BMC Pregnancy And Childbirth[JOURNAL]
Sun
200 papers
Labor support in low- and middle-income countries - transformative impact of birth companions and doulas on maternal and neonatal outcomes: a narrative review.
Akankwasa P, Kakooza J, Katongole J … +4 more , Namutosi E, Abdullahi AA, Lewis CR, Okurut E
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393554 · Full text
BACKGROUND: Maternal and neonatal morbidity and mortality remain disproportionately high in low- and middle-income countries (LMICs), partly due to inadequate intrapartum support, psychosocial stress, and disrespectful m...
BACKGROUND: Maternal and neonatal morbidity and mortality remain disproportionately high in low- and middle-income countries (LMICs), partly due to inadequate intrapartum support, psychosocial stress, and disrespectful maternity care. Continuous labor support from birth companions or doulas offers a low-cost, high-impact intervention with demonstrated benefits in high-income settings, yet LMIC-focused evidence remains fragmented. This review synthesizes current evidence on the effects of birth companionship and doula care on maternal, neonatal, psychosocial, and implementation outcomes in LMICs. METHODS: A narrative review was conducted using structured searches of PubMed, Scopus, Web of Science, Lens.org, and WHO documents. Eligible studies were published between 2015 and 2025, conducted in LMICs or relevant to LMIC contexts, and reported empirical findings on continuous intrapartum support from informal companions, trained lay companions, or professional doulas. Data were synthesized thematically across maternal, neonatal, psychosocial, and implementation domains. A structured narrative appraisal was used due to heterogeneity in study design and outcome measures. RESULTS: A total of 27 studies were included in the narrative synthesis. These comprised 8 primary studies in LMICs, 6 high-income country (HIC) studies involving marginalized populations, and 13 systematic reviews. Continuous labor support was consistently associated with shorter labor, higher rates of spontaneous vaginal birth, reduced use of pharmacologic analgesia and oxytocin augmentation, and lower maternal anxiety and stress markers. Neonatal benefits included higher Apgar scores, earlier breastfeeding initiation, and enhanced mother-infant bonding. Psychosocial improvements were mediated through emotional reassurance, advocacy, improved communication, and culturally responsive support. Implementation barriers identified across LMIC studies included provider resistance, facility space limitations, inadequate training, and sociocultural constraints, while facilitators included community engagement, structured companion training, and phased integration into maternity systems. Evidence quality varied widely, with few LMIC-specific randomized trials and heterogeneous operational definitions of "continuous support." CONCLUSIONS: Evidence demonstrates that birth companions and doulas improve maternal well-being, early neonatal outcomes, and respectful maternity care in LMIC settings. Effective scale-up requires context-adapted implementation strategies, provider orientation, policy alignment, and rigorous LMIC-based trials assessing clinical outcomes, cost-effectiveness, and equity impacts. Companion-inclusive intrapartum care represents a feasible, low-cost strategy for strengthening quality and experience of maternity care in resource-limited health systems.
Comparing the health implications of heat exposure in pregnant women in rural and urban Tamil Nadu: An exploratory cohort study.
Shanmugam R, Venugopal V
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387498 · Full text
BACKGROUND: Increased temperatures caused by climate change may have an adverse impact on pregnant women's health outcomes. Understanding the disparities in heat vulnerabilities between rural and urban pregnant women (RP...
BACKGROUND: Increased temperatures caused by climate change may have an adverse impact on pregnant women's health outcomes. Understanding the disparities in heat vulnerabilities between rural and urban pregnant women (RPW and UPW) could help prioritize and develop tailored interventions to protect the most vulnerable. METHODS: We conducted an observational cohort study from 2018 to 2021 among 680 pregnant women in Tamil Nadu from six districts. We measured the wet bulb globe temperature (WBGT) exposure and Heat Strain Indicators (HSI) such as urine specific gravity and core body temperature using standardised protocols. We used a validated questionnaire to elucidate the self-reported heat strain symptoms (SHSS), adverse pregnancy outcomes (APOs), and adverse birth outcomes (ABOs). RESULTS: A higher percentage of RPWs had WBGT exposure (55%) above the permissible limit with an average WBGT of 26.8 °C ± 1.0 °C compared to the UPW (45%) with an average exposure of 26.9 °C ± 0.8 °C. RPWs were more likely than UPWs to report SHSS (84% vs. 71%) and HSIs (31% vs. 22%) among 680 women. After controlling for the potential confounders, heat exposed RPWs (N = 372) had nearly double the risk of APOs (95% CI 1.2-5.2) and thrice the risk of ABOs (95% CI 1.3-7.4). Furthermore, based upon the heat exposure during the first trimester the heat exposed RPWs (N = 248) had a 4-fold higher risk of miscarriages than the UPWs (95% CI 1.1-16.5). The lack of awareness and mitigation strategies against heat risk, low socioeconomic status, and reduced access to welfare facilities can contribute to RPW's high heat risk vulnerability. CONCLUSION: The study underscores the necessity to protect RPW from heat and APOs. In-depth cohort studies are required to identify risk factors and develop protective strategies for these women. TRIAL REGISTRATION: Not applicable.
Comparison of SARS-CoV-2 total and neutralizing antibody transfer to neonates from vaccinated mothers vs. mothers infected during pregnancy: an observational study.
Ojeda AV, Coronel-Ruiz C, Romero XC … +9 more , Castellanos JE, De la Hoz-Valle J, Bonilla-Cortés L, Sanchez S, González RA, Reyes-Clavijo G, Buitrago-Flechas SM, Perdomo P, Beltrán Acosta SL
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387485 · Full text
BACKGROUND: Differences in antibody production against SARS-CoV-2 arise from both, infection and immunization, leading to variations in neutralization capacity and transplacental antibody transfer during pregnancy. A dee...
BACKGROUND: Differences in antibody production against SARS-CoV-2 arise from both, infection and immunization, leading to variations in neutralization capacity and transplacental antibody transfer during pregnancy. A deeper understanding of these mechanisms can provide valuable insights into neonatal protection against viral exposure and inform the evaluation of vaccination strategies during pregnancy. This study aimed to compare the transfer of IgG and neutralizing antibodies between neonates born to mothers vaccinated against SARS-CoV-2 either during or before gestation and those born to mothers infected during pregnancy. METHODS: A multicenter cohort study was conducted across four hospitals in Bogotá, Colombia, from March to October 2023. The study assessed IgG and neutralizing antibodies in blood samples from pregnant women and umbilical cord blood from 86 mother-child pairs. The cohort comprised 40 mothers vaccinated during pregnancy (46.5%), 35 vaccinated before pregnancy (40.6%), and 11 infected with SARS-CoV-2 during pregnancy (12.8%). Statistical analysis involved Fisher's exact test for categorical variables and ANOVA for continuous variables. The Pearson correlation coefficient was employed to evaluate the correlation between maternal and umbilical cord neutralizing antibodies. Additionally, logistic regression was utilized to examine the association between neutralizing antibodies in maternal and umbilical cord blood. RESULTS: The proportion of patients with positive neutralizing antibodies (defined as > 20%) differed significantly between groups, with the highest percentage observed in pregnant women vaccinated before pregnancy (85.7%). Notably, the transfer rate of neutralizing antibodies was significantly higher in infected mothers (mean = 1.0, Interquartile Range = 1.0-1.2, p = 0.014). A moderate-to-strong correlation was identified between maternal and cord neutralization percentages (r = 0.6003), irrespective of the group. Furthermore, vaccination before pregnancy (Log Odds ratio (LOR) 3.18 [95% CI 1.95-4.40]) or infection during pregnancy (LOR 2.89 [95% CI 1.17-4.61]) was associated with a higher probability of achieving a higher neutralization percentage compared to those vaccinated during pregnancy. CONCLUSION: This study provided evidence of maternal antibody mediated immune response to both, SARS-CoV-2 infection and COVID-19 vaccination. The findings suggest that vaccination prior to pregnancy elicits more effective antibody responses compared to vaccination during pregnancy, highlighting the effectiveness of anti-COVID-19 vaccination prior to pregnancy.
Identification of exosomal miRNA-based predictive signatures for gestational diabetes mellitus via multi-algorithm machine learning.
Jiang P, Huang J, Wang S … +1 more , Dai C
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387451 · Full text
BACKGROUND: Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy, leading to adverse maternal and neonatal outcomes. Exosomal microRNAs (exo-miRNAs) have emerged as promising noninvasive bi...
BACKGROUND: Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy, leading to adverse maternal and neonatal outcomes. Exosomal microRNAs (exo-miRNAs) have emerged as promising noninvasive biomarkers due to their stability and regulatory roles in glucose metabolism. However, robust diagnostic models integrating exo-miRNAs profiles for early prediction of GDM remain lacking. METHODS: In this study, we used the GSE192813 dataset as a discovery cohort to identify differentially expressed exo-miRNAs (DE-exo-miRNAs) in exosomes between GDM and normal glucose tolerance (NGT) pregnancies. After differential expression analysis, five machine learning (ML) feature selection algorithms (LASSO, Random Forest, SVM-RFE, XGBoost, and Boruta) were applied to identify robust predictive DE-exo-miRNAs features. Subsequently, ten classification algorithms (including Logistic Regression, Random Forest, SVM, XGBoost, LightGBM, CatBoost, KNN, Naïve Bayes, Neural Network, and Decision Tree) were combined with the five feature-selection methods, generating 50 distinct ML models. Model performance was evaluated through repeated 7:3 train-test splits, and the best-performing classifier was externally validated using GSE114860. RESULTS: A total of 12 DEmiRNAs were identified in GSE192813, of which a subset of key exo-miRNAs (including miR-423-5p, miR-99a-5p, miR-148a-3p, miR-192-5p, and miR-122-5p) were consistently selected across multiple algorithms. Among the 50 ML combinations, the XGBoost + Boruta model achieved the highest diagnostic accuracy, with an AUC exceeding 0.90 and an overall accuracy greater than 90% in the discovery dataset. External validation in GSE114860 demonstrated stable performance, achieving an accuracy above 80% and good calibration. Functional enrichment analysis of target genes indicated significant involvement in insulin signaling, lipid metabolism, and inflammatory pathways. CONCLUSION: This integrative machine learning framework successfully identified a robust exo-miRNAs-based predictive signature for GDM. The model exhibited high diagnostic accuracy and generalizability across independent cohorts, highlighting its potential for early, noninvasive screening and precision management of gestational diabetes mellitus.
Performance of the Pre-Eclampsia Integrated Estimate of Risk-Machine Learning (PIERS-ML) model in a Kenyan cohort of women with pre-eclampsia- a retrospective test derivation validation study.
Nyagaka F, Montgomery-Csobán T, Gichere I … +6 more , Mwaniki M, Kavanagh K, Magee LA, von Dadelszen P, Oindi F, And the PIERS Consortium
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387442 · Full text
OBJECTIVE: Pre-eclampsia is a cause of significant maternal morbidity and mortality, with delivery initiating resolution. The Pre-eclampsia Integrated Estimate of RiSk-machine learning (PIERS-ML) tool provides individual...
OBJECTIVE: Pre-eclampsia is a cause of significant maternal morbidity and mortality, with delivery initiating resolution. The Pre-eclampsia Integrated Estimate of RiSk-machine learning (PIERS-ML) tool provides individualized risk estimates to guide joint decision-making for women with pre-eclampsia. While it has been externally validated in the UK, our objective was to test PIERS-ML performance in Kenya. DESIGN: Retrospective cohort validation study. SETTING: Two tertiary hospitals in Nairobi, Kenya. POPULATION: Women admitted with pre-eclampsia who had not experienced any element of the main outcome measure. METHODS: Test performance was assessed by stratification capacity, area under the receiver-operator curve (AUROC), area under the precision-recall curve (AUPRC), and decision curve analysis. MAIN OUTCOME MEASURES: Any component of the PIERS primary outcome of maternal death or major maternal organ dysfunction within 48 h of admission. RESULTS: Among 2,002 women with pre-eclampsia, 408 (20.4%) experienced an adverse maternal outcome within 48 h of admission (including 4 deaths) and a further 74 (3.7%) between 3-7 days. Missingness was substantial for most laboratory variables, particularly at the public hospital. Despite this, individual level imputation enabled model assessment. PIERS-ML demonstrated good discrimination (AUROC 0.68; AUPRC 0.40) and clinically meaningful stratification: high-risk women had doubled outcome rates and the single very high-risk woman experienced an event. Decision curve analysis showed greater net benefit than treating all or none. Patterns of missingness and more severe outcomes suggested a higher risk Kenyan case mix. CONCLUSION: In a high-morbidity Kenyan cohort, the PIERS-ML tool accurately identified personalised risk in women admitted with pre-eclampsia.
Diagnostic performance of serum uric acid and proteinuria for classifying pre-eclampsia severity among pregnant women at Banadir Hospital, Mogadishu, Somalia: a comparative cross-sectional study.
Mahdi AO, Abdi AI, Abdi AA
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387441 · Full text
BACKGROUND: Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality, particularly in low-resource settings. While hypertension and proteinuria are central to diagnosis, additional biomarkers may...
BACKGROUND: Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality, particularly in low-resource settings. While hypertension and proteinuria are central to diagnosis, additional biomarkers may assist in classifying disease severity at presentation. Serum uric acid (SUA) has been linked to endothelial dysfunction and oxidative stress in pre-eclampsia, but evidence from Somalia is limited. OBJECTIVE: To assess the diagnostic performance of serum uric acid in classifying pre-eclampsia severity and to compare its discriminatory ability with semi-quantitative proteinuria among pregnant women attending Banadir Hospital, Mogadishu, Somalia. METHODS: A hospital-based comparative cross-sectional study was conducted among 322 pregnant women (161 normotensive controls and 161 women with pre-eclampsia) at Banadir Hospital. Pre-eclampsia cases were classified into non-severe and severe disease based on standard clinical criteria. Serum uric acid levels and urine protein were measured at presentation. Receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of serum uric acid and proteinuria to discriminate severe from non-severe pre-eclampsia, and areas under the curve (AUCs) were compared using the DeLong test. RESULTS: Serum uric acid levels increased progressively from normotensive pregnancy to non-severe and severe pre-eclampsia (p < 0.001). Women with severe pre-eclampsia had significantly higher serum uric acid and proteinuria levels compared with those without severe features. Serum uric acid demonstrated excellent discriminatory performance for classifying disease severity (AUC = 0.985; 95% CI: 0.972-0.998). Internal validation using bootstrap resampling (5,000 iterations) confirmed stable performance (bootstrap AUC = 0.985; 95% CI: 0.970-0.997). The optimal cut-off value for serum uric acid was 7.0 mg/dL, which yielded a sensitivity of 95.1% and a specificity of 96.3%. Proteinuria showed comparable performance (AUC = 0.986; 95% CI: 0.978-0.995; bootstrap AUC = 0.986; 95% CI: 0.977-0.994), with no statistically significant difference between the two biomarkers (p > 0.05). CONCLUSION: Serum uric acid was significantly associated with pre-eclampsia severity and demonstrated excellent ability to discriminate severe from non-severe disease at presentation, comparable to semi-quantitative proteinuria. Serum uric acid may serve as a useful complementary laboratory marker for severity classification in tertiary referral settings, particularly in low-resource environments.
Temporal trends and maternal factors associated with congenital anomalies among live births in São Paulo, Brazil: a population-based study, 2015-2023.
Venancio FA, Dos Santos LM, de Camargo Cremonez A … +6 more , de Melo GM, Paes MER, Lira MEC, Scherole ACB, Narante BLP, Vitorelli-Venancio DC
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387440 · Full text
BACKGROUND: Congenital anomalies are a major cause of infant morbidity, mortality, and long-term disability worldwide. Their occurrence is influenced by maternal, demographic, and healthcare-related factors, and temporal...
BACKGROUND: Congenital anomalies are a major cause of infant morbidity, mortality, and long-term disability worldwide. Their occurrence is influenced by maternal, demographic, and healthcare-related factors, and temporal patterns may vary according to anomaly group and surveillance quality. In Brazil, population-based analyses remain limited, especially those examining overall prevalence together with system-specific trends. METHODS: This population-based retrospective study used data from the Brazilian Live Birth Information System (SINASC). All live births registered in São Paulo between 2015 and 2023 were eligible. Annual prevalence rates of congenital anomalies were calculated per 10,000 live births with 95% confidence intervals (95% CI). Maternal, pregnancy, and neonatal characteristics were compared according to congenital anomaly status using Pearson's chi-square test. Temporal comparisons across predefined epidemiological periods were performed using count regression models with live births as the offset. Annual temporal trends were further assessed using log-linear and segmented trend models, with annual percent changes (APC) estimated for overall prevalence and major anomaly groups. Factors associated with congenital anomalies were assessed using adjusted logistic regression. RESULTS: A total of 4,329,485 live births were analyzed, of which 53,217 (1.23%) presented congenital anomalies. Overall prevalence increased from 103.90 per 10,000 live births in 2015 to 143.92 in 2023. In segmented trend analysis, total congenital anomaly prevalence increased by 2.01% per year (95% CI 0.17-3.89). Musculoskeletal anomalies were the most frequent group throughout the series, whereas circulatory anomalies showed a sustained increase (APC = 5.78%; 95% CI 3.46-8.15). Digestive anomalies showed a marked recent increase after 2022, while nervous system anomalies declined from 2017 onward (APC = - 5.25%; 95% CI - 9.30 to - 1.03). In exploratory period-based analyses, 2023 had a higher rate than the 2018-2019 baseline in the negative binomial model (IRR = 1.179; 95% CI 1.028-1.353; p = 0.0188), while no significant differences were found for the Zika or COVID-19 periods. In the adjusted model, higher odds of congenital anomalies were observed among male newborns, older mothers, and multiple pregnancies, whereas prenatal care was associated with lower recorded odds. CONCLUSIONS: Congenital anomaly prevalence increased in São Paulo between 2015 and 2023, accompanied mainly by increases in circulatory and digestive system anomalies. These findings highlight the importance of continuous population-based surveillance and system-specific trend analysis.
Contemporary approaches to extracorporeal membrane oxygenation usage in extended peripartum period over a decade - a systematic review.
Mondal S, Lee K, Kheirbek L … +6 more , Ibekwe SO, Bharadwaj S, Shipper AG, Wong MJ, Ryan E, Tanaka KA
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387433 · Full text
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has become a valuable tool in critical care medicine when conventional treatment to severe cardiopulmonary failure fails. ECMO use in adults has significantly increa...
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has become a valuable tool in critical care medicine when conventional treatment to severe cardiopulmonary failure fails. ECMO use in adults has significantly increased over the past several years to approximately 60 per million adults because of its potential survival benefits. This drastic increase in ECMO use comes from its technological evolution over the last decade. However, ECMO utilization in obstetric patients remains limited, although the incidence of life-threatening cardiopulmonary conditions potentially benefiting from ECMO continues to rise in these patients. The objective of this systematic review was to evaluate the evolution of ECMO and its use in the extended peripartum period. METHOD: PRISMA 2020 guidelines were followed. We constructed searches in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (Wiley). Results were limited to articles published since 2010 with adult subjects till 2020. SELECTION CRITERIA: Inclusion criteria Literature published in English since 2010 regarding adult peripartum patients requiring ECMO extending up to 3 months post-delivery. Exclusion criteria Animal studies, National Inpatient Sample (NIS) data, reviews, editorials, and conference abstracts. Cases involving EXIT-to-ECMO or support initiated beyond three months postpartum were also excluded. Data was collected and reviewed using Covidence portal. Initially, 2169 studies were screened for title and abstract review. Afterwards, 304 studies were selected for retrieval and full text review. Finally,136 articles were included in the study after full text review. RESULTS: Studies were separated based on their nature into two broad groups - case reports (110) and cohort studies & case series (26). The most common indication to initiate ECMO was cardiomyopathy (heart failure), and most mothers requiring ECMO were in the antenatal period. Mean duration on ECMO was 8, 9 and 11 days (case series, case reports and cohort studies, respectively). Maternal survival was noted to be as high as 89% in case reports, 87% in case series, and 78% in cohort studies. Fetal survival rate was also generally high. Nevertheless, it is important to point out that a significant number of the included studies did not report fetal outcomes and, hence, the fetal survival rate could not be confidently inferred. CONCLUSIONS: Timely initiation of ECMO in the peripartum period is associated with favorable maternal and fetal outcomes. Given the rarity of ECMO utilization in obstetrics, case reports were highly represented in the study. Accordingly, regression findings should be interpreted cautiously and considered hypothesis-generating rather than confirmatory.
Criteria based clinical audit of selected obstetric emergencies standard of care and feto-maternal outcomes in public hospitals of West Shoa Zone, Central Ethiopia.
Damme TG, Demissie DB, Abeya SG
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387429 · Full text
INTRODUCTION: Evidence suggests that criteria based clinical audit is improving the quality of emergency obstetric care services. Therefore, this criteria based clinical audit was conducted to assess the emergency obstet...
INTRODUCTION: Evidence suggests that criteria based clinical audit is improving the quality of emergency obstetric care services. Therefore, this criteria based clinical audit was conducted to assess the emergency obstetric standard of care and their feto-maternal outcomes in public hospitals of West Shoa Zone, Central Ethiopia. METHODS AND MATERIALS: An institutional based retrospective cross-sectional study design was conducted using criteria-based clinical audit from September 01 to December 30, 2023. The medical records of women admitted with selected obstetric emergencies were selected through systematic sampling technique from maternity logbook registor and reviewed using stardarized check list. The data were collected through a kobo tool and exported to SPSS software version 27 for analysis. First, descriptive statistics were conducted. Additionally, a chi-square test was applied to test the differences in feto-maternal outcomes by study variables. RESULTS: A total of 438 medical records of women admitted with selected obstetric emergencies were reviewed. The quality of care that the mother received was 83.2% for severe preclapsia/eclampsia, 82% for antepartum hemorrhage, 82.8% for obstructed labor and 78.4% for post partum hemorrhage as per the standards. Related to feto-maternal adverse outcomes, the maternal mortality rate was 684.9/100,000LB and the perinatal mortality rate was 114.2/1000LB. Variables; such as type of hospital, type of obstetric emergencies, history of ANC service follow up and women hospital stay were significantly associated with both severe maternal outcomes and perinatal mortality in the chi-square analysis. Additionally, rural residences, severe maternal outcomes, referral from another facility and coming from more than 10 KM were also significantly associated with the perinatal mortality. CONCLUSION AND RECOMMENDATION: The standards of emergency obstetric care provided were acceptable but not optimal to fully meet the established clinical standards. Additionally, significant proportions of study participants were incountered adverse feto-maternal outcomes. Thus, this criteria-based clinical audit of obstetric emergency treatment is an excellent and applicable tool to evaluate health facilities clinical services and feto-maternal outcomes in poor resource settings. Therefore, authors urge all healthcare facilities to apply regular criteria based clinical audit to improve quality of emergency obstetric care and its documentation.
Evaluation of maternal health literacy and its impact on pregnancy outcomes: A longitudinal study in a tertiary care hospital, Karachi.
Samir K, Ishaque A, Imran M … +3 more , Subash T, Subash A, Gianchand N
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387415 · Full text
INTRODUCTION: Maternal health literacy (MHL) plays a crucial role in impacting pregnancy outcomes, access to healthcare, and the general health of mothers and newborns. In Pakistan, where health challenges such as popula...
INTRODUCTION: Maternal health literacy (MHL) plays a crucial role in impacting pregnancy outcomes, access to healthcare, and the general health of mothers and newborns. In Pakistan, where health challenges such as population growth, maternal education deficits, and poverty persist, health literacy is a growing concern. Despite progress, with 58% general health literacy recorded in 2019, gaps remain, particularly in maternal health awareness. OBJECTIVES: This project intends to assess the level of maternal health literacy among pregnant women and to examine its association with selected maternal and neonatal outcomes at a tertiary care hospital in Karachi. METHODOLOGY: This longitudinal observational study was conducted at The Indus Hospital, Karachi. A total of 386 pregnant women (gestational age > 28 weeks) were enrolled and interviewed using non-probability consecutive sampling during the third trimester, then prospectively followed through labor and the immediate postpartum period to document maternal and neonatal outcomes via clinical records. MHL was assessed using a validated questionnaire covering sociodemographic details, health knowledge, information seeking behaviors, and decision-making processes. Association between MHL and pregnancy outcomes were analyzed using descriptive statistics and chi-square tests. RESULTS: The findings revealed that Maternal health literacy (MHL) was inadequate in majority of participants (65.8%). Preterm birth (40.4%) and low birth weight (34.9%) were the most frequent adverse outcomes, while gestational diabetes was the most common prenatal complication. MHL was significantly associated with husband's education (p = 0.033), maternal employment status (p = 0.005), gestational diabetes (p = 0.027) and preterm delivery (p = 0.036). No significant association was observed between maternal health literacy and postnatal complications (p > 0.05). CONCLUSION: This study signifies the importance of maternal health education, its impact on outcomes and reveals significant gaps in maternal health literacy. These results highlighted the need to consider maternal health literacy in antenatal care strategies to improve maternal and neonatal health outcomes.
Factors associated with inadequate iron supplementation among pregnant women in the Brazilian Unified Health System: a cross-sectional study.
de Souza IPD, Bertotti D, de Souza CPD … +2 more , Maule DC, de Paiva Rodrigues Hsu L
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387414 · Full text
BACKGROUND: Gestational anemia remains an important public health problem, especially in developing countries, and is associated with adverse maternal and perinatal outcomes. Prophylactic iron supplementation during preg...
BACKGROUND: Gestational anemia remains an important public health problem, especially in developing countries, and is associated with adverse maternal and perinatal outcomes. Prophylactic iron supplementation during pregnancy is a simple and effective strategy to prevent this condition and is routinely recommended during prenatal care. In Brazil, supplements are provided free of charge through the public health system; however, adherence to treatment remains variable. This study aimed to identify the sociodemographic and healthcare-related factors associated with inadequate iron supplementation among pregnant women receiving care in the public health system. METHODS: This cross-sectional study was conducted between March 2023 and May 2024 at the Maternity Unit of the Irmandade da Santa Casa de Misericórdia de São Paulo, a quaternary teaching hospital located in São Paulo, Brazil, and a reference center for obstetric care within the Brazilian Unified Health System (SUS). Women aged ≥ 18 years who were evaluated within 24 h after delivery were eligible. The exclusion criteria included fetal death, multiple pregnancies, and the presence of major fetal malformations. Data, including sociodemographic information, clinical history, prenatal care characteristics, and iron supplementation during pregnancy, were obtained through a structured questionnaire administered during the immediate postpartum period. RESULTS: A total of 381 patients were included. Overall, 176 women (46.2%) had adequate iron supplementation during pregnancy and 205 (53.8%) had inadequate supplementation. Among the variables analyzed, drug use during pregnancy was the only sociodemographic factor that was significantly associated with inadequate iron supplementation (p = 0.001 crude OR 2.93, 95% CI 1.57-5.48). A trend toward greater adherence was observed among pregnant women followed exclusively within the public health system than among those receiving private, mixed, or overseas prenatal care, although this difference was not statistically significant. In multivariable logistic regression, self-reported drug use (aOR 2.54, 95% CI 1.33-4.87; p = 0.005), non-use of other vitamins during pregnancy (aOR 6.00, 95% CI 2.45-14.72; p < 0.001) and inadequate prenatal care (aOR 0.49 for adequate vs. inadequate prenatal care, 95% CI 0.25-0.94; p = 0.033) remained independently associated with inadequate iron supplementation. CONCLUSIONS: Inadequate iron supplementation during pregnancy is associated mainly with social and behavioral vulnerability, particularly drug use. These findings suggest that adherence depends not only on the availability of supplements but also on the quality of prenatal care and professional guidance. Public health strategies aimed at health education, strengthening primary care, and longitudinal follow-up of pregnant women may contribute to improving adherence and reducing the prevalence of gestational anemia.
Ulipristal acetate for use in medical management of early pregnancy loss: a pilot feasibility study.
Hagey JM, Tang JH, Morse JE … +1 more , Bryant AG
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387351 · Full text
Mifepristone availability for medical management of early pregnancy loss (EPL) is limited in some settings. We report a single site, single arm pilot of ulipristal acetate for EPL management as an alternative to mifepris...
Mifepristone availability for medical management of early pregnancy loss (EPL) is limited in some settings. We report a single site, single arm pilot of ulipristal acetate for EPL management as an alternative to mifepristone. While recruitment was challenging, all participants adhered to study protocol and passed their pregnancy without additional intervention. TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT05216952), registered January 19, 2022, https//clinicaltrials.gov/study/NCT05216952.
Development of a predictive model for preeclampsia utilizing time-of-flight mass spectrometry based on novel nanomaterials integrated with machine learning.
Ding A, Peng J, Yao R … +5 more , Peng J, Wang H, Zhao Q, Zhang H, Dong X
BMC Pregnancy Childbirth · 2026 Jul · PMID 42387345 · Full text
BACKGROUND: Preeclampsia (PE) is a serious complication of pregnancy, causing irreversible damage to multiple systems and organs of both mother and baby, and can even be life-threatening. Early diagnosis and intervention...
BACKGROUND: Preeclampsia (PE) is a serious complication of pregnancy, causing irreversible damage to multiple systems and organs of both mother and baby, and can even be life-threatening. Early diagnosis and intervention are key to improving maternal and fetal outcomes. Traditional diagnostic methods primarily rely on clinical symptoms and relatively single laboratory indicators, suffering from issues such as low sensitivity and insufficient specificity. Treatment is limited to symptomatic drug therapy for hypertension, and apart from terminating the pregnancy, there is a lack of effective treatment options. In recent years, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has shown great potential in disease biomarker screening due to its advantages of high sensitivity, high throughput, and rapid analysis. METHODS: This study utilized MALDI-TOF MS technology based on novel inorganic nanosilica material, combined with high-throughput multi-omics(proteomics, peptidomics and metabolomics) analysis, to perform machine learning modeling and optimization analysis on 159 samples from the First People's Hospital of Yunnan Province. RESULTS: Testing on the validation cohort showed an AUC value as high as 0.93 for preeclampsia detection, with the model's efficiency and accuracy surpassing traditional diagnostic methods. Furthermore, the machine learning model analysis identified 20 potential biomarkers associated with preeclampsia. CONCLUSIONS: By constructing a diagnostic model for preeclampsia onset, this study can provide a basis for exploring the pathological mechanisms of preeclampsia. Simultaneously, it offers a novel technical approach for the screening and prediction of preeclampsia, holding significant clinical application value.
The associations between maternal disability and perinatal outcomes among Black and/or Hispanic women in PRAMS.
Harkins SE, Liu J, Sabatello M … +1 more , Barcelona V
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380902 · Full text
BACKGROUND: Women racialized as Black and/or Hispanic have high rates of adverse perinatal outcomes due to systemic racism. It is unknown if rates are higher among Black and/or Hispanic women with disabilities, who may e...
BACKGROUND: Women racialized as Black and/or Hispanic have high rates of adverse perinatal outcomes due to systemic racism. It is unknown if rates are higher among Black and/or Hispanic women with disabilities, who may experience additional barriers to perinatal healthcare, including disability-based discrimination (i.e., ableism). Therefore, we examined the associations between maternal disability and preterm birth (< 37 weeks' gestation), low birthweight (< 2500 g), small for gestational age (< 10th percentile), and attendance at a postpartum health visit among Black and/or Hispanic women. METHODS: We conducted a cross-sectional study of Pregnancy Risk Assessment Monitoring System (PRAMS) data from participants who identified as Black and/or Hispanic between 2018 and 2019 across 22 jurisdictions (N = 9,034). Maternal disability was the primary exposure measured using the Washington Group-Short Set of Questions on Functioning, which asks respondents to rate their level of difficulty seeing, hearing, walking or climbing steps, remembering or concentrating, self-care, and communicating. Response options include "no difficulty," "some difficulty," "a lot of difficulty," and "I cannot do this at all." We examined differences in perinatal outcomes by overall disability status, disability severity, and disability type. We adjusted for demographic and clinical factors using multivariable logistic regression. RESULTS: The prevalence of disability was 7.7%. There were no significant differences in preterm birth or low birthweight by maternal disability. Participants with any disability were significantly less likely to have a small for gestational age infant (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] = 0.37, 0.86) and to attend the postpartum visit compared to participants without disabilities (aOR = 0.38, 95% CI = 0.25, 0.57). We also found that as the level of self-reported difficulty increased, the odds of attending a postpartum health visit significantly decreased. Participants who reported blindness/low vision, cognition disability, communication disability, or multiple disabilities had significantly lower odds of attending the visit compared to participants without disabilities. CONCLUSIONS: Maternal disability was associated with lower odds of attending a postpartum health visit among Black and/or Hispanic participants in PRAMS, while small for gestational age differed by disability status and severity. Future research should identify barriers to postpartum healthcare for Black and/or Hispanic women with disabilities to inform culturally and disability-specific interventions.
Pregnancy and related complications in achondroplasia: a scoping review.
Shah K, Sheth K, Shah D … +1 more , Shah H
BMC Pregnancy Childbirth · 2026 Jul · PMID 42380889 · Full text
Very few articles have investigated pregnancy in women with achondroplasia. A scoping review methodology was used to record and summarize the existing research evidence. The review process was conducted in accordance wit...
Very few articles have investigated pregnancy in women with achondroplasia. A scoping review methodology was used to record and summarize the existing research evidence. The review process was conducted in accordance with the PRISMA-ScR guidelines. Original studies and case series mentioning achondroplasia with a minimum of 5 pregnancies were included. A total of 1527 articles were screened by title and abstract. Twenty-one full-text articles were reviewed for eligibility criteria. Seven studies were included. The reference details, study characteristics, topics of interest, and main findings are presented. The combination of short stature and a narrow pelvis led to a difficult antenatal and intrapartum period. Over the past decades, the number of publications on achondroplasia has increased overall, but pregnancy-related articles are still lacking. Multicentre studies should be initiated following methodological reference standards to strengthen the reliability and generalizability of the findings and to increase their relevance for implementation in clinical practice.
Evaluating progestin-primed and GnRH antagonist ovarian stimulation protocols in PGT-A cycles: implications for clinical practice.
Elmas B, Karaosmanoglu O, Yuceturk A … +6 more , Aslan IO, Turan BA, Peker N, Albayrak O, Berkil H, Tiras B
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380839 · Full text
BACKGROUND: Progestin-primed ovarian stimulation (PPOS) has emerged as an alternative to GnRH-antagonist protocols in IVF, yet its impact on embryo chromosomal competence remains controversial. Evidence is particularly l...
BACKGROUND: Progestin-primed ovarian stimulation (PPOS) has emerged as an alternative to GnRH-antagonist protocols in IVF, yet its impact on embryo chromosomal competence remains controversial. Evidence is particularly limited regarding whether PPOS influences blastocyst euploidy rates and key clinical outcomes in PGT-A cycles, and whether these effects vary according to maternal age and ovarian reserve status. METHODS: This retrospective cohort study included 1,843 PGT-A cycles (666 PPOS, 1,177 GnRH antagonist) performed at a single tertiary IVF center between January 2016 and January 2024. Controlled ovarian stimulation was performed with either oral medroxyprogesterone acetate or daily cetrorelix, followed by vitrification of all biopsied blastocysts and subsequent frozen embryo transfer. Primary outcomes were blastocyst euploidy and clinical pregnancy rates. Secondary outcomes included embryological parameters, miscarriage, live birth, and cumulative pregnancy rates. Subgroup analyses were performed according to maternal age and ovarian reserve. RESULTS: The mean age was 37.64±4.48 years in the PPOS group and 37.80±3.49 years in the GnRH-antagonist group; age and other baseline characteristics were comparable between groups. PPOS cycles had a shorter stimulation duration (median 8 vs. 9 days, p = 0.001), with comparable gonadotropin requirements and embryological outcomes. Euploidy (32.6% vs. 32.1%, p = 0.653), mosaicism, and aneuploidy rates did not differ significantly. Clinical pregnancy, live birth, and cumulative pregnancy rates were equivalent. CONCLUSION: PPOS and GnRH antagonist protocols yield comparable embryological and clinical outcomes in PGT-A cycles, including in advanced maternal age and diminished ovarian reserve subgroups. With its shorter stimulation duration and cost-effectiveness, PPOS is a valid alternative when fresh transfer is not planned.
Does the number of abnormal values in the oral glucose tolerance test impact pregnancy outcomes?
Gluska H, Yagur Y, Margalit S … +6 more , Sokolik K, Pardo E, Shechter-Maor G, Biron-Shental T, Kovo M, Weitzner O
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380820 · Full text
BACKGROUND: Gestational diabetes mellitus (GDM) affects over 10% of pregnancies worldwide, leading to various maternal and neonatal complications. The American College of Obstetricians and Gynecologists (ACOG) recommends...
BACKGROUND: Gestational diabetes mellitus (GDM) affects over 10% of pregnancies worldwide, leading to various maternal and neonatal complications. The American College of Obstetricians and Gynecologists (ACOG) recommends a two-step diagnostic approach using the Glucose Challenge Test (GCT) and the oral glucose tolerance test (OGTT), which can yield between 0 and 4 abnormal values (AbVs). The primary objective of this study was to evaluate the association between the number of AbVs in the OGTT and the risk of GDMA2 - gestational diabetes mellitus requiring pharmacological treatment (insulin or oral glucose-lowering agents) - compared with GDMA1, which is diet-controlled. Secondary outcomes included assessing the relationship between the number of AbVs and adverse maternal and neonatal outcomes, considering its impact on the course of pregnancy, delivery, maternal health, and neonatal outcomes. METHODS: This retrospective cohort study included all pregnant women who underwent OGTT between the years 2015 and 2022, and diagnosed with GDM, at our department. The study cohort was divided into four groups based on the number of AbVs in the OGTT: one AbV, two AbVs, three AbVs and four AbVs group. Maternal characteristics and pregnancy outcomes were compared between these groups. RESULTS: A total of 1821 women diagnosed with GDM following the diagnostic OGTT were included in the analysis. The distribution of abnormal OGTT AbVs was as follows: one AbV (36.95%), two AbVs (43.71%), three AbVs (16.09%), and four AbVs (3.24%). Presence of GDMA2 varied significantly among groups (p < 0.001), with higher occurrence correlating with increased AbVs. Maternal outcomes differed across the AbV groups in induction of labor (p < 0.001), episiotomy (p = 0.006), and maternal composite outcomes (p = 0.011). Neonatal outcomes also differed across the AbV groups, with differences in gestational age at delivery (p = 0.007) and Apgar score < 7 (p = 0.021). Logistic regression adjusted for confounders revealed that the number of AbVs (aOR 1.2, 95% CI 1.01-1.42) and maternal BMI (aOR 1.07, 95% CI 1.05-1.1) were significantly associated with GDMA2. CONCLUSIONS: An elevated number AbVs indicates challenges in glycemic control through dietary measures alone, necessitating potential medical interventions. An increased number of AbVs in OGTT was associated with GDMA2 and induction of labor. Differences were also observed across groups in episiotomy rates and Apgar < 7, although Apgar < 7 did not show a consistent positive correlation with the number of AbVs. From the study results we can infer that OGTT serves not only as a diagnostic tool for GDM but also enables healthcare practitioners to enhance their awareness of potential adverse outcomes for both the mother and neonate through meticulous analysis of AbVs.
RT-qPCR detection of SARS-CoV-2 RNA in placentas of women with spontaneous abortion: a retrospective pilot study.
Parnian R, Talei GR, Khanizadeh S … +3 more , Haghighatian Z, Seyfi M, Heydarifard Z
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380805 · Full text
BACKGROUND: Concerns about the possible effects of SARS-CoV-2 on pregnancy have been raised because ACE2 receptors are expressed in placental cells, and previous studies have suggested potential associations with adverse...
BACKGROUND: Concerns about the possible effects of SARS-CoV-2 on pregnancy have been raised because ACE2 receptors are expressed in placental cells, and previous studies have suggested potential associations with adverse outcomes such as spontaneous abortion and preterm birth. This retrospective pilot study aimed to detect SARS-CoV-2 RNA in archived FFPE placental tissues from women who experienced spontaneous abortion. METHODS: This cross-sectional study analyzed 83 paraffin blocks of placentas from mothers who had spontaneous abortions between winter 2021 and summer 2022. RNA was extracted, assessed for quality and quantity, and RT-qPCR was employed to identify the SARS-CoV-2 genome. Histopathological evaluations were also performed, with results analyzed using SPSS version 26. RESULTS: Among the 83 samples, 35 mothers (42.2%) were aged 30 to 40, with ages from 17 to 57. The most common symptom was bleeding (57.83%). Maternal SARS-CoV-2 test returned negative for 73 (87.9%) and positive for 10 (12.1%). Half of the abortions occurred in the first trimester, and 25.3% of mothers had hypertension, while 9.6% had hyperthyroidism. Three placental samples (3.6%) tested positive for SARS-CoV-2 RNA and exhibited histopathological findings consistent with the placentitis triad previously reported in SARS-CoV-2-associated cases. CONCLUSION: In this retrospective pilot study, SARS-CoV-2 RNA was detected in 3.6% of archived FFPE placental tissues from spontaneous abortion cases, and all positive samples showed histopathological features consistent with the placentitis triad described in previous reports. However, given the small number of positive cases and the limitations of the study design, these findings should be considered descriptive and hypothesis-generating, and no causal relationship can be inferred. Further prospective studies with larger cohorts are needed to clarify the relationship between SARS-CoV-2 infection and pregnancy outcomes.
Reproductive carrier screening among Chinese couples experiencing unexplained recurrent pregnancy loss.
Duan H, Jiang Z, Zhang Y … +2 more , Zhou C, Li J
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380799 · Full text
BACKGROUND: To investigate the prevalence of pathogenic/likely pathogenic (P/LP) variants in 485 genes associated with autosomal recessive and X-linked disorders among Chinese couples experiencing unexplained recurrent p...
BACKGROUND: To investigate the prevalence of pathogenic/likely pathogenic (P/LP) variants in 485 genes associated with autosomal recessive and X-linked disorders among Chinese couples experiencing unexplained recurrent pregnancy loss (RPL). METHODS: From March 2021 to December 2024, 48 couples with unexplained RPL and 100 control couples were recruited. A carrier screening panel covering 485 genes associated with 540 autosomal recessive and 84 X - linked hereditary diseases was used. Genomic DNA sequencing was performed, and variants were interpreted based on the American College of Medical Genetics and Genomics (ACMG) classification system. RESULTS: Among the RPL couples, 93.8% (45/48) carried at least one P/LP variant, and 54.2% (26/48) carried three or more. High carrier rates were observed for GJB2 (1/12), DUOX2 (1/14), SRD5A2 (1/14), ABCA4 (1/16), and UGT1A1 (1/16). The carrier frequency of SRD5A2 variants was significantly higher in RPL females than in controls (P < 0.05). Two couples were identified as high-risk for offspring with phenylketonuria (PKU) or spinal muscular atrophy (SMA). CONCLUSIONS: Chinese couples with unexplained RPL exhibit a high prevalence of P/LP variants, particularly in metabolic and developmental genes. These findings indicate potential genetic contributions to RPL pathogenesis and highlight the clinical utility of carrier screening for reproductive counseling. Future research should explore the roles of heterozygous variants in pregnancy loss and validate the associations in larger cohorts.
Full-term delivery in pregnancy complicated with suspected residual cervical alveolar soft part sarcoma: a case report and literature review.
Sheng YR, Xiao XR, Ye YZ
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380784 · Full text
INTRODUCTION: Alveolar soft part sarcoma (ASPS) is an exceptionally rare soft tissue malignancy, with limited data available on fertility preservation and pregnancy management. Managing ASPS during pregnancy poses unique...
INTRODUCTION: Alveolar soft part sarcoma (ASPS) is an exceptionally rare soft tissue malignancy, with limited data available on fertility preservation and pregnancy management. Managing ASPS during pregnancy poses unique challenges, particularly when the condition is incidentally discovered following surgery initially performed for presumed benign conditions. CASE PRESENTATION: We present the case of a young woman who underwent a transvaginal clamp procedure for a cervical myoma and a curettage due to irregular vaginal bleeding. Histopathological examination confirmed the presence of cervical ASPS. Shortly thereafter, an unexpected pregnancy was identified, prior to the completion of a comprehensive staging assessment and evaluation of residual lesions. The patient expressed a strong desire to continue the pregnancy. Under the guidance of a multidisciplinary team (MDT), she underwent close surveillance throughout her pregnancy. Histopathology revealed a low Ki-67 proliferation index, and a series of pelvic magnetic resonance imaging (MRI) scans showed no evidence of mass lesions. The patient successfully carried the pregnancy to term and delivered a healthy infant via cesarean section. During the cesarean section, a suspicious lesion was identified; however, biopsies and placental pathology confirmed the absence of residual tumor or metastasis. Follow-up at 42 days postpartum revealed no signs of tumor recurrence. CONCLUSION: Our case provides valuable evidence supporting the safety of fertility preservation in patients with cervical ASPS in the short term. Additionally, we outline a management approach for pregnancies complicated by rare, low-grade malignancies through multidisciplinary evaluation. Our experience suggests that, with rigorous and dynamic evaluations, it may be possible for these patients to safely navigate pregnancy.
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