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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (15 July 2024) | Viewed by 37708

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Special Issue Editors

Prof. Dr. Amanda Rodrigues Amorim Adegboye

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Guest Editor

Centre for Agroecology, Water and Resilience (CAWR) & Centre for Healthcare Research (CHR), Coventry University, Coventry CV8 3LG, UK
Interests: nutrition; maternal and women’s health; health inequality; equity and diversity; obesity; dairy intake; gestational outcomes; chronic diseases; oral health
Special Issues, Collections and Topics in MDPI journals

Dr. Kim Bul

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Guest Editor

Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK
Interests: serious games; games for health; gamification; behaviour change in children and adolescents; technology-based intervention research; postpartum weight management

Dr. Dayana Rodrigues Farias

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Guest Editor

Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
Interests: maternal and child nutrition; pregnancy; gestational outcomes; blood pressure; mental health; lipid metabolism; leptin; translational research and cohort studies

Dr. Maria Beatriz Trindade De Castro

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Guest Editor

Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
Interests: sustainability; nutrition assessment; public health; epidemiology; gestational weight gain; gestational diabetes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite significant improvements in maternal and child health in the last two decades, preventable pregnancy complications and maternal and child death remain key issues in global health and should remain at the top of the global agenda including the UN Sustainable Development goals.

Worldwide maternal and child-health-related outcomes are markedly affected by environmental and socio-demographic factors including access to healthcare, vaccination, good nutrition, adequate housing, clean water and sanitation, education and employment. Evidence shows that women and babies from Black and minority ethnic groups or other deprived communities are more likely to have poorer health outcomes compared to White peers and more affluent communities.

The World Health Organization (WHO) [1] states that tackling inequalities affecting health outcomes, particularly gender, sexual and reproductive health and human rights, is vital to ensure that “all women have access to respectful and high-quality maternity care”.

Following the success of the previous Special Issue “Pregnancy and Child Health”, this Special Issue aims to further advance scientific and professional knowledge in the field of maternal and child health. We have a particular interest in studies related to equity, diversity and inclusion and sustainable interventions addressing health inequalities among women, mothers and children.

This Special Issue will accept manuscripts addressing maternal and child health practice, policy and research, exploring a wide range of topics and disciplines, such as epidemiology, public health, nutrition, nursing, social sciences, demography, health status assessment, innovative service initiatives, service evaluation, economic evaluation, policy analysis, advocacy and professional development. It will include the following types of articles:

Primary research (qualitative, quantitative and mixed-methods studies);
Systematic, mapping, scoping and narrative reviews;
Methodological papers;
Case studies;
Commentaries and position papers;
Brief reports.

Reference

[1] The World Health Organization (WHO). Maternal Health. Available online: https://www.who.int/health-topics/maternal-health#tab=tab_1 (accessed on 16 November 2022).

Prof. Dr. Amanda Rodrigues Amorim Adegboye
Dr. Kim Bul
Dr. Dayana Rodrigues Farias
Dr. Maria Beatriz Trindade De Castro
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

maternal health
pregnancy
child health
women’s health and wellbeing
health inequalities
diversity and inclusion and sustainability

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Related Special Issue

Pregnancy and Child Health in International Journal of Environmental Research and Public Health (12 articles)

Published Papers (13 papers)

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17 pages, 741 KiB

Open AccessArticle

“It Empowers You to Empower Them”: Health Professional Perspectives of Care for Hyperglycaemia in Pregnancy Following a Multi-Component Health Systems Intervention

by Diana MacKay, Louise Maple-Brown, Natasha Freeman, Jacqueline A. Boyle, Sandra Campbell, Anna McLean, Sumaria Corpus, Cherie Whitbread, Paula Van Dokkum, Christine Connors, Elizabeth Moore, Ashim Sinha, Yvonne Cadet-James, John Boffa, Sian Graham, Jeremy Oats, Alex Brown, H. David McIntyre and Renae Kirkham

Int. J. Environ. Res. Public Health 2024, 21(9), 1139; https://doi.org/10.3390/ijerph21091139 - 28 Aug 2024

Viewed by 902

Abstract

The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before (n = 183) and following (n = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed (n = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, p < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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12 pages, 372 KiB

Open AccessArticle

Exploring Maternal Socio-Demographic Factors Shaping Children’s Dietary Patterns in Brazil: Results from the 2019 National Health Survey

by Flávia dos Santos Barbosa Brito, Emanuela Santos da Costa, Ariane Cristina Thoaldo Romeiro, Debora Martins dos Santos, Alexandre dos Santos Brito, Alessandra Silva Dias de Oliveira and Amanda Rodrigues Amorim Adegboye

Int. J. Environ. Res. Public Health 2024, 21(8), 992; https://doi.org/10.3390/ijerph21080992 - 29 Jul 2024

Viewed by 985

Abstract

This study aimed to identify the dietary patterns of Brazilian children aged 6–23 months and to investigate their association with maternal socio-demographic factors. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. Mothers of 1616 children aged 6–23 months reported on their children’s dietary intake. Dietary patterns were identified using principal component analysis, and their associations with maternal socio-demographic characteristics were assessed using linear regression models. The first consisted of healthy patterns and the second, unhealthy ones. Linear regression showed that adherence to a healthy dietary pattern was higher among children of mothers who were older (β = 0.02, p = 0.01), had more years of education (β = 0.49, p = 0.04), reported living with a partner (β = 0.29, p = 0.01), and resided in an urban area (β = 0.35, p = 0.01). Conversely, adherence to the unhealthy pattern was positively associated with mothers who declared themselves as black or brown (β = 0.25, p = 0.03). Our results show that older mothers with higher levels of education and paid work and who live with a partner are more likely to contribute to their children’s healthy eating patterns. We conclude that socio-demographic factors may influence the quality of the food offered to children. Nevertheless, advocating for public policies promoting nutritious complementary diets emphasising fresh and minimally processed foods remains crucial for children whose mothers do not possess these favourable socio-demographic characteristics. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

15 pages, 863 KiB

Open AccessArticle

Trends in Complementary Feeding Indicators in Children Aged 6–23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015–2019

by Andreia Andrade-Silva, Dayana Rodrigues Farias, Thais Rangel Bousquet Carrilho, Inês Rugani Ribeiro de Castro, Gilberto Kac and Maria Beatriz Trindade de Castro

Int. J. Environ. Res. Public Health 2024, 21(7), 923; https://doi.org/10.3390/ijerph21070923 - 15 Jul 2024

Cited by 1 | Viewed by 1273

Abstract

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program—the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child’s age. The Prais–Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (−10.02%) and non-BFP children (−9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6–23 months, particularly for those experiencing greater social vulnerability. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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18 pages, 1922 KiB

Open AccessArticle

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects

by Adana A. M. Llanos, Adiba Ashrafi, Teresa Olisa, Amber Rockson, Alexis Schaefer, Jasmine A. McDonald, Mary Beth Terry, Dede K. Teteh-Brooks, Dustin T. Duncan, Beatrice Irungu, Cecilia Kimani and Esther Matu

Int. J. Environ. Res. Public Health 2024, 21(7), 846; https://doi.org/10.3390/ijerph21070846 - 28 Jun 2024

Viewed by 1544

Abstract

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15–50 years to complete a questionnaire that ascertained hair product use in the last 7–14 days, ever using hair dyes and chemical relaxers, and participants’ perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants’ sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02–1.06 and OR 2.05, 95% CI: 1.38–3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01–1.06 and OR 1.93, 95% CI: 1.30–2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients—which may be hormone disruptors or carcinogens—and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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24 pages, 4529 KiB

Open AccessArticle

Infant Care: Predictors of Outdoor Walking, Infant Carrying and Infant Outdoor Sleeping

by Nicole Rheinheimer, Stefania V. Vacaru, Julie C. van Immerseel, Simone Kühn and Carolina de Weerth

Int. J. Environ. Res. Public Health 2024, 21(6), 694; https://doi.org/10.3390/ijerph21060694 - 28 May 2024

Viewed by 1321

Abstract

Background. Although spending time outdoors is beneficial for development, little is known about outdoor time during infancy. The aim of this study was to assess frequencies and durations of (1a) outdoor walking and carrying in mother–infant dyads and (1b) infant outdoor sleeping in a stationary cot or pram. We furthermore aimed to identify associations of (2a) outdoor walking and carrying and (2b) infant outdoor sleeping, with infant, maternal and environmental sample characteristics. Methods. An online survey was distributed among mothers of 0- to 12-month-old infants. Initially, 1453 mothers were recruited, of which 1275 were included in the analyses. With respect to (1a) the outcomes of interest were: mother–infant dyads’ total weekly duration of walking in minutes, frequency of walking on weekdays, as well as weekends, and the frequency of using an infant carrier during walks, as well as the daily duration of carrying in hours (indoors and outdoors together). With respect to (1b) the outcome variables were: placing the infant outdoors to sleep (yes/no), the total weekly duration of outdoor sleeping and the weekly frequency of outdoor sleeping. For aim 2, associations of the outcome variables with infant (i.e., age), maternal (i.e., working status) and environmental (i.e., house type) sample characteristics were assessed. Results. Mother–infant dyads engaged in walks for a total weekly duration of 201 min, for approximately one to three walks over weekdays (Monday through Friday), as well as one to three walks on the weekend. The infant carrier was used by 22% of mothers at least half of the time during outdoor walks, and 18% reported a daily duration of infant carrying of one hour or more. Among other associations, infant and maternal enjoyment of outdoor walking correlated positively with the duration as well as the frequency of walking during weekdays and during the weekend. Furthermore, employed mothers walked for a shorter duration and less frequently on weekdays as compared to mothers on maternity leave or mothers without a paid job. The availability of nearby recreational areas correlated positively with the weekly duration and frequency of walks. The infant carrier was used more frequently during outdoor walks if more than one child lived in the household. Infant carrying during outdoor walks was also related to infant behavior at night. Roughly a third of the mothers (29%) regularly had their infant sleep outdoors for a weekly duration of four hours and a weekly frequency of approximately one to two times. Younger infants, infants of mothers with higher education and infants living in detached houses were more likely to be placed outdoors to sleep. Discussion. We identified associations of infant, maternal and environmental characteristics with outdoor time spent during infancy. These results lay the foundation for future research on the effects of the outdoors on child development as well as on facilitators and barriers for caregivers. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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12 pages, 317 KiB

Open AccessArticle

Provision of E-Cigarettes for Smoking Cessation in Pregnancy: Perceptions and Experiences of Pregnant Women from Two UK Sites

by Eleanor Lutman-White, Riya Patel, Lauren Bell, Deborah Lycett, Kelly Hayward, Ruth Sampson, Janani Arulrajah and Maxine Whelan

Int. J. Environ. Res. Public Health 2024, 21(4), 472; https://doi.org/10.3390/ijerph21040472 - 12 Apr 2024

Cited by 1 | Viewed by 2146

Abstract

Introduction: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users’ experiences of using e-cigarettes as a tool for smoking cessation during pregnancy. Methods: Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight. Results: Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain. Conclusions: Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

17 pages, 1023 KiB

Open AccessArticle

Implementing E-Cigarettes as an Alternate Smoking Cessation Tool during Pregnancy: A Process Evaluation at Two UK Sites

by Eleanor Lutman-White, Riya Patel, Deborah Lycett, Kelly Hayward, Ruth Sampson, Janani Arulrajah and Maxine Whelan

Int. J. Environ. Res. Public Health 2024, 21(3), 291; https://doi.org/10.3390/ijerph21030291 - 1 Mar 2024

Cited by 1 | Viewed by 2511

Abstract

Smoking during pregnancy increases the risk of adverse maternal and foetal health outcomes, with effective smoking cessation support important. E-cigarette use in the general population has increased rapidly in recent years, with their use viewed as an alternate, additional offer to nicotine-replacement therapy and behavioural support. However, their use in pregnancy has limited investigation. This study aimed to understand how two e-cigarette pilots for pregnant women were delivered and implemented. Referrals to the general stop smoking in pregnancy service, as well as pilot enrolment, engagement and outcomes were recorded. Seven professionals involved in pilot 2 design, setup and/or delivery took part in semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were deductively coded into CFIR. In total, 124 of 296 women accessed at least one visit after being contacted and offered the e-cigarette pilot (Pilot 1: N = 99, Pilot 2: N = 25). In Pilot 2, 13 (of 25) reached 4 weeks, and common reasons for withdrawal by 12 weeks included relapse, loss of contact and no further support wanted. Forty-five (36.3%) validated quits were reported (Pilot 1: 32 of 99 (32.3%); Pilot 2: 13 of 25 (52%)). Facilitators included regular communication and the advisors physically taking e-cigarettes to home visits. Barriers included misalignment between the pilot and the standard treatment offer and availability of the staff resource. Enrolment to both pilots was demonstrated, with greater enrolment in one pilot and notable quit rates among women across both pilots. The perceived role of e-cigarettes for pregnant women varied, and a lack of staff resources explained some challenges. Adaptations may be needed during scale-up, including additional resources and the alignment of the e-cigarette provision to standard treatment. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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13 pages, 541 KiB

Open AccessArticle

Knowledge, Attitudes, and Subjective Norms Associated with COVID-19 Vaccination among Pregnant Women in Kenya: An Online Cross-Sectional Pilot Study Using WhatsApp

by Sylvia Ayieko, Walter Jaoko, Rose Okoyo Opiyo, Elkanah Omenge Orang’o, Sarah E. Messiah, Kimberly Baker and Christine Markham

Int. J. Environ. Res. Public Health 2024, 21(1), 98; https://doi.org/10.3390/ijerph21010098 - 16 Jan 2024

Cited by 1 | Viewed by 2267

Abstract

COVID-19 vaccination during pregnancy has been recommended, but the perceptions related to uptake remain unexplored. This pilot study aimed to explore how perceptions influence COVID-19 vaccine uptake among a sample of 115 pregnant women in Kenya, recruited via WhatsApp. Data were collected using an adapted online questionnaire between May and October 2022. Logistic analyses assessed the relationship between COVID-19 vaccination uptake and the Theory of Reasoned Action (TRA) constructs: attitudes and subjective norms. COVID-19 vaccination coverage was 73%, with vaccine hesitancy estimated at 41.4% among the unvaccinated group. Most participants had completed college education and had good knowledge of COVID-19 vaccines. There was no significant effect of enrollment in WhatsApp pregnancy groups on attitudes toward COVID-19 vaccination. Pregnant women were concerned about vaccine effectiveness (31.1%), and almost one-half (47.3%) were discouraged from receiving COVID-19 vaccines. Positive attitudes towards vaccination were associated with COVID-19 vaccination (aOR 2.81; 95% CI 1.12–7.04; p = 0.027), but no significant relationship was found between COVID-19 vaccination and strong subjective norms (influences to get COVID-19 vaccines). Our findings suggest that strategies to improve vaccination should consider targeting attitudes and proximal social networks (friends/family) to facilitate vaccination decision-making. WhatsApp can be used for research distribution and enhance the dissemination of accurate information. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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12 pages, 355 KiB

Open AccessArticle

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

by Briony Hill, Alexandra Azzari Wynn-Jones, Kimberley J. Botting, Emma H. Cassinelli, Michael P. Daly, Caitlin Victoria Gardiner, Stephanie J. Hanley, Nicola Heslehurst, Regine Steegers-Theunissen, Sarah Verbiest and Helen Skouteris

Int. J. Environ. Res. Public Health 2023, 20(22), 7034; https://doi.org/10.3390/ijerph20227034 - 8 Nov 2023

Cited by 1 | Viewed by 2690

Abstract

Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

15 pages, 1074 KiB

Open AccessArticle

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

by Gemma Pearce, Lauren Bell, Sally Pezaro and Emma Reinhold

Int. J. Environ. Res. Public Health 2023, 20(20), 6957; https://doi.org/10.3390/ijerph20206957 - 21 Oct 2023

Cited by 2 | Viewed by 10367

Abstract

One in 20 births could be affected by hypermobile Ehlers–Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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16 pages, 861 KiB

Open AccessArticle

Co-Created Solutions for Perinatal Professionals and Childbearing Needs for People with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

by Gemma Pearce, Lauren Bell, Paul Magee and Sally Pezaro

Int. J. Environ. Res. Public Health 2023, 20(20), 6955; https://doi.org/10.3390/ijerph20206955 - 21 Oct 2023

Cited by 3 | Viewed by 3077

Abstract

Individuals living with hypermobile Ehlers-Danlos syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) have reported feeling discredited and unsupported by healthcare professionals. However, the level of knowledge about hEDS/HSD among maternity staff remains unknown. Informed by patient and public involvement, this research aimed to investigate maternity staff’s knowledge and confidence in supporting people with hEDS/HSD, examine people with hEDS/HSD’s experiences of perinatal care, and co-create tools to help maternity staff support people childbearing with hEDS/HSD. Two online mixed-methods international surveys were completed by childbearing people with hEDS/HSD (N = 955) and maternity staff (N = 307). This was followed by the co-creation of three tools with 17 co-creators and a design team. Two main qualitative themes were identified through thematic analysis: (1) a need for recognition of hEDS/HSD in perinatal care and (2) the delivery of appropriate individualised perinatal care. Quantitatively, people with hEDS/HSD perceived maternity professionals to have a low level of knowledge about the conditions. Respectively, maternity staff reported low levels of confidence in supporting people with hEDS/HSD. The co-created tools provide applicable outputs for both education and practice and include an i-learn module hosted by the Royal College of Midwives, a tool for perinatal records, and infomercials. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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9 pages, 336 KiB

Open AccessCommunication

Pregnancy Care during the COVID-19 Pandemic in Germany: A Public Health Lens

by Antonia Leiße, Julia Dötzer, Alice Ruhnau, Leona Aschentrup, Florian Fischer and Kamil J. Wrona

Int. J. Environ. Res. Public Health 2023, 20(3), 2721; https://doi.org/10.3390/ijerph20032721 - 3 Feb 2023

Viewed by 2491

Abstract

The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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13 pages, 1244 KiB

Open AccessStudy Protocol

The MothersBabies Study, an Australian Prospective Cohort Study Analyzing the Microbiome in the Preconception and Perinatal Period to Determine Risk of Adverse Pregnancy, Postpartum, and Child-Related Health Outcomes: Study Protocol

by Naomi Strout, Lana Pasic, Chloe Hicks, Xin-Yi Chua, Niki Tashvighi, Phoebe Butler, Zhixin Liu, Fatima El-Assaad, Elaine Holmes, Daniella Susic, Katherine Samaras, Maria E. Craig, Gregory K. Davis, Amanda Henry, William L. Ledger and Emad M. El-Omar

Int. J. Environ. Res. Public Health 2023, 20(18), 6736; https://doi.org/10.3390/ijerph20186736 - 9 Sep 2023

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Abstract

The microbiome has emerged as a key determinant of human health and reproduction, with recent evidence suggesting a dysbiotic microbiome is implicated in adverse perinatal health outcomes. The existing research has been limited by the sample collection and timing, cohort design, sample design, and lack of data on the preconception microbiome. This prospective, longitudinal cohort study will recruit 2000 Australian women, in order to fully explore the role of the microbiome in the development of adverse perinatal outcomes. Participants are enrolled for a maximum of 7 years, from 1 year preconception, through to 5 years postpartum. Assessment occurs every three months until pregnancy occurs, then during Trimester 1 (5 + 0–12 + 6 weeks gestation), Trimester 2 (20 + 0–24 + 6 weeks gestation), Trimester 3 (32 + 0–36 + 6 weeks gestation), and postpartum at 1 week, 2 months, 6 months, and then annually from 1 to 5 years. At each assessment, maternal participants self-collect oral, skin, vaginal, urine, and stool samples. Oral, skin, urine, and stool samples will be collected from children. Blood samples will be obtained from maternal participants who can access a study collection center. The measurements taken will include anthropometric, blood pressure, heart rate, and serum hormonal and metabolic parameters. Validated self-report questionnaires will be administered to assess diet, physical activity, mental health, and child developmental milestones. Medications, medical, surgical, obstetric history, the impact of COVID-19, living environments, and pregnancy and child health outcomes will be recorded. Multiomic bioinformatic and statistical analyses will assess the association between participants who developed high-risk and low-risk pregnancies, adverse postnatal conditions, and/or childhood disease, and their microbiome for the different sample types. Full article

(This article belongs to the Special Issue Women's Health, Pregnancy and Child Health)

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