Medical Specialties Commons^™

Comparing The Trends Of Postpartum Depression Screening Scores During And Before The Covid-19 Pandemic, Elif S. Duran, Dung Dang, Tony Ogburn

MEDI 9331 Scholarly Activities Clinical Years

Introduction:

Postpartum depression includes major and minor depressive disorders affecting women in the time period after childbirth. The studies reviewed in our literature found that the COVID-19 pandemic has increased the risk of postpartum depression for women. Our study location, the Rio Grande Valley is one of the hardest-hit locations by the COVID-19 pandemic in the United States. Our patient population is also one with the higher risk factors for postpartum depression. As such, we are expecting the psychological impact of the pandemic to be even more magnified, and thus, actions need to be taken to support the vulnerable population …

Learning From Changes Concurrent With Implementing A Complex And Dynamic Intervention To Improve Urban Maternal And Perinatal Health In Dar Es Salaam, Tanzania, 2011-2019, Brenda Sequeira Dmello, Ziada Sellah, Grace Magembe, Natasha Housseine, Nanna Maaløe, Thomas Van Den Akker, Dan W. Meyrowitsch, Timothy Mushi, Mangalu Masweko, Dorcas Jidayi, Jos Van Roosmalen, Hussein Kidanto

Faculty of Health Sciences, East Africa

Introduction Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city’s facility births.

Methods Multiple intervention components addressed gaps across the maternal and perinatal continuum of …

Evaluation Of Time-Dependent Camber And Deflections In Bridge Girders, Furkan Cakmak

Wayne State University Theses

A methodology to predict each stage of camber and displacements in composite prestressed concrete and steel bridge superstructures from inception to end of service life including a prediction of rebound in deck replacement projects is presented. The methodology invokes the use of multiple creep curves and allows the proper simulation of various construction activities each of which feature unique loading events. The proposed method captures the influence of several factors, such as creep and shrinkage of beam and deck concrete as well as prestresses losses induced because of these phenomena. Additionally, the prediction methodology offers the capability to quantify the …

Sexual Behaviour Patterns And Sti Risk: Results Of A Cluster Analysis Among Men Who Have Sex With Men In Portugal, Karel Blondeel, Sonia Dias, Martina Furegato, Armando Seuc, Ana Gama, Ricardo Fuertes, Luís Mendão, Marleen Temmerman, Igor Toskin

Obstetrics and Gynaecology, East Africa

Objectives: Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus.

Design: A cross-sectional behavioural survey was conducted in Portugal among MSM, using a …

Servqual Measurement In A Healthcare Setting: Before And After Corrective Strategy Implementation, Jerome Christia, Aaron Ard, Lorraine Runion

Atlantic Marketing Journal

In the United States, the most dominant industry is services, yielding the highest volume of total employment and gross domestic product. Due to this insight, academics and business professionals continue to research and apply strategies to achieve distinctive competitive advantages in the services arena. The steady growth and increasing significance of the service sector in the United States and other developed markets has resulted in a sizeable body of related research addressing a variety of issues such as service quality and its characteristics. Healthcare is an impactful service industry that has received a considerable amount of attention. In the healthcare …

Uptake And Determinants Of Cervical Cancer Screening Among Health Care Workers In Aga Khan University Hospital, Nairobi Kenya., Doreen Moraa Osoro

Master of Medicine in Obstetrics and Gynecology

Background: The cancer burden has been rising globally. The reported incidence of cervical cancer is 13.1 / 100,000 globally and 40 / 100,000 in Kenya. Up to 88% of all cervical cancer deaths have been reported in lower to middle-income countries. In comparison, developed countries had up to two to four times lower rates of cervical cancer incidence and mortality. The burden of cancers attributable to carcinogenic infections has potentially modifiable risk factors, for which prevention tools already exist. There is a gap in the implementation of evidence-based interventions including primary prevention with the HPV vaccine and secondary prevention with …

Neither “Post-War” Nor Post-Pregnancy Paranoia: How America’S War On Drugs Continues To Perpetuate Disparate Incarceration Outcomes For Pregnant, Substance-Involved Offenders, Becca S. Zimmerman

Pitzer Senior Theses

This thesis investigates the unique interactions between pregnancy, substance involvement, and race as they relate to the War on Drugs and the hyper-incarceration of women. Using ordinary least square regression analyses and data from the Bureau of Justice Statistics’ 2016 Survey of Prison Inmates, I examine if (and how) pregnancy status, drug use, race, and their interactions influence two length of incarceration outcomes: sentence length and amount of time spent in jail between arrest and imprisonment. The results collectively indicate that pregnancy decreases length of incarceration outcomes for those offenders who are not substance-involved but not evenhandedly -- benefitting white …

Repair Of Vesicouterine Fistula By Not Using Traditional O' Connor Method, Lubna Razzak, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

A 25-year-old female patient visited our clinic with complaint of cyclic haematuria. She had previous two Caesarean Sections at a secondary care hospital. Her complete urinalysis showed abundant red blood cells. Through computed tomography a fistula tract between the posterior wall of the bladder and the anterior wall of the lower uterine segment was diagnosed. The Cystoscopy revealed a fistulous opening with a diameter of nearly 1.5 cm localized between the bladder and uterine cavity. Fistulae was repaired by abdominal approach without transection of bladder. Surgery was performed by mobilization of bladder and wide anterior uterine dissection. A 2cm defect …

Utilizing Patient-Derived Epithelial Ovarian Cancer Tumor Organoids To Predict Carboplatin Resistance, Justin W. Gorski

Theses and Dissertations--Clinical and Translational Science

The development of patient-derived tumor organoids (TOs) from epithelial ovarian cancer tumor obtained at the time of primary or interval debulking surgery has the potential to play an important role in precision medicine.

Here, we utilize TOs to test front-line chemotherapy sensitivity and to investigate genomic drivers of carboplatin resistance. We developed six high grade serous epithelial ovarian cancer tumor organoids from tissue obtained during debulking surgery (2 neoadjuvant carboplatin exposed, 4 chemo-naïve). Each organoid line was screened for sensitivity to carboplatin at four different doses (100, 10, 1 and 0.1µM). Cell viability curves and resultant EC50 values were determined …

A Simulation-Based Outreach Program Improves Delivery Room Team Confidence In Neonatal Resuscitation At Rural Community Hospitals, Allison Zanno, Misty Melendi, Micheline Chipman, Jeffrey Holmes, Alexa Craig, Samantha Piro, Anna Gilbert, Sarah Gabrielson, Leah Mallory, Anya Culter, Mary Ottolini

Costas T. Lambrew Research Retreat 2021

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.

The Injustice Of Unfit Clinical Practice Guidelines In Low-Resource Realities, Nanna Maaløe, Anna Marie Rønne Ørtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Thomas Van Den Akker, Monica Lauridsen Kujabi, Hussein Kidanto, Tarek Meguid, Ib Christian Bygbjerg

Obstetrics and Gynaecology, East Africa

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation …

Planned Delivery At 37 Weeks Gestation Versus Expectant Management For Non-Severe Chronic Hypertension, A Systematic Review., Jackson Njuguna

Master of Medicine in Obstetrics and Gynecology

Background: Chronic hypertension is independently associated with an increased incidence of adverse maternal and perinatal outcomes. Delayed delivery carries maternal risks, while early delivery increases fetal risk, so appropriate timing is important. The optimal timing of delivery for women with this condition has not been adequately addressed by the available literature. Objective: To review the literature that assesses the benefits and risks of a policy of planned delivery versus expectant management in pregnant women with non-severe chronic hypertension at 37 weeks gestation. Our primary outcomes were composite maternal outcome (super-imposed pre-eclampsia, placental abruption, maternal admission to intensive care unit and …

Association Between Prepregnancy Obesity And Health Behaviors, Adverse Conditions, And Birth Outcomes In South Dakota, Lily Sanderson

Electronic Theses and Dissertations

Introduction: Prepregnancy obesity is associated with an increased risk for various adverse outcomes for mother and fetus. These adverse associations exist within the realms of preconception health, prenatal health, birth outcomes, and postnatal health.
Methods: This retrospective cohort study used data from the South Dakota Pregnancy Risk Assessment Monitoring System (SD PRAMS) survey, which is an ongoing statebased surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. The 2017 and 2018 SD PRAMS sampled a total of 3,805 mothers who were randomly selected from birth certificate records to be representative of all South Dakota women …

Impact Of Smoking And Hpv Status On Cervical Cancer Survival In Women Living In Kentucky, 2004-2005 And 2014-2015, Brittany M. Mckinley

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

BACKGROUND/ OBJECTIVE: Cervical cancer is the fourth most commonly occurring malignancy in women worldwide, with an estimated 530,000 new cases and 270,000 new deaths each year (Small et al, 2017). While the incidence of cervical cancer has decreased by approximately 1.9% per year between 2007 and 2011, the death rate has remained stable (Bernard et al, 2014). Studies have shown that nearly all cervical cancer cases are associated with the Human Papilloma Virus (HPV). Many studies support the association of smoking with increased risk of invasive cervical cancer in women with high-risk HPV (Castle et al, 2002; Fang et al, …

The Benefits Of Statins As Adjunct Therapy For Non-Pregnant And Non-Lactating Women Diagnosed With Pcos, Claire Barre

Capstone Showcase

Introduction: Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting about 20% of women in reproductive age. PCOS is associated with many health risks, one of which is an increased risk of cardiovascular and metabolic disorders. There is no set treatment plan to help decrease the risk of cardiometabolic diseases, but some standard recommended treatments include lifestyle changes, oral contraceptive pill (OCP), and metformin. The review analyzes the potential benefit of adding statins as an adjunct therapy (I) to decrease the cardiometabolic disease risk (O) in women diagnosed with PCOS (P) compared to the current recommended intervention (C). …

The Efficacy Of In Vitro Fertilization In Treating Infertility Due To Anovulatory Pcos In Comparison To Ovulation Induction Via Letrozole, Amanda Salay

Capstone Showcase

Abstract:

Introduction: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder found in women of reproductive age that often causes infertility. The first-line treatment for infertility in anovulatory PCOS patients is ovulation induction. In vitro fertilization (IVF) is a third line treatment often used as a last resort. PCOS patients have higher failure risks of first- and second-line medications. Therefore, this review analyzes if adverse pregnancy outcomes (O) are reduced more with IVF (I) versus using letrozole for ovulation induction (C) in women aged 20-30 struggling with infertility due to anovulatory PCOS (P).

Methods: A literature search on Pubmed and EBSCOhost …

The Effects Of Psychological Intervention On Pregnant Women With Elevated Cortisol Levels And Adverse Birth Events, Megan Mellon

Capstone Showcase

Elevated levels of stress, anxiety, and depression during pregnancy are thought to influence cortisol levels. Dysregulations in cortisol, as a byproduct of the hypothalamic-pituitary axis, have been associated with preterm birth and adverse birth outcomes. Studies have demonstrated poorer long-term effects of antenatal stress on child neurodevelopment, temperament, and cognition. Psychological interventions of cognitive behavioral therapy (CBT), mindfulness, and gratitude have shown to have a positive effect on psychological wellbeing across various populations. The purpose of this literature review was to analyze a collection of randomized-controlled trials to conclude if psychological interventions during pregnancy for women with elevated levels of …

Efficacy Of Myo-Inositol In The Treatment Of Polycystic Ovarian Syndrome (Pcos), Rachel Mathews

Capstone Showcase

Polycystic ovarian syndrome (PCOS) is a disorder that results from insulin resistance. Symptoms include chronic anovulation, polycystic ovaries, acne, hirsutism, and infertility. Although there is currently no cure for PCOS, treatments such as metformin, clomiphene citrate, and reproductive assistive techniques (IVF) have been used to target specific symptoms. Recent research has suggested that myo-inositol may be beneficial in the treatment of PCOS. Therefore, this review analyzes the addition of myo-inositol (I) in adult patients with PCOS (P) compared to current methods such as metformin, clomiphene citrate, and assisted therapies alone (C) in improving ovulation and fertility (O). A literature search …

Improving Ob Trauma Care Using A Standardized Protocol, Johanna Renee Ridley, Madeline Elaine Huff, Abaigeal Thompson

MEDI 9331 Scholarly Activities Clinical Years

Introduction

Timely evaluation of a pregnant woman experiencing trauma has significant implications. To optimize trauma care for obstetrical patients, our Level I Trauma Center at Doctors Hospital at Renaissance initiated a Standard Operating Procedure (SOP) which puts an OBGYN at bedside within 15 minutes of arrival. This involves calling an ‘OB Trauma Alert’ and arranging expedited travel to the center. We performed a quality improvement initiative to evaluate operational compliance.

Methods

The IRB deemed this project non-regulated research. Therefore, we reviewed obstetrical trauma admissions and subsequent deliveries of pregnant women >20 weeks presenting within 2 years before SOP implementation through …

The Effect Of Implementing Ob Trauma Activation Standards On Maternal & Fetal Outcomes, Johanna Renee Ridley, Abaigeal Thompson

MEDI 9331 Scholarly Activities Clinical Years

The risk of trauma during pregnancy is not well established in the United States but is associated with significant morbidity and mortality. The overall goal of this study is to to initiate a formal ongoing process by which DHR can utilize objective measures to monitor and evaluate the quality of OB trauma services. We will use a Continuous Quality Improvement (CQI) approach to evaluate the effect of implementing an OB Trauma Activation Procedure, which places an OB team (obstetrician and labor RN) at the bedside within 15 minutes on maternal and fetal outcomes. 1,285 subjects were initially filtered to remove …

Modeling Longitudinal Change In Cervical Length Across Pregnancy, Hope M. Wolf, Shawn J. Latendresse, Jerome F. Strauss Iii, Timothy P. York

Graduate Research Posters

Introduction: A short cervix (cervical length < 25 mm) in the mid-trimester (18 to 24 weeks) of pregnancy is a powerful predictor of spontaneous preterm delivery (gestational age at delivery < 37 weeks). Although the biological mechanisms of cervical remodeling have been the subject of extensive investigation, very little is known about the rate of change in cervical length over the course of a pregnancy, or the extent to which rapid cervical shortening increases maternal risk for spontaneous preterm delivery.

Methods: A cohort of 5,160 unique women carrying 5,971 singleton pregnancies provided two or more measurements of cervical length during pregnancy. Cervical length was measured in millimeters using a transvaginal 12-3 MHz ultrasound endocavity probe (SuperSonic Imagine). Maternal characteristics, including relevant medical history and birth outcome data, were collected for each participant. Gestational age at delivery was measured from the first day of each woman’s last menstrual period and confirmed by ultrasound. Repeated measurements of cervical length during pregnancy were modeled as a longitudinal, multilevel growth curve in MPlus. A three-level variance structure was …

Toward An Interactive, Patient-Specific, Vr-Based Obstetrics Simulator, Michel A. Audette, Marco Parente, Dulce Oliveira, Sreekanth Arikatla, Alfred Abuhamad, Rumit Singh Kakar, Mark Scerbo, Lucia Tabacu, John Conery, Christopher Macgowan, Renato Natal Jorge

Electrical & Computer Engineering Faculty Publications

This paper presents a nascent collaborative effort to achieve a Virtual Reality (VR)-based, real-time, haptics-driven patient-specific obstetrics simulator. The high-level architecture and preliminary results are presented here; the latter are based on offline birthing simulation developed by team in conjunction with open-source visualization tools. The cornerstones of this simulator will be high-fidelity generic offline birthing simulation, an anatomy-to-image nonrigid registration pipeline exploiting fetal MRI, the open-source interactive medical simulation toolkit IMSTK augmented by high-throughput deep learning-based soft tissue deformation, open-source musculoskeletal dynamics simulation platform SimTk for representing fetal motion. The initial emphasis will be on shoulder dystocia. The two main …

Learning From Changes Concurrent With Implementing A Complex And Dynamic Intervention To Improve Urban Maternal And Perinatal Health In Dar Es Salaam, Tanzania, 2011-2019, Brenda Sequeira Dmello, Ziada Sellah, Grace Magembe, Natasha Housseine, Nanna Maaløe, Thomas Van Den Akker, Dan W. Meyrowitsch, Timothy Mushi, Mangalu Masweko, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Introduction: Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city’s facility births.

Methods: Multiple intervention components addressed gaps across the maternal and perinatal continuum of …

Perceived Barriers And Facilitators To Cervical Cancer Screening In Asian American Women, Bouathong Thepsombath

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this systematic review is to explore barriers and facilitators of cervical cancer screening in Asian-American women. Articles selected for review were found using a database search method using select predetermined key terms. The clinical question this review sought to answer is: In Asian-American women (21-65 years of age), how does perception of cervical cancer screening impact screening compliance? Nine articles addressing the topic of interest were included in the review. Emerging themes related to answering the question under study included the health literacy of Asian-American women, modesty, acculturation, income comfortability, and self-efficacy. This review found information that …

Women’S Perception Of Preeclampsia And Antenatal Care Attendance In Northwestern Nigeria, Aisha Nana Adamu

Walden Dissertations and Doctoral Studies

Researchers have demonstrated a significant relationship between antenatal care (ANC) attendance and pregnant women’s sociodemographic characteristics. What has not been clearly studied is the relationship between ANC attendance and pregnant women’s perceptions about conditions such as preeclampsia (PE) that could affect their pregnancies. ANC could facilitate the timely management of these conditions, ultimately improving the outcomes for PE affected women. In this study the relationship between pregnant women’s perceptions about PE and their ANC attendance was examined. Guided by the health belief model (HBM), the research questions were used to explore the associations between four HBM constructs (perceived susceptibility, severity, …

Rapid Induction Of The Unfolded Protein Response And Apoptosis By Estrogen Mimic Ttc-352 For The Treatment Of Endocrine-Resistant Breast Cancer, Balkees Abderrahman, Philipp Y Maximov, Ramona F Curpan, Sean W Fanning, Jay S Hanspal, Ping Fan, Charles E Foulds, Yue Chen, Anna Malovannaya, Antrix Jain, Rui Xiong, Geoffrey L Greene, Debra A Tonetti, Gregory R J Thatcher, V Craig Jordan

Faculty, Staff and Students Publications

Patients with long-term estrogen-deprived breast cancer (BC), after resistance to tamoxifen or aromatase inhibitors develops, can experience tumor regression when treated with estrogens. Estrogen’s anti-tumor effect is attributed to apoptosis via the estrogen receptor (ER). Estrogen treatment can have unpleasant gynecological and non-gynecological adverse events thus the development of safer estrogenic agents remains a clinical priority. Here, we study synthetic selective estrogen mimics (SEMs) BMI-135 and TTC-352, and the naturally-occurring estrogen estetrol (E4), which are proposed as safer estrogenic agents compared to 17β-estradiol (E2), for the treatment of endocrine-resistant BC. TTC-352 and E4 are being evaluated in BC clinical trials. …

Is There An Association Between The Vaginal Microbiome And First Trimester Miscarriage? A Prospective Observational Study, Monica Shahid, Julie A. Quinlivan, George Mendz, Michael Peek, Natalia Castaño-Rodríguez

IHR Papers and Journal Articles

Aim

To examine whether there are differences in the vaginal microbiome of women who miscarry compared to those who have normal pregnancy outcomes.

Methods

Prospective observational study conducted at the Canberra Hospital, Australia, with 24 participant women in the first trimester of pregnancy. The vaginal microbiomes of the 24 women were characterized using sequencing analysis of the V4 region of the 16S rRNA gene employing an Illumina MiSeq instrument with QIAGEN reagents. Vaginal microbiome data were correlated with pregnancy clinical metadata.

Results

Ordination plots showed differences in the composition of microbiomes of women who miscarried and controls. In nulliparous women, …

Dach1 Mutation Frequency In Endometrial Cancer Is Associated With High Tumor Mutation Burden, Mckayla J. Riggs, Nan Lin, Chi Wang, Dava W. Piecoro, Rachel W. Miller, Oliver A. Hampton, Mahadev Rao, Frederick R. Ueland, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

OBJECTIVE: DACH1 is a transcriptional repressor and tumor suppressor gene frequently mutated in melanoma, bladder, and prostate cancer. Loss of DACH1 expression is associated with poor prognostic features and reduced overall survival in uterine cancer. In this study, we utilized the Oncology Research Information Exchange Network (ORIEN) Avatar database to determine the frequency of DACH1 mutations in patients with endometrial cancer in our Kentucky population.

METHODS: We obtained clinical and genomic data for 65 patients with endometrial cancer from the Markey Cancer Center (MCC). We examined the clinical attributes of the cancers by DACH1 status by comparing whole-exome sequencing (WES), …

Regional Trends In Birth Weight In Low- And Middle-Income Countries 2013-2018, Irene Marete, Osayame Ekhaguere, Carla M. Bann, Sherri L. Bucher, Paul Nyongesa, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Robert L. Goldenberg, Shivaprasad S. Goudar

Community Health Sciences

Background: Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network).
Methods: The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The …

Association Of Parity With Birthweight And Neonatal Death In Five Sites: The Global Network's Maternal Newborn Health Registry Study, Ana Garces, Wilton Perez, Margo S. Harrison, Kay S. Hwang, Tracy L. Nolen, Robert L. Goldenberg, Archana B. Patel, Patricia L. Hibberd, Adrien Lokangaka, Sarah Saleem

Community Health Sciences

Background: Nulliparity has been associated with lower birth weight (BW) and other adverse pregnancy outcomes, with most of the data coming from high-income countries. In this study, we examined birth weight for gestational age z-scores and neonatal (28-day) mortality in a large prospective cohort of women dated by first trimester ultrasound from multiple sites in low and middle-income countries.
Methods: Pregnant women were recruited during the first trimester of pregnancy and followed through 6 weeks postpartum from Maternal Newborn Health Registry (MNHR) sites in the Democratic Republic of Congo (DRC), Guatemala, Belagavi and Nagpur, India, and Pakistan from 2017 and …