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Background In Tanzania, 35% of pregnant women fail to complete four antenatal care (ANC) visits, increasing their risk for pregnancy-related complications, maternal mortality, and stillbirth. We evaluated the effectiveness of a Mobile Fetal Heart Monitor (Melody International Ltd, iCTG) device in improving pregnancy and childbirth outcomes in Tanzania. Methods We used a pragmatic, non-randomized clinical trial to evaluate the effectiveness of the 8-month implementation of iCTG. Pregnant women at 32 gestational age or above were monitored using iCTG in intervention facilities ( n  = 492), while control facilities ( n  = 271) continued standard care. The primary outcome was the completion of ≥ 4 ANC visits, with secondary outcomes including abnormal fetal heart rate (FHR) detection, birth method, institutional births, Apgar scores, and perinatal outcomes. Binary, multinomial, and Poisson regression models were used to determine the intervention effect. Results iCTG users were twice as likely to complete fewer than 4 ANC visits (OR: 2.5, 95% CI: 1.28–4.75, p  = 0.007). However, iCTG was associated with higher abnormal FHR detection rates (8.08, 95% CI: 2.51–26.02; p  < 0.001), increased risk of caesarean section ( p  < 0.001), reduced risk for Apgar scores < 7 at 5 min ( p  = 0.024) and fewer perinatal deaths ( p  = 0.003). There were no significant differences in newborn admission ( p  = 0.41) or institutional births ( p  = 0.26). Conclusion Implementing iCTG for antepartum FHR monitoring effectively detected abnormal FHR and was associated with improved newborn outcomes, highlighting its potential to improve perinatal outcomes in Tanzania. However, no effect was found on the number of ANC visits and institutional births. Further studies are needed to assess the effectiveness of iCTG in diverse populations and contexts and identify key factors for optimal implementation. Trial registration The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (ID: UMIN000051932) on 18 August 2023. ( https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000058801 ).

Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517).

\"From New York Times bestselling author of Expecting Better, a guide to navigating a second pregnancy when the first did not go as planned-with Dr. Nathan Fox, Maternal Fetal Medicine specialist. In Expecting Better, Emily Oster revolutionized the pregnancy landscape with her data-driven approach. In the years since, she kept hearing questions from readers on how to approach a second pregnancy when the first has not gone as planned. The Unexpected is a book that Oster hopes no one needs-but in reality, 50 percent of pregnancies include complications, and we don't talk about it. Preeclampsia, miscarriage, hyperemesis gravidarum, preterm birth, postpartum depression: these are lonely experiences, and that isolation makes treatment harder to access-and crucial research and policy change less likely to happen. The Unexpected lays out the data on recurrence and treatments shown to lower or mitigate risk for these conditions in subsequent pregnancies. It also provides readers roadmaps to facilitate productive conversations with their providers, with insights from lauded maternal fetal medicine specialist Dr. Nathan Fox. By bridging the knowledge gap and making space for difficult conversations, The Unexpected promises to make the hardest parts of pregnancy a little bit less so\"-- Provided by publisher.

Adolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes. This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa. The \"Teen MomConnect\" intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants' pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups. Overall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages (\"high-responders\"; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045). Engagement with the intervention's 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence. Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565. RR2-10.2196/43654.

Home delivery and late and infrequent attendance at antenatal care (ANC) are responsible for substantial avoidable maternal and pediatric morbidity and mortality in sub-Saharan Africa. This cluster-randomized trial aimed to determine the impact of a community health worker (CHW) intervention on the proportion of women who (i) visit ANC fewer than 4 times during their pregnancy and (ii) deliver at home. As part of a 2-by-2 factorial design, we conducted a cluster-randomized trial of a home-based CHW intervention in 2 of 3 districts of Dar es Salaam from 18 June 2012 to 15 January 2014. Thirty-six wards (geographical areas) in the 2 districts were randomized to the CHW intervention, and 24 wards to the standard of care. In the standard-of-care arm, CHWs visited women enrolled in prevention of mother-to-child HIV transmission (PMTCT) care and provided information and counseling. The intervention arm included additional CHW supervision and the following additional CHW tasks, which were targeted at all pregnant women regardless of HIV status: (i) conducting home visits to identify pregnant women and refer them to ANC, (ii) counseling pregnant women on maternal health, and (iii) providing home visits to women who missed an ANC or PMTCT appointment. The primary endpoints of this trial were the proportion of pregnant women (i) not making at least 4 ANC visits and (ii) delivering at home. The outcomes were assessed through a population-based household survey at the end of the trial period. We did not collect data on adverse events. A random sample of 2,329 pregnant women and new mothers living in the study area were interviewed during home visits. At the time of the survey, the mean age of participants was 27.3 years, and 34.5% (804/2,329) were pregnant. The proportion of women who reported having attended fewer than 4 ANC visits did not differ significantly between the intervention and standard-of-care arms (59.1% versus 60.7%, respectively; risk ratio [RR]: 0.97; 95% CI: 0.82-1.15; p = 0.754). Similarly, the proportion reporting that they had attended ANC in the first trimester did not differ significantly between study arms. However, women in intervention wards were significantly less likely to report having delivered at home (3.9% versus 7.3%; RR: 0.54; 95% CI: 0.30-0.95; p = 0.034). Mixed-methods analyses of additional data collected as part of this trial suggest that an important reason for the lack of effect on ANC outcomes was the perceived high economic burden and inconvenience of attending ANC. The main limitations of this trial were that (i) the outcomes were ascertained through self-report, (ii) the study was stopped 4 months early due to a change in the standard of care in the other trial that was part of the 2-by-2 factorial design, and (iii) the sample size of the household survey was not prespecified. A home-based CHW intervention in urban Tanzania significantly reduced the proportion of women who reported having delivered at home, in an area that already has very high uptake of facility-based delivery. The intervention did not affect self-reported ANC attendance. Policy makers should consider piloting, evaluating, and scaling interventions to lessen the economic burden and inconvenience of ANC. ClinicalTrials.gov NCT01932138.

\"Explaining the practical implications of new discoveries in 'life-course biology', Nutrition and Lifestyle for Pregnancy and Breastfeeding is an informed resource on factors that affect offspring development. The impact of parental lifestyle and behavioural choices influence not only fetal development and birth outcomes, but also postnatal development, yet guidance on appropriate diet, behaviour, and exposures during pregnancy is often confusing and contradictory. With accessible explanations of the latest scientific research, and clear summaries and recommendations, this book is a valuable and authoritative guide for all levels of health care providers. The authors provide an overview of the background evidence, highlighting the importance of lifestyle choices prior to and during pregnancy. In-depth discussions of nutritional and lifestyle factors that impact on pregnancy and offspring outcomes are based on the latest research and exploration of key scientific studies. Nutrition and Lifestyle for Pregnancy and Breastfeeding is a manual offering both scientific and clinical evidence to empower health care providers and ensure they have the information necessary to confidently care for prospective and new parents.\"-- Publisher's website.

Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum. Methods Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating. Results Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88 % in the caseload group and 74 % in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95 % CI 2.79, 4.03), intrapartum care (OR 2.14; 95 % CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95 % CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95 % CI 2.64, 3.85). Conclusion For women at low risk of medical complications, caseload midwifery increases women’s satisfaction with antenatal, intrapartum and postpartum care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).