MuM-PreDiCT is a research collaboration across the UK that will conduct data-driven research to characterise and understand the determinants and consequences of pre-existing multimorbidity (MM) in pregnant women, and to predict and prevent MM and its adverse consequences in women and their offspring. The multidisciplinary approach undertaken, using existing quantitative data and new stakeholder data, aims to detail the burden of pre-existing MM in pregnant women, understand how morbidities accumulate and cluster from the pre-pregnancy stage through the maternity journey to their long-term healthcare, and then investigate what determinants should be targeted to influence MM through early interventions; explore women's experiences, and current health service provision to inform recommendations for practice; investigate the impact of pre-existing MM and multiple prescriptions on pregnancy, postpartum and long-term outcomes for mothers and their offspring; and investigate the extent to which pregnancy complications predict future MM in risk prediction models.

A significant outcome of this collaboration will be the creation of a comprehensive dataset on pregnancy and postpartum outcomes for mothers and their children, directly contributing to the core vision and objectives of the MIREDA Partnership. Specifically, the database will include pregnancy and birth records of English mothers aged 15-50 and their offspring, derived from electronic health records that link primary and secondary care data from the Clinical Practice Research Datalink (CPRD, GOLD, and Aurum) and linked to Hospital Episode Statistics (HES). This will be achieved through a federated analysis model in collaboration with the Centre for Health Data Science at the Institute of Applied Health Research, University of Birmingham.

The number of maternal deaths and maternal mortality rates for selected causes, 2000 to most recent year.

Abstract Introduction Maternal mortality represents an event of great magnitude in Brazil and worldwide. The occurrence of maternal death reflects the lack of access to health services and unfavorable socioeconomic conditions. Objective To correlate maternal changes and puerperal pregnancy outcome in maternal death. Methods Cross-sectional and retrospective study. We used data collected from 53 medical records of pregnant women and postpartum women who died at a Reference State Hospital in high risk gestation in Goiás. Results Mortality occurred in women aged 20 to 34 years (76%), single (55%), first pregnancy (38%), from the interior of the State (60%) and 62% had the childbirth at the institution of the study. The main obstetric causes were 55% direct and 24% indirect, being predominant in the puerperal period (83%). The maternal mortality ratio was 228.4. There was a significant association between complications at childbirth and the place of birth (P = 0.001). Conclusion The maternal death occurred in single women, of reproductive age, coming from other counties, for direct causes and in the puerperium. It is necessary to improve the access to health services in obstetrics, since most cases are preventable.

IntroductionMaternal and neonatal complications related to pregnancy and childbirth pose a significant risk of morbidity and mortality to both the mother and the child. Despite its benefits in reducing maternal and neonatal mortality and morbidity associated with pregnancy and childbirth, the majority of Ethiopian mothers were dropped from the maternal continuum of care. Furthermore, there is a dearth of data regarding the status of the maternal continuum of care and its underlying factors in southern Ethiopia.ObjectiveThis study aimed to assess the completion of the maternity continuum of care and its predictors among postpartum women who had given birth in the previous six months in the Gedeb district of Gedio Zone, southern Ethiopia.MethodsA community-based cross-sectional survey was conducted among 625 postpartum women selected by simple random sampling from June 1 to 30, 2022. The data was collected through face-to-face interviews using pretested, structured questionnaires. The association between the explanatory variables and the maternity continuum of care was examined using bivariate and multivariable logistic regression models. The adjusted odds ratio (AOR) with a 95% confidence interval was employed to measure the strength of association and the level of significance was set at p

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited coughing with sputum. WOMEN'S STATUS Women's Status and Employment.

Studies have shown that overweight and obese women are at increased risk for several complications of pregnancy, including gestational diabetes mellitus, hypertension, preeclampsia, and cesarean delivery. Additionally, the children of overweight or obese pregnant women show an increased risk of prematurity, congenital anomalies, and childhood obesity. The Lifestyle Interventions for Expectant Mothers (LIFE-Moms) consortium was a network of seven clinical centers and a data coordinating center to identify effective behavioral and lifestyle interventions that improve weight, glycemic control, and outcomes in obese and overweight pregnant women and their children.

Participants were randomized between 9 weeks 0 days and 15 weeks 6 days gestation, and followed through one-year postpartum. Standardized measures were collected throughout gestation: at baseline (9-15 weeks), 24-27 weeks, 35-36 weeks, delivery, and one-year postpartum. Eligibility criteria, specific outcome measures, and assessment procedures were standardized across trials. Measures that were collected in all seven trials were defined as ‘core’ data and measures collected by four to six trials were defined as ‘super-shared’ data. All core and super-shared measures had a standardized definition and/or detailed procedures to facilitate uniform collection, a standardized training and certification process, and were entered into a common dataset at the data coordinating center.

The Aberdeen Maternity and Neonatal Databank (AMND) was initiated in the department of Obstetrics and Gynaecology, University of Aberdeen, in 1950, by the late Professor Sir Dugald Baird, in collaboration with the Medical Research Council’s (MRC’s) Medical Sociology Unit. It was originally set up as a resource for the study of the physiology, pathology and sociology of pregnancy, but the usefulness of the AMND has extended significantly beyond this through linkage with other health and social care records as well as intergenerational and family linkages.

The AMND is an invaluable resource for life-course epidemiology, especially since it is one of the earliest and most comprehensive obstetric databases. From the year 1950 to the present, this unique database has been recording all the obstetric and fertility-related events occurring in women residing in Aberdeen, Scotland, UK.

Data are collected from every pregnancy event occurring in Aberdeen Maternity Hospital which is part of the National Health Services (NHS) Grampian.

Aberdeen Maternity Hospital is the only maternity hospital in the city of Aberdeen and serves the Grampian region as well as the Northern Isles, Shetland and Orkney, for tertiary maternity care. A dedicated midwives’ unit also based at the hospital provides shared maternity care for uncomplicated pregnancies. The hospital provides antenatal and postnatal care, with about 4000–5000 babies born every year. In addition, an early pregnancy unit based at the hospital manages complications such as miscarriage and other pregnancy loss. The AMND also captures data from these units.

The AMND population coverage varies according to different areas. It covers about 99% of Aberdeen and about 97% of the entire Grampian region. This differential coverage is due to a small proportion of home births and deliveries in peripheral hospitals.

This description references the International Journal of Epidemiology, Volume 45, Issue 2, April 2016, Pages 389–394, https://doi.org/10.1093/ije/dyv356

Placenta Accreta Spectrum (PAS) is an abnormal attachment of trophoblastic tissues to the uterine myometrium. It is a dangerous pregnancy complication and one of the leading causes of maternal morbidity and mortality. PAS may induce serious complications such as postpartum haemorrhage (PPH) and hysterectomy. Prior caesarean delivery and placenta previa are the major risk factors of PAS. The rate of caesarean delivery (CD) without medical indication has been raised in recent years. In the current study, we evaluated 142 women with a history of prior CD and divided them into two groups. Eighty-five patients had prior CD and PAS in their current pregnancy (case group) and fifty-seven patients had prior CD without PAS (control group). Demographic data and past gynaecological history, such as placenta previa, were collected. We found the prior CD and placenta previa increase the risk of PAS significantly. PAS was associated with more emergent caesarean deliveries and hysterectomies. We didn`t find a significant association between prior hysteroscopies and curettages with increased risk of PAS.

Breastfeeding provides the optimal nutrition for an infant. However, breastfeeding practice is on decline globally. Attitude toward breastfeeding may determine the practice. This study aimed to examine postnatal mothers’ attitude to breastfeeding and its determinants. A cross-sectional study was conducted, and data on attitude were collected using the Iowa Infant Feeding Attitude Scale (IIFAS). A convenience sample of 301 postnatal women were recruited from a major referral hospital in Jordan. Data on sociodemographic characteristics, pregnancy and delivery outcomes were collected. SPSS was used to analyze the data and identify the determinants of attitudes to breastfeeding. The mean total attitude score for participants was 65.0 ±7.15, which is close to the upper limit of the neutral attitude range. Factors associated with attitude that is positive to breastfeeding were high income (p = 0.048), pregnancy complications (p = 0.049), delivery complications (p = 0.008), prematurity (p = 0.042), intention to breastfeed (p = 0.002) and willingness to breastfeed (p = 0.005). With binary logistic regression modelling, determinants of attitude positive to breastfeeding were highest income level and willingness to breastfeed exclusively (OR = 14.77, 95%CI = 2.25–99.64 and OR = 3.41, 95%CI = 1.35–8.63 respectively). We conclude that mothers in Jordan have neutral attitude to breastfeeding. Breastfeeding promotion programs and initiatives should target low-income mothers and the general population. Policymakers and health care professionals can use the results of this study to encourage breastfeeding and improve breastfeeding rate in Jordan.