BMC Pregnancy And Childbirth[JOURNAL]
Sun
200 papers
Antenatal depression and associated obstetric and psychosocial factors among pregnant women attending the public health clinics in Malaysia.
Kamarudin SS, Muhamad NA, Maamor NH … +12 more , Harrun NH, Tengku Baharudin Shah TPN, Nik Azhan NAF, Jamalluddin NH, Rosli '', Leman FN, Rosli NAS, Abd Manab NS, Mohd Noor N, Abdul Jabbar N, Ibrahim N, My Perinatal Depression Team
BMC Pregnancy Childbirth · 2026 Jun · PMID 42380779 · Full text
BACKGROUND: Antenatal depression is a common but under reported complication of pregnancy and childbirth, particularly in low and middle-income settings. This study aimed to estimate the prevalence of antenatal depressiv...
BACKGROUND: Antenatal depression is a common but under reported complication of pregnancy and childbirth, particularly in low and middle-income settings. This study aimed to estimate the prevalence of antenatal depressive symptoms and identify associated obstetric and psychosocial factors among antenatal women attending public health clinics. METHODS: A multi-centre cross-sectional study was conducted in public health clinics. Participants completed self-administered questionnaire on sociodemographic characteristics, obstetric history and psychosocial factors. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) with a score ≥ 12 was used to indicate probable antenatal depression. Data were analysed using R Software version 4.5.2. RESULTS: A total of 572 women were included in the analysis, and prevalence of antenatal depression was 9.6%. In the multiple logistic regression adjusted for age, education, race and household income, antenatal depression was independently associated with unplanned pregnancy ( aOR 2.20, 95% CI 1.03 - 5.02), exposure to stressful event ( aOR 2.99, 95% CI 1.42 - 6.27), present of depressive symptoms in the past two weeks ( aOR 8.25, 95% CI 3.47 - 19.94) and self-perceived present of high worries ( aOR 4.56, 95% CI 1.84 - 13.18). Perceived maternal emotional support during upbringing was protective ( aOR 0.16, 95% CI 0.05 - 0.53). CONCLUSION: Around one in ten women were screened positive for probable antenatal depression which was associated with unplanned pregnancy, stressful life events, recent depressive symptoms and high worry, while maternal emotional support from upbringing was protective. Finding support routine brief mental health screening practices that also considers other symptoms such as anxiety to improve case-finding and guide targeted support for women at higher risk, alongside interventions that build supportive relationships and break intergenerational cycles of distress.
Predictors of maternal and perinatal mortality among pregnant women with preeclampsia and eclampsia at Garissa County Referral Hospital: a retrospective cohort study.
Nur AA, Degu A
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374319 · Full text
BACKGROUND: Preeclampsia and eclampsia are severe complications of pregnancy that significantly contribute to maternal and fetal mortality. A comprehensive understanding of the predictors of these conditions is essential...
BACKGROUND: Preeclampsia and eclampsia are severe complications of pregnancy that significantly contribute to maternal and fetal mortality. A comprehensive understanding of the predictors of these conditions is essential for developing effective interventions. Despite preeclampsia and eclampsia being among the leading contributors to maternal and fetal mortality in resource-limited areas in Kenya, especially the arid and semi-arid regions such as Garissa, limited studies have specifically examined the predictors of maternal and perinatal mortality among women with preeclampsia and eclampsia. Therefore, this study aimed to investigate the predictors of perinatal and maternal mortality among pregnant women with preeclampsia and eclampsia at Garissa County Referral Hospital. METHODS: A retrospective cohort study was used to evaluate the records of 138 eligible pregnant women diagnosed with preeclampsia and eclampsia from 1st January 2019 to 31st December 2023. The study aimed to determine the predictors of maternal and perinatal mortality among pregnant women diagnosed with preeclampsia and eclampsia. A data abstraction tool capturing sociodemographic, clinical, treatment modalities, and outcome variables was used to collect data. Descriptive analysis was used to present mortality rates and management modalities, while binary logistic regression was used to determine the predictors of mortality among preeclampsia and eclampsia patients. RESULTS: The mean age of the participants in this study was 26.86 ± 7.6 years. There were higher cases of preeclampsia (63.0%) than eclampsia (37.0%) observed. Maternal mortality was 13.0%, while the perinatal mortality was 42.7%. The findings indicated that 34.1% of patients had a postpartum haemorrhage and 14.5% had a placental abruption. Neonatal complications were observed in 26.0% of the fetuses, with respiratory distress being the most prevalent (20.0%). Diabetes mellitus (AOR = 8.9, 95% CI = 2.1-41.4, p = 0.003) and multigravida status (AOR 3.6, 95% CI = 1.6-8.5, p = 0.002) were the significant predictors of maternal and perinatal mortality, respectively. CONCLUSION: The maternal and perinatal mortality among mothers with preeclampsia and eclampsia was comparable to the rates reported in similar settings. The significant predictors of maternal and perinatal mortalities were diabetes and multigravida status, respectively, highlighting the need for timely antenatal care and close monitoring for multigravida women and those with pre-existing conditions like diabetes.
Explanatory model for "becoming a mother" among first-time mothers who experienced high-risk pregnancies.
Cho H, Ahn S
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374310 · Full text
BACKGROUND: High-risk pregnancies can disrupt the transition to motherhood by limiting maternal-infant interaction, increasing psychological distress, and undermining confidence in assuming the maternal role; however, fe...
BACKGROUND: High-risk pregnancies can disrupt the transition to motherhood by limiting maternal-infant interaction, increasing psychological distress, and undermining confidence in assuming the maternal role; however, few studies have modeled how relational, social, and health-related factors jointly influence this process. Guided by Mercer's theory of maternal role attainment, this cross-sectional study developed and tested an explanatory structural equation model that described the process of becoming a mother among first-time mothers with a history of high-risk pregnancies. METHODS: In this cross-sectional study, we tested a hypothesized structural equation model for the process of becoming a mother among first-time mothers with high-risk pregnancies. A total of 320 women within 6 months postpartum who had a physician-confirmed high-risk singleton pregnancy and lived with a spouse completed an online survey. Assessed variables included the mother-infant relationship, spousal support, social support, maternal health, maternal role confidence, and the process of becoming a mother. RESULTS: A total of 320 mothers were included in the final analysis. First-time mothers who had experienced high-risk pregnancies demonstrated a stronger sense of becoming a mother when they reported a more positive mother-infant relationship (β = 0.64, p = .001), a more supportive spousal relationship (β = 0.10, p = .003), higher levels of social support (β = 0.36, p = .008), better maternal health (lower scores indicating poorer health; β = -0.52, p = .002), and higher maternal role confidence (β = 0.42, p = .003). CONCLUSIONS: Women who had experienced high-risk pregnancies were both directly and indirectly influenced by their mother-infant and spousal relationships, social support, maternal health, and maternal role confidence. These findings suggest that perinatal care for primiparas with a history of high-risk pregnancy should include brief, structured interventions that strengthen mother-infant bonding and spousal support, proactively address physical and emotional symptoms, and provide targeted opportunities to build confidence in assuming the maternal role.
The link between nutrient intake and anthropometric indices with COVID-19 infection in pregnant women.
Mirshafaei MA, Khodarahmi S, Dorosti M … +11 more , Falahnejad Z, Khosravani A, Mohammadian MK, Faghihshojaei N, Sharami SH, Naghshi N, Samiei S, Mirsadeghi MN, Khoshdooz S, Doaei S, Milani F
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374308 · Full text
OBJECTIVE: The incidence and severity of COVID-19 complications in pregnant women may be significantly influenced by their nutritional status. So, the present study aimed to investigate the association between nutrient i...
OBJECTIVE: The incidence and severity of COVID-19 complications in pregnant women may be significantly influenced by their nutritional status. So, the present study aimed to investigate the association between nutrient intake and anthropometric indices with COVID-19 infection in pregnant women. METHODS: This case‑control study was conducted on 117 pregnant women infected with COVID-19 as the case group, and 126 non-infected pregnant women as the control group. Information on demographic, social, anthropometric and biochemical indicators was collected. In both groups, food intake data were collected using a valid food frequency questionnaire (FFQ) covering the previous year. RESULTS: Higher vitamin D levels were associated with reduced odds of COVID-19 (OR = 0.93, CI95%:0.89-0.99, P = 0.02), even after adjusting for age, underlying diseases, caloric intake, and levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). No significant associations were observed between weight, height, body mass index (BMI), and other dietary nutrients with the risk of COVID-19. CONCLUSION: Pregnant women with insufficient dietary vitamin D intake are suggested to be at a significantly higher risk of COVID-19. Therefore, ensuring adequate vitamin D consumption is essential. It is recommended to conduct further longitudinal investigations to obtain more definitive results, particularly among pregnant women.
Effect of preimplantation genetic testing for aneuploidy on pregnancy outcomes of patients with recurrent miscarriage: a retrospective study.
Dong M, Ma M, Liu J … +3 more , Mu S, Yang Y, Gao Y
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374292 · Full text
BACKGROUND: Miscarriage is a common complication of pregnancy, and it is defined as spontaneous pregnancy loss before the fetus reaches viability. However, there are no clear pathological factors identified as causes of...
BACKGROUND: Miscarriage is a common complication of pregnancy, and it is defined as spontaneous pregnancy loss before the fetus reaches viability. However, there are no clear pathological factors identified as causes of recurrent miscarriage in some cases. Preimplantation genetic testing for aneuploidy (PGT-A) has been shown to have some advantages in the live birth rate in limited populations with a favorable prognosis. Hence, we investigated whether PGT-A improves pregnancy outcomes in patients with recurrent pregnancy loss. METHODS: We conducted a retrospective study including patients with a history of recurrent pregnancy loss from December 2021 to June 2022 receiving assisted reproduction therapy in the first medical center of the Chinese PLA General Hospital. The patients were divided into PGT-A and non-PGT-A groups, and we compared the pregnancy outcomes between the PGT-A and non-PGT-A groups. RESULTS: PGT-A significantly increased the clinical pregnancy rate per embryo transfer (ET) (58.7 vs. 32.3%, p = 0.023) and live birth rate per ET (50.0 vs. 25.8%, p = 0.034). However, there were no differences in biochemical pregnancy rates per ET (69.6 vs. 51.6%, P = 0.111), biochemical pregnancy loss rates (15.6 vs. 37.5%, p = 0.089), and miscarriage rate per clinical pregnancy (11.5 vs. 20.0%, p = 0.511) between the PGT-A and non-PGT-A groups. CONCLUSIONS: PGT-A was associated with significant improvements in clinical pregnancy and live birth rates in patients with recurrent pregnancy loss. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200056991 http//www.chictr.org.cn/). Registration Date 20,220,225.
Childbirth readiness and its influencing factors in the Yangtze River Delta region of China: a cross-sectional study.
Zhou N, Hu S, Sun F … +2 more , Wu D, Liu M
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374276 · Full text
BACKGROUND: Childbirth readiness is an important strategy in maternal and child health. Current research on the factors influencing childbirth readiness has focused primarily on resource-poor settings to reduce mortality...
BACKGROUND: Childbirth readiness is an important strategy in maternal and child health. Current research on the factors influencing childbirth readiness has focused primarily on resource-poor settings to reduce mortality rates. However, in resource-rich areas, emphasis is placed on the experience and quality of childbirth. Based on Meleis' transition theory, this study examines the factors affecting childbirth readiness in China's economically active Yangtze River Delta region from multiple perspectives. METHODS: This cross-sectional study was conducted from March to May 2023, using convenience sampling to select 350 pregnant women in late pregnancy at a tertiary level A maternity hospital in Wuxi, China. Outcomes were assessed based on the General Information Questionnaire, along with the Childbirth Readiness Scale (CRS), eHealth Literacy Scale (eHEALS), Fear of Birth Scale (FOBS), and Family Adaptation, Partnership, Growth, Affection, and Resolve Index (Family APGAR Index) scores. An independent samples t-test or ANOVA was used for one-way analysis, and multiple linear regression was used for multifactorial analysis to determine the factors influencing childbirth readiness. RESULTS: The statistical results showed that the total mean scores of the CRS, eHEALS, FOBS, and Family APGAR Index were 74.60 ± 8.97, 32.36 ± 6.18, 43.94 ± 24.42, and 8.41 ± 2.10, respectively. According to the multivariate linear regression analysis, abortion (p = 0.033); parity (p < 0.001); attending maternity school (p = 0.048); and eHEALS (p < 0.001), FOBS (p = 0.015), and Family APGAR Index (p = 0.046) scores were the main factors affecting childbirth readiness. CONCLUSION: Current research indicates that pregnant women have moderate-to-high levels of childbirth readiness. Pregnant women with a history of abortion and multiparity and those who attended maternity schools have relatively high levels of childbirth readiness. Family care support and e-health literacy are positive factors, whereas fear of birth is a negative factor for childbirth readiness. Therefore, the government and healthcare institutions can provide personalized childbirth readiness services to pregnant women based on the individual characteristics mentioned above.
Magnitude and trend of maternal mortality in Rajasthan from 2014 to 2021 - spatio-temporal analysis supported by findings from a systems approach study.
Raghav P, Radhakrishnan RV, Baskaran P … +7 more , Rustagi N, Gupta MK, Mishra NC, Viswanathan H, Singh T, Gupta M, Garg S
BMC Pregnancy Childbirth · 2026 Jun · PMID 42374271 · Full text
BACKGROUND: The higher maternal mortality in Rajasthan (one of the Empowered Action Group states in India) is attributed to various determinants in health systems, geographical context, and socio-cultural customs. This s...
BACKGROUND: The higher maternal mortality in Rajasthan (one of the Empowered Action Group states in India) is attributed to various determinants in health systems, geographical context, and socio-cultural customs. This study aimed to assess the magnitude and trend of maternal deaths in Rajasthan and the associated medical, social and health system factors by comparing their distribution across two selected districts. METHODOLOGY: Spatiotemporal analysis of maternal mortality in the state was done using the secondary data. Household surveys and healthcare facility visits were conducted (systems approach study) to assess and compare maternal deaths in two selected districts of Rajasthan (Jodhpur and Udaipur). Verbal autopsies were conducted to ascertain the causes of maternal mortality and the contributing factors. Quantitative data analysis (SPSS and Jamovi) and spatiotemporal analysis (Python) were done. RESULTS: A total of 8784 maternal deaths have been reported in Rajasthan in the past seven years (2014-21). Among the reported maternal deaths in Jodhpur and Udaipur, majority were facility based (81% and 64%, respectively), mostly between the ages 21 and 25 years. There was an overall increasing trend of Maternal Mortality Ratio (MMR) for Rajasthan (2014-2021 HMIS data). From the verbal autopsy of 248 deaths (173 in Jodhpur and 75 in Udaipur), it was observed that obstetric hemorrhages accounted for about 40% of deaths in both the districts. Comparison of the two districts revealed significant differences in characteristics of the deceased women, including socioeconomic status, rural residence, access to ambulance services, place of delivery, and treatment-seeking behavior. CONCLUSION: The low MMR from secondary data do not reflect the status in the field, but merely a result of poor reporting and lack of strong surveillance. Beyond medical causes, maternal mortality was associated with significant differences in social and health-system factors. Strengthening of surveillance and response systems to address the observed spatiotemporal clustering of maternal deaths in the State is highly recommended.
A prospective longitudinal interventional cohort study on maternal nutrition and pregnancy outcomes in urban Cameroon (CAMELIA): study protocol.
Zemsi S, Ekwoge D, Saha B … +13 more , Kalla V, Minkam A, Ayeni D, Tsanga M, Ndi JA, Powo A, Baban T, Guewo M, Katte JC, Ondobo X, Sobngwi-Tambekou J, Fezeu L, Sobngwi E
BMC Pregnancy Childbirth · 2026 Jun · PMID 42366411 · Full text
BACKGROUND: Maternal nutritional exposures during pregnancy are critical determinants of maternal and neonatal outcomes, yet remain inadequately characterized in many African settings, including Cameroon. The CAMELIA (Ca...
BACKGROUND: Maternal nutritional exposures during pregnancy are critical determinants of maternal and neonatal outcomes, yet remain inadequately characterized in many African settings, including Cameroon. The CAMELIA (Cameroon Maternal and Early Life Assessment) cohort aims to evaluate maternal nutritional status early in pregnancy, implement a structured nutritional intervention, and assess its impact on maternal, neonatal, and long-term metabolic outcomes. METHODS: CAMELIA is a prospective, longitudinal interventional cohort enrolling 1,200 pregnant women at less than 22 weeks' gestation in an urban primary healthcare facility in Cameroon (Hôpital Monseigneur Jean Zoa, Yaoundé). Participants are recruited at the first antenatal visit and followed through delivery and up to 42 days postpartum. Data and biological samples are collected across four visits: at enrolment (< 22 weeks), between 24 and 32 weeks of gestation, at delivery, and at 42 days postpartum. A structured multi-modal nutritional intervention (SUN-APP program) is initiated at enrolment, delivered through individual counselling, group education, monthly interactive workshops, and digital health support via weekly WhatsApp and SMS messages. Gestational hyperglycaemia is screened using fasting capillary blood glucose at V1 and V2, applying a threshold of ≥ 92 mg/dL. Primary outcomes are feasibility and acceptability of the intervention. Secondary outcomes include prevalence of gestational hyperglycaemia, hypertensive disorders, anaemia, low birth weight, and preterm birth. The study holds ethical approval from the Cameroon National Ethics Committee (CNERSH; approval no. 2025/04/1790/CE/CNERSH/SP) and is registered in the ISRCTN registry (ISRCTN13961105). CONCLUSIONS: The CAMELIA study provides a scalable and replicable framework for embedding structured nutritional risk screening and targeted interventions into routine antenatal care in a low-resource African setting. Findings will inform strategies for the prevention of gestational metabolic disorders and adverse perinatal outcomes across generations. TRIAL REGISTRATION: ISRCTN13961105. Registered 14 August 2025.
Potential for primary prevention of low birth weight in pregnancies with and without gestational diabetes mellitus: a prospective cohort study in Central China.
Wu Y, Xiao H, Chen L … +2 more , Qin J, Wang T
BMC Pregnancy Childbirth · 2026 Jun · PMID 42365249 · Full text
BACKGROUND: Low birth weight (LBW) remains a critical global health challenge, yet the differential contributions of risk factors in pregnancies with and without gestational diabetes mellitus (GDM) are poorly characteriz...
BACKGROUND: Low birth weight (LBW) remains a critical global health challenge, yet the differential contributions of risk factors in pregnancies with and without gestational diabetes mellitus (GDM) are poorly characterized. This study aimed to identify modifiable first-trimester risk factors for LBW in GDM and non-GDM subpopulations within a Chinese context, and quantify the preventable LBW burden by population attributable fraction (PAF) estimation adjusted for risk factor interdependence. METHODS: This prospective cohort study enrolled 34,031 pregnant women from Central China (2013-2019), stratified by GDM (n = 5414) and non-GDM (n = 28,617) groups. Early-pregnancy exposures included advanced maternal age, passive smoking, alcohol intake, no folic acid used, low education, and pre-pregnancy underweight. Multivariable logistic regression and principal component analysis-adjusted PAFs were used to quantify preventable LBW burdens while accounting for risk factor overlap. RESULTS: Five risk factors were identified in both GDM (advanced maternal age, passive smoking, underweight, no folic acid used, and low education) and non-GDM (advanced maternal age, alcohol intake, underweight, no folic acid used, and low education) pregnancies. It was found that 18.4% and 33.4% of LBW cases could be theoretically prevented through these five identified risk factors in both GDM and non-GDM cohorts, respectively. Among four shared contributors, low education emerged as the primary modifiable risk factor (adjusted PAF: 9.3% in GDM; 20.1% in non-GDM), followed by underweight (adjusted PAF: 3.7% in GDM; 5.8% in non-GDM), advanced maternal age (adjusted PAF: 3.3% in GDM; 4.8% in non-GDM), no folic acid used (adjusted PAF: 0.9% in GDM; 2.2% in non-GDM). Passive smoking and alcohol intake are specific risk factors for pregnant women with GDM and non-GDM, respectively, with adjusted PAF of 1.1% and 0.5%. CONCLUSION: This study significantly contributes to the advancement of precision public health approaches by elucidating modifiable risk profiles associated with LBW in both GDM and non-GDM populations. These findings highlight population-specific heterogeneity in preventable disease burdens, revealing that a significant proportion of LBW cases could be reduced through targeted antenatal interventions.
Aetiology, survival time and mortality predictors among early neonates at two tertiary hospitals of Lusaka, Zambia.
Musonda M, Patrick K, Choolwe J … +1 more , Bellington V
BMC Pregnancy Childbirth · 2026 Jun · PMID 42365244 · Full text
BACKGROUND: Over 2.3 million neonatal deaths occurred globally in 2022, representing 1 in 58 newborns, with neonatal deaths of about 6,300 every day. Of these, 73% died in the early neonatal period and one third within 2...
BACKGROUND: Over 2.3 million neonatal deaths occurred globally in 2022, representing 1 in 58 newborns, with neonatal deaths of about 6,300 every day. Of these, 73% died in the early neonatal period and one third within 24 h. Despite the 47% globally neonatal deaths decline from 2000 to 2015, Zambia's perinatal and neonatal mortality rates have remained high at 33 and 27 per 1000 total births, respectively. This study aimed to determine the aetiology of early neonatal deaths and to analyse survival time and mortality predictors among normal and low birthweight early neonates in the neonatal intensive care units at two tertiary hospitals of Lusaka, Zambia. METHODS: A prospective cohort study was conducted involving neonatal deaths that occurred in the neonatal intensive care units at the Women Newborn Hospital (WNH) and Levy Mwanawasa Teaching Hospital (LMUTH) tertiary hospitals of Lusaka, Zambia from September 1, 2023 to January 30, 2024. Data were analysed using SPSS Version 30. Associations with death were studied using Chi square and Fischer's exact tests. Descriptive statistics were used to summarise frequency distributions, and cox proportional hazard regression to analyze predictors of early neonatal deaths and survival time. RESULTS: Among the 404 participants, prematurity, sepsis, birth asphyxia and congenital anomalies were notable causes of death. A total of 62 neonates (42.5%) died within the first 30 min of admission, while 224 (58.8%) died within 1.5 h of arrival. Predictors of shorter neonatal survivor included maternal age > 35 AHR 5.70 (95% CI: 1.41-23.10, p < 0.015), foetal seizures AHR 1.81 (95% CI: 1.33-2.46, p < 0.0001), ANC booking had strong association with birthweight (p = 0.001) but was not in the adjusted model. and Rhesus negative 10 (2.5%) AHR 4.48 (95% CI: 1.58-12.70, p < 0.005). Low birthweight babies had AHR 1.95 (1.33-2.86, p < 0.001), walking and use of public transport to hospital had AHR 4.99 (95% CI: 1.07-23.28, p < 0.041) and 4.24 (95% CI: 1.10-16.36, p < 0.036), respectively and foetal anomalies AHR 2.48 (95% CI: 1.25-4.94, p < 0.010). CONCLUSION: Almost 60% of early neonatal deaths occurred within 1.5 h of admission, with the majority (42%) having been within 30 min. Major causes of death included prematurity, sepsis, birth asphyxia, and congenital anomalies. Predictors to shorter survival time highlight critical areas that need attention. There is need to strengthen health promotion on the importance of early antenatal booking. This will enhance early detection of disease, targeted interventions to manage of high-risk pregnancies and access to comprehensive emergency obstetrics and neonatal care sites.
A study on current status and influencing factors of pregnant women's body image in China: A mixed-methods study.
Zhang Y, Yu R, Zhao H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363134 · Full text
BACKGROUND: Recent studies indicate that negative body image adversely affects the physical and psychological well-being of pregnant women and undermines family harmony, thereby jeopardizing maternal and infant health. D...
BACKGROUND: Recent studies indicate that negative body image adversely affects the physical and psychological well-being of pregnant women and undermines family harmony, thereby jeopardizing maternal and infant health. Despite its significant impact, this issue has received scant scholarly attention in China. Body image is not formed in isolation; according to the socio-cultural model, it is constructed through the dynamic interplay of socio-cultural context, family interactions, media messages, and social comparisons. Therefore, it is imperative to investigate the current status and influencing factors of body image among pregnant women in China to establish an evidence base for developing culturally targeted interventions. METHODS: An exploratory sequential mixed-methods design was employed. Phase 1 involved semi-structured in-depth interviews with 17 pregnant women, analyzed using reflexive thematic analysis to develop themes. Phase 2 consisted of a questionnaire survey with 160 pregnant women, utilizing a self-designed questionnaire, the Chinese version of the Body Image in Pregnancy Scale (BIPS), the Perceived Social Support Scale (PSSS), and the Simplified Coping Style Questionnaire (SCSQ). SPSS 25 was utilized for statistical analysis. The qualitative findings directly informed the focus and variable selection for the quantitative phase. RESULTS: Three qualitative themes emerged: key factors influencing body image, consequences and outcomes of body image, and the desire for recognition and support. Quantitatively, body image dissatisfaction was moderate (BIPS score: 97.78 ± 15.57). Multiple linear regression identified greater gestational weight gain (β = 0.691, p = 0.008), lower family support (β = -0.804, p = 0.015), and parity (β = -6.819, p = 0.022) as significant predictors of poorer body image. Qualitative insights provided contextual depth to these statistical associations. CONCLUSIONS: Body image dissatisfaction was moderate among Chinese pregnant women and is influenced by weight gain, family support, and parity. The exploratory sequential design allowed for a deep understanding of lived experiences before quantitative measurement, ensuring the relevance of the measured constructs. Interventions should focus on weight management education and enhancing family support, particularly for first-time mothers, while also addressing and challenging the broader socio-cultural expectations surrounding unrealistic body ideals during pregnancy and the postpartum period.
Cultural adaptation and psychometric evaluation of the Pregnancy-Related Anxiety Questionnaire- Revised 2 (PRAQ-R2) in the Sri Lankan setting.
Amathullah AS, Rishard M, Hettigoda K … +1 more , Dilara Wijesinghe MS
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363122 · Full text
BACKGROUND: Pregnancy-Related Anxiety (PRA) is a significant yet often overlooked mental health issue. The absence of validated tools for assessing PRA in multilingual contexts hinders the provision of equitable care. Th...
BACKGROUND: Pregnancy-Related Anxiety (PRA) is a significant yet often overlooked mental health issue. The absence of validated tools for assessing PRA in multilingual contexts hinders the provision of equitable care. This study aimed to fill this gap by culturally adapting and validating the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) for Sinhala and Tamil populations. METHODS: We conducted a cross-sectional study involving 200 pregnant women, with 100 participants in each language group. These women attended antenatal clinics at two tertiary care hospitals in the Western Province of Sri Lanka between 2024 and 2025. Participants were selected using convenience sampling, excluding those with diagnosed psychiatric disorders. The PRAQ-R2 was translated following WHO guidelines, including forward and back-translation, expert panel review by clinical psychologists, obstetricians, and midwives, and cognitive pretesting. We used exploratory factor analysis to validate the tool. Internal consistency was evaluated using Cronbach's alpha. RESULTS: The exploratory factor analysis of both translated versions confirmed the original three-factor structure of the PRAQ-R2, comprising fear of giving birth, worries about bearing a child with a disability, and concerns about physical appearance. All items showed acceptable factor loadings. Internal consistency was good for both versions. The Sinhala version demonstrated subscale Cronbach's alpha values of 0.813, 0.922, and 0.733, with an overall alpha of 0.86, while the Tamil version showed corresponding values of 0.705, 0.879, and 0.733, with an overall alpha of 0.81. CONCLUSION: Sinhala and Tamil PRAQ-R2 are valid and reliable tools for assessing PRA in Sri Lanka.
Increased point shear wave elastography values of the placenta, fetal lung, and fetal liver in patients with intrahepatic cholestasis of pregnancy.
Özer M, Özer PT, Oğlak SC … +7 more , Gölbaşı H, İleri A, Emiralioğlu Çakır Z, Halisçelik MA, Bolluk G, Yılmaz EZ, Ekin A
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363108 · Full text
OBJECTIVE: The application of point shear wave elastography (pSWE) in obstetrics gained popularity in examining the elasticity of the placenta and maternal tissues in high-risk pregnancies This study aimed to utilize pSW...
OBJECTIVE: The application of point shear wave elastography (pSWE) in obstetrics gained popularity in examining the elasticity of the placenta and maternal tissues in high-risk pregnancies This study aimed to utilize pSWE to determine the elasticity values of these tissues in pregnant women with or without intrahepatic cholestasis of pregnancy (ICP), and to investigate its potential as a novel, non-invasive diagnostic approach beyond conventional methods. MATERIALS AND METHODS: This prospective case-control study, conducted between February 2022 and June 2023, included 120 singleton pregnant women (60 with ICP and 60 body mass index [BMI]- and gestational age-matched healthy controls). All participants underwent B-mode ultrasonography, Doppler examination, and pSWE at 36 weeks of gestation in a single session. Placental (central and peripheral), fetal lung, and fetal liver stiffness values were measured, and the mean of ten valid measurements was used for analysis. Correlations between stiffness values and biochemical parameters were evaluated. Logistic regression analyses were performed to identify independent predictors of ICP. RESULTS: Cases with ICP had a significantly higher mean stiffness value in both the peripheral (9.29 ± 2.45 kPa) and the central (9.03 ± 2.79 kPa) part of the placentas, fetal lung (10.86 ± 3.33 kPa), and fetal liver (4.85 ± 1.17 kPa) than those of the control cases (4.92 ± 2.26 kPa, 4.61 ± 2.11 kPa, 5.76 ± 2.62 kPa, and 3.81 ± 0.99 kPa, respectively, p < 0.001). There was a significant positive correlation between the mean elasticity values of the placenta, fetal lung, and fetal liver and AST, ALT, and TBA values at diagnosis, and a significant negative correlation between the mean elasticity values of the placenta, fetal lung, and fetal liver and the gestational week at diagnosis. CONCLUSION: We showed increased stiffness values on pSWE at the peripheral and central parts of the placenta, fetal lung, and fetal liver in ICP cases compared to healthy pregnancies. Also, higher stiffness values of the placenta and fetal organs were significantly and positively associated with AST, ALT, and TBA values at diagnosis, and significantly and negatively associated with the gestational week at diagnosis. The pSWE might provide evidence of histopathological findings in ICP.
Ophthalmic artery Doppler measurements in Chinese women with healthy pregnancies.
Wu X, Cao D, Huang X … +4 more , Chen J, Li N, Li Y, Chen M
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363090 · Full text
OBJECTIVE: The aim of this study was to establish a reference range for ophthalmic artery (OA) Doppler parameters in Chinese women with healthy pregnancies. METHODS: A prospective cross-sectional study was performed to a...
OBJECTIVE: The aim of this study was to establish a reference range for ophthalmic artery (OA) Doppler parameters in Chinese women with healthy pregnancies. METHODS: A prospective cross-sectional study was performed to assess OA Doppler parameters in 300 healthy women between 11 and 32 weeks of gestation between October 2022 and December 2022. We took two measurements in each eye and recorded the following measurements: the first peak of systolic velocity (PSV1), the second peak of systolic velocity (PSV2), end-diastolic velocity (EDV), mean velocity (MV), pulsatility and resistance indices (PI, RI), the ratio of the second peak to the first peak of systolic velocity (PR), and systolic/diastolic (S/D) pressure. The relationship between the RI, PI, PR, PSV2 and gestational age (GA) was analysed by Spearman rank correlation and linear regression analysis.The 5th and 95th percentiles of OA Doppler indices (PI, RI, PR, PSV2) for 11-32 gestational weeks were computed via the LMS method. RESULTS: A total of 283 healthy pregnant women at different gestational ages were enrolled in this study to analyze the correlation between OA hemodynamic parameters and GA With an increase in GA, the PR of the OA exhibited a progressive downward trend: the mean RPR value was 0.67 ± 0.08 at 12 weeks of gestation and decreased to 0.54 ± 0.07 at 30 weeks, with the difference being statistically highly significant (P < 0.001), while no significant changes were observed in the PI, RI, and PSV2 of the OA. The 5th and 95th prediction intervals for each GA are presented. Intra- and interobserver variability was considered satisfactory. CONCLUSIONS: PR of OA is a GA-dependent hemodynamic index that decreases progressively with advancing gestation, whereas the PI, RI, and PSV2 of OA remain stable throughout the observation period. These findings provide a reliable reference for the clinical assessment of maternal ocular hemodynamics during pregnancy.
Association of maternal hemoglobin and ferritin levels with fetal cortical maturation: a prospective neurosonographic study.
Haksever M, Taşdemir D
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363088 · Full text
OBJECTIVE: To evaluate the association between maternal hemoglobin and ferritin levels and fetal cortical maturation assessed by neurosonography between 30 and 34 weeks of gestation. METHODS: This prospective observation...
OBJECTIVE: To evaluate the association between maternal hemoglobin and ferritin levels and fetal cortical maturation assessed by neurosonography between 30 and 34 weeks of gestation. METHODS: This prospective observational study included 187 singleton pregnancies between 30 + 0 and 34 + 6 weeks of gestation. Maternal hemoglobin and ferritin levels were measured at the time of fetal neurosonographic evaluation. Detailed neurosonography was performed using standardized axial and coronal planes to assess linear cortical measurements and semi-quantitative cortical maturation scores. Global cortical development and Sylvian fissure opercularization were graded using established scoring systems. Group comparisons were performed according to maternal anemia status (hemoglobin < 11 g/dL). Correlation, multivariable regression, receiver operating characteristic (ROC), dose-response, effect size, and sensitivity analyses were conducted. RESULTS: Maternal hemoglobin levels showed weak but statistically significant positive correlations with selected regional cortical parameters, including the frontal angle/parameter, cingulate sulcus depth, and cavum septi pellucidi (CSP) length. Maternal ferritin levels were not significantly associated with any cortical maturation marker. CSP length was significantly shorter in anemic pregnancies. In multivariable regression analysis, gestational age was the only independent predictor of the global cortical development score. ROC analyses demonstrated poor discriminative performance of hemoglobin and ferritin for identifying low global cortical development or reduced CSP length. Dose-response analyses across hemoglobin tertiles showed monotonic increases in selected regional cortical parameters, although effect sizes were small. CONCLUSION: Maternal hemoglobin levels are weakly associated with selected regional neurosonographic markers of fetal cortical maturation during the third trimester, whereas ferritin levels show no significant association. Gestational age remains the primary determinant of global cortical maturation. These findings suggest subtle within-cohort associations rather than definitive evidence of overt abnormal cortical maturation.
Maternal circulating lipid metabolic heterogeneity in preeclampsia: machine learning identifies clinically distinct subtypes.
Gan J, Cao L, Shao J … +7 more , Gu W, Hu R, Xiong Y, Wang Y, Zhao H, Zhou Q, Li X
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363077 · Full text
BACKGROUND: Preeclampsia is associated with dyslipidemia. Maternal circulating lipid profiles may reflect underlying placental-metabolic interactions. We aimed to identify distinct maternal circulating lipid metabolic su...
BACKGROUND: Preeclampsia is associated with dyslipidemia. Maternal circulating lipid profiles may reflect underlying placental-metabolic interactions. We aimed to identify distinct maternal circulating lipid metabolic subtypes and assess their association with clinical outcomes among preeclamptic women. METHODS: A retrospective cohort study of 1,124 women with preeclampsia (2018-2022) was conducted. Third-trimester serum lipids (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)) were analyzed. Unsupervised k-means clustering (Euclidean distance, k = 4 optimized by consensus culmulative distribution function) was used to identify subtypes. Clinical characteristics and pregnancy outcomes were compared across clusters. RESULTS: We identified four lipid metabolic subtypes of preeclampsia with distinct clinical profiles. Four subtypes were identified: Cluster 1 (low metabolic subtype, LMS, 33.5%), Cluster 2 (high HDL subype, HHS, 35.0%), Cluster 3 (high triglyceride subtype, HTS, 11.7%), and Cluster 4 (high metabolic subtype, HMS, 19.8%). The HTS subtype with elevated triglycerides and highest pre-pregnancy body mass index (median 23.92 kg/m), had the lowest rates of preterm birth (3.1%, p = 0.016) and low birth weight (3.8%, p < 0.001). Conversely, the HMS subtype exhibited the highest blood pressure and proteinuria levels. CONCLUSIONS: This study establishes lipid-driven subtypes of preeclampsia with distinct clinical trajectories, suggesting placental lipid handling may be a key modulator in disorder heterogeneity. This heterogeneity underscores the importance of lipid-based stratification for understanding placental dysfunction in preeclampsia.
Chinese couples' lived experiences and decision-making on pregnancy continuation following prenatal anomaly detection: phenomenological and theory of planned behaviour insights.
Chen L, Zhang X, Yin W … +4 more , Qian Q, Yang D, Feng S, Yu H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42363067 · Full text
OBJECTIVES: Prenatal detection of fetal anomalies creates significant emotional and decision-making challenges for expectant parents. International research has described shock, uncertainty, and distress following diagno...
OBJECTIVES: Prenatal detection of fetal anomalies creates significant emotional and decision-making challenges for expectant parents. International research has described shock, uncertainty, and distress following diagnosis, yet little is known about how such experiences unfold within Chinese cultural and family contexts. Family authority, lineage expectations, and concerns about stigma may shape how parents interpret the diagnosis and negotiate reproductive choices. Evidence remains limited regarding how Chinese couples experience emotional disruption, navigate family involvement, and make sense of the diagnosis during a period marked by uncertainty and moral pressure. This study sought to address this gap by exploring the lived experiences of Chinese couples following detection of a suspected or confirmed fetal anomaly. METHOD: The qualitative phenomenological study employed Moustakas' transcendental phenomenology(TP) and Ajzen's Theory of Planned Behavior(TPB). Conducted in Suzhou City, situated in the Yangtze River Delta region of Eastern China, the research spanned from November 21, 2024, to February 15, 2025. The participants were 30 couples who had experienced prenatal anomaly detection in the past 12 months. RESULTS: Analysis identified five themes that described how couples experienced emotional rupture, cultural pressure, and relational strain after receiving a prenatal anomaly diagnosis. Parents reported an abrupt loss of their anticipated future, marked by shock, temporal disruption, and efforts to regain a sense of control. Decision-making occurred within a landscape shaped by moral tension, clinical uncertainty, and unequal options. Cultural expectations related to filial piety, lineage, and family reputation influenced how parents interpreted the diagnosis and negotiated reproductive choices. Family and clinical support played complex roles by offering stability for some and creating additional pressure for others. The diagnosis also reshaped couple relationships, strengthening some bonds while exposing significant strain in others. CONCLUSIONS: Chinese couples experiencing potential fetal congenital anomalies undergo intense emotions and employ various coping strategies. Their decisions are influenced by medical advice, cultural influences, and the availability of resources. By integrating the TP and TPB, this study examines their experiences and decision-making processes, emphasizing the need for culturally tailored support and counseling that respects their emotional and cultural contexts.
Roles and applications of artificial intelligence in fetal and placental MRI: a literature review.
Ding D, Zhu F, Tang X … +1 more , Ding Z
BMC Pregnancy Childbirth · 2026 Jun · PMID 42351041 · Full text
BACKGROUND: Artificial intelligence (AI) has been increasingly integrated with fetal and placental magnetic resonance imaging (MRI) to enhance the detection of abnormalities and streamline diagnostic processes. MRI, know...
BACKGROUND: Artificial intelligence (AI) has been increasingly integrated with fetal and placental magnetic resonance imaging (MRI) to enhance the detection of abnormalities and streamline diagnostic processes. MRI, known for its superior soft tissue contrast and multiplanar imaging capabilities, is a critical tool for evaluating complex fetal and placental conditions. However, the large volume of MRI data often poses challenges for clinicians in providing timely and accurate diagnoses. Fetal and placental MRI are subject to several inherent limitations, including fetal motion artifacts, low signal-to-noise ratio, and operator-dependent variability, which can reduce image quality and hinder accurate diagnosis. Artificial intelligence has shown significant potential in addressing these challenges. For example, AI-based methods have been applied to motion artifact reduction, automated organ segmentation, and disease classification. In addition, recent studies have demonstrated that AI can reduce MRI scan times by up to 60% without compromising image quality, thereby improving diagnostic accuracy and workflow efficiency. METHODS: A systematic PubMed search was conducted on January 16, and May 20, 2024, using predefined terms related to fetal and placental MRI and AI. Peer-reviewed English studies were included, while irrelevant articles, reviews, and editorials were excluded. Disagreements during the review process were resolved by a third reviewer. RESULTS: After systematic screening, 74 studies on AI applications in fetal MRI and 32 studies on placental MRI were included. Key applications in fetal MRI included motion correction (17.6%), organ segmentation (48.6%), and disease classification (6.8%). For placental MRI, studies primarily focused on placental invasion assessment (53.1%) and segmentation (28.1%). Relevant studies published between 2016 and 2024 were categorized by application area and analyzed in detail. CONCLUSIONS: This review synthesizes extensive research on AI applications in fetal and placental MRI, highlighting its potential to enhance imaging quality, automate tasks such as segmentation and motion correction, and improve diagnostic accuracy. However, challenges remain, including reliance on small, single-center datasets, limited demographic and pathological diversity, and a predominance of Two-Dimensional (2D) imaging techniques. Addressing these issues through the development of diverse, multi-center datasets and the exploration of advanced Three-Dimensional (3D) imaging methods is essential. By overcoming these barriers and integrating multimodal approaches, AI holds immense promise for revolutionizing prenatal diagnostics and advancing personalized care.
A multilevel modelling approach to understanding antenatal care utilisation in Uganda.
Towongo MF, Navaneetham K, Letamo G … +1 more , Ngome E
BMC Pregnancy Childbirth · 2026 Jun · PMID 42351028 · Full text
BACKGROUND: This study aims to investigate the factors influencing the adequacy of antenatal care service utilisation among women in Uganda, a country with the high maternal mortality rate in East Africa (336 deaths per...
BACKGROUND: This study aims to investigate the factors influencing the adequacy of antenatal care service utilisation among women in Uganda, a country with the high maternal mortality rate in East Africa (336 deaths per 100,000 live births). One of the causes maternal morbidity and mortality is the underutilisation of antenatal care services, posing a significant challenge to achieving SDG 3.1, which aims to reduce maternal mortality to 70 deaths per 100,000 live births by 2030. METHOD: The study utilised secondary data from the 2016 Uganda Demographic and Health Survey (UDHS), focusing on women aged 15 to 49 who had given birth in the five years preceding the survey. Data analysis involved univariate, bivariate and multilevel binary logistic regression models. RESULTS: The findings from the adjusted model revealed that the adequacy of antenatal care services was 6.4% among women in Uganda. Moreover, individual and community-level factors influenced the adequacy of antenatal care service utilisation. Employment status emerged as a significant factor at the individual level, with employed women more likely to use antenatal care services adequately (AOR = 1.53, 95% CI: 1.13-2.08). Region of residence and community media saturation were influential at the community level, with women in the Northern and Western regions (AOR = 2.35, 95% CI: 1.34-3.43; AOR = 1.85, 95% CI: 1.29-2.67) and those in media-saturated communities more likely to utilise antenatal care services adequately (AOR = 1.85, 95% CI: 1.29-2.67). CONCLUSIONS: The study underscores the limited utilisation of ANC services among women. Factors such as employment status, region of residence, and community media saturation play pivotal roles in determining the adequacy of antenatal care service utilisation. The government is urged to strengthen community media campaigns targeting underperforming regions which underutilizing antenatal care services, so as to improve service quality and access.
Eye-mask and earplugs as sleep aid on glucose metabolism in sleep-deprived pregnancy: a randomized controlled trial.
Nurulhuda AS, Mohammad Som N, Hong J … +5 more , Teo IH, Vimaladevi A, Gan F, Hamdan M, Tan PC
BMC Pregnancy Childbirth · 2026 Jun · PMID 42350994 · Full text
BACKGROUND: Gestational diabetes is associated with short sleep duration. Both conditions are common in pregnancy, especially in later pregnancy. Eye mask and earplugs when used at home in sleep-deprived pregnancy has be...
BACKGROUND: Gestational diabetes is associated with short sleep duration. Both conditions are common in pregnancy, especially in later pregnancy. Eye mask and earplugs when used at home in sleep-deprived pregnancy has been shown to extend nocturnal sleep. Data is sparse on the effect of sleep aids on glucose metabolism through extending sleep. We sought to evaluate use of eye-mask and earplugs on fasting and 2-hour plasma glucose levels at routine oral glucose tolerance test (OGTT) and on actigraph-derived night sleep duration in women with sleep-deprived pregnancy. METHODS: A randomized trial was conducted in a university hospital in Malaysia from July 2021 to August 2022. Sleep-deprived (≤ 7 h night sleep duration) women, on being scheduled for routine OGTT for gestational diabetes screening were enrolled. Participants were randomized to the use of eye-mask and earplugs as sleep aid or no intervention in the week prior to OGTT appointment. All participants were asked to wear the actigraph watch during night sleep in the week prior to OGTT. Pittsburgh Sleep Quality Index (PSQI) data was also obtained at enrollment and at OGTT. The primary outcome was fasting and 2-hour glucose levels at OGTT and actigraph-derived night sleep duration. Secondary outcomes were actigraph-derived wakening after sleep onset, sleep efficiency, and PSQI-derived sleep quality and self-reported night sleep duration. The t test, Mann-Whitney U test, Chi square test, and Fisher exact test were used as appropriate for the data. RESULTS: 240 women were randomized; 120 to each intervention. Data on OGTT results were available from 116 to 117 participants and on actigraph-derived sleep data from 100 to 103 participants for eye-mask and earplugs vs. no intervention arms respectively. The primary outcome of fasting glucose level was mean ± standard deviation (mmol/l ) 4.4 ± 0.5 vs. 4.3 ± 0.4, mean difference (95% CI) 0.03 (-0.86 to 1.46) p = 0.611, 2-hour level was 6.3 ± 1.4 vs. 6.4 ± 1.3, mean difference (95% CI) -0.11 (-0.45 to 0.23) p = 0.536, and total night sleep duration (minutes) 347 ± 50 vs. 349 ± 47, mean difference (95% CI) -2.6 (-16.0 to 10.9) p = 0.707for eye-mask and earplugs vs. no intervention arms respectively. Secondary outcomes were also not significantly different. CONCLUSION: One-week use of eye-mask and earplugs as a sleep aid in women with sleep-deprived pregnancy does not decrease glucose levels at oral glucose tolerance test or extend actigraph-derived sleep duration. ETHICS OVERSIGHT: This trial was approved by the Medical Research Ethics Committee of University Malaya Medical Centre (UMMC) on July 1, 2021 (reference number MREC ID NO: 202157 - 10120). CLINICAL TRIAL REGISTRATION: This study was registered in ISRCTN registry on July 14, 2021, with trial identification number: ISRCTN 17,526,076, http://www.isrctn.com/ISRCTN17526076.
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