BMC Pregnancy And Childbirth[JOURNAL]
Sun
200 papers
Evaluation of fetal brain development in growth restriction subtypes using brain MRI volume measurement.
Xie CF, Zhong CY, Tang W … +1 more , Peng S
BMC Pregnancy Childbirth · 2026 Jun · PMID 42304241 · Full text
BACKGROUND: This retrospective study aims to explore the value of brain MRI volume measurements in evaluating fetal brain development in fetal growth restriction (FGR) fetuses, by comparing 2 subtypes of FGR with appropr...
BACKGROUND: This retrospective study aims to explore the value of brain MRI volume measurements in evaluating fetal brain development in fetal growth restriction (FGR) fetuses, by comparing 2 subtypes of FGR with appropriate gestational age (AGA) fetuses. METHODS: A total of 169 fetal brain MRI with suspected abnormal development, identified through ultrasound screening at this hospital between 2021 and 2025 were analyzed,11 cases were excluded. 98 cases were FGR fetuses (43 early-onset subtypes and 55 late-onset subtypes), and 60 were AGA fetuses, gestational age ranging from 26 to 37 weeks. Three-dimensional reconstruction and image segmentation were performed on fetal intracranial tissues including cerebrum, cerebellum and brainstem. Changes in brain volume at different gestational weeks were analyzed to assess the development of fetal brain anatomical structures. RESULTS: In both groups, the Pearson correlation coefficients for cerebrum, brainstem, and cerebellum volume with head circumference and gestational age were greater than 0.8, indicating a strong correlation. Across all gestational age subgroups (26-31 weeks), cerebral, brainstem, and cerebellar volumes were all significantly smaller in early-onset FGR fetuses than in AGA fetuses (independent-samples t-test; e.g., at 26-27 weeks: cerebrum 87.3 ± 9.2 cm³ vs. 113.2 ± 10.3 cm³, brainstem 1.7 ± 0.2 cm³ vs. 2.7 ± 0.3 cm³, cerebellum 3.3 ± 0.6 cm³ vs. 4.6 ± 1.0 cm³; all p < 0.05; early-onset FGR n = 43, AGA n = 30, analysed across three gestational age windows of 10 fetuses each). For late-onset FGR fetuses (32-37 weeks; n = 55 vs. AGA n = 30, analysed across three gestational age windows of 10 fetuses each), cerebral volume was significantly reduced compared with AGA fetuses across all gestational age subgroups (e.g., at 32-33 weeks: 160.1 ± 18.7 cm³ vs. 194.1 ± 18.2 cm³; p < 0.05), while there was no statistically significant difference in brain stem volume between late-onset FGR and AGA fetuses at 34 weeks(4.6 ± 0.7cm vs. 5.0 ± 0.5cm; BH-FDR adjusted p = 0.228) or later(5.2 ± 0.7cm vs. 5.5 ± 0.6cm; BH-FDR adjusted p = 0.206), nor in cerebellum volume at 36 weeks or later(14.0 ± 1.6cm vs. 15.5 ± 2.2cm; BH-FDR adjusted p = 0.110). DISCUSSION: MRI measurement of fetal brain volume can serve as a predictor of brain development in 2 subtypes of FGR. In early-onset FGR, volumes of the brainstem, cerebellum and cerebrum consistently showed smaller growth prior to 32 weeks. Late-onset FGR was characterized by persistently smaller cerebrum volume. Brainstem volume was no longer significantly different from AGA levels by 34 weeks, and cerebellum volume approached AGA levels after 36 weeks.
Evaluation of systemic immune-inflammatory biomarkers in eclampsia: a retrospective cohort study.
Yılmaz A, Kurt D
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298516 · Full text
OBJECTIVE: To evaluate systemic immune-inflammatory biomarkers in patients diagnosed with eclampsia and to investigate their potential association with inflammation. METHODS: This retrospective study included 31 patients...
OBJECTIVE: To evaluate systemic immune-inflammatory biomarkers in patients diagnosed with eclampsia and to investigate their potential association with inflammation. METHODS: This retrospective study included 31 patients with eclampsia and 51 healthy pregnant women matched for age and parity. Hematological biomarkers-including NLR, MLR, PLR, SII, SIRI, PNR, dNLR, and AISI-were calculated using complete blood count data collected prior to delivery. Statistical comparisons between groups were performed using appropriate tests based on data distribution. RESULTS: There were no statistically significant differences in NLR, MLR, SII, SIRI, dNLR, or AISI between groups (p > 0.05). The PLR and PNR levels were significantly lower in the eclampsia group (p = 0.021 and p = 0.044). Additionally, the eclampsia group had significantly lower gestational age and neonatal birth weight, and higher rates of cesarean section, ICU admission, and maternal complications (all p < 0.001). CONCLUSION: This study found no significant association between eclampsia and most systemic immune-inflammatory biomarkers. PLR and PNR values were significantly lower in the eclampsia group. These markers may serve as potential negative predictive biomarkers, but their diagnostic value remains limited. Further prospective studies are needed to clarify their clinical utility in eclampsia.
Handling the challenges of accessing reliable and tailored information on physical activity during pregnancy: a mixed-methods, cross-perspective investigation.
Hyvärinen M, van Poppel M, Legardeur H … +3 more , Haubry M, Wegrzyk J, de Labrusse C
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298505 · Full text
BACKGROUND: Physical inactivity during pregnancy remains a major public health challenge. Although many interventions have been shown to significantly increase physical activity (PA), their real‑world impact remains limi...
BACKGROUND: Physical inactivity during pregnancy remains a major public health challenge. Although many interventions have been shown to significantly increase physical activity (PA), their real‑world impact remains limited. Healthcare professionals represent a key lever for addressing this challenge, yet PA is still insufficiently promoted despite recognized health benefits. Embedding PA promotion into maternity care, particularly through midwives, appears promising, but how to ensure equitable implementation that supports informed decision‑making in practice remains unclear. This study therefore aims to better understand how behavioral determinants, professional PA promotion practices, and pregnant individuals' characteristics collectively influence decisions to engage in PA during pregnancy and to inform a framework for implementation. METHODS: A mixed‑methods study was conducted in two maternity hospitals in Western Switzerland. Ninety‑five pregnant women completed a survey on their perceptions of PA communication across professions, and 16 participated in semi‑structured interviews. Additionally, 19 hospital‑based midwives were interviewed about their practices. Data collected in parallel were analysed separately using descriptive and inferential statistics, and thematic analysis informed by the Theoretical Domains Framework (TDF) and the Capability‑Opportunity‑Motivation‑Behavior (COM‑B) model. Integration of findings occurred after separate analyses using the Pillar Integration Process. RESULTS: Most participants were in their third trimester (76%), highly educated (79%), and followed by private obstetrician‑gynecologists (82%). Access to PA information often relied on women's own proactivity, with 37% receiving no information and 59% wanting more. Incomplete and non-spontaneous communication across professions negatively shaped women's PA decision‑making due to misbeliefs and negative emotions. Hospital‑based midwives frequently forgot or avoided the topic, especially when unconfident or perceiving low interest, due to limited training, procedures, and resources, contributing to inconsistent and inaccurate PA communication. Together, these insights informed a COM‑B‑based framework designed to strengthen hospital-based midwives' capability, opportunity, and motivation and promote spontaneous PA communication targeting knowledge, beliefs about consequences, and emotion to support tailored decision about PA during pregnancy. CONCLUSION: This study provides insights into how multilevel determinants shape access to PA information. It presents a theory‑driven framework to guide strategies for integrating systematic, spontaneous, and tailored PA communication into care to support informed decisions to engage in PA during pregnancy.
Subtotal versus total hysterectomy in placenta accreta spectrum management at a tertiary centre in saudi arabia: a retrospective study.
Alharbi NA, Abdulhamed GI, Mohsina SI … +2 more , Alsharif AA, Almojel SA
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298492 · Full text
BACKGROUND: Placenta accreta spectrum (PAS) is a major contributor to life-threatening obstetric hemorrhage and is increasingly encountered worldwide due to rising caesarean delivery rates. Caesarean hysterectomy remains...
BACKGROUND: Placenta accreta spectrum (PAS) is a major contributor to life-threatening obstetric hemorrhage and is increasingly encountered worldwide due to rising caesarean delivery rates. Caesarean hysterectomy remains the cornerstone of management in most cases; however, the optimal surgical techniques, subtotal versus total hysterectomy, continue to be debated. Current evidence is limited and heterogeneous, and practice often varies according to surgeon preference and intraoperative findings. By evaluating outcomes in a large cohort at a national tertiary referral center, this study aims to clarify the comparative safety and effectiveness of subtotal versus total hysterectomy in PAS management. METHODS: We conducted a retrospective cohort study of women with PAS who underwent caesarean hysterectomy between 2018 and 2023. The primary outcome was intraoperative quantified blood loss (QBL). Secondary outcomes included operative time and bladder injury. Multivariable linear regression on log-transformed QBL and operative time was used to estimate adjusted geometric mean ratios, while bladder injury was analyzed using multivariable logistic regression. All models adjusted for surgical urgency, antenatal PAS severity, suspected cervical involvement, number of prior caesarean deliveries, gestational age at delivery, and surgeon identifier. RESULTS: Among the included patients, subtotal hysterectomy was associated with significantly lower intraoperative blood loss compared with total hysterectomy (adjusted geometric mean ratio 0.36, 95% CI 0.32-0.41; p-value < 0.001). Operative time was also significantly shorter in the subtotal hysterectomy group (adjusted geometric mean ratio 0.54, 95% CI 0.50-0.59; p-value < 0.001). In addition, subtotal hysterectomy was associated with a significantly lower odds of bladder injury (adjusted odds ratio 0.19, 95% CI 0.05-0.68; p-value = 0.013). CONCLUSION: Subtotal hysterectomy was associated with significantly lower intraoperative blood loss, shorter operative time, and fewer bladder injuries compared to total hysterectomy for placenta accreta spectrum. These findings support subtotal hysterectomy as a feasible and potentially safer surgical option in selected cases. While these findings support subtotal hysterectomy as a viable option, the retrospective design and potential selection bias highlight the need for individualized decision-making. Further multicenter prospective research with standardized surgical criteria is needed to confirm these results, minimize confounding from PAS severity, and determine the most effective surgical approach.
Risk factors for massive intraoperative hemorrhage during cesarean section in patients with complete placenta previa and placenta accreta spectrum, without prior cesarean delivery: a retrospective case-control study.
Cao P, Liu P, Ji L … +1 more , Qiao C
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298487 · Full text
BACKGROUND: Research on placenta accreta spectrum (PAS) primarily focuses on patients with complete placenta previa (cPP) and a prior cesarean delivery. Studies on patients without a prior cesarean delivery are relativel...
BACKGROUND: Research on placenta accreta spectrum (PAS) primarily focuses on patients with complete placenta previa (cPP) and a prior cesarean delivery. Studies on patients without a prior cesarean delivery are relatively scarce. With the increasing maternal age and a growing number of patients with infertility, the incidence of cPP accompanied by PAS has risen, even among individuals without a prior cesarean delivery. Relying solely on the preoperative PASUSS score may underestimate the actual severity of PAS. This study aims to explore the risk factors for massive intraoperative hemorrhage (MIH) during cesarean section in patients with cPP and PAS who have no prior cesarean delivery, based on baseline patient characteristics and ultrasound indicators. METHODS: Retrospective data were collected from 109 patients diagnosed with cPP accompanied by PAS and without a prior cesarean delivery, who were admitted to Shengjing Hospital affiliated with China Medical University between January 2020 and December 2024. MIH during cesarean section was defined as blood loss of ≥ 2000 mL during the procedure. Participants were classified into two groups: the MIH group (22 cases) and the non-MIH group (87 cases). Independent risk factors for MIH were identified through univariate and multivariate logistic regression analysis. RESULTS: In patients with cPP and PAS diagnosed mainly through clinical criteria and no prior cesarean delivery, the incidence of MIH was approximately 20.18%. Independent risk factors for MIH include maternal age, hysteroscopic adhesiolysis, and a higher preoperative PASUSS score. CONCLUSIONS: In clinical practice, it is essential not only to prioritize the preoperative PASUSS score but also to pay close attention to the patient's baseline characteristics. This approach enables accurate identification of individuals at high risk for MIH, thereby improving patient prognosis.
Assessing stakeholders' acceptability of implementing the midwifery continuity of care model in China: a convergent mixed-method study.
Yu C, Dong S, Wang X … +4 more , Zhu C, Min H, Qian X, Gu C
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298482 · Full text
BACKGROUND: The midwifery continuity of care (MCoC) model, in which a known midwife or small team provides coordinated care throughout pregnancy, birth, and the postnatal period, is recommended internationally. In China,...
BACKGROUND: The midwifery continuity of care (MCoC) model, in which a known midwife or small team provides coordinated care throughout pregnancy, birth, and the postnatal period, is recommended internationally. In China, however, maternity care remains predominantly obstetrician-led and fragmented. Successful implementation of MCoC critically depends on stakeholder acceptance, yet evidence on their perspectives in the Chinese context is scarce. This study aimed to assess the acceptability of implementing the MCoC model among maternity care providers and childbearing women in China. METHODS: A convergent parallel mixed-methods design was adopted. Nationwide cross-sectional surveys were administered to 896 maternity care providers, and focus group discussions were conducted with care providers and childbearing women. Quantitative data were analyzed using descriptive statistics and chi-square tests; qualitative data were analyzed inductively using thematic analysis. RESULTS: Among the 896 providers (median age 35 years), 835 (93.2%) expressed willingness to accept and implement the MCoC model in clinical practice. Acceptability varied significantly by stakeholder group (P < 0.05), being highest among midwives (96.7%), followed by obstetric nurses (93.5%) and obstetricians (88.9%). Key facilitators included supportive leadership (95.3%), endorsement from obstetricians (79.8%) and buy-in from pregnant women (77.9%), as well as support from collaborating hospitals (63.0%). Qualitative analysis yielded four main themes: (1) High feasibility of implementing the MCoC model; (2) Women's unmet needs for relational continuity within current maternity care; (3) Positive expectations toward the MCoC model; and (4) Barriers to implementing the MCoC model. CONCLUSIONS: The acceptability of the MCoC model was high among stakeholders in China. Supportive leadership, targeted education and training, and strategic publicity are crucial for its successful introduction and scale-up.
First trimester, one-tube screening for pregnancy complications via placental biomarkers.
Hua R, Li S, Han X … +7 more , Tang Z, Ye B, Tan Y, Wang S, Sun J, Cheng W, Wang Y
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298474 · Full text
BACKGROUND: Early pregnancy screening to identify high-risk women for targeted prevention is effective for reducing pregnancy complications. Placental biomarkers, including PlGF and PAPP-A, are linked to adverse outcomes...
BACKGROUND: Early pregnancy screening to identify high-risk women for targeted prevention is effective for reducing pregnancy complications. Placental biomarkers, including PlGF and PAPP-A, are linked to adverse outcomes, yet their combined predictive value for pregnancy complications remains unclear. Here, a retrospective cohort study was conducted to assess first-trimester prediction models incorporating PlGF, PAPP-A, and maternal factors for major obstetric complications. METHODS: This was a retrospective cohort study using data that were prospectively collected during first-trimester screening. A cohort study was conducted at the International Peace Maternity and Child Health Hospital of China Welfare Institution (Shanghai, China) from December 2021 to October 2022. A total of 4046 participants were recruited during the first-trimester screening, excluding those with miscarriages and those without delivery data. In our routine screening, all pregnant women were tested for placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A). The mean arterial pressure (MAP) and uterine artery pulsatility index (UTPI) were also measured in accordance with the Fetal Medicine Foundation guidelines, along with maternal characteristics and medical history collected via face-to-face interviews. Multivariable logistic regression was used for model development. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS: Among 4046 initially recruited participants, data from 3910 participants regarding fetal growth restriction (FGR), gestational diabetes mellitus (GDM), placenta previa and preterm birth (PTB) were analyzed. For the PE analysis, a subgroup of 1,588 women with available UTPI measurements was evaluated. The best models for predicting FGR were the indicator height, PAPP-A levels, and PlGF levels, with an AUC of 0.742 (95% CI: 0.633-0.851). Regarding GDM prediction, the model including BMI and PAPP-A levels had the best AUC (0.667, 95% CI: 0.622-0.713). With respect to placenta previa prediction, the model including age and PlGF levels had the best AUC (0.765, 95% CI: 0.588-0.941). For PTB, indicators such as the PlGF multiples of the median (MoM), PAPP-A, type I diabetes and systemic lupus erythematosus had the best performance, with an AUC of 0.665 (95% CI: 0.553-0.776). For PE screening using the Fetal Medicine Foundation (FMF) competing-risk model (PAPP-A, PIGF, MAP, and UTPI), the model achieved an AUC of 0.847 for preterm PE (< 37 weeks), with a detection rate of 50.00%, and an AUC of 0.777 for term PE (≥ 37 weeks), with a detection rate of 95.12% at the recommended risk cutoff of 1 in 100. CONCLUSION: First-trimester screening using PlGF, PAPP-A, and maternal factors shows preliminary associations with common obstetric complications, suggesting the potential utility of these biomarkers in early risk stratification, providing a proof-of-concept tool for early risk stratification and improved management of high-risk pregnancies to reduce maternal and fetal morbidity. However, these models require validation in larger, more diverse populations before clinical consideration.
Forced migrant fathers' experiences of pregnancy and childbirth: a hermeneutic phenomenological study.
Mprah A, Haith-Cooper M, Meddings F
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298455 · Full text
INTRODUCTION: There is an increasing body of literature exploring migrant (including forced migrant) women's experiences of maternity care in their host country. However, there is a paucity of research around the perspec...
INTRODUCTION: There is an increasing body of literature exploring migrant (including forced migrant) women's experiences of maternity care in their host country. However, there is a paucity of research around the perspective of migrant fathers. OBJECTIVE: This study aims to explore the experiences of forced migrant fathers during the pregnancy and childbirth of their partners, examining the challenges and emotional dynamics encountered in these transitional periods. METHOD: A hermeneutic phenomenological approach was employed to gain a deep understanding of the fathers' lived experiences. In-depth, semi-structured interviews were conducted with 15 forced migrant fathers who had recently experienced the birth of a child. The data were analyzed using framework analysis to identify and interpret the core themes emerging from their narratives. RESULTS: The analysis identified several key themes, including being sidelined, alien NHS maternity journey and living in the asylum system. Despite these challenges, many fathers expressed a strong desire to support their partners and play an active role in the upbringing of their children. Forced migrant fathers often felt marginalised in the healthcare system due to cultural misunderstandings and language barriers. Their narratives highlighted the need for more inclusive practices that recognize and support the unique challenges they face. Emotional resilience and adaptive strategies were commonly observed, demonstrating their commitment to their families amidst challenges. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: The study underscores the importance of culturally sensitive and inclusive healthcare practices to support forced migrant fathers during pregnancy and childbirth. Healthcare providers should be trained to recognize the specific needs of this population, ensuring that fathers are actively involved and supported. Improving communication and providing tailored resources can enhance the overall well-being of forced migrant families and contribute to positive childbirth experiences. By acknowledging and addressing the unique challenges faced by forced migrant fathers, healthcare systems can foster more equitable and supportive environments for all families.
Exploring perceived awareness, barriers and enablers of pregnant women towards physical activity in Ethiopian cities: a qualitative study.
Endalew ES, Tucho GT, Mattisson K … +9 more , Oudin A, Papadopoulou E, Girmay AM, Denu ZA, Garedew MG, Kedir I, Moges T, Tessema M, Malmqvist E
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298449 · Full text
BACKGROUND: According to the World Health Organization, all healthy pregnant women are recommended to engage in at least 150 min of regular moderate-intensity aerobic activity per week. This level of physical activity is...
BACKGROUND: According to the World Health Organization, all healthy pregnant women are recommended to engage in at least 150 min of regular moderate-intensity aerobic activity per week. This level of physical activity is associated with numerous physical and psychological health benefits and helps to reduce the risk of being overweight, gestational diabetes, and preeclampsia. Despite its importance, adherence to the recommended levels of physical activity is low among pregnant women in Ethiopia, particularly in urban areas. Therefore, there is a need for a better understanding of barriers and enablers that affect physical activity levels. Thus, this study explored the perceived awareness, barriers, and enablers that influence pregnant women's physical activity in their everyday lives. METHODS: Seven focus group discussions were conducted with 45 pregnant women who attended routine antenatal care visits at selected health centers in four Ethiopian cities. The data were transcribed and exported to NVivo version 14 software for data management and analysis. An inductive process of thematic analysis was employed, and themes were developed. RESULTS: Most of the pregnant women had awareness about the health benefits of physical activity. However, some lacked awareness regarding safety precautions and the types of physical activities that can be done during pregnancy. Additionally, some had misconceptions about physical activity throughout the first trimester, believing that it results in abortion. The preferred method of physical activity was walking, both as a means of transportation and recreation. Health conditions, personal factors (such as being office worker, time constraint lack of commitment), societal factors (such as fear of judgment, culture) and environmental factors(such as lack of paved sidewalks, unfavorable weather conditions) were identified as barriers whereas partner support, experience sharing from pregnant women who had been exercising previously and having access to green space were identified as facilitators. CONCLUSIONS: This study identified several barriers and enablers that influence physical activity during pregnancy. By addressing Identified barriers, policy makers can create more enabling conditions for women to engage in safe, regularphysical activity during pregnancy, thereby reducing NCDs and improving maternal wellbeing and pregnancy outcomes.
Investigating spiritual health and social well-being and its relationship with the attitude towards childbearing among nurses.
Karimi M, Zareipour M, Mehraji F … +1 more , Zayer M
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298447 · Full text
BACKGROUND: Although spiritual health and social well-being can influence attitudes toward childbearing, little is known about their combined role among nurses. Therefore, this study aims to investigate the relationship...
BACKGROUND: Although spiritual health and social well-being can influence attitudes toward childbearing, little is known about their combined role among nurses. Therefore, this study aims to investigate the relationship between spiritual health and social well-being with attitudes toward childbearing among nurses working at Khoy University of Medical Sciences. METHODS: This cross-sectional study was conducted using stratified random sampling and involved 320 employed nurses at the university. The data collection instrument comprised a questionnaire that included demographic characteristics, measures of spiritual health, social well-being, and attitudes toward childbearing. The relationships among the variables were analyzed using statistical tests, including correlation coefficients, one-way analysis of variance (ANOVA), and multiple linear regression. RESULTS: The mean scores for spiritual health, social well-being, and attitude toward childbearing were 79.89 ± 15.93, 61.69 ± 9.74, and 57.00 ± 11.14, respectively. Spiritual health was significantly associated with attitude toward childbearing (β = 0.11, p = 0.007), and social well-being was also significantly associated with attitude toward childbearing (β = 0.10, p = 0.006). Among demographic variables, age (p = 0.004), education level (p = 0.006), economic status (p = 0.002), and number of children (p < 0.002) showed significant associations with attitude toward childbearing. The existential dimension of spiritual health (β = 0.22, p = 0.007) and the integration (β = 0.79, p < 0.001) and acceptance (β = 0.37, p = 0.046) dimensions of social well-being were the most influential factors. CONCLUSIONS: This study highlights the significance of spiritual health and social well-being in shaping nurses' attitudes toward childbearing. Therefore, it is recommended that suitable educational and supportive programs be developed to enhance the spiritual and social health of nurses, which may aid in improving their decision-making regarding childbearing. By fostering these aspects, healthcare organizations can contribute to more positive attitudes and informed choices among nurses relating to parenting and family planning.
Proportion and risk factors of retinal changes in pregnant women with HELLP syndrome.
Wu L, Chen W, Ye M … +5 more , Zhou T, Lin D, Zheng H, Wang L, Lin H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298446 · Full text
BACKGROUND/AIMS: To report the proportion and risk factors associated with retinal changes in Chinese pregnant women diagnosed with HELLP syndrome. METHODS: A retrospective review of medical records was conducted for all...
BACKGROUND/AIMS: To report the proportion and risk factors associated with retinal changes in Chinese pregnant women diagnosed with HELLP syndrome. METHODS: A retrospective review of medical records was conducted for all pregnant women with HELLP syndrome delivered at the Second Affiliated Hospital of Wenzhou Medical University between September 2010 and August 2023. Retinal changes were identified and were categorized into retinal vascular changes and serous retinal detachment based on the ophthalmology consultation records. The proportion of retinal changes was calculated, and associated risk factors were analyzed. RESULTS: A total of 70 cases with HELLP syndrome were included, with a mean age of 30.1 ± 5.2 years. Forty-nine cases received ophthalmology consultation, presenting a consultation rate of 70.0%. The proportion of retinal changes was 55.1% (27/49) in cases with HELLP syndrome. The proportion of retinal vascular changes and serous retinal detachment were 30.6% (15/49) and 24.5% (12/49), respectively. Patients with retinal vascular change (120.7 ± 8.0 mmHg) and those with serous retinal detachment (116.7 ± 14.5 mmHg) demonstrate significantly elevated diastolic blood pressure at the time of HELLP syndrome diagnosis compared to case without retinal changes (110.1 ± 12.4 mmHg, P = 0.032). HELLP syndrome cases treated with corticosteroids were more likely to develop serous retinal detachment compared to those not receiving corticosteroids (40.0% vs. 13.8%, P = 0.040). CONCLUSION: The proportion of retinal changes was 55.1% among Chinese pregnant women with HELLP syndrome. Elevated diastolic blood pressure was identified as associated risk factor for developing retinal changes. The use of corticosteroids may have more risk of developing serous retinal detachment.
Validity and reliability of the Chinese version of the Barriers to Physical Activity during Pregnancy Scale (BPAPS) in pregnant women.
Ye L, Shang X, Gui M … +7 more , Sun L, Yao H, Zhang Y, Li L, Wang F, Amiri-Farahani L, Liao Y
BMC Pregnancy Childbirth · 2026 Jun · PMID 42298433 · Full text
BACKGROUND: Despite regular physical activity (PA) is beneficial to maternal health and her fetus, engagement in PA among pregnant women is inactive. It is essential to assess barriers to PA in this population to increas...
BACKGROUND: Despite regular physical activity (PA) is beneficial to maternal health and her fetus, engagement in PA among pregnant women is inactive. It is essential to assess barriers to PA in this population to increase pregnant women's PA level. However, there is a lack of reliable and valid tools to evaluate barriers to PA during pregnancy in China. Therefore, the study aimed to translate and validate the Barriers to Physical Activity during Pregnancy Scale (BPAPS) in Chinese pregnant women. METHODS: A study of 448 pregnant women was conducted in China from November to December 2023. After obtaining the author's permission, the translation of the BPAPS was carried out with a standardized procedure. The validity of the BPAPS was measured by the content validity, construct validity, and criterion validity in this study. The reliability of the BPAPS was evaluated using internal consistency and test-retest. RESULTS: The final Chinese version of the BPAPS had four domains with 28 items. The content validity index of all items ranged from 0.875 to 1.000. Exploratory factor analysis extracted four factors, explaining 62.332% of the total variance. The four-factor model was confirmed. The initial model did not fit well. After modification, the final model had a reasonable fit to the data: the chi-square to degrees of freedom ratio was 2.439, the root mean-square-error of approximation was 0.068, the comparative fit index was 0.913, the incremental fit index was 0.913, and the tusker-lewis index was 0.903. This scale also had good criterion validity (r = 0.605, P<0.001). The Cronbach's alpha and intraclass correlation coefficient of the total scale were 0.942 and 0.860, indicating good reliability. CONCLUSION: The Chinese version of the BPAPS has good reliability and validity. It can be used as an effective tool to assess barriers to PA in Chinese pregnant women.
Current situation and influencing factors of knowledge, attitude and practice of breast engorgement among postpartum women: a cross-sectional study.
Li A, Tu S, Guo Q … +2 more , Gao J, Liu Q
BMC Pregnancy Childbirth · 2026 Jun · PMID 42289661 · Full text
OBJECTIVE: To understand the current situation of knowledge, attitude and practice of breast engorgement in postpartum women and analyze its influencing factors. METHODS: From August 2019 to December 2019, by using the m...
OBJECTIVE: To understand the current situation of knowledge, attitude and practice of breast engorgement in postpartum women and analyze its influencing factors. METHODS: From August 2019 to December 2019, by using the method of convenient sampling, 530 postpartum women in the department of obstetrics in 3 tertiary hospitals were investigated with the breast engorgement knowledge, attitude and practice and general data questionnaire. RESULTS: The scores of breast engorgement of knowledge, attitude, practice and total KAP were (8.90 ± 3.17), (33.83 ± 3.54), (31.67 ± 1.41) and (74.41 ± 12.26). The results of regression analysis showed that participation in school during pregnancy and knew breast engorgement were influencing factors of breast engorgement knowledge score. Graduate and above (maternity), participation in school during pregnancy and vaginal delivery were influencing factors of attitude score towards breast engorgement. Artificial feeding and mixed feeding were influencing factor of practice score of breast engorgement. Participation in school during pregnancy, knew breast engorgement, artificial feeding, mixed feeding and commercial and service personnel (spouse) were influencing factors of total score of KAP of breast engorgement (P<0.05). CONCLUSION: The level of knowledge about breast engorgement is low, the attitude towards breast engorgement is positive, and the practice to breast engorgement need to be improved. Health care workers should formulate and implement targeted nursing education and intervention to improve the level of knowledge, attitude and practice of breast engorgement in order to reduce the incidence of breast engorgement.
The mediating role of fetal health anxiety in the relationship between fear of childbirth and preferred mode of delivery among pregnant women.
Akın Yamak Ö, Boyraz Yanık HG, Erbil N
BMC Pregnancy Childbirth · 2026 Jun · PMID 42289659 · Full text
BACKGROUND: Pregnancy and childbirth involve significant psychological and physiological changes in women. Some pregnant women experience intense anxiety, which may lead to serious concerns that contribute to the develop...
BACKGROUND: Pregnancy and childbirth involve significant psychological and physiological changes in women. Some pregnant women experience intense anxiety, which may lead to serious concerns that contribute to the development of fear of childbirth. This study aimed to determine the mediating role of fetal health anxiety in the relationship between fear of childbirth and preferred mode of delivery among pregnant women. METHODS: This descriptive and correlational study was conducted with 241 pregnant women who attended outpatient clinics and polyclinics in two cities in the Black Sea Region. The data were collected between September and December 2025. Data were collected using the Personal Information Form, the Anxiety subscale of Depression Anxiety Stress Scale-21, the Fetal Health Anxiety Inventory, the Tokophobia Assessment Questionnaire, and the Pregnant Women's Preferences for Mode of Delivery Questionnaire. Data were analyzed using descriptive statistics, Pearson correlation, Cronbach's alpha reliability analysis, linear regression, and mediation analysis. Statistical significance was set at p < 0.05. RESULTS: The mean age of the participants was 29.70 ± 4.80 years. Among the pregnant women, 22.8% reported mild anxiety and 11.6% reported moderate anxiety. Fear of childbirth was positively and weakly correlated with anxiety (r = 0.175), positively and moderately correlated with fetal health anxiety (r = 0.395), and negatively and moderately correlated with preferred mode of delivery (r = - 0.374) (p < 0.001). Fetal health anxiety showed a positive and moderate correlation with anxiety (r = 0.433) and a negative and moderate correlation with preferred mode of delivery (r = - 0.336) (p < 0.001). Fear of childbirth and fetal health anxiety were significantly associated with preferred mode of delivery (R = 0.427, R² = 0.183, F = 17.656, p < 0.001), explaining 18% of the variance. According to standardized regression coefficients, fear of childbirth (β = -0.286) and fetal health anxiety (β = -0.210) were significant predictors of preferred mode of delivery. Analysis of the t-test results for the regression coefficients indicated that fear of childbirth and fetal health anxiety were significant predictors of pregnant women's preferences for mode of delivery. The findings further showed that fear of childbirth had a significant negative effect on preferred mode of delivery (β = -0.286). CONCLUSIONS: Fetal health anxiety mediates the relationship between fear of childbirth and preferred mode of delivery, contributing an additional indirect effect to the influence of fear of childbirth on preferred mode of delivery.
Expanded adverse childhood experiences and postpartum mental health among an under-resourced sample of Spanish- and English-speaking mothers referred for community-based mental health services during pregnancy.
Hash JB, Nelson DC, Fleming CB … +5 more , Oxford ML, Lohr MJ, de Castro AB, Bleil ME, Spieker SJ
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288803 · Full text
BACKGROUND: Adverse childhood experiences (ACEs) historically include 10 types of adversities (the "Conventional 10"), developed in the context of the landmark CDC-Kaiser ACEs study. These 10 ACEs are associated with an...
BACKGROUND: Adverse childhood experiences (ACEs) historically include 10 types of adversities (the "Conventional 10"), developed in the context of the landmark CDC-Kaiser ACEs study. These 10 ACEs are associated with an increased risk of perinatal depression and anxiety, but they may also overlook traumas that harm disadvantaged and minoritized groups. This study investigated an Expanded set of ACEs (the Conventional 10 plus five additional) among a sample of Spanish- and English-speaking postpartum mothers who had previously received a referral for a prenatal mental health concern from a community-based service providing care to under-resourced populations. Specific aims were to: (1) Describe the Conventional 10 and Expanded 15 ACEs in this sample, and compare the Conventional 10 in this sample to that of the existing landmark CDC-Kaiser ACEs study sample (reference sample), (2) Investigate demographic variation in the Conventional 10 and Expanded 15 ACE scores in this sample, and (3) Examine associations between ACEs and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) at 6-12 weeks postpartum in this sample. METHODS: Participants included 244 Spanish- and English-speaking mothers from under-resourced communities who were previously referred for a mental health concern during pregnancy. Participants reported on their ACEs and their 6-to-12-week postpartum mental health including depression, anxiety, and post-traumatic stress symptoms. Reference sample data (descriptives of the Conventional 10 ACEs in the CDC-Kaiser ACEs study sample women) were obtained from a publicly available report. RESULTS: The proportion of mothers reporting each of the Conventional 10 ACEs was greater in this sample than that of the reference CDC-Kaiser sample. Among the present study sample, mothers who came to the United States (US) in adulthood reported fewer ACEs compared to mothers born in the US. Additionally, among the present study sample, correlations with the postpartum mental health outcomes were slightly larger for the Expanded 15 ACE score than the Conventional 10 (rs = 0.31-0.42 and 0.26-0.37, respectively). CONCLUSIONS: Future studies should consider the context of how and with whom ACEs measures are developed. TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT02724774 registration date 3242016).
The risk of congenital malformations and neonatal outcomes among singletons and twins born after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and Bayesian network meta-regression analysis.
Yuan T, Ju Y, Du J … +8 more , Sun F, Li X, Li X, Liu C, Zong L, Chen X, Li X, Han Z
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288796 · Full text
BACKGROUND: While in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have been widely used for infertility treatment, concerns still persist towards the potential risks of congenital malformations a...
BACKGROUND: While in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have been widely used for infertility treatment, concerns still persist towards the potential risks of congenital malformations and adverse neonatal outcomes. In this work, we estimate the risk of congenital malformations and neonatal outcomes among singletons and twins born after IVF or ICSI. METHODS: The PubMed, Cochrane Library, Scopus, Embase, and Google Scholar databases were systematically searched to identify eligible studies. A Bayesian network meta-regression model was used to synthesize direct and indirect evidence. The natural logarithm of the hazard ratio (lnHR) and its standard error (SElnHR) were calculated to obtain pooled hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for the number of fetuses. The primary outcome was congenital malformations (CM). All analyses were performed using RStudio version 4.3.1. RESULTS: A total of 24 studies were included in the Bayesian network meta-regression, comprising 105,152 IVF, 254,538 ICSI, and 4,048,050 spontaneous conception (SC) pregnancies. Compared with SC, singletons conceived by IVF and ICSI showed higher risks of CM (HR 1.32, 95% CI 1.19-1.48; HR 1.47, 95% CI 1.35-1.62). For circulatory system malformations, singletons conceived by ICSI had a higher risk than those conceived by SC (HR 1.47, 95% CI 1.19-1.87) and IVF (HR 1.41, 95% CI 1.04-1.93). Among twins, ICSI was associated with increased risks of CM (HR 1.17, 95% CI 1.05-1.32), preterm birth (PTB) (HR 1.39, 95% CI 1.04-1.98), and perinatal death (HR 1.61, 95% CI 1.12-2.45). Singletons conceived by IVF also showed higher risks of PTB (HR 1.54, 95% CI 1.10-2.22) and low birth weight (LBW) (HR 1.59, 95% CI 1.13-2.21). CONCLUSIONS: Both IVF and ICSI were associated with higher risks of congenital malformations in singletons, while only ICSI was associated with elevated risks in twins. IVF was associated with increased risks of preterm birth and low birth weight in singletons, whereas ICSI was associated with greater risks of circulatory malformations in singletons and preterm birth and perinatal death in twins. These findings may assist clinicians in counseling ART patients about potential risks and underscore the importance of vigilant perinatal monitoring, rather than serving as direct clinical recommendations.
Healthcare experiences and needs of patients with pregnancy of unknown location: a qualitative study.
Vinekar K, Shimshi Z, Doty AM … +4 more , Kolowrat S, Mercier R, Berger A, Rising KL
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288786 · Full text
BACKGROUND: Patients presenting with bleeding or pelvic pain in early pregnancy are commonly found to have pregnancies of unknown location (PUL), with no sonographic findings of intrauterine nor ectopic pregnancy. We aim...
BACKGROUND: Patients presenting with bleeding or pelvic pain in early pregnancy are commonly found to have pregnancies of unknown location (PUL), with no sonographic findings of intrauterine nor ectopic pregnancy. We aimed to explore healthcare experiences and needs of patients presenting with PUL. METHODS: This was a qualitative study using semi-structured interviews to explore healthcare experiences among patients with PUL. Patients were eligible if they presented with bleeding or abdominopelvic pain to the OB/GYN office or emergency department and were found to have a PUL followed in an electronic health record tracking list; had an initial human chorionic gonadotropin (hCG) level of > 5 mIU/mL; spoke English; and were 18 years or older. Quasi-inductive directed content analysis was performed using NVivo 13. RESULTS: We conducted 20 qualitative interviews from November 2023 to March 2024. 60% (n = 12) of participants identified as non-Hispanic Black, all identified as cis-gendered women, and the mean age was 30.6 years. All participants were insured and most (65%) had public insurance. Analysis resulted in findings around three general domains of PUL healthcare experiences: provider communication, care environment and timely access to necessary services. Participants generally appreciated a resident-staffed phone line for discussing questions and results. They noted successes and gaps in provider communication of uncertain diagnoses, mental health resources, and optimization of care environment, perhaps in a dedicated pregnancy emergency care unit. CONCLUSIONS: In facing the diagnostic uncertainty of PUL, patients voiced needs for more direct communication, more timely care and support resources, and more targeted pregnancy-specific emergency care. Our findings reveal opportunities for improvement in provider training and healthcare organizational structuring to better meet patient needs.
Feasibility of multi-component intervention for blood pressure control in pregnancy in Nigeria and Ghana: a pilot randomized clinical trial.
Abdulkadir ZA, Opare-Addo PA, Adedokun TA … +5 more , Makanjuola AI, Donkor-Baah C, Musa OI, Okuyemi K, Adjei TK
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288777 · Full text
BACKGROUND: Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidities and mortalities. They are 5 times as prevalent in Sub-Saharan Africa with relatively higher rate of adverse outcomes....
BACKGROUND: Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidities and mortalities. They are 5 times as prevalent in Sub-Saharan Africa with relatively higher rate of adverse outcomes. Challenges in management are as a result of physiologic changes in pregnancy, restricted choice of antihypertensives, sub-optimal response to medications in pregnancy and the exclusion of pregnant women from most drug trials. Objectives of this study are to determine the feasibility of delivering multi-component intervention for blood pressure control in women with chronic hypertension in pregnancy, evaluate mean change in systolic blood pressure over the follow-up period, proportion of participants who achieve optimal blood pressure control and the occurrence of adverse maternal and fetal outcomes. METHODOLOGY: This was a pilot multi-center randomized controlled trial involving 60 pregnant women with chronic hypertension in pregnancy randomized into intervention arm (multi-components intervention) and control arm (usual care) in 2 tertiary hospitals in Nigeria and Ghana. Key outcomes were feasibility indices, mean change in blood pressure, proportion of subjects that achieved normal blood pressure, and adverse maternal/fetal outcomes. Data was analysed using Statistical Package for Social Sciences Software (SPSS version 23, 2011, SPSS Inc. Chicago, Illinois). Key feasibility indices were determined, mean difference of blood pressures across all study visits calculated and pairwise comparisons made using Bonferroni correction. Comparison of proportion with uncontrolled BP were made in both study groups. Proportions of Maternal/perinatal outcomes were identified. RESULTS: Retention rates were 86.7% and 96.7% in Nigeria and Ghana respectively. Mean change in systolic and diastolic blood pressures in the intervention arm from study enrolment to completion was 10.6mmHg (3.1 - 18.1) (p=0.007) and 6.9mmHg (1.9 - 11.9) (p=0.009) respectively. Proportion of participants who achieved optimal blood pressure were comparable between the two groups (20% in the intervention group and 24.1% in the control, p =0.701). Occurrence of adverse maternal/fetal outcomes were comparable in both groups, however, the odds of developing superimposed pre-eclampsia was 27% more in the control group compared to intervention group. CONCLUSION: It is feasible and acceptable to deliver multi-component intervention for blood pressure control in pregnant women with chronic hypertension in Africa.
COVID-19 lockdowns and gestational diabetes risk: trimester-specific exposure and stratified outcomes.
Dominsky O, Yogev Y, Lerner-Geva L
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288774 · Full text
BACKGROUND: The COVID-19 pandemic disrupted physical activity, nutrition, and stress, key determinants of gestational diabetes mellitus (GDM). We examined whether pandemic-period delivery and lockdown exposure were assoc...
BACKGROUND: The COVID-19 pandemic disrupted physical activity, nutrition, and stress, key determinants of gestational diabetes mellitus (GDM). We examined whether pandemic-period delivery and lockdown exposure were associated with GDM prevalence. METHODS: We conducted a historical cohort study at a tertiary medical center including singleton deliveries ≥ 24 weeks during April 2018-October 2019 (pre-pandemic) and April 2020-October 2021 (pandemic). The pandemic period encompassed three national lockdowns. The primary outcome was GDM diagnosed using standardized two-step screening. Secondary outcomes included cesarean delivery and macrosomia. Multivariable logistic regression adjusted for maternal age, pre-pregnancy BMI, parity, chronic hypertension, and pre-gestational diabetes. Trimester-specific lockdown exposure was assessed. RESULTS: Among 31,060 deliveries (15,190 pre-pandemic; 15,870 pandemic), GDM prevalence increased from 5.4% to 7.8% (p < 0.001). After adjustment, the association remained significant (adjusted OR 1.29, 95% CI 1.12-1.49). First-trimester lockdown exposure showed the strongest association (adjusted OR 1.6, 95% CI 1.3-2.0). Despite rising GDM, cesarean delivery rates and macrosomia remained stable, though cesarean for suspected macrosomia increased (5.7% to 8.1%, p < 0.001). Mean gestational weight gain did not differ between periods. CONCLUSIONS: Pandemic-period delivery was associated with increased GDM independent of gestational weight gain, potentially related to stress-mediated metabolic dysregulation, dietary quality changes, or reduced physical activity beyond caloric excess. First-trimester lockdown exposure showed the strongest association with GDM risk. These findings underscore the need for proactive interventions during public health emergencies, including digital health infrastructure, early pregnancy support, and integrated mental health care.
Perspectives on postpartum continuity of antiretroviral therapy care at Volta Regional Hospital, Ghana.
Doe GM, Delali DK, Yabila S … +2 more , Doe R, Adam A
BMC Pregnancy Childbirth · 2026 Jun · PMID 42288768 · Full text
BACKGROUND: Human Immunodeficiency Virus remains a major global health issue, disproportionately affecting women in sub-Saharan Africa. Although access to antiretroviral therapy has increased, maintaining treatment durin...
BACKGROUND: Human Immunodeficiency Virus remains a major global health issue, disproportionately affecting women in sub-Saharan Africa. Although access to antiretroviral therapy has increased, maintaining treatment during the postpartum period continues to be difficult. Poor retention raises the risk of viral rebound, drug resistance, mother-to-child transmission, and maternal health problems. This study explored how HIV-positive postpartum mothers, mentor mothers, and healthcare professionals experience and navigate postpartum ART care continuity at Volta Regional Hospital, Ghana. METHODS: An exploratory descriptive qualitative study was conducted among thirty HIV-positive postpartum mothers, two mentor mothers, and seven healthcare workers at Volta Regional Hospital, Ghana. Data were collected through face-to-face semi-structured interviews and a focus group discussion, and analysed using inductive thematic analysis with Atlas.ti version 7.5.0. RESULTS: Out of 30 HIV-positive postpartum mothers, only 11 achieved optimal ART care continuity. Four analytical themes emerged: motherhood as the anchor of adherence; navigating stigma and secrecy across the care continuum; the embodied consequences of adherence and non-adherence; and structural gaps and human bridges. Whilst motherhood powerfully motivated adherence, the postpartum household, shaped by in-law presence, financial constraints, and partner dynamics, simultaneously created new barriers, making the postpartum period a site of competing forces rather than simply reduced motivation. Stigma operated as a structurally reproduced force across the antenatal-to-postpartum transition, with the shift from integrated ANC to standalone ART services increasing HIV service visibility and driving clinic avoidance, whilst non-disclosure differentially burdened women without partner support. Adherence and non-adherence produced immediate bodily consequences, with sustained treatment producing physical transformation and emotional normalisation, whilst disengagement brought rapid deterioration and initial side effects representing a critical vulnerability window. The transition from monthly antenatal to longer postpartum appointment intervals created a structural gap, within which mentor mothers emerged as critical human bridges spanning clinical, community, and relational dimensions of care. CONCLUSION: Continuity of ART after childbirth was fragmented, placing mothers and infants at increased risk, and shaped by the interplay of personal, relational, and health system factors. Strengthening mentor mother programmes, structured couple counselling, and systematic postnatal follow-up are essential to improving postpartum ART retention. Equally, redesigning postpartum HIV service delivery to restore the protective integration of antenatal care is critical for addressing the structural drivers of disengagement identified in this study.
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