Maternal and Child Health Commons^™

Comparison Of Sexually Transmitted Infections And Adverse Perinatal Outcomes In Underserved Pregnant Patients Before Vs During The Covid-19 Pandemic In Texas, Irene A Stafford, Jennie O Coselli, Danielle F Wilson, Courtney Y Wang, Baha M Sibai

Faculty, Staff and Student Publications

This cohort study assesses the rates of sexually transmitted infections (STI) and associated adverse perinatal outcomes among underserved pregnant patients during the COVID-19 pandemic in a public health system in Southeastern Texas.

Theoretical Explanations On The Persistence Of Ethno-Medical Pregnancy Nutrition Interventions And Recommendations For Possible Biomedical Interventions, Roselyter Riang’A

Population Health, East Africa

Background: Ethno-medical maternal health care practices during pregnancy are extensive among women especially in Low and Middle Income Countries. Little is known as to why there is an extensive use and reliance on ethno-medical malnutrition remedies over biomedical care, and that they can stand the test of time, even though some are detrimental to human health or based on scientifically incorrect notions.

Methods: From September 2014 through April 2018, a narrative review rather than a systematic review format was conducted in PubMed, Google Scholar, and Web of Science to identify and evaluate all associated literature. This review brings …

Exposure To Family Planning Messages And Teenage Pregnancy: Results From The 2017 Philippine National Demographic And Health Survey, Veincent Christian F. Pepito, Arianna Maever L. Amit, Clinton S. Tang, Luis Miguel B. Co, Neil Andrew K. Aliazas, Sarah J. De Los Reyes, Raymundo S. Baquiran, Lourdes Bernadette S. Tanchanco

Ateneo School of Medicine and Public Health Publications

Background

Teenage pregnancy is known to have physical, emotional, and psychosocial effects. Because of these risks, family planning and contraception messages have been disseminated in various forms of media, but their association with teenage pregnancy has not been studied previously in the Philippines. This study aims to examine the association between exposure to various family planning and contraception messages disseminated in various media channels and pregnancy among Filipino women aged 15–19. The study also intended to examine interactions between the different media channels where these family planning and contraception messages are being disseminated on their effect on teenage pregnancy.

Methods …

Differential Gene Expression In Cord Blood Of Infants Diagnosed With Cerebral Palsy: A Pilot Analysis Of The Beam Cohort, Maria L V Dizon, Raye-Ann O Deregnier, Steven J Weiner, Michael W Varner, Dwight J Rouse, Maged M Costantine, Ronald J Wapner, John M Thorp, Sean C Blackwell, Nina K Ayala, Antonio F Saad, Steve N Caritis, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal-Fetal Medicine Units Network

Faculty, Staff and Student Publications

The Beneficial Effects of Antenatal Magnesium clinical trial was conducted between 1997 and 2007, and demonstrated a significant reduction in cerebral palsy (CP) in preterm infants who were exposed to peripartum magnesium sulfate (MgSO4). However, the mechanism by which MgSO4 confers neuroprotection remains incompletely understood. Cord blood samples from this study were interrogated during an era when next-generation sequencing was not widely accessible and few gene expression differences or biomarkers were identified between treatment groups. Our goal was to use bulk RNA deep sequencing to identify differentially expressed genes comparing the following four groups: newborns who ultimately developed CP treated …

Pain That Only She Must Bear: On The Invisibility Of Women In Judicial Abortion Rhetoric, Francesca Laguardia

Department of Justice Studies Faculty Scholarship and Creative Works

The graphic and bodily facts of a legal question of rights are relevant to the courts, particularly in questions that directly implicate physical bodies and pain, such as right to die cases, or what level of search may be allowable and when. However, in the case of abortion, or more specifically the bodily ramifications of pregnancy and childbirth, this detail is conspicuously absent. This article, relying on a content analysis of over 220 legal opinions on abortion rights, documents this absence of rhetoric. Particularly in the context of other discussions of pain and physical health risks in these very same …

Maternal Occupational Exposures And Fetal Growth In A Spanish Birth Cohort, Jennifer Ish, David Gimeno Ruiz De Porras, Elaine Symanski, Ferran Ballester, Maribel Casas, George L Delclos, Mònica Guxens, Jesús Ibarluzea, Carmen Iñiguez, Loreto Santa-Marina, Michael D Swartz, Kristina W Whitworth

Faculty, Staff and Student Publications

While the epidemiologic literature suggests certain maternal occupational exposures may be associated with reduced measures of size at birth, the occupational literature employing fetal biometry data to assess fetal growth is sparse. The present study examines associations between maternal occupational exposures and ultrasound-measured fetal growth. We included 1,739 singleton pregnancies from the INfancia y Medio Ambiente (INMA) project (2003-2008). At 32 weeks of pregnancy, interviewers ascertained mothers' employment status and assessed job-related physical loads, work schedules, and job strain during pregnancy. Job titles were linked to a job-exposure matrix to estimate exposure to 10 endocrine disrupting chemical (EDC) groups. We …

The Contribution Of Racism-Related Stress And Adversity To Disparities In Birth Outcomes: Evidence And Research Recommendations, Sabrina R. Liu, Laura M. Glynn

Psychology Faculty Articles and Research

Currently, racial and ethnic differences in adverse birth outcomes and infant mortality are some of the largest and most persistent health disparities in the United States. This narrative review article synthesizes existing literature to present a conceptual model of how racism-related stress and adversity are critical determinants of such disparities. We describe how historical and ongoing racism has created conditions wherein women of color are disproportionately exposed to chronic, multilayered stress and adversity and how the biological consequences of exposure to these stressors confers risk for adverse birth outcomes. Next, we identify important priorities and considerations for future research, including …

The Efficacy Of A Personalized Mhealth Coaching Program During Pregnancy On Maternal Diet, Supplement Use, And Physical Activity: Protocol For A Parallel-Group Randomized Controlled Trial, Rozina Nuruddin, Khadija Vadsaria, Nuruddin Badruddin Mohammed, Saleem Sayani

Community Health Sciences

Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration.
Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program's effect on maternal and offspring health outcomes and assessment of …

A Comparison Of Methods Of Discontinuing Nasal Cpap In Premature Infants <30 Weeks Gestation: A Feasibility Study, Brittany Duyka, Claire Beaullieu, Amir M Khan

Faculty, Staff and Student Publications

OBJECTIVE: The objective of this study was to determine whether abrupt discontinuation vs gradual wean of nasal CPAP (NCPAP) in infantstherapy.

STUDY DESIGN: We performed a single-center, randomized control trial of premature infants born(n = 66), comparing discontinuation of NCPAP from 6 cmH

RESULTS: Duration of NCPAP or mechanical ventilation was longer in the slow wean arm compared to the fast wean arm (17 vs 12 days, p = 0.03). There were no differences observed in secondary outcomes.

CONCLUSION: In weaning NCPAP, abrupt discontinuation may be associated with a shorter duration of positive pressure respiratory support compared to a gradual …

Pregnancy And Childbirth Expectations During Covid-19 In A Convenience Sample Of Women In The United States, Tishra Beeson, Amy Claridge, Amie Wojtyna, Debra Rich, Gracie Minks, Adrienne Larson

All Faculty Scholarship for the College of Education and Professional Studies

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content …

Causes And Circumstances Of Maternal Death: A Secondary Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials Cohort, Annet M. Aukes, Kristina Arion, Jeffrey N. Bone, Jing Li, Marianne Vidler, Mrutyunjaya B. Bellad, Zahra Hoodbhoy, Rahat Qureshi, Sana Sheikh, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.
Methods: The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were …

Blood Pressure Thresholds In Pregnancy For Identifying Maternal And Infant Risk: A Secondary Analysis Of Community-Level Interventions For Pre-Eclampsia (Clip) Trial Data, Jeffrey N. Bone, Laura A. Magee, Joel Singer, Hannah Nathan, Rahat Qureshi, Charfudin Sacoor, Esperança Sevene, Andrew Shennan, Mrutyunjaya B. Bellad, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings.
Methods: We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their …

Covid-19 Deliveries: Maternal Features And Neonatal Outcomes, Viviana Zlochiver, Blair Tilkens, Ana Cristina Perez Moreno, Fatima Aziz, M. Fuad Jan

Journal of Patient-Centered Research and Reviews

Integrated, data-driven criteria are necessary to evaluate delivery outcomes in pregnancies affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing COVID-19 pandemic. This study analyzed maternal demographics, clinical characteristics, treatments, and delivery outcomes of 85 ethnically diverse, adult pregnant women who tested positive for SARS-CoV-2 at the time of delivery. Median maternal and gestational ages were 27 years (interquartile range [IQR]: 23–31) and 39 weeks (IQR: 37.3–40.0), respectively. Of the 85 SARS-CoV-2–positive participants, 67 (79%) had no COVID-19 symptoms at the time of routine COVID-19 admission testing, 14 (16%) reported mild COVID-19 symptoms, and 4 (5%) presented …

Role Of Community Engagement In Maternal Health In Rural Pakistan: Findings From The Clip Randomized Trial, Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N. Bone, Marianne Vidler, Sumedha Sharma, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Community-based strategies to promote maternal health can help raise awareness of pregnancy danger signs and preparations for emergencies. The objective of this study was to assess change in birth preparedness and complication readiness (BPCR) and pregnant women's knowledge about pre-eclampsia as part of community engagement (CE) activities in rural Pakistan during the Community Level Interventions for Pre-eclampsia (CLIP) Trial.
Methods: The CLIP Trial was a cluster randomized controlled trial that aimed to reduce maternal and perinatal morbidity and mortality using CE strategies alongside mobile health-supported care by community health care providers. CE activities engaged pregnant women at their homes …

Pregnancy And Substance Use, Elise Withers, Krista Thompson, Emily Hamilton, Maren Wright Voss

All Current Publications

The use of alcohol and other harmful substances, such as cocaine, opioids, and marijuana during pregnancy has increased over the last decades (Sebastiani et al., 2018). Using these substances can be very harmful to the unborn baby and mother (Viteri et al., 2015). This fact sheet covers (1) the consequences of substance use and (2) the current recommendations for substance use during pregnancy.

Maternal Sociodemographic Factors And Antenatal Stress, Maheshwari Andhavarapu, James Orwa, Marleen Temmerman, Wangira Musana

Obstetrics and Gynaecology, East Africa

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, …

Improved First Trimester Maternal Iodine Status With Preconception Supplementation: The Women First Trial, Amy E. Young, Jennifer F. Kemp, Charis Uhlson, Jamie L. Westcott, Sumera Aziz Ali, Sarah Saleem, Ana Garcès, Lester Figueroa, Manjunath S. Somannavar, Shivaprasad S. Goudar

Community Health Sciences

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non-pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient-fortified lipid-based nutrient supplement containing 250-μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks …

Mindfulness-Based Interventions For Prenatal Stress, Anxiety, And Depression, Fiona Kate Rice

Expressive Therapies Capstone Theses

Pregnant people in the United States (US) face myriad barriers to resource accessibility when seeking support, including financial gatekeeping, discrimination, and cis-gendering of the process. Commodification of prenatal support is exhaustive and contributes to a growing exclusivity of traditionally accessible interventions designed to reduce stress, anxiety, and depression, and to promote positive fetal outcomes and parent-child bond. Mindfulness-based interventions are particularly appropriate for reducing stress, anxiety, and depression in pregnancy. Mindfulness-based interventions are intersectional, accessible means of pregnancy and childbirth support with evidence-based outcomes of positive birth experiences and results. Mindfulness is defined as nonjudgmental awareness of the present moment. …

The Impact Of Exercise On Pregnant Women Aged 18-40 And Fetal Development, Jinisha Patwa

Rowan-Virtua Research Day

68% of those who performed minimum level exercise prior to pregnancy stopped completely during early pregnancy.

Women stop exercising during pregnancy due to worries about the impact it may have on the development of the fetus.

Starting moderate-intensity, weight-bearing exercise early in pregnancy increases placental growth rate and volume.

Exercise reduces the risks of excess gestational weight gain and high maternal body weight before pregnancy.

Physical exercise reduces the risk of gestational diabetes mellitus.

Predictors Of Iron Consumption For At Least 90 Days During Pregnancy: Findings From National Demographic Health Survey, Pakistan (2017-2018), Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Rehman, Nadir Suhail

Section of Internal Medicine

Background: Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.
Methods: We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy …

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 …

Preconceptional Lipid-Based Nutrient Supplementation In 2 Low-Resource Countries Results In Distinctly Different Igf-1/Mtor Placental Responses, Marisol Castillo-Castrejon, Ivana V. Yang, Elizabeth J. Davidson, Sarah J. Borengasser, Purevsuren Jambal, Jamie Westcott, Jennifer F. Kemp, Ana Garces, Sumera Aziz Ali, Sarah Saleem

Community Health Sciences

Background: Preconceptional maternal small-quantity lipid-based nutrient supplementation (SQLNS) improved intrauterine linear growth in low-resource countries as demonstrated by the Women First Preconception Maternal Nutrition Trial (WF). Fetal growth is dependent on nutrient availability and regulated by insulin-like growth factor 1 (IGF-1) through changes in placental transfer capacity, mediated by the mechanistic target of rapamycin (mTOR) pathway.
Objectives: Our objective was to evaluate the role of placental mTOR and IGF-1 signaling on fetal growth in women from 2 low-resource countries with high rates of stunting after they received preconceptional SQLNS.
Methods: We studied 48 women from preconception through delivery who were …

Maternal Prenatal Cortisol Programs The Infant Hypothalamic–Pituitary–Adrenal Axis, Jessica L. Irwin, Amy L. Meyering, Gage Peterson, Laura M. Glynn, Curt A. Sandman, Laurel M. Hicks, Elysia Poggi Davis

Psychology Faculty Articles and Research

One of the key proposed agents of fetal programming is exposure to maternal glucocorticoids. Experimental animal studies provide evidence that prenatal exposure to elevated maternal glucocorticoids has consequences for hypothalamic–pituitary–adrenal (HPA) axis functioning in the offspring. There are very few direct tests of maternal glucocorticoids, such as cortisol, during human pregnancy and associations with infant cortisol reactivity. The current study examined the link between maternal prenatal cortisol trajectories and infant cortisol reactivity to the pain of inoculation in a sample of 152 mother-infant (47.4% girls) pairs. The results from the current study provide insight into fetal programming of the infant …

The Cortico-Limbo-Thalamo-Cortical Circuits: An Update To The Original Papez Circuit Of The Human Limbic System, Jochen Profit, Paul J Sharek, Xin Cui, Courtney C Nisbet, Eric J Thomas, Daniel S Tawfik, Henry C Lee, David Draper, J Bryan Sexton

Faculty, Staff and Student Publications

OBJECTIVES: Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety climate, and teamwork are related to aspects of NICU quality of care is poorly understood. The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture.

STUDY DESIGN: Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, …

Characterizing Prenatal Maternal Distress With Unique Prenatal Cortisol Trajectories, Gage Peterson, Emma V. Espel, Elyssia Poggi Davis, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Objective: It is widely assumed that glucocorticoids represent a primary mechanism through which exposure to adversity and maternal psychological distress shape prenatal developmental trajectories of both mother and fetus. However, despite repeated investigations and the fact that prenatal cortisol has been reliably linked to developmental outcomes, the empirical evidence supporting an association between prenatal cortisol and maternal distress is scarce. In this study, a novel approach to assessing links between maternal prenatal psychological distress and gestational cortisol profiles, general growth mixture modeling (GGMM), was applied. Method: Measures of pregnancy anxiety, perceived stress, and state anxiety and depressive symptoms as well …

Prenatal Depression And Risk Of Short Interpregnancy Interval In A Predominantly Puerto Rican Population, Sami Backley, Alex Knee, Penelope Pekow, Glenn Markenson, Katharine O White, Corina Schoen, Lisa Chasan-Taber

Faculty, Staff and Student Publications

Background: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates.

Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006–2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the …

Dancing During Labor: Are Women Down To Boogie?, Drew A. Horter, Kayla Heslin, Marie Forgie, Emily Malloy, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Recent social media trends have demonstrated increased interest in dancing during the final weeks of pregnancy and labor. However, there is limited evidence about dancing during labor and its impact on labor pain and duration as well as patient satisfaction. Before conducting a prospective study, given that enrollment is often challenging, our feasibility study aimed to assess the willingness of pregnant women to participate in a future study evaluating low-impact dance during labor. We anonymously surveyed a convenience sample of English-speaking/reading pregnant women who presented for prenatal care at 1 of 3 clinics from June 2019 to July 2019. Questions …

Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy

Senior Honors Theses

This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …

A Mixed-Methods Analysis Of Abortion Attitudes And Perceptions Among Women Living In Alabama And South Carolina, Anthony Peluso

Electronic Theses and Dissertations

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access …

Barriers To Maternal Retention In Hiv Care In Ghana: Key Differences During Pregnancy And The Postpartum Period., Kwame S. Sakyi, Margaret Y. Lartey, Caitlin E. Kennedy, Julie A. Dension, Luke C. Mullany, Prince G. Owusu, Emma Sacks, Emily A. Hurley, Pamela J. Surkan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Maternal retention in HIV care is lower for women in the postpartum period than during pregnancy, but the reasons are poorly understood. We examined key differences in barriers to retention in HIV care during and after pregnancy.

METHODS: We conducted semi-structured, in-depth interviews with 30 postpartum women living with HIV. Participants were recruited from two tertiary facilities implementing Option B+ for prevention of mother-to-child HIV transmission in Accra, Ghana. We collected data from mothers who had disengaged from HIV care and those who were still engaged in care. The interviews were analyzed using principles adapted from grounded theory.

RESULTS: …