To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Pregnancy induces vast physiological shifts within several systems of the expectant mother’s body, including haemodynamic, haematological, renal, endocrine and metabolic functions. These are necessary to adjust conditions for optimal growth and development of the fetus but are finely tuned to avoid subsequent compromise to maternal health; an imbalance of which may present with medical complications to both mother and baby.
It is essential to understand normal physiological changes in pregnancy in order to appreciate pathology, which may arise. This chapter aims to outline the main changes that occur, and further, to delineate a few common obstetric emergencies and complications that may develop during pregnancy.
Edited by
Liz McDonald, East London NHS Foundation Trust,Roch Cantwell, Perinatal Mental Health Service and West of Scotland Mother & Baby Unit,Ian Jones, Cardiff University
Women with intellectual disabilities have children more frequently than in the past. This is partly a result of changes in attitudes towards people with intellectual disabilities. Institutional care in many parts of the world is less common and sterilisation of women with intellectual disabilities is less frequent. However, women with intellectual disabilities experience greater social disadvantage than other women, negative attitudes towards their having children, and judgements about their abilities to parent successfully. They have poorer pregnancy and neonatal health outcomes due to health inequalities and socio-economic deprivation and are more likely to have their children removed from their care. The rate of mental disorders in women with intellectual disabilities is high leading to increased utilisation of healthcare services during the perinatal period and after delivery. Recognising perinatal mental disorders in women with intellectual disabilities can be challenging for clinicians because of communication difficulties in the woman and a lack of training for the clinician. Assessment and support to women with intellectual disabilities and mental disorders has to be adapted to take account of their individual needs. Training of clinical staff in understanding intellectual disabilities is essential in enhancing the care they receive and ensuring equity of access to services.
Optimising nutrition during lactation is critical for the mother and infant. The relationship between fermented food consumption and the mother’s gut microbiota and nutritional and inflammation status is unknown. Mageu is a fermented grain commonly consumed in Southern Africa. We randomised South African mothers to consume a live-culture mageu, pasteurised store-bought mageu or no mageu from 4 to 10 weeks postpartum. Clinical and dietary data, stool microbiota and nutritional and inflammatory biomarkers were assessed until week 15. Plant protein intake was higher among mageu users than non-users. Live-culture mageu increased gut α-diversity from weeks 4 to 10. Circulating ferritin was lower among live-culture mageu users at week 10 compared with non-users. In systems analyses, mageu intake was associated with distinct bacterial, inflammatory and nutritional signatures, primarily driven by interleukin (IL)-6, ferritin, soluble transferrin receptor and Eubacterium hallii. These results suggest that mageu has benefits for lactating mothers’ gut health and, therefore, possibly their infants.
The influence of the maternal antenatal environment on infant growth and development beyond the neonatal period is not well understood. This study investigated associations between maternal cardiometabolic health and lifestyle on infant growth during the first year of life. This sub-study of the longitudinal Microbiome Understanding in Maternity Study included 87 mother-infant dyads. Maternal anthropometrics were collected at each trimester. Lifestyle was assessed through the Australian Eating Survey (Trimester T1 and T3) and International Physical Activity Questionnaire (T1, T2 and T3). Infant anthropometrics were measured at birth, 6 weeks, 6 months and 12 months. Changes in weight, weight-for-age z-score, length-for-age z-score, rapid weight gain and conditional weight gain (CWG) were determined. Multiple linear regression was used to assess associations between maternal parameters and infant growth, adjusting for common confounders. Maternal T1 weight (CWG: p = 0.03), T3 weight (CWG: p = 0.03) and GWG (weight z-score change: p = 0.031) were positively associated with increased infant growth from 0 to 6 months. Greater maternal fat mass was associated with increased CWG (p = 0.042) from 6 weeks to 6 months. Higher quality maternal T1 diet was associated with increased infant growth (weight z-score change: p = 0.022, CWG: p = 0.013) from 0 to 12 months. Increased maternal physical activity was associated with increased CWG (p = 0.022) and length z-score change (p = 0.024) from 0 to 12 months in T1, and increased CWG from 6 to 12 months in T2 (p = 0.014) and T3 (p = 0.047). Markers of maternal cardiometabolic health risk and healthier lifestyle were associated with increased infant growth. Further investigation is required to confirm findings and investigate links with future health sequelae.
CHD affect approximately 1% of live births globally and are the most common congenital anomaly. Contemporary data on CHD risk in offspring of affected mothers remains limited. This study evaluated CHD incidence in offspring of mothers with CHD at a southeastern U.S. academic medical centre.
Methods:
We conducted a retrospective review of patients with CHD who received prenatal care between 2015 and 2023 at a multidisciplinary Cardio-Obstetrics clinic. Patients with acquired heart disease, syndromic or inherited CHD, and deliveries at outside hospitals with missing delivery data were excluded. The primary outcome was infant CHD incidence, confirmed by postnatal echocardiography. Secondary outcomes were neonatal intensive care unit admission, early in-hospital cardiac surgery, and in-hospital infant mortality.
Results:
A total of 186 mothers with 195 pregnancies and 198 infants were included. CHD was diagnosed in 16 infants (8.1%), most commonly ventricular septal defect. Of affected infants, none required early in-hospital surgery, and one experienced in-hospital mortality, though this infant had severe extracardiac anomalies concerning an underlying genetic syndrome.
Conclusion:
The incidence of CHD among offspring of mothers with CHD in our cohort was higher than the general population; however, the majority of defects were non-critical and did not require early intervention. These findings offer important context for prenatal counselling and tailored fetal/neonatal echocardiography screening in this high-risk population.
To examine how race, income and food insecurity (FI) interact during pregnancy and whether FI contributes to disparities in maternal and infant health outcomes.
Design:
Observational cohort study employed sequential explanatory a mixed-methods design, with a survey phase (including Household Food Security Survey Module [HFSSM] six-item) and medical record abstraction followed by semi-structured interviews.
Setting:
Online survey, virtual interviews.
Participants:
The participants were individuals who gave birth in Louisiana, USA, between June 2020 and June 2021. The quantitative phase comprised 1691 individuals who completed the survey. A nested cohort of forty individuals (evenly split by race (Black v. White) and income (low v. high)) subsequently completed semi-structured interviews.
Results:
Race and income were independently associated with both FI and maternal and infant health outcomes. When considering both income and FI, low-income individuals with FI were 1·73 times more likely to deliver low birthweight (LBW) infants (adjusted Odds Ratio [aOR] 95 % CI: 1·07, 2·82) and 1·43 times more likely to experience adverse infant outcomes (aOR 95 % CI: 1·02, 2·00) than high-income individuals without FI. Black individuals with FI were 2·49 times more likely to deliver LBW infants (aOR 95 % CI: 1·45, 4·29) than White individuals without FI. Interview findings revealed low-income individuals faced disproportionate barriers to accessing healthy food and making dietary choices, which were further complicated by pregnancy-related conditions.
Conclusions:
The interplay between race, income and FI significantly increases the risk of adverse infant health outcomes, demonstrating a synergistic effect. Targeted efforts to address FI, particularly among low-income pregnant individuals, are essential to improving maternal and infant health outcomes.
This historical study examines the evolving landscape of gender equality within the Anglican Church in the Diocese of Central Tanganyika (DCT), with a focus on health-related developments in the post-colonial period. Tracing the trajectory from entrenched gender-based limitations to broader inclusivity, the article highlights how women, once marginalized in Church health initiatives, have gained visibility and agency, particularly since the 1980s. The period marks a turning point in which women began to access education, participate in leadership and contribute to health programmes that had long been male-dominated. Traditional gender roles have gradually shifted, reflecting a redefinition of responsibility within the Church and a growing embrace of shared leadership rooted in Christian values of love, cooperation and mutual respect. However, despite institutional advancements and theological support for equality, enduring gender disparities, especially in rural health services, continue to pose serious challenges. This study underscores the dual narrative of progress and persistent inequality, offering an important account of the Anglican Church’s ongoing journey towards holistic gender inclusion in health and ministry.
Endothelial progenitor cells (EPCs) are key regulators of vascular homeostasis in both health and disease, playing a crucial role in regenerating the human vascular lining throughout life. These circulating cells can differentiate into mature endothelial cells and are increasingly recognized as important biological markers of vascular function and cumulative risk for various diseases, including cardiovascular conditions. In recent decades, the role of EPCs, particularly the endothelial colony-forming cells (ECFCs) subtype, in pregnancy-related disorders and maternal and neonatal endothelial health has garnered significant attention. Evidence suggests that ECFCs may serve as predictor of future endothelial health in women and their offspring following pregnancy complications, making them particular relevant for research and therapeutic applications in adulthood, as well as potential indicators of vascular health. This review summarizes the evidence on EPCs, specifically ECFCs, as biomarkers of endothelial health in pregnancy, pregnancy-related diseases and ageing, with a focus on maternal and foetal endothelial abnormalities that may serve as prognostic factors for the development of future diseases.
Certain prescription drugs used during pregnancy are associated with offspring autism spectrum disorder (ASD). Nonetheless, ASD risk following prenatal exposure to most drugs remains unknown. Furthermore, methodological challenges and ethical concerns hinder the scope for causal inference.
Methods
We used a case-cohort study design of a nationally representative sample from Israel to examine the associations between maternal prescription drug use during pregnancy and offspring ASD. To scrutinize these associations, the analyses were (a) adjusted for indication proxy (level 2 Anatomical Therapeutic Chemical (ATC) codes), (b) repeated using shared pharmacological targets as exposures, and (c) inspected further through target-enrichment analysis.
Results
The sample included 1,400 individuals with and 94,713 without an ASD diagnosis. Among all drugs prescribed during pregnancy, five were statistically significantly associated with increased offspring ASD risk after adjustment for indication proxy (e.g., hazard ratio [95% confidence interval] cyproterone = 2.71 [1.17–6.25] and prednisolone = 2.10 [1.27–3.49]), and two with decreased risk (ferrous sulfate = 0.82 [0.68, 0.99] and lynestrenol = 0.43 [0.2, 0.93]). Further analysis revealed four pharmacological targets shared by these drugs, which were themselves associated with ASD (e.g., neuronal acetylcholine receptor α4β4 = 1.45 [1.05–1.99] and serotonin 2b receptor = 1.31 [1.04–1.61]). Enrichment analysis suggested the association between ASD and medications affecting cholinergic and serotonergic signaling.
Conclusions
Increased ASD risk followed prenatal exposure to five prescription drugs, and decreased risk followed exposure to two. Subsequent analyses suggested no confounding by indication in these associations, but further studies are warranted.
Preterm labor, marked by cervical changes between 20 0/7 and 36 6/7 weeks’ gestation, is a significant contributor to preterm birth, accounting for 50% of such cases and is associated with increased neonatal mortality and long-term health issues. Understanding preterm labor involves considering diverse factors, including maternal medical history, demographics, and current pregnancy characteristics. Modifiable risk factors such as short interpregnancy intervals and substance use play a role in its onset. Diagnostic tools like transvaginal ultrasonography and fetal fibronectin aid in identifying at-risk individuals. Effective management of preterm labor is a pivotal aspect of obstetric care. Tocolytics, antenatal corticosteroids, and group B streptococcus prophylaxis are integral interventions. Decisions about the mode of delivery include the potential benefits of cesarean delivery in extreme prematurity. This case underscores the importance of vigilant monitoring, timely diagnosis, and intervention in addressing preterm labor, thereby mitigating its adverse effects on maternal and neonatal health.
The health and well-being of families is an important consideration for federal, state, and/or local levels of government. Family health policies based on recent knowledge of early childhood development have evolved to emphasise the importance of providing every child with the best possible start to life. Childhood sets the foundation for future health and well-being and is recognised by the 1979 United Nations Convention on the Rights of the Child. To impact health inequalities, government policies and services must address the social determinants of early child health, development and well-being.
Mothers of Sierra Leone leverages the power of filmic storytelling to improve maternal health outcomes in Sierra Leone, a country with one of the planet’s highest maternal mortality rates. Since 2019, we have operated as part of Lehigh University’s Global Social Impact program, working with a team of interdisciplinary students to amplify the voices of Sierra Leonean women rather than transmit Western medical expertise. Our project is based on two premises: (1) we will not solve the healthcare crisis in Sierra Leone through technology and (2) women experience better healthcare outcomes when they are confident and comfortable to advocate for themselves. Our focus group and survey data indicate that our filmic storytelling improves women’s confidence to advocate for themselves and increases their knowledge of available health services. Maternal mortality may be one of the most expansive health challenges facing our planet today because we struggle to comprehend or delimit its parameters, including structural and systemic racism, networks of capitalism, insufficient infrastructure, disparate access to medicine, and patriarchal violence. Our failures to tell public, accessible, and equitable stories about maternal mortality exacerbates and often exoticizes this crisis.
This chapter explores the Islamic teachings on pregnancy, breastfeeding, and child welfare, highlighting the religion’s emphasis on the well-being of mothers and children. It explores the Qur’anic verses and Prophetic Hadiths that underline the importance of social support, nutrition, and education in the lives of mothers and children. By aligning Islamic principles and global initiatives, such as the United Nations Convention on the Rights of the Child, this chapter demonstrates the contributions of Islam to the universal pursuit of human development and well-being. This exploration aims to provide valuable insights into the role of Islam in promoting a supportive, nurturing, and educational environment for mothers and children, fostering a better understanding of the religion’s perspectives on these critical aspects.
Iron deficiency anaemia (IDA) in pregnancy is a significant public health problem worldwide, but little is known about factors associated with dietary iron intake among pregnant women especially from low- and middle-income countries(3). This study assessed factors associated with dietary iron intake among pregnant women attending primary health centres in Ifako-Ijaiye Lagos, Nigeria. Sociodemographic information and dietary intakes were elicited from 432 apparently healthy singleton pregnant women using a pre-tested questionnaire and 24 hour- dietary recall, respectively. Dietary iron intakes was estimated from foods and drinks reported using the West African Food Composition Table and adjusted for energy intakes using the residual method(1). Chi-square test and one-way ANOVA was used to compare categorical and continuous variables respectively by tertiles of energy-adjusted dietary iron intakes at a two-sided P<0.05(2).Mean age and dietary iron intake was 28.5 ± 4.6years and 20.3 ± 3.3mg/day, respectively for all respondents. Energy-adjusted iron intakes by tertiles of energy-adjusted dietary intakes were; 16.6 ± 1.4mg/day for the first tertile, 19.7± 1.0mg/day for the second tertile and 23.7 ± 2.0mg/day for the third tertile. Age, gestational age, parity, education, marital status, and income differed insignificantly by tertiles of energy-adjusted dietary iron intakes. Current evidence suggests a statistically insignificant association between sociodemographic factors and dietary iron intakes in this sample, but further studies are vital for designing culturally relevant interventions to promote the consumption of iron-rich foods among women in this population.
Little research has explored relationships between prenatal substance use policies and rates of maternal mortality across all 50 states, despite evidence that prenatal substance use elevates risk of maternal death. This study, utilizing publicly available data, revealed that state-level mandated testing laws predicted maternal mortality after controlling for population characteristics.
Existing literature shows the importance of maternity leave as a strategy for women to balance work and family responsibilities. However, only a few studies focused on the long-run impact of maternity leave length on maternal health. Therefore, how exactly they are related remains unclear. We examine women’s selection into different lengths of maternity leave as a potential explanation for the inconclusive findings in the literature on the association between maternity leave and maternal health. This study aims to unravel the association between maternity leave length and mothers’ long-term health in Germany. Drawing on detailed data from the German Statutory Pension Fund (DRV), we estimated the association between maternity leave length and sick leave from 3 years following their child’s birth for 4,243 women living in Germany in 2015 by applying discrete-time logistic regression. Our results show a negative relationship between maternity-leave length and long-term maternal health, likely driven by negative health selection. Long maternity leaves of more than 24 months were associated with worse maternal health in the long run, while a positive association emerged for vulnerable women with pre-existing health problems.
The Dobbs opinion emphasizes that the state’s interest in the fetus extends to “all stages of development.” This essay briefly explores whether state legislators, agencies, and courts could use the “all stages of development” language to expand reproductive surveillance by using novel developments in consumer health technologies to augment those efforts.
The aim of this study is to explore nutrition-related health needs, the perceptions and beliefs regarding the double burden of malnutrition, as well as barriers and facilitators in accessing nutritious food among the local population in rural Tanzania.
Design:
A qualitative study design using semi-structured individual interviews and focus-group discussions (FGD) was used. Basic socio-demographic information was obtained from all participants.
Setting:
The study was conducted in four villages within the catchment area of the Shirati KMT Hospital in Rorya district, in north-western Tanzania.
Participants:
Men and women in the reproductive age as well as Community Health Workers (CHW) were included.
Results:
In total, we performed fourteen interviews (N 41), consisting of four FGD, one dual and nine individual interviews. The three most significant topics that were identified are the large knowledge gap concerning overweight and obesity as a health problem, changing weather patterns and its implications on food supply and the socio-cultural drivers including gender roles and household dynamics.
Conclusion:
Environmental and socio-cultural factors play a crucial role in the determinants for DBM, which underlines the importance of understanding the local context and the nutrition practices and beliefs of the communities. Future nutritional interventions should aim towards more inclusion of men in project implementation as well as support of women empowerment. CHW could play a key role in facilitating some of the suggested interventions, including nutritional counselling and increasing awareness on the drivers of the double burden of malnutrition.
We aimed to study supplement use in relation to dietary intake among pregnant women in Sweden, and adherence to the Nordic Nutrition Recommendations among supplement and non-supplement users. Pregnant women were recruited at registration to antenatal care in 2013–2014. In third trimester, supplement use was collected using a questionnaire, and dietary intake was collected using a FFQ. The majority (64 %) of the 1044 women reported use of one or more supplements. Among all, 0–23 % reported dietary intakes above recommended intake (RI) of vitamin D, folate, Fe and Se. Median dietary intakes of thiamine (1·4 v. 1·3 mg P = 0·013), phosphorus (1482 v. 1440 mg P = 0·007), folate (327 v. 316 µg P = 0·02), Fe (12 v. 11·5 mg P = 0·009), Mg (361 v. 346 mg P < 0·001) and Zn (10·7 v. 10·4 mg P = 0·01) were higher among supplement users compared with non-users. Larger proportions of supplement users than non-users adhered to RI of dietary intakes of thiamine (42 % v. 35 % P = 0·04) and Mg (75 % v. 69 % P = 0·05). Among non-users, a minority had dietary intakes above RI for vitamin D (6 %), folate (10 %) and Fe (21 %). The majority (75–100 %) of supplement users had total intakes above RI for most nutrients. In conclusion, supplement use contributed substantially to reaching RI for vitamin D, folate and Fe. Supplement users had a higher dietary intake of several nutrients than non-users. This highlights that non-supplement users are at risk of inadequate nutrient intakes during pregnancy, suggesting a need for heightened awareness of nutritional adequacy for pregnant women.
Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital.
Methods:
Clinical charts were reviewed to collect data on all referrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT.
Results:
In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020.
Conclusion:
Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there was increased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.