participants, over 97% recommended exercising during the second and third trimesters of pregnancy. Cardio exercises were the most commonly suggested type (93.1% in the second trimester and 88.5% in the third trimester), followed by relaxation exercises (87.7% and 89.8%, respectively). The majority recommended exercising 2–3 times per week, with session durations ranging from 15 to 30 min in the second trimester and 30 to 45 min in the third trimester. The intention for recommending physical activity during the second trimester was associated with the profession (p < 0.001), the personal attitude toward the necessity of exercising (p = 0.006), the participants’ belief regarding the importance of being informed about relevant recommendations (p = 0.003), and the degree of knowledge regarding the relevant international guidelines (p = 0.031). With respect to the third trimester, the associated factors included gender (p = 0.011), the participant’s profession (p = 0.006), the degree of knowledge regarding the relevant international guidelines (p = 0.008), their positive attitude toward physical activity during pregnancy (p = 0.011), and the degree of knowledge regarding the relevant international guidelines (p = 0.008). Conclusions: The aforementioned factors should be taken into consideration when designing interventions for the promotion of physical activity during pregnancy. The structure of relevant instruments would facilitate the evaluation of health professionals’ behavior toward physical activity. Full article

Background: Interactive conversational agents (chatbots) simulate human conversation using natural language processing and artificial intelligence. They enable dynamic interactions and are used in various fields, including education and healthcare. Objective: This systematic review aims to identify and synthesize studies on chatbots for women and expectant parents in the preconception, pregnancy, and postnatal period through 12 months postpartum. Methods: We searched in six electronic bibliographic databases (MEDLINE (Ovid), CINAHL (EBSCO), Embase, Web of Science, Inspec, and IEEE Xplore) using a pre-defined search strategy. We included sources if they focused on women in the preconception period, pregnant women and their partners, mothers, and fathers/coparents of babies up to 12 months old. Two reviewers independently screened studies and all disagreements were resolved by a third reviewer. Two reviewers independently extracted and validated data from the included studies into a standardized form and conducted quality appraisal. Results: Twelve studies met the inclusion criteria. Seven were from the USA, with others from Brazil, South Korea, Singapore, and Japan. The studies reported high user satisfaction, improved health intentions and behaviors, increased knowledge, and better prevention of preconception risks. Chatbots also facilitated access to health information and interactions with health professionals. Conclusion: We provide an overview of interactive conversational agents used in the perinatal period and their applications. Digital interventions using interactive conversational agents have a positive impact on knowledge, behaviors, attitudes, and the use of health services. Interventions using interactive conversational agents may be more effective than those using methods such as individual or group face-to-face delivery. Full article

Inequities related to teen pregnancy are a complex social and health problem across the globe. Evaluation of research assumptions can help to move research forward when considering complex public health issues. Drawing on previous critical reviews, this scoping review sought to map not just what teen pregnancy research is available, but how current public health research was orienting to teen pregnancy in Canada. This review included studies focused on general or intended teen pregnancy within a public health Canadian context. Both grey and peer-reviewed literature were searched, with only studies in English and French included. In total 32 studies were analyzed. Taking a multifaceted approach to assessing research orientation this scoping review applied an adapted health equity framework to consider alignment between awareness and action and utilized discourse analysis to explore constructions of pregnancy intention. Results showed although a portion of research fell within the acknowledge and illuminate categories, most of the research utilized public health language rooted in biomedical and individualistic discourses and focused on influencing individual action, rather than greater societal change. Adding to the growing body of teen pregnancy research in Canada, this scoping review revealed potential epistemological barriers related to limited research approaches, applied public health action, and engagement with topic overall, leading to a call for more diverse, critically reflective, and disruptive approaches to teen pregnancy research in Canada to address teen pregnancy-related inequities at the root. Full article

Background/Objective: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides breastfeeding support to participating women in low-income households. This study aimed to determine the relationships between prenatal maternal and household characteristics and breastfeeding duration, as well as whether these characteristics modify associations of prenatal breastfeeding intention with breastfeeding duration. Methods: This is a prospective cohort study of pregnant respondents to Los Angeles County (LAC), California, WIC surveys conducted between 2005 and 2020 (n = 1014). Associations of prenatal breastfeeding intention with duration (months) of any or fully breastfeeding, determined by WIC infant food package issuance, were assessed with linear regression models. Results: Most women reported the intention to breastfeed (67.7%) and perceived breastfeeding support during pregnancy from WIC and family/friends was associated with breastfeeding intention (both p-values < 0.0001). Stronger breastfeeding intention, lower maternal BMI, greater maternal age, greater maternal education, paternal cohabitation and employment, and greater breastfeeding support from family/friends were associated with longer duration of any or fully breastfeeding in multivariable models. Stronger breastfeeding intention was more strongly associated with longer duration of any breastfeeding among women with lower BMI (interaction p-value 0.03). Conclusions: Breastfeeding support from WIC is an important contributor to stronger breastfeeding intention. Given the robust association of breastfeeding intention with breastfeeding duration, regardless of maternal and household characteristics, WIC breastfeeding support during pregnancy represents an important mechanism to improve breastfeeding outcomes in this population. Further research is needed to understand the directionality of associations between breastfeeding support and intention among WIC participants. Full article

Previous reviews have investigated machine learning (ML) models used to predict the risk of developing preeclampsia. However, they have not addressed the intended deployment of these models throughout pregnancy, nor have they detailed feature performance. This study aims to provide an overview of existing ML models and their intended deployment patterns and performance, along with identified features of high importance. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was performed in January and February 2024. It included all papers published before March 2024 obtained from the scientific databases: PubMed, Engineering Village, the Association for Computing Machinery, Scopus, and Web of Science. Of a total of 198 identified studies, 18 met the inclusion criteria. Among these, 11 showed the intent to use the ML model as a single-use tool, two intended a dual-use, and two intended multiple-use. Ten studies listed the features of the highest importance, with systolic and diastolic blood pressure, mean arterial pressure, and hypertension frequently mentioned as critical predictors. Notably, three of the four studies proposing dual or multiple-use models were conducted in 2023 and 2024, while the remaining study is from 2009. No single ML model emerged as superior across the subgroups of PE. Incorporating body mass index alongside hypertension and either mean arterial pressure, diastolic blood pressure, or systolic blood pressure as features may enhance performance. The deployment patterns mainly focused on single use during gestational weeks 11+0 to 14+1. Full article

Background: Approximately half of all women develop palpitations during pregnancy, with a quarter experiencing arrhythmias. While most presentations are benign, some cases can result in sudden cardiac death or serious symptom development. Considering such clinical presentation, healthcare providers must acquire knowledge in this area to provide comprehensive prenatal, perinatal, and postnatal care. However, no study could be located that focused on women’s life experiences of such complications during or in the post-pregnancy period. Objectives: The study aims to share the results of a study that explored the life experience of one woman who developed non-sustained ventricular tachycardia during her third pregnancy that lasted into the postpartum period. Methods: Using narrative inquiry self-study methodology, a woman’s experiences were explored to uncover the challenges she faced in coping with such complications during a period of transition for herself and her family. This methodology allowed for an in-depth understanding of how these complications could affect all aspects of her life. Results: Four narrative threads were produced: (1) diagnostic challenges and delayed recognition; (2) impact on maternal identity and family dynamics; (3) navigating healthcare systems and treatment decisions; and (4) long-term adaptation and resilience. Conclusions: The intention was to add to this topic area to ensure future researchers, current and future healthcare providers, and patients have literature they can refer to when studying, providing care for, or experiencing similar health complications. Acquiring this knowledge can aid healthcare professionals to ensure appropriate care is provided, risks are minimized, and their recovery is well supported. Full article

Background/Objectives: Truncus arteriosus communis (TAC) is a rare congenital heart defect characterized by a single arterial trunk that supplies systemic, pulmonary, and coronary circulations. This defect, constituting approximately 1–4% of congenital heart diseases, poses significant challenges in prenatal diagnosis, management, and postnatal outcomes. Methods: A retrospective analysis was conducted at the local tertiary referral center on cases of TAC diagnosed prenatally between 2019 and 2024. Additionally, a systematic literature review was performed to evaluate the accuracy of prenatal diagnostics and the presence of associated anomalies in fetuses with TAC and compare already published data with the local results. The review included studies that especially described the use of fetal echocardiography, the course and outcome of affected pregnancies, and subsequent management strategies. Results: The analysis of local prenatal diagnoses revealed 14 cases. Of the 11 neonates who survived to birth, the TAC diagnosis was confirmed in 7 instances. With all seven neonates undergoing surgery, the intention-to-treat survival rate was 86%, and the overall survival rate was 55%. By reviewing published case series, a total of 823 TAC cases were included in the analysis, of which 576 were diagnosed prenatally and 247 postnatally. The presence of associated cardiac and extracardiac manifestations as well as genetic anomalies was common, with a 22q11 microdeletion identified in 27% of tested cases. Conclusions: Advances in prenatal imaging and early diagnosis have enhanced the management of TAC, allowing for the detailed planning of delivery and immediate postnatal care in specialized centers. The frequent association with genetic syndromes underscores the importance of genetic counseling in managing TAC. An early surgical intervention remains crucial for improving long-term outcomes, although the condition is still associated with significant risks. Long-term follow-up studies are essential to monitor potential complications and guide future management strategies. Overall, a coordinated multidisciplinary approach from prenatal diagnosis to postnatal care is essential for improving outcomes for individuals with TAC. Full article

Varied hospital systems demonstrate diverse and often very different approaches to patient care. This may best be analyzed by looking at specific disorders and outcomes in a population with these disorders. As one such lens, hypertensive disorders of pregnancy (HDPs) continue to pose a severe health risk for mothers and infants, and breastfeeding outcomes play a crucial role in determining long-term maternal and fetal health. This pilot study investigated breastfeeding outcomes in two hospitals, as representatives for differing healthcare systems, among patients diagnosed with HDPs. Data were collected for 12 months at two hospitals, one private and one military, on 729 patients diagnosed with HDPs. Data were analyzed for infant maturity at birth and breastfeeding outcomes. Most participants (83.2%) stated their intention to breastfeed for the first six months of life. By hospital discharge, only 56% (p = 0.0001) of the private hospital participants were breastfeeding compared to 65% of the military hospital participants. In addition, while 69% of infants were born before term, more infants were born before term at the private hospital (71%) than at the military hospital (65%), with 37% (private) and 42% (military) of preterm infants breastfeeding at hospital discharge. Significant differences existed between these two hospital systems in the number of those initiating breastfeeding and breastfeeding at hospital discharge. The military hospital was more successful in assisting these high-risk women in meeting their breastfeeding intentions. Changes in hospital practices, such as metrics and incentivization, focusing on breastfeeding support, could improve the rate of breastfeeding at hospital discharge and impact long-term health outcomes. Full article

We present the case of a 32-year-old pregnant woman in the 32 + 3 weeks of pregnancy who presented to the hospital with an exacerbation of pain in the right flank. The diagnostic evaluation revealed the presence of severe anemia and a spontaneous adrenal hemorrhage (SAH) in the right adrenal gland. The patient was transferred to the Perinatology, Obstetrics and Gynecology Clinic with the intention of undergoing preterm childbirth. However, the doctors made a risky decision to wait until week 37 and to terminate the pregnancy at that point. The decision was right, as a cesarean section was performed without complications, and the patient gave birth to a healthy child. Spontaneous adrenal hemorrhage (SAH) is a rare condition, defined as spontaneous hemorrhage without trauma or anticoagulant therapy. Due to bleeding and damage to the adrenal cortex, SAH can lead to adrenal insufficiency. Because of its non-specific symptoms and potentially fatal outcomes for the patient and fetus, it should be considered during diagnostics. Full article

The AVERT PRETERM trial (NCT03151330) evaluated whether screening clinically low-risk pregnancies with a validated maternal blood biomarker test for spontaneous preterm birth (sPTB) risk, followed by preventive treatments for those screening positive, would improve neonatal outcomes compared to a clinically low-risk historical population that had received the usual care. Prospective arm participants with singleton non-anomalous pregnancies and no PTB history were tested for sPTB risk at 19^1/7–20^6/7 weeks’ gestation and followed up with after neonatal discharge. Screen-positive individuals (≥16% sPTB risk) were offered vaginal progesterone (200 mg) and aspirin (81 mg) daily, with twice-weekly nurse phone calls. Co-primary outcomes were neonatal morbidity and mortality, measured using a validated composite index (NMI), and neonatal hospital length of stay (NNLOS). Endpoints were assessed using survival analysis and logistic regression in a modified intent-to-treat population comprising screen-negative individuals and screen-positive individuals accepting treatment. Of 1460 eligible participants, 34.7% screened positive; of these, 56.4% accepted interventions and 43.6% declined. Compared to historical controls, prospective arm neonates comprising mothers accepting treatment had lower NMI scores (odds ratio 0.81, 95% CI, 0.67–0.98, p = 0.03) and an 18% reduction in severe morbidity. NNLOS was shorter (hazard ratio 0.73, 95% CI, 0.58–0.92, p = 0.01), with a 21% mean stay decrease among neonates having the longest stays. Sensitivity analyses in the entire intent-to-treat population supported these findings. These results suggest that biomarker sPTB risk stratification and preventive interventions can ameliorate PTB complications in singleton, often nulliparous, pregnancies historically deemed low risk. Full article