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Introduction: self-medication during pregnancy is a common practice in many low- and middle-income countries, despite the associated risks for both mother and fetus. This study aimed to estimate the prevalence of self-medication and identify its associated factors among pregnant women in the N'Djamena Nord district of Chad. Methods: this was a multicenter cross-sectional study conducted among 348 pregnant women conveniently recruited from 15 public health centers in the N'Djamena Nord district. Data were collected through individual interviews using a structured questionnaire administered via KoboCollect. Univariate and then multivariable Generalized Estimating Equations (GEE) models were applied using a Poisson distribution and an exchangeable correlation structure to identify factors associated with self-medication. Statistical significance was set at 5%. Results: the prevalence of self-medication during pregnancy was 37.9% (95% CI: 32.8-43.0). Factors significantly associated with this practice included living in an urban area (Adjusted Prevalence Ratio [APR] = 1.54; 95% CI: 1.05 - 2.28), living in a polygamous household (APR = 1.21; 95% CI: 1.04-1.39), a history of self-medication (APR = 1.76; 95% CI: 1.36-2.28), and lack of knowledge about the associated risks (APR = 1.72; 95% CI: 1.39-2.12). Conclusion: self-medication is a common practice among pregnant women in the N'Djamena Nord district, driven by both structural and behavioural factors. These findings highlight the need to strengthen prenatal education and develop targeted prevention strategies to mitigate the risks associated with this practice.

Fetal growth restriction is a major complication of pregnancy and is associated with stillbirth, infant death and child morbidity. Ultrasound monitoring of pregnancy is becoming more common in Africa for fetal growth monitoring in clinical care and research, but many countries have no national growth charts. We evaluated the new international fetal growth standards from INTERGROWTH-21.sup.st and WHO in a cohort from southern Benin. Repeated ultrasound and clinical data were collected in women from the preconceptional RECIPAL cohort (241 women with singleton pregnancies, 964 ultrasounds). We modelled fetal biometric parameters including abdominal circumference (AC) and estimated fetal weight (EFW) and compared centiles to INTERGROWTH-21.sup.st and WHO standards, using the Bland and Altman method to assess agreement. For EFW, we used INTERGROWTH-21.sup.st standards based on their EFW formula (IG21st) as well as a recent update using Hadlock's EFW formula (IG21hl). Proportions of fetuses with measurements under the 10.sup.th percentile were compared. Maternal malaria and anaemia prevalence was 43% and 69% respectively and 11% of women were primigravid. Overall, the centiles in the RECIPAL cohort were higher than that of INTERGROWTH-21.sup.st and closer to that of WHO. Consequently, the proportion of fetuses under 10.sup.th percentile thresholds was systematically lower when applying IG21st compared to WHO standards. At 27-31 weeks and 33-38 weeks, respectively, 7.4% and 5.6% of fetuses had EFW <10.sup.th percentile using IG21hl standards versus 10.7% and 11.6% using WHO standards. Despite high anemia and malaria prevalence in the cohort, IG21st and WHO standards did not identify higher than expected proportions of fetuses under the 10.sup.th percentiles of ultrasound parameters or EFW. The proportions of fetuses under the 10.sup.th percentile threshold for IG21st charts were particularly low, raising questions about its use to identify growth-restricted fetuses in Africa.

self-medication during pregnancy is a common practice in many low- and middle-income countries, despite the associated risks for both mother and fetus. This study aimed to estimate the prevalence of self-medication and identify its associated factors among pregnant women in the N'Djamena North District of Chad. this was a multicenter cross-sectional study conducted among 348 pregnant women conveniently recruited from 15 public health centers in the N'Djamena North District. Data were collected through individual interviews using a structured questionnaire administered via KoboCollect. Univariate and then multivariable Generalized Estimating Equations (GEE) models were applied using a Poisson distribution and an exchangeable correlation structure to identify factors associated with self-medication. Statistical significance was set at 5%. the prevalence of self-medication during pregnancy was 37.9% (95% CI: 32.8-43.0). Factors significantly associated with this practice included living in an urban area (Adjusted Prevalence Ratio [APR] = 1.54; 95% CI: 1.05 - 2.28), living in a polygamous household (APR = 1.21; 95% CI: 1.04-1.39), a history of self-medication (APR = 1.76; 95% CI: 1.36-2.28), and lack of knowledge about the associated risks (APR = 1.72; 95% CI: 1.39-2.12). self-medication is a common practice among pregnant women in the N'Djamena North District, driven by both structural and behavioural factors. These findings highlight the need to strengthen prenatal education and develop targeted prevention strategies to mitigate the risks associated with this practice.

Abstract Background Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow. Methods The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks’ gestation (wg), and UA Doppler measurement was performed 1–3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow). Results Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2–16.3 and aOR 3.3, 95% CI = .9–11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler. Conclusions Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.

Background Fetal growth restriction is a major complication of pregnancy and is associated with stillbirth, infant death and child morbidity. Ultrasound monitoring of pregnancy is becoming more common in Africa for fetal growth monitoring in clinical care and research, but many countries have no national growth charts. We evaluated the new international fetal growth standards from INTERGROWTH-21st and WHO in a cohort from southern Benin. Methods Repeated ultrasound and clinical data were collected in women from the preconceptional RECIPAL cohort (241 women with singleton pregnancies, 964 ultrasounds). We modelled fetal biometric parameters including abdominal circumference (AC) and estimated fetal weight (EFW) and compared centiles to INTERGROWTH-21st and WHO standards, using the Bland and Altman method to assess agreement. For EFW, we used INTERGROWTH-21st standards based on their EFW formula (IG21st) as well as a recent update using Hadlock’s EFW formula (IG21hl). Proportions of fetuses with measurements under the 10th percentile were compared. Results Maternal malaria and anaemia prevalence was 43% and 69% respectively and 11% of women were primigravid. Overall, the centiles in the RECIPAL cohort were higher than that of INTERGROWTH-21st and closer to that of WHO. Consequently, the proportion of fetuses under 10th percentile thresholds was systematically lower when applying IG21st compared to WHO standards. At 27–31 weeks and 33–38 weeks, respectively, 7.4% and 5.6% of fetuses had EFW <10th percentile using IG21hl standards versus 10.7% and 11.6% using WHO standards. Conclusion Despite high anemia and malaria prevalence in the cohort, IG21st and WHO standards did not identify higher than expected proportions of fetuses under the 10th percentiles of ultrasound parameters or EFW. The proportions of fetuses under the 10th percentile threshold for IG21st charts were particularly low, raising questions about its use to identify growth-restricted fetuses in Africa.