Maternal and Child Health Commons^™

Reducing Extreme Heat Impacts On Health In Pregnant Women And Infants: A Community Based Intervention In Kilifi, Kenya, Adelaide Lusambili, Fiona Scorgie, Martha Oguna, Matthew Chersich, Stanley Luchters, Giorgia Gon, Veronique Filippi, Sari Kovats, Kevin Mccawley, Jeremy Hess

Institute for Human Development, East Africa

High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behavior-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and …

The Influence Of Scientific, Genetic, And Health Literacy On Carrier Screening Decision-Making, Brenna D. Albracht

Dissertations and Theses (Open Access)

For those wishing to assess their reproductive risks and make informed decisions in their reproductive planning, carrier screening for autosomal recessive and X-linked conditions, as well as cell-free DNA (cfDNA) screening for aneuploidy, are recommended during pregnancy. Despite similarities in purpose, sample requirements, insurance coverage, and safety, a lower percentage of individuals elect carrier screening than cfDNA screening, suggesting there may be a disconnect in what patients perceive as valuable information for their pregnancy. Previous studies have attempted to explain the factors associated with carrier screening uptake or decline; however, no models have yet accounted for a patient’s literacy level …

Planning For Scale: Analysis Of Adaptations And Contextual Factors Influencing Scale-Up Of The Quali-Dec Intervention To Optimize Caesarean Section Use, Soha El-Halabi, Claudia Hanson, Alexandre Dumont, Amanda Cleeve, Helle Mölsted Alvesson, Charles Kaboré, Guillermo Carroli, Pisake Lumbiganon, Quoc Nhu Hung Mac, Ana Pilar Betran

Centre of Excellence in Women and Child Health

Background: Researchers are encouraged to plan for scale through purposeful and guided assessment of scalability of an intervention. This study analysed factors potentially influencing scale-up and synthesised early adaptations of the QUALI-DEC intervention aiming to improve the appropriate use of caesarean section. The intervention consists of opinion leader engagement, audit and feedback for caesarean section, a tool to help women make an informed decision on the mode of birth, and labour companionship.

Methods: We conducted a framework analysis, which was guided by the scalability assessment framework by Zamboni et al., a 34-item checklist with a three-point scale. We used data …

Pregnancy Care Integrating Translational Science, Everywhere (Precise): A Prospective Cohort Study Of African Pregnant And Non-Pregnant Women To Investigate Placental Disorders – Cohort Profile, Rachel Craik, Joseph Akuze, Marie-Laure Volvert, Hannah Blencowe, Moses Mukhanya, Angela Koech, Grace Mwashigadi, Marleen Temmerman, Marvin Ochieng, Emily Mwadime

Centre of Excellence in Women and Child Health

Purpose: The Pregnancies' Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study …

Measured And Self-Reported Hypertension Among Women Of Reproductive Age, Gambia, Kenya, Mozambique, Laura Magee, Esperanca Sevene, Anne Rerimoi, Rachel Craik, Ashley Muteti, Marleen Temmerman, Marianne Vidler, Umberto D’Alessandro, Anna Roca, Jeffrey Bone

Centre of Excellence in Women and Child Health

Problem In sub-Saharan Africa, hypertension prevalence is usually estimated from participant recall. We assessed the accuracy of self-reported hypertension in women of reproductive age.

Approach In PRECISE (PREgnancy Care Integrating translational Science, Everywhere), an observational prospective cohort study, we recruited 1825 non-pregnant women of reproductive age, 610 in the Gambia, 609 in Kenya and 606 in Mozambique. We compared self-reported and measured hypertension (systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg). We adjusted hypertension prevalence for age, body mass index, education, parity, and antihypertensive medicine and oral contraceptive use.

Local setting PRECISE was conducted in both urban …

Racial Disparity And Environmental Influences On Perinatal Health In Jefferson County, Kentucky., Felicia A Pugh

Electronic Theses and Dissertations

Background: Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities. Objectives: This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) and examines associations between maternal ambient heavy metal exposures and birth outcomes in Jefferson County, Kentucky, 2017-2022. Methods: Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents were used. Incidence of SMM, stillbirth, preterm birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) …

Labour Companionship And Respectful Treatment Of Women During Childbirth: A Cross-Sectional Study Across 16 Hospitals In Benin, Malawi, Tanzania And Uganda, Soha El-Halabi, Kristi Sidney Annerstedt, Christian Agossou, Fadhlun Al-Beity, Andrea B. Pembe, Phillip Wanduru, Bianca Kandeya, Jean-Paul Dossou, Helle Molsted-Alvesson, Claudia Hanson

Centre of Excellence in Women and Child Health

Introduction: Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi, Tanzania and Uganda.

Methods: We conducted a cross-sectional survey using a validated questionnaire administered to women at discharge after birth between December 2021 and March 2024. The main outcomes were factor-weighted respectful treatment score and its subscores on maintained respect and dignity, privacy and maintained confidentiality and no physical and verbal …

Knowledge, Attitudes, And Motivation Regarding Exclusive Breastfeeding Between Medical And Nonmedical Students: A Cross-Sectional Study, Melviana Lubis, Meisyah Putri Rozi

Makara Journal of Health Research

Background: Exclusive breastfeeding provides substantial health benefits; however, disparities in knowledge and support persist. This study aimed to compare knowledge levels, attitudes, and motivation levels regarding exclusive breastfeeding between female medical and nonmedical students.

Methods: A cross-sectional survey was conducted at Universitas Muhammadiyah Sumatera Utara and involved 314 students from the 2023 cohort. A validated questionnaire was used to assess knowledge levels (16 items), attitude (IIFAS, 16 items), and motivation (15 items). Data were analyzed using the chi-square test, odds ratio (OR), and Spearman’s correlation.

Results: Medical students demonstrated significantly higher levels of knowledge (OR = 3.50; …

Maternal Dietary, Nutritional Status, And Its Association With Low-Birth Weight: A Scoping Review, Tri Siswati, Devi Septia Ningrum, Adinda Safitri, Almira Sitasari

Indonesian Journal of Public Health Nutrition (IJPHN)

Maternal diet and nutritional status during pregnancy influence birth outcomes. This review article aims to synthesize key studies examining the relationship between maternal dietary intake, nutritional status, and the occurrence of low birth weight (LBW). This study applies a scoping review from PubMed and Google Scholar (2018–2023). Observational and experimental studies were included. Articles met the criteria if they involved pregnant women aged 17+, human studies, full-text availability, and were in English or Indonesian. Fourteen studies met the inclusion criteria and were analyzed. The findings revealed that maternal intake of essential macronutrients, including energy and protein, along with key micronutrients …

The Art Of Resiliency: Patient Stories Of Maternal Mental Health Experiences, Sara Santarossa, Becca Austin, Molly A. Bell, Samantha C. Henry, Ashley Inclima, Hailey Maddox, Tara G. Smith, Leah Copeland, Dana Murphy, Ashley Redding, Amy Loree

Journal of Patient-Centered Research and Reviews

As part of a Patient-Centered Outcomes Research Institute Eugene Washington Engagement Award aimed at improving capacity to address maternal mental health in research, this collection of stories describes experiences from six unique patient perspectives. Using motherhood as a common thread, these six stories weave together the patients’ challenges and barriers juxtaposed with their hopes and dreams. Exploring such topics as infant loss, expectations versus the reality of the postpartum experience, grief, loss of identity, loss of physical or emotional safety, advocacy, and perseverance through challenging maternal mental health experiences, these tales of resiliency leverage the voices and lived experiences of …

Breaking The Cycle: Reducing Maternal Mortality Disparities In Minnesota, Grace Hambike

Undergraduate Research Symposium 2025

A comparative analysis of Minnesota's maternal mortality rates with states implementing successful maternal health initiatives and a review of policies supporting doulas, midwives, and culturally competent care models. Conclusions show that addressing maternal mortality disparities requires systemic healthcare reforms and culturally competent interventions. Expanding access to doulas, midwives, and community-based care can significantly improve maternal outcomes. Future research should focus on long-term effects of policy changes and continued surveillance of maternal health disparities.

Maternal Physical And Mental Health In The State Of South Carolina: Creating High-Quality Educational Materials, Elizabeth Chard

Entry-Level Occupational Therapy Doctorate - Doctoral Capstone Symposium

This capstone project, in collaboration with the Empowering Moms team at the Medical University of South Carolina, aimed to establish the foundation for a statewide occupational therapy initiative focused on maternal mental and physical health education as a preventative approach to addressing rising maternal mortality rates. The project involved assessing the needs of mothers, developing evidence-based educational materials, and compiling a comprehensive resource list to enhance access to information for mothers and community health partners (CHPs) across South Carolina. To support this initiative, a website and REDCap surveys were created to facilitate information dissemination and track outcomes. Embedded within the …

Building Bridges: A Community Health Worker Training Course, Taylor A. Ramsey, Lesley Khan-Farooqi, Phd, Otd, Otr, Dr. Sharita Ambrose, Dhed., Mph, Ches, Chwi

Spring 2025 OTD Capstone Symposium

Building Bridges: A Community Health Worker Training Course is a comprehensive 20-hour continuing education course designed for community health workers (CHWS) who work with Black pregnant women. This training course was developed for and in collaboration with Allure Alliance Incorporated, a non-profit organization whose mission is to improve the lives of Black women through community programming, education, and advocacy. This training course reflects an interprofessional collaborative approach to addressing the racial disparities in the Black maternal health population in the U.S. The course includes evidence-based strategies and health management interventions derived from the Occupational Therapy Practice Framework, 4th Edition (OTPF-4), …

Prenatal Exposure To Pm2.5 Concentration And Risk Of Preterm Birth In New Mexico; A Seasonal Pattern And Spatio-Temporal Modeling., Onyedikachi J. Okeke

Mathematics & Statistics ETDs

This study investigates the association between prenatal PM2.5 exposure and preterm birth risk in New Mexico (2014–2021). Using descriptive statistics, time series models, and spatial analyses, findings show an average preterm birth rate of 14.87 per 1,000 live births, with moderate correlation (r = 0.727) between PM2.5 levels and very preterm births. While traditional models revealed no significant global effect, spatial methods such as Geographically Weighted Regression (GWR) and Multiscale GWR uncovered strong spatial heterogeneity. PM2.5 effects varied by county (coefficients: -0.00154 to 0.00150), with clustering evident in 2018–2019 (Moran’s I = 0.155–0.174). Results highlight the limitations of global models …

"Health Gatekeepers": The Influence Of Women On Health Practices In Rural, Central Appalachia, Reese Lycan

Senior Theses

Women have historically assumed leadership roles in familial and community health promotion, intervention, and facilitation. While the role of women in family health is globally understood and the historical importance of female leadership has been documented, there remains a gap in knowledge regarding the role of women as “health gatekeepers”. Furthermore, when considering the Appalachian region, there are limited studies regarding women’s place in leadership as far as health is concerned. Therefore, this study employs a hermeneutic phenomenological framework to explore the lived experiences of women in relation to their family and community’s health in rural, Central Appalachia- a region …

Role Of Race And Ethnicity In The Development, Diagnosis, And Treatment Of Gestational Diabetes Mellitus, Gabrielle D. Shupard

Senior Theses

Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy, and rates of this disease have been steadily increasing over the past ten years. GDM disproportionately impacts racial and ethnic minorities at higher rates than their Caucasian counterparts. In this study, the PRECEDE model framework was employed during a literature review to gain a greater understanding of the complex risk factors contributing to differences in the development, diagnosis, and treatment of GDM among these population subgroups. The second part of this study concentrated on reviewing the extent to which current literature evaluates the role of race and ethnicity …

Community Perspectives On Maternal Dietary Diversity In Rural Kenya, Mozambique And The Gambia: A Precise Network Qualitative Study, Mai-Lei Woo Kinshella, Shilla Dama, Onesmus Wanje, Rosa Pires, Helena Boene, Papa Jagne, Hawanatu Jah, Angela Koech, Grace Mwashigadi, Violet Naanyu

Centre of Excellence in Women and Child Health

Pregnant and lactating women in sub-Saharan Africa are vulnerable to micronutrient inadequacies, with risk of adverse pregnancy outcomes. Adequate intakes of diverse foods are associated with better micronutrient status and recommended by the World Health Organization as part of healthy eating counselling during antenatal care. However, our understanding of community knowledge of dietary diversity within the context of maternal diets is limited. We used a descriptive qualitative approach to explore community perceptions of dietary diversity during pregnancy and lactation, as well as influencing factors in sub-Saharan Africa. A total of 47 in-depth interviews were conducted between May and October 2022 …

Standardization And Quality Control Of The Introduction Of A Noninvasive Cardiac Output Monitor For Pregnancy Measurements In A Low- And Middle-Income Country, Helen Perry

Centre of Excellence in Women and Child Health

Introduction :There is increasing awareness of the role of the maternal cardiovascular system in complicated pregnancies. Despite the high disease burden, noninvasive cardiac output monitors have not been used extensively in low- and middle-income countries. The aim of this study was to evaluate the quality control of the use of the ultrasonic cardiac output monitor (USCOM) 1A® in a LMIC.

Material and Methods This was a quality assessment study of the introduction of the USCOM 1A® to measure maternal hemodynamic indices. Inter-observer agreement was assessed across all four study sites by intraclass correlation coefficient. Quality control was assessed using pre-defined …

The Impact Of Discretion On Human Service Workers Supporting The Health Of Unaccompanied Minors In Foster Care, Diana M. Clark

Senior Theses

Unaccompanied children (UCs) are a vulnerable population that enters government custody and accesses healthcare via the Office of Refugee Resettlement (ORR)'s system of care. While prior research has focused on generating policy recommendations to improve healthcare services available to UCs both in ORR custody and following release from custody, this thesis will instead expand upon the experiences of staff members working at ORR-contracted agencies. These workers make decisions that have short- and long-term implications on the health and wellbeing of UCs. Drawing from 65 in-depth interviews with human service workers in ORR-contracted voluntary agencies, this thesis uses street-level bureaucracy framework …

Cell-Free Dna Results Indicating Mosaic Monosomy X Of Likely Maternal Origin: Impact On Genetic Counseling Practices And Patient Experiences, Audrey Mcbride, Ashley Cannon, Siddharth Prakash, Aaron W Roberts, Angela Seasely, Anna C E Hurst, Laura Hendon

Faculty, Staff and Student Publications

Objective: To investigate the current genetic counseling practices involving a cfDNA result indicating mosaic monosomy X of likely maternal origin, and to better understand the perspectives of patients who have received this result.

Method: A total of 60 prenatal genetic counselors completed surveys about their experiences with this result, cfDNA consenting practices, and management practices. In addition, qualitative interviews were conducted with 5 patients to gain insight into their experiences with result disclosure and follow-up care.

Results: 95% of genetic counselors reported feeling prepared to counsel on these results. However, responses to current practices varied. Of the genetic counselors surveyed, …

Mothers’ Characteristics And Children's Diarrhea Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr.

Journal of Social, Behavioral, and Health Sciences

Mothers’ characteristics influence children’s health and development. We conducted a cross-sectional study to assess the influence of mothers’ education level, employment status, and exposure to domestic violence on diarrhea among children under 5 years old using secondary data from 2010, 2015, and 2020 Rwanda Demographic Health Surveys. We used stratified descriptive statistics, pairwise comparisons, and logistic regression designs to assess (a) the prevalence of mothers per education level, employment status, and exposure to domestic violence; (b) their variation over time; and (c) their influence on diarrhea among children under 5 years old between 2010 and 2020 in Rwanda. According to …

Cost-Effectiveness Of Intrapartum Azithromycin To Prevent Maternal Infection, Sepsis, Or Death In Low-Income And Middle-Income Countries: A Modelling Analysis Of Data From A Randomised, Multicentre, Placebo-Controlled Trial, Jackie K. Patterson, Simon Neuwahl, Sydney Kirsch, Janet L. Moore, Alan T.N. Tita, Waldemar A. Carlo, Adrien Lokangaka, Antoinette Tshefu, Musaku Mwenechanya, Elwyn Chomba, Avinash Kavi, Mrityunjay C. Metgud, Shivaprasad S. Goudar, Richard J. Derman, Poonam Shivkumar, Manju Waikar, Archana Patel, Patricia L. Hibberd, Paul Nyongesa, Fabian Esamai, Osa A. Ekhaguere, Sherri Bucher, Saleem Jessani, Shiyam S. Tikmani, Sarah Saleem, Blair J. Wylie, Robert L. Goldenberg, Sk Masum Billah, Ruth Lennox, Rashidul Haque, William A. Petri, Manolo Mazariegos, Nancy F. Krebs, Jennifer J. Hemingway-Foday, Denise Babineau, Marion Koso-Thomas, Elizabeth M. Mcclure, Melissa Bauserman

Global Health Articles

BACKGROUND: Sepsis is one of the leading causes of maternal mortality globally. In 2023, the Azithromycin Prevention in Labor Use (A-PLUS) trial showed intrapartum azithromycin for women planning a vaginal birth reduced the risk of maternal sepsis or death and infection. We aimed to evaluate the cost-effectiveness of intrapartum azithromycin for pregnant people planning a vaginal birth in low-income and middle-income countries (LMICs) using A-PLUS trial data.

METHODS: We compared the benefits and costs of intrapartum azithromycin versus standard care across 100 000 model simulations using data from the A-PLUS trial and a probabilistic decision tree model that included 24 …

The Importance Of Recruitment Of Low-Income Pregnant Persons In Interdisciplinary Research To Understand The Impact Of Social And Environmental Determinants: Lessons Learned About Implementation And Recruitment, Erika R. Marquez, Amanda Haboush-Deloye, Elizabeth M. Lawrence, Selam Ayele, Courtney Coughenour, Nora Doyle, Wynona Dizon, Lizbeth Perez Rodriguez, Chloe Bombara

Environmental & Global Health Faculty Research

Background: Prior research indicates that enrolling underrepresented populations in clinical research is challenging. Although research has identified some barriers to participation and strategies to overcome them, studies have made little progress in being inclusive and representative. There remains a great need for including racial/ethnic minorities, low-income families, and pregnant women in research. The purpose of this article is to describe the implementation of enrollment strategies used in our study to understand the feasibility of building a maternal cohort and better understand the relationship between environmental and social impacts on maternal exposure and child outcomes.

Methods: Working across multiple academic units, …

Arrest The Midwife, Dereck Daschke

Journal of Religion & Film

This is a film review of Arrest the Midwife (2025), directed by Elaine Epstein.

Health Equity & Parental Leave: Addressing Gaps In Maternal Health Policy, Destiny L. Smith

Public Health Capstone Projects

Objective: This capstone project at Duquesne University will address health equity by focusing on employer-provided maternal and parental leave policies in the United States among underserved groups. It aims to address the gaps in these policies and analyze how disparities in leave policies across different industries can impact maternal and infant health outcomes.

Priority Population Served: This study will primarily target underserved employees who had to take some type of leave policy while working for an intended employer.

Methods: This project will engage in data analysis of the 2024 BIRTH survey results that the Pittsburgh Business Group on …

Michelle Obama: Moving Towards Childhood Obesity Solutions, Ian Gallagher

Osmosis Magazine

Throughout the Obamas' time in office, approval ratings made it clear the most popular Obama was not the man in the Oval Office. First Lady Michelle Obama consistently received higher approval ratings than her husband during his time in office. This could be attributed to her strong devotion to her family and her appearance as a genuinely good and caring person. During her time in office she drew the attention of the public by shedding light on one of the worst health epidemics currently afflicting the country: childhood obesity.

Neonatal Outcomes In Periviable Births Weighing ≤ 500 Grams, Bijan Morshedi, Diego Maurente, Ursula Griffiths-Randolph, Elisabeth Kamano, Katharine Hopkins, Dana Baraki, Juliana Martins, Steven Warsof

Eastern Virginia Medical Journal

Background: The average rate of preterm birth in the US in 2021 was 10.1%. Although the rate of mortality from preterm birth has been decreasing, complications remain the leading cause of death in infants under the age of 5 years worldwide. Gestational age (GA) and birth weight (BW) remain the 2 most important variables for predicting survivability in preterm births, and lower GA and BW are both correlated with lower survivability.

Objective: To explore outcomes of neonates born in the periviable period (20 weeks and 0 days to 25 weeks and 6 days) with BW ≤ 500 g and to …

Microglial Disruption In Young Mice With Early Chronic Exposure To Lead, Christina Sobin, Mayra Flores Montoya, Natali Parisi, Tanner Schaub, Miguel Cervantes, Rodrigo Armijos

Departmental Papers (PH)

The mechanisms by which early chronic lead (Pb) exposure alters brain development have not been identified. We examined neuroimmune system effects in C57BL/6J mice with Pb exposure, including levels that may be common among children in lower socioeconomic income environments. Pups were exposed via dams’ drinking water from birth to post-natal day 28 to low, high or no Pb conditions. We compared gene expression of neuroinflammatory markers (study 1); and microglial mean cell body volume and mean cell body number in dentate gyrus, and dentate gyrus volume (study 2). Blood Pb levels in exposed animals at sacrifice (post-natal day 28) …

Trauma In Pregnancy: A Statistical Retrospective Analysis Of Leading Causes And Demographic Insights, Andrea Argenal, Sonya Bhatia, Sowmya Duddu, Julia Paz, Sriya Gullapalli, Kelsey Baker, Bharathi Gadad

Research Symposium

Background: Trauma during pregnancy is a significant contributor to maternal and fetal morbidity and mortality. Understanding the leading causes of trauma can guide interventions to improve outcomes of injuries for pregnant women. This study aimed to analyze the distribution of trauma causes in a cohort of pregnant women treated in Texas Emergency Department over the year 2021.

Methods: A retrospective statistical analysis was conducted on a sample of 96 pregnant women who experienced trauma. Data was collected from the Texas Emergency Department for patients admitted to the hospital during 2021 and categorized by the cause of injury; some of these …

From Crisis To Action: Investigation, Research, And Response In The Rio Grande Valley Following The Anencephaly Cluster Of 1990-1991, Jonathan Hebert, Miguel Lopez, Padmanabhan Rengasamy

MEDI 9331 Scholarly Activities Clinical Years

The 1990-1991 birth defect cluster of anencephaly in the Rio Grande Valley has had lasting effects on Texas public health and birth defect prevention nationwide. The purpose of this study is to clearly illuminate public health efforts to investigate, identify, and combat the rise of anencephaly and other neural tube defects (NTDs) in the Rio Grande Valley and other border counties following the 1990-1991 cluster, as well as to report the findings of each branch of environmental, infectious, and genetic investigation into the possible causes of the disaster. Information was gathered via a literature review and from other sources including …