Journal of midwifery & women's health最新文献

{"title":"Childhood Maltreatment, Labor Duration, and Intrapartum Synthetic Oxytocin Dose and Duration: A Potential Oxytocin-Linked Contributor to Labor Outcomes in Black Birthing People","authors":"Abby Britt CNM, MSN, MA Public Anthropology,&nbsp;Melinda Higgins PhD,&nbsp;Anne Dunlop MD, MPH,&nbsp;Vasiliki Michopoulos PhD,&nbsp;Nicole Carlson CNM, PhD","doi":"10.1111/jmwh.13762","DOIUrl":"10.1111/jmwh.13762","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Black pregnant people are disproportionately impacted by childhood maltreatment and maternal morbidity and mortality related to labor dysfunction. One largely unexplored link between these disparities is the maternal oxytocin system, which is affected by childhood maltreatment and integral to labor. The current study examines relationships between maternal childhood maltreatment, labor duration, and intrapartum synthetic oxytocin requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a secondary data analysis of a completed prospective cohort study involving Black pregnant people recruited from 2 academic medical centers in Atlanta, Georgia. Participants had no health complications, term labor, and a singleton fetus in cephalic presentation (N = 109). Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Labor duration and synthetic oxytocin data were collected via health record abstraction. Associations were examined between childhood maltreatment, labor duration, and synthetic oxytocin requirements after stratification by mode of labor onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant associations were found between childhood maltreatment and labor duration in the total sample (N = 109). However, among the induction of labor sample (n = 47), both small-to-moderate and larger associations were found between childhood emotional (<i>β</i>, 0.253; <i>P</i> = .073) and physical (<i>β</i>, 0.398; <i>P</i> = .003) abuse and labor duration after adjusting for parity, epidural analgesia use, and body mass index. Additionally, in the labor induction sample, there were significant, moderate-to-large associations between higher levels of childhood physical abuse with higher intrapartum synthetic oxytocin dose (<i>ρ</i>, 0.433; <i>P</i> = .002), longer duration (<i>ρ</i>, 0.381; <i>P</i> = .008), and higher average dose per hour (<i>ρ</i>, 0.312; <i>P</i> = .033).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In a sample of Black pregnant people who underwent labor induction, childhood emotional and physical abuse were associated with longer labor duration. Childhood physical abuse was associated with higher synthetic oxytocin requirements. Further research is needed to understand the potential relationships between maternal childhood maltreatment and labor outcomes to inform future interventions toward birth outcome equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"629-639"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equitable Medicaid Reimbursement Policies Increase Midwifery-Led Births: An Interrupted Time Series Analysis With a Synthetic Control Group","authors":"Elizabeth Simmons PhD,&nbsp;Kavita Singh PhD,&nbsp;Mollie Wood PhD,&nbsp;Alyssa J. Mansfield PhD,&nbsp;Karen Sheffield-Abdullah CNM, RN, PhD,&nbsp;Grace Hoover BSPH,&nbsp;Anna Austin PhD","doi":"10.1111/jmwh.13776","DOIUrl":"10.1111/jmwh.13776","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Birthing people in the United States suffer from poor pregnancy outcomes and a lack of perinatal care providers, especially nurse-midwives. Prenatal and intrapartum care by a certified nurse-midwife (CNM) is associated with improved perinatal health and lower costs among low-risk pregnant people. Medicaid programs in 20 states reimburse CNMs 10% to 25% less than physicians. On January 1, 2006, an Illinois policy went into effect requiring Medicaid to reimburse CNMs at the same rate as physicians. The objective of this study was to evaluate the association between equal Medicaid reimbursement of CNMs and physicians and CNM-led births in Illinois.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included all live births to people aged 18 years or older in Illinois between June 1, 2003, and November 30, 2009. We used an interrupted time series analysis, with and without a synthetic control group, to assess the change in the level and trend of the proportion of CNM-attended births after the implementation of the Illinois policy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study period included 1,103,238 eligible live births in Illinois. Illinois and the synthetic control group were similar overall. Compared with a synthetic control group, we found an increase of 48.1 per 10,000 live births in the level of the number of births attended by a CNM (95% CI, −175.7 to 272.0) and an increasing trend of births attended by a CNM (2.8 per 10,000 live births; 95% CI, −7.4 to 13.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings support evidence that equitable reimbursement will help increase access to CNMs among the Medicaid population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"569-575"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Breastfeeding and Neurodevelopment at 6 Years of Age in the French PELAGIE Birth Cohort","authors":"Marion Monperrus RM, MPH,&nbsp;Cécile Chevrier PhD,&nbsp;Nathalie Costet PhD,&nbsp;Maela Le Lous MD, PhD,&nbsp;Jonathan Y. Bernard PhD,&nbsp;Gaïd Le Maner-Idrissi PhD,&nbsp;Agnès Lacroix PhD,&nbsp;Pauline Blanc-Petitjean RM, PhD,&nbsp;Sylvaine Cordier PhD,&nbsp;Florence Rouget MD, PhD,&nbsp;Christine Monfort MS,&nbsp;Ronan Garlantézec MD, PhD,&nbsp;Rémi Béranger RM, PhD","doi":"10.1111/jmwh.13766","DOIUrl":"10.1111/jmwh.13766","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Breastfeeding has been shown to be associated with improved child cognitive performance, but the causality of this association is still debated because it tends to disappear when accounting for maternal cognitive performance and socioeconomic status. We aimed to explore the relationship between breastfeeding and the cognitive performance of children in the French general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From the PELAGIE woman-child cohort, which included pregnant women between 2002 and 2006 in Brittany (France), 286 children were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV) and the Developmental Neuropsychological Assessment (NEPSY) scales at age 6. Associations between breastfeeding and cognitive performance were assessed using multivariable linear regression models adjusted for maternal verbal cognitive performance and education level, familial stimulation and environment (Home Observation for Measurement of the Environment scale), and Rey's Social Deprivation Index (contextual indicator). In addition, we performed structural equation modeling (SEM) to investigate the complex interrelation between these variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children who were breastfed for at least 4 months had significantly higher scores on the WISC Verbal Comprehension Index (WISC-VCI) than those who were never breastfed or who were breastfed less than 15 days (β_adjusted, 4.95 points; 95% CI, 0.54-9.37). Among the 193 children who were breastfed, the duration of breastfeeding, in particular during the first 4 months, was increasingly associated with the WISC-VCI score. We also observed statistically significant associations between breastfeeding itself or the duration of breastfeeding and better performance on several NEPSY subtests, including visual attention, design copying, arrows, and narrative memory. SEM analysis confirmed these associations. No statistical association was observed between breastfeeding and the WISC Working Memory Index or other NEPSY subtests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These data support current national and World Health Organization global 2025 targets of promoting breastfeeding for at least 4 to 6 months.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 4","pages":"640-650"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13766","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biodynamic Interventions in Labor: A State of the Science Review","authors":"Honor Vincent MA, BSc,&nbsp;Alice Hodder MA (Hons), BSc,&nbsp;Shawn Walker PhD","doi":"10.1111/jmwh.13772","DOIUrl":"10.1111/jmwh.13772","url":null,"abstract":"<p>Biodynamic interventions are targeted suggestions for postural changes thought to quicken the progress or ease the discomfort of labor and birth, especially when fetuses are not in the optimal position. Although biodynamic interventions carry almost no risks and come from a rich anecdotal body of evidence, they have generally not been subject to rigorous evaluation. Current clinical practice guidelines support the use of intravenous oxytocin and manual or instrumental rotation for delayed labor progress and fetal malposition; however, these interventions are associated with increased risks of maternal and neonatal morbidities. The use of biodynamic interventions may be an effective alternative to optimizing fetal position and labor progress, with fewer associated risks. This state of the science review examines research describing the efficacy of various biodynamic interventions on labor progress, fetal malposition, and mode of birth within specific clinical contexts. The review also seeks to draw out key findings for clinical practice and identify gaps in the literature for future research.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"422-430"},"PeriodicalIF":2.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Scholarly Publishing","authors":"Melissa D. Avery CNM, PhD","doi":"10.1111/jmwh.13777","DOIUrl":"10.1111/jmwh.13777","url":null,"abstract":"<p>Artificial Intelligence (AI) is all around us. An email titled <i>Meet Gemini, your new AI assistant</i> appeared in my email inbox recently. I was curious about what might be available to help me to become more efficient. I was also a little skeptical and even more cautious. Might this new assistant suggest something inappropriate, irrelevant, or even false?</p><p>Questioning the use of AI technologies is particularly relevant in scholarly publishing for authors, editors, peer reviewers, and even everyday readers. We typically ask: were the research methods sound, was the analysis done correctly, are the conclusions appropriate? What is most important to consider related to AI when interacting with the <i>Journal of Midwifery &amp; Women's Health</i> (<i>JMWH</i>) and other scholarly journals?</p><p>First, some definitions of AI may be helpful. One expert defined AI as “algorithmic-based technologies that solve complex tasks which previously required human thinking.” Another simply referred to AI as “whatever hasn't been done yet.” In addition, the expert clarified that the <i>intelligence</i> part of AI includes both learning and thinking. A third expert explained AI technologies as requiring higher-level knowledge to do their work.<span>¹</span></p><p>New tools referred to as generative AI or GenAI have become available in the last several years. This large language model technology refers to tools that learn from large amounts of publicly available information, including the possibility of copyrighted material, and can generate content such as human-sounding text, images, audio, and video. Numerous ethical concerns have been raised related to their use in scholarly publishing.<span>²</span> These are important questions to ask and answer, including topics such as intellectual property, other rights to material, privacy, and confidentiality.<span>³</span> Questions are also being raised about known biases in GenAI based on the material used to train programs and the possibility of amplifying existing biases that may worsen health disparities rather than helping to make improvements. Expert humans guiding the tool development and training will be essential to prevent harm from poorly developed tools.<span>⁴</span></p><p>The <i>JMWH</i> Editors and Associate Editors approved a new editorial policy related to AI use in 2024.<span>⁵</span> The policy interprets guidance provided by thought leaders in scholarly publishing such as the World Association of Medical Editors<span>⁶</span> and the JAMA Network, publisher of the AMA Style Guide, adopted by <i>JMWH</i>.<span>⁷</span> Authors remain ultimately responsible for all information in their published work, including proper citing of sources, lack of plagiarism, and any material derived from AI tools. Any use of such tools must be acknowledged, including which tool(s) were used and how they were used. In addition, GenAI","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"385-386"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13777","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of a Telehealth Group Intervention to Reduce Perinatal Depressive Symptoms: A Mixed Methods Analysis","authors":"Eli Iacob PhD, MSCI, MSTAT,&nbsp;Ryoko Kausler PhD, MSN, FNP-C,&nbsp;Marcia Williams PhD, MSN, FNP-C,&nbsp;Uma Dorn PhD,&nbsp;Sara Simonsen CNM, PhD, MS, MSPH,&nbsp;Marcela Smid MD, MS, MA,&nbsp;Gwen Latendresse CNM, PhD, MS","doi":"10.1111/jmwh.13767","DOIUrl":"10.1111/jmwh.13767","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Perinatal depression affects approximately 20% of childbearing individuals and is associated with adverse perinatal outcomes. Nonpharmacological therapies are effective for mild to moderate depression, but multiple access barriers exist, including financial constraints and the inconvenience of in-person appointments. Remote access (ie, telehealth) to services is a promising option, but few studies have evaluated the effectiveness of this approach. The objective of this study was to use a mixed methods approach in a randomized controlled trial to evaluate the effectiveness of a group videoconference intervention to reduce symptoms of perinatal depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were assigned to a videoconference intervention group (VCI; mindfulness-based cognitive behavioral therapy) or an attention control group (AC; childbirth preparation or early parenting education) via a videoconference system. Groups of 4 to 6 pregnant and postpartum individuals with mild to moderate symptoms of depression attended a one-hour session for 9 weeks using an electronic device from their own home. The Edinburgh Postnatal Depression Scale (EPDS) measured depression symptoms before and after intervention with follow-up to 8 months. Focus groups assessed participants’ telehealth experiences and were analyzed for common themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From May 2020 through May 2022, 81 participants were randomized, and 69 (85.2%) ultimately initiated study participation (36 in VCI, 33 in AC group). Participants in both groups had a significant decrease in EPDS score of 3.36 (95% CI, 4.55-2.17) that was maintained 8 months postintervention. There were no significant interactions between time and intervention group (all <i>P</i> &gt;.249). In the focus group analysis, themes of connection, shared experience, empowerment, and community building were consistent between the 2 intervention groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Both intervention groups had clinically meaningful improvement in EPDS scores up to 8 months postintervention. Anchored in the common themes in the qualitative analysis, our results suggest that participation in telehealth group sessions, regardless of session content, may be beneficial in reducing depression symptom burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"431-441"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Reviews to Inform Practice, May/June 2025","authors":"Abby Howe-Heyman CNM, PhD,&nbsp;Nena R. Harris CNM, PhD, FNP-BC, CNE","doi":"10.1111/jmwh.13768","DOIUrl":"https://doi.org/10.1111/jmwh.13768","url":null,"abstract":"&lt;p&gt;Postpartum hemorrhage (PPH) is defined as a blood loss of 500 mL or more within 24 hours of birth.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; PPH occurs in approximately 1% to 3% of births in the United States.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Globally, 20% of pregnancy-related deaths are attributed to PPH,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and in the United States, approximately 11% of pregnancy-related deaths are caused by PPH.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; A factor that may influence the incidence of PPH is the length and course of the third stage of labor, defined as the period from the birth of the newborn to the complete expulsion of the placenta and membranes.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The expected length of the third stage is generally accepted as 30 minutes.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; In the case of a prolonged third stage, the recommended management is usually manual removal of the placenta.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; Recently, some clinicians and researchers have begun to consider reducing the length of time for expectant management of the third stage of labor and have suggested that manual removal of the placenta is indicated after 20 minutes.&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt; de Vries&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; and colleagues conducted a systematic review and meta-analysis to evaluate the association between the length of the third stage of labor after a vaginal birth and adverse maternal outcomes. They also sought to identify whether the risk of adverse maternal outcomes can be reduced by performing manual removal of the placenta earlier than current clinical practice.&lt;/p&gt;&lt;p&gt;The authors conducted a search of 7 databases and screened the reference lists of national guidelines from high-income countries regarding the prevention of PPH. Randomized trials, comparative studies, and prospective and retrospective cohort trials that were published between January 1, 2000, and June 13, 2023, in English, French, German, Italian, and Dutch languages were eligible for inclusion in the review. The primary outcome of interest was adverse maternal outcomes, defined as any complication occurring to the birthing person during or after birth, such as PPH, blood transfusion, intensive care unit admission, and peripartum hysterectomy. The secondary outcome of interest was the risk of adverse outcome as it related to the length of the third stage of labor. The researchers identified 16 articles that addressed the relationships between the length of the third stage of labor and maternal outcomes and 3 articles that evaluated the association between the timing of the manual removal of the placenta and adverse maternal outcomes. One article measured both outcomes of interest, so a total of 18 articles were included in the full review.&lt;/p&gt;&lt;p&gt;Included studies were conducted in the United States, Australia, Denmark, the Netherlands, Israel, Switzerland, Sweden, Japan, and Egypt, and one study was conducted across multiple countries; the authors do not indicate how many of the 18 studies were conducted in","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"515-522"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open-Label Randomized Controlled Trial and Feasibility Study of an Oral Probiotic Intervention to Reduce Group B Streptococcus Colonization in Pregnant People by the Time of Birth","authors":"Katrina Nardini CNM, WHNP-BC, MPH,&nbsp;Lisa Hanson CNM, PhD,&nbsp;Noelle Borders CNM, DNP,&nbsp;Maharaj Singh PhD,&nbsp;Anna Shields CNM, DNP, FNP,&nbsp;Victoria Y. Trujillo BA,&nbsp;Robyn Lawton CNM,&nbsp;Emily Malloy CNM, PhD","doi":"10.1111/jmwh.13765","DOIUrl":"10.1111/jmwh.13765","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The purpose of this midwife-led study was to determine the feasibility of a randomized controlled trial (RCT) of probiotics to reduce group B <i>Streptococcus</i> (GBS) colonization by the time of birth in healthy, GBS-positive, pregnant adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An open-label randomized clinical trial comparing Florajen Digestion, a commercially available combination oral probiotic, with usual care (ClinicalTrials.gov NCT04721912) was conducted in a midwifery practice serving a racially and ethnically diverse population. Eligible patients who tested positive for GBS at routine third-trimester screening were offered informed consent and participation. The primary outcome was feasibility for a larger RCT, including feasibility of probiotic use among participants. Secondary outcomes were intrapartum GBS colonization and Antepartum Gastrointestinal Symptoms of Pregnancy (AP-GI-SA) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 68 participants were enrolled and randomized; 65 participants completed the study, but only 46 had intrapartum cultures collected and processed. Among the 23 pregnant individuals who were eligible but chose not to participate, 3 indicated that they did not want to take a probiotic. After an average of 14 days of the intervention, 7 of 25 (28%) participants in the probiotic group had a negative intrapartum GBS result compared with 3 of 21 (14.3%) in the control group (odds ratio, 2.33; 95% CI, 0.52-10.48). There was no difference in perinatal outcomes or AP-GI-SA scores between groups. No adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The feasibility of a larger RCT was demonstrated. Challenges identified included intrapartum GBS collection and laboratory processing during the COVID-19 pandemic. The study was not powered to detect a significant difference in intrapartum GBS colonization, although a larger decrease in GBS colonization was noted among probiotic-using participants. Florajen Digestion may show efficacy in a RCT with a longer intervention period. It is possible that the probiotic intervention duration was too brief to show a reduction in gastrointestinal pregnancy symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"460-467"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13765","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Gestacional (Gestational Diabetes)","authors":"","doi":"10.1111/jmwh.13770","DOIUrl":"https://doi.org/10.1111/jmwh.13770","url":null,"abstract":"&lt;p&gt;La diabetes es una enfermedad donde hay demasiada azúcar (glucosa) en la sangre pero insuficiente glucosa en las células. Nuestras células usan glucosa como fuente de energía para todas las funciones del cuerpo. Para transportar el azúcar (glucosa) de la sangre a las células, es necesario la insulina. La diabetes resulta cuando el cuerpo pierde la capacidad de producir insulina (diabetes tipo 1), o cuando la insulina que produce el cuerpo no funciona bien (diabetes tipo 2).&lt;/p&gt;&lt;p&gt;La diabetes gestacional (DG o GDM por sus siglas en inglés) es la diabetes que ocurre por primera vez durante el embarazo. Durante el embarazo, la placenta produce hormonas que impiden que la insulina mueva la glucosa de la sangre a las células. Esto es para garantizar que el bebé reciba suficiente azúcar. Estos cambios llevan a que algunas mujeres tengan más glucosa (azúcar) en la sangre de lo que se considere sano – esto es la diabetes gestacional.&lt;/p&gt;&lt;p&gt;Cuando una persona tiene DG, su bebé también tiene niveles más altos de (glucosa) azúcar. El bebé guarda este exceso de azúcar en forma de grasa. Esta grasa aumenta la probabilidad de que el bebé tenga obesidad y que de adulto sufra de alta presión, enfermedad cardiaca y diabetes tipo 2. El bebé también puede tener dificultades al nacer si él o ella es demasiado grande (pesado). A raíz de la DG, el recién nacido puede tener cambios repentinos en sus niveles de azúcar en su sangre que puedan requerir de atención médica especial inmediatamente después del parto.&lt;/p&gt;&lt;p&gt;La mayoría de las mujeres tienen factores de riesgo para la DG. Es por esto que los proveedores de atención médica generalmente ofrecen una prueba de sangre para la DG a todas las mujeres embarazadas. Su proveedor le ofrecerá una prueba de detección para la DG ya sea al principio de su embarazo o cuando tenga entre 24 y 28 semanas de embarazo, dependiendo de su probabilidad de tener DG.&lt;/p&gt;&lt;p&gt;En la mayoría de los casos de DG, el comer comidas saludables a horas regulares y evitar los alimentos azucarados mantendrá los niveles de glucosa en la sangre a un nivel normal. El ejercicio también bajará sus niveles de azúcar. Algunas mujeres que tienen DG necesitan tomar una pastilla o inyección de insulina para controlar sus niveles de glucosa.&lt;/p&gt;&lt;p&gt;Si tiene DG, se le pedirá que usted revise sus niveles de glucosa en la sangre varias veces al día. Se reunirá con un educador de diabetes o una enfermera quien le enseñará cómo usar una máquina para revisar sus niveles de glucosa en su sangre. También aprenderá en que horario debe medir sus niveles de glucosa, ya sea antes o después de las comidas. Usted y su proveedor usarán los resultados de sus pruebas de niveles de azúcar para elegir el mejor tratamiento para su DG.&lt;/p&gt;&lt;p&gt;Las mujeres que desarrollan DG tienen una alta probabilidad de desarrollar diabetes tipo 2 más adelante en la vida. Debe hacerse una prueba de sangre entre 4 a 12 semanas después de dar a luz para asegurarse de que no sigue con diabetes. El c","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"529-530"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth Options After Having a Cesarean","authors":"","doi":"10.1111/jmwh.13774","DOIUrl":"https://doi.org/10.1111/jmwh.13774","url":null,"abstract":"<p>Overall, your risk of having complications is less if you give birth vaginally. You will likely spend less time in the hospital and recover faster with less pain. Your baby has less chance of breathing problems shortly after a vaginal birth when compared to babies born by cesarean.</p><p>You have a higher chance of uterine rupture (uterus opening at the old scar), which is dangerous for you and your baby. Uterine rupture is very rare. Uterine rupture happens to about 7 or 8 of every 1000 people who labor after having a previous cesarean. This is a less than a 1% chance of uterine rupture if you have labor after a cesarean. If your uterus does rupture, there is a higher chance your baby will die. This means that of 10,000 people who had a cesarean and try to have a VBAC, 2 babies will die.</p><p>You can schedule when your birth will likely happen and know what to expect from surgery. You can talk to the surgeon about being awake for the surgery and safely involving family in the cesarean birth.</p><p>Overall, about 3 out of 4 people who try to have a VBAC will have a successful vaginal birth. Some things in your medical history affect your chance of success.\u0000\u0000 </p><p>Choosing your method of birth is an important and very personal decision. Before you make your decision, talk to your health care provider who can help you learn about your chance of having a successful VBAC and your risk of uterine rupture. Your health history, what happened during your last labor, and how your current pregnancy is going will help guide your health care provider to counsel you if a VBAC or repeat cesarean is the best plan of care for you. If your baby is breech, you are carrying more than one baby, or you have had more than one cesarean, your provider may be less likely to recommend that you have a VBAC. You and your family can also discuss how you feel about the following reasons to have a VBAC or repeat cesarean.\u0000\u0000 </p><p>It is safest to have a VBAC in a hospital so you and your baby can be monitored during labor. Signs of distress in the baby are usually the first sign of uterine rupture. Because of this, you will have continuous fetal heart rate monitoring during labor. An IV will be placed so that it is available in case there is an emergency. You should be able to have any type of pain medicine you would like.</p><p>Flesch-Kincaid Grade Level: 7.4</p><p>Approved May 2025. This handout replaces “Birth Options after Having a Cesarean” published in Volume 61, Number 6, November/December 2016.</p><p>This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.</p>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"70 3","pages":"531-532"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}