Search Results (12)

Background: Maternal vaccination is a critical primary preventive approach and an integral part of life-course immunization strategy, influencing the infection-associated morbidity and mortality in pregnant women, foetuses, and young infants. Despite clear guidelines for the administration of vaccines against tetanus, diphtheria, pertussis (Tdap), influenza, and COVID-19 during pregnancy, maternal vaccination rates remain suboptimal in Ireland as per the National Immunisation Office of the Health Service Executive (HSE). Aim: This review explores the prevailing status, uptake factors, and maternal immunization-specific vaccine hesitancy in Ireland. Method: A scoping review was conducted, searching nine electronic databases, including the Irish health research repository Lenus. The search strategy utilised a Population–Concept–Context framework (pregnant women—vaccine uptake/hesitancy—Ireland). Key factors identified and categorised according to the 5A framework: access, affordability, awareness, acceptance, and activation. Results: Searches yielded 2457 articles, and 12 eligible studies were included for review. Influencing factors were identified in each of the 5A dimensions, with the majority relating to acceptance and awareness. Positively associated factors included healthcare provider (HCP) recommendation and knowledge of vaccine safety. Potential antenatal barriers were maternal lack of knowledge of vaccine-preventable illness severity, infection risks, and vaccine safety concerns. A pregnant woman’s primary motivation for antenatal immunization was protection of her infant; however, the reluctance of HCPs to prescribe all recommended antenatal vaccines, inadequate immunization-specific discussion during antenatal consultations, and suboptimal knowledge of pregnancy-specific vaccine safety hampered potential positive influences. The Irish national immunization policy was a facilitator of affordability. Activation can be achieved through public health awareness campaigns and interdisciplinary promotion of maternal vaccination uptake. Conclusions: Maternal vaccination uptake in Ireland remains suboptimal, and a coordinated, targeted approach updating HCP recommendations, enhancing maternal awareness, and highlighting vaccine safety in pregnancy would be required to meet the life-course immunization goals recommended by WHO. By adopting a life-course immunization approach for healthy living, with maternal vaccination as the pivotal central point, vaccination programmes could close immunity gaps at various life stages. Full article

Background: Isotretinoin is a highly effective treatment for moderate-to-severe acne, but strict contraceptive measures are required because of its teratogenicity. The European Pregnancy Prevention Programme (PPP) aims to minimise foetal exposure through structured protocols. However, real-world data on patient compliance and treatment outcomes are limited. Methods: This retrospective study included 569 female patients aged 14–25 years treated with isotretinoin in Poland (2021–2022). Patients were assigned to three groups based on PPP compliance: full (Group I), partial (Group IIA), and minimal (Group IIB). Data on contraception, cumulative dose, treatment duration, adverse events, laboratory monitoring, and therapy discontinuation were analysed using non-parametric statistical tests (p < 0.05). Results: No pregnancies occurred during treatment. Overall compliance with PPP requirements was high: 100% of the patients used contraception or declared abstinence. The majority (92.79%) used condoms, 1.93% used oral contraceptives, and 7.21% reported abstinence. Significant differences in cumulative isotretinoin dose were observed between the groups (Kruskal–Wallis H = 19.89, p < 0.001), with Group I receiving a lower mean dose than those in Groups IIA (p < 0.001) and IIB (p < 0.01). Notably, all therapy discontinuations (4.75%) occurred in Group I (full compliance), which may reflect stricter monitoring and an earlier identification of adverse effects or patient concerns. These discontinuations were associated with lower cumulative dosing (Mann–Whitney Z = 7.81, p < 0.001) than that seen in the other groups. An inverse correlation between age and cumulative dose was also found (H = 13.09, p = 0.0004), with younger patients (≤17 years) more likely to reach therapeutic targets. Conclusions: Isotretinoin therapy under structured PPP protocols is safe and effective, with no pregnancies reported and excellent contraceptive compliance. Significant differences in dosing and adherence patterns highlight the need for flexible patient-centred approaches to optimise safety and outcomes. Full article

Objective: In the United Kingdom (UK) and most countries worldwide, midwives are professionally required to undertake an initial perinatal mental health (PMH) risk assessment at every maternity contact. However, studies have found that midwives feel that they are not well-equipped to provide effective care for women with PMH needs. This study explores how the newly qualified midwives (NQMs) are prepared through pre-registration midwifery education and placements to have sufficient confidence in their knowledge, attitude, skills, and habits (KASH) for their post-registration PMH role. Methods: This explanatory sequential mixed methods study collected survey data from two independent groups: NQMs (n = 50), who qualified from 10 UK universities, and senior specialist midwives (SSMs) (n = 32). Descriptive and inferential responses were analysed using SPSS. Statistical differences between the ranged Likert scale responses of the NQMs and SSMs were analysed using the Mann-Whitney U test. The p-value of <0.05 was considered statistically significant. The semi-structured interview phase comprised of NQMs (n = 12) and SSMs (n = 8). The qualitative data were thematically analysed using NVivo. Results: The pre-registration midwifery programme significantly prepared the NQMs to have sufficient confidence in their knowledge of the related PMH role, multidisciplinary team (MDT) role, and available services (p < 0.05) and good attitude towards women with varying PMH conditions (p < 0.0005). The NQMs had sufficient confidence in their skills in using the validated tool for PMH assessment, to build rapport to facilitate disclosure, and recognise deteriorating PMH (p < 0.01). They had regular habits of discussing PMH well-being at booking and made prompt referrals (p < 0.05). The NQMs were not prepared to have sufficient knowledge of PMH medications, perinatal suicide prevention, and the impact of maternal mental health on partners (p < 0.01) including children (p < 0.05); skills in managing PMH emergencies (p < 0.05), and to regularly discuss suicidal thoughts (p < 0.01), issues of self-harm, and debrief women following pregnancy or neonatal losses and traumatic births (p < 0.05). Some aspects were either confirmed or contradicted at the interviews. Conclusions and recommendations: The pre-registration midwifery programme prepares the NQMs to some extent for their post-registration PMH role. Perceived areas for improvement suggest implications for the development of educational, practice, policy, and preceptorship to facilitate the NQMs’ sustainable confidence in their KASH. Full article

To date, pregnant women are excluded from programmes delivering community-directed treatment of ivermectin (CDTI) for onchocerciasis and preventive chemotherapy of other helminthiases because of concerns over ivermectin safety during pregnancy. This systematic exclusion sustains an infection reservoir at the community level and deprives a vulnerable population from known benefits—there are indications that treating O. volvulus infected women may improve pregnancy outcomes and reduce the risk that their children develop onchocerciasis-associated morbidities. Furthermore, teratogenic effects are seen in non-clinical experiments at doses that far exceed those used in CDTI. Lastly, early, undetected and undeclared pregnancies are being systematically exposed to ivermectin in practice. Treatment of this population requires appropriate supporting evidence, for which we propose a three-pronged approach. First, to develop a roadmap defining the key steps needed to obtain regulatory clearance for the safe and effective use of ivermectin in all pregnant women who need it. Second, to conduct a randomised placebo-controlled double-blind clinical trial to evaluate the safety and benefits of ivermectin treatment in O. volvulus infected pregnant women. Such a trial should evaluate the possible effects of ivermectin in reducing adverse pregnancy outcomes and neonatal mortality, as well as in reducing the incidence of onchocerciasis-associated epilepsy. Third, to establish a pregnancy registry for women who inadvertently received ivermectin during pregnancy. This situation is not unique to ivermectin. Access to valuable therapies is often limited, delayed, or denied to pregnant women due to a lack of evidence. Concerns over protecting vulnerable people may result in harming them. We need to find acceptable ways to build robust evidence towards providing essential interventions during pregnancy. Full article

The sexual and reproductive health (SRH) needs of adolescent girls and young women (AGYW) aged 10–24 years remain a cause for concern in the countries of East and Southern Africa (ESA). High rates of adolescent pregnancy and HIV prevalence prevail, and prevention programmes are challenged to identify those at greatest risk. This review aimed to identify tools being used in ESA countries that support the recording of factors that make AGYW vulnerable to SRH risks and document their use. A mixed-methods approach was used to find available English language tools that had been designed to assess the vulnerability of AGYW SRH risks including literature reviews and key informant interviews with thirty-five stakeholders. Twenty-two tools were identified, and experiences of their use obtained through the interviews. All but one tool focused on HIV prevention, and most aimed at establishing eligibility for programmes, though not aligned with programme type. Analyses of the content of seventeen tools showed information collection related to behavioral, biological, and structural risk factors of HIV and other aspects of AGYWs’ lives. There was considerable diversity in the ways in which these questions were framed. Aspects of the processes involved in undertaking the risk and vulnerability assessments are presented. Full article

(1) Background: Nearly one out of ten Ghanaian female adolescents aged 15–19 has experienced childbearing in urban settlements compared to twice this number in the rural populations due to unintended pregnancies. This study assessed the linkages between knowledge, attitudes, and use of contraceptives and adolescent pregnancy in one of the highly affected Municipalities (i.e., Komenda-Edina-Eguafo Abrem [KEEA]) in Ghana. (2) Methods: Employing a facility-based sampling method, 378 female adolescents aged 15–19 were selected. Unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CI) and p-values were used for significant variables at p < 0.05. (3) Results: Pregnant adolescents were 2 times more likely to indicate that the procedure of procuring contraceptives is quite uncomfortable (aOR = 2.42, 95% CI = [1.29–4.55]; p = 0.006). Also, pregnant adolescents were 5 times more likely to have ever used traditional contraceptive methods than their non-pregnant counterparts (aOR = 5.02, 95% CI = [2.60–9.71]; p < 0.001). On the contrary, pregnant adolescents had lower odds of indicating that contraceptives are for only married people (aOR = 0.38, 95% CI = [0.20–0.70]; p = 0.002) and that it feels bad to receive contraceptive information from parents and relatives than non-pregnant adolescents (aOR = 0.42, 95% CI = [0.24–0.74]; p = 0.003). Pregnant adolescents were less likely to use modern contraceptives than their non-pregnant adolescents (aOR = 0.18, 95% CI = [0.11–0.31]; p < 0.001). (4) Conclusions: The findings indicate that female adolescents’ use of traditional contraceptives is associated with the risk of pregnancy in KEEA Municipality within the Central Region of Ghana. However, adolescents who had the perception that contraceptives are for married people and those who used modern contraceptives were less likely to get pregnant. Government and non-governmental organizations in Ghana should implement educational policies and programmes aimed at educating sexually-active female adolescents on modern contraceptives and the need to use them to prevent pregnancies. The basis for such policies and programmes should be based on evidence that compared to traditional contraceptives, modern contraceptives are more effective. In addition, there is the need to provide accurate information regarding the use of contraceptives to adolescents that will help change their attitudes towards the use of contraceptives. Full article

Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565 g vs. 2017: 3405 g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years—(2012: OR 1.9 (95% CI: 1.1–2.9) and 2017: OR = 2.1 (95% CI: 1.5–2.9), p < 0.05—, as well as in overweight women—2012: OR 1.8 (95% CI: 1.2–2.7) and 2017: OR 2.6 (95% CI: 1.9–3.4), p < 0.05—during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy. Full article

Postnatal depression (PND) remains underdiagnosed and undertreated in different socio-economic backgrounds in South Africa. This study determined the prevalence of and clinical and obstetric risk factors for PND symptoms among HIV positive women in health facilities in a rural health district in South Africa. The Edinburgh Postnatal Depression Scale was used to measure PND from 386 women who had delivered a live infant. More than half (58.5%) tested HIV positive during the current pregnancy. The prevalence of PND symptoms was 42.5%. Logistic regression analysis yielded significant associations between clinical and obstetric variables of pre-term baby (p-value < 0.01), baby health status p-value < 0.01), baby hospitalization, (p-value < 0.01), and knowing the baby’s HIV status (p-value = 0.047). Maternal variables associated with PND were level of education (p-value < 0.01), monthly income (p-value < 0.01), and source of income (p-value = 0.05). At multivariate analysis, none of the clinical and obstetrical risk factors were independently associated with the PND. The high prevalence of PND symptoms underscore the need to integrate routine screening for PND in prevention of mother to child transmission of HIV programmes to enable early diagnosing and treatment of PND. Full article

Background: Physical exercise helps to maintain a healthy lifestyle and its practice is recommended for women during pregnancy as a means of limiting the negative effects on the body that may take place and to optimise well-being, mood and sleep patterns, as well as encouraging daily physical activity, enhancing the ability to work and preventing pregnancy-related complications. Aim: To analyse the quality of life in pregnancy for women who complete a programme of moderate physical activity in water, following a designed method that the woman can perform physical exercise safely during pregnancy called the SWEP (study of water exercise during pregnancy) method. Materials and methods: A randomised clinical trial was performed. One hundred and twenty-nine pregnant women were randomly assigned either to an exercise class following the SWEP method (EG, n = 65) or to a control group (CG, n = 64). The trial began in week 20 of pregnancy (May 2016) and ended in week 37 (October 2016). Heath-related quality of life (HRQoL) was evaluated with the SF36v2 health questionnaire at weeks 12 and 35 of pregnancy. Results: The HRQoL score decreased significantly between weeks 12 and 35 of gestation, except for the mental health component, which in the CG fell by −3.28 points and in the EG increased slightly (p > 0.05). Among the CG, the score for the mental health component at week 35 was ≤42, indicating a positive screening risk of depression (39.20 ± 4.16). Conclusions: Physical activity programmes in water, such as SWEP, enhance the HRQoL of pregnant women. Full article

Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”. Full article

Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal. Full article

Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women. Full article