Pharmacologic mydriasis is essential for retinopathy of prematurity (ROP) screening; however, conventional ophthalmic drops substantially exceed neonatal conjunctival sac volume, leading to systemic absorption and potential adverse effects. Microdrop administration may reduce drug exposure while preserving adequate pupillary dilation. This study aimed to determine whether microdrop administration of phenylephrine and tropicamide is noninferior to standard drops in achieving adequate mydriasis for ROP screening via a bottle adapter. This single-center, randomized, parallel-group noninferiority trial was conducted in a tertiary neonatal unit in Chennai, India. Preterm infants undergoing routine ROP screening were randomized to receive either microdrops (10.26 µL) or standard drops (26.58 µL) of 2.5
Advances in technology and reproductive health knowledge have increased the incidences of both emergency and elective C-section. In Tanzania the prevalence of C-section is lowest in Simiyu Region (1.5
Most Latin American countries have national retinopathy of prematurity (ROP) screening guidelines, but how consistently these thresholds are applied and whether the metric used affects cross-country comparability is poorly documented. We analysed data from the SPROP (Sociedad Panamericana de Retinopatía del Prematuro) database (2021–2024), including 333 of 343 registrants from 17 countries who provided gestational age (GA) and/or birth weight (BW) screening cutoffs. We assessed between- and within-country variation, guideline concordance, and relative variability of GA and BW thresholds using the coefficient of variation (CV). Hospital-level alignment was classified as wider, at, or narrower than the national guideline. BW cutoffs were 3.6 to 5.1 times more variable than GA cutoffs across all countries. Mean GA cutoffs approximated national guidelines, but with marked country-level differences: Argentina applied broader cutoffs than recommended (Δ = +1.5 weeks; 50.5
Perinatal regionalization is a healthcare model designed to ensure that high-risk mothers and newborns receive care in facilities equipped with appropriate expertise and technology. While evidence supports its effectiveness in improving outcomes, the implementation of regionalized systems remains inconsistent and vulnerable to a range of clinical, structural, and financial barriers. This scoping review aimed to identify, categorize, and synthesize the reported challenges that hinder the effective functioning of perinatal regionalization systems across diverse settings. A scoping review methodology was used following the PRISMA-ScR guidelines. Studies were included if they reported on barriers to regionalized perinatal care. PubMed, Science Direct, and Web of Science were searched covering publications up to May 2024; updated in June 2026. Data were extracted and thematically analyzed, leading to the development of a structured framework of challenge domains. After screening and reviewing the retrieved studies, 41 papers included in final synthesis from which 67 challenges of perinatal regionalization were identified. These challenges were organized into 27 subthemes within seven categories: (1) clinical and medical challenges, including unpredictability of high-risk childbirths and clinical contraindications to maternal transport; (2) socio-economic and geographic barriers, such as distance from tertiary centers and poverty; (3) cultural and patient-centered concerns, including loss of patient rights and connection, and cultural resistance; (4) provider-centered factors, such as loss of prestige, perceived viability, and practice behaviors; (5) organizational and financial disincentives, including competition between hospitals and misaligned reimbursement models; (6) transport and logistical limitations; and (7) structural constraints in low-resource settings, including inadequate infrastructure and weak referral networks. Perinatal regionalization is undermined by interrelated challenges across multiple levels of the health system. Addressing these barriers requires systemic reform, improved coordination, and context-specific strategies to ensure access to risk-appropriate care for all mothers and newborns. The framework of challenges developed in this review can inform policy, planning, and future research on strengthening regionalized perinatal care.
Malignant hyperthermia (MH) is a rare pharmacogenetic disorder triggered by volatile anesthetics and succinylcholine. MH susceptibility in pregnancy requires prospective anesthetic planning to ensure maternal and fetal safety. This case reports the successful management of an urgent cesarean section under spinal anesthesia in a parturient with pre-pregnancy genetic confirmation of MH susceptibility. A 27-year-old primigravida (G1P0) at 38 weeks gestation presented with labor pain. She had a known pathogenic RYR1 variant (c.10561G > A) identified before pregnancy due to significant family history (grandfather’s intraoperative death). Labor failed to progress in the first stage, necessitating an urgent (Category 2) lower segment cesarean section. Preoperative physical and neuromuscular examinations were normal. The patient had autosomal dominant MH susceptibility confirmed by whole exome sequencing. Regional anesthesia was selected as the preferred trigger-free technique; a single-shot spinal anesthetic with 12 mg of 0.5
Breus’ mole (massive subchorionic thrombohaematoma, MST) is a rare placental disorder that can cause catastrophic postpartum haemorrhage due to acute rupture of a high-tension haematoma. However, the mechanism of this haemorrhage remains insufficiently understood in clinical practice. Case 1: A 31-year-old woman, G4P1, was admitted at 26⁺¹ weeks of gestation for intrauterine foetal death. She had a history of chronic hypertension and obesity. Serial ultrasound revealed progressive placental thickening (39→87→97 mm) with a massive subchorionic haematoma. Her haemoglobin concentration decreased rapidly from 112 to 48 g/L. During emergency forceps extraction of the placenta, acute rupture of the haematoma wall occurred, resulting in an instantaneous haemorrhage of approximately 1500 mL. The patient survived after massive blood transfusion. Placental pathology revealed a 9 × 7 × 2 cm haematoma beneath the chorionic plate, which was consistent with Breus’ mole with maternal vascular malperfusion. Case 2: A 35-year-old primigravida was admitted at 26⁺³ weeks of gestation with threatened preterm labour. She had hypothyroidism, and the foetus had sex chromosome mosaicism. Serial ultrasound revealed progressive placental thickening (36→57→82→91 mm), with a haematoma covering 100
Prenatal opioid use continues to contribute to rising rates of neonatal opioid withdrawal syndrome (NOWS) and adverse maternal-infant outcomes in the United States. The Managing Abstinence in Newborns (MAiN) 2.0 model was implemented to expand evidence-based, family-centered NOWS care practices across hospitals in South Carolina (SC). This study evaluated the midpoint implementation of MAiN 2.0 by examining maternal and infant outcomes alongside healthcare provider perspectives on implementation facilitators and barriers. A convergent mixed-methods design was used. Quantitative and qualitative data were collected from opioid-exposed mother-infant dyads and healthcare providers at four rural SC hospitals participating in MAiN 2.0. Quantitative data were used to compare maternal and infant outcomes between the baseline and midpoint implementation periods using independent-samples t-tests and chi-square tests. Outcomes included NOWS severity, length of stay, discharge disposition, prenatal care utilization, rooming-in, and use of supportive services. Semi-structured interviews were conducted with 23 key informants in clinical and healthcare administrative hospital roles. Qualitative data were analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Data were triangulated to contextualize findings. Significant improvements were observed at the midpoint of implementation. Peak NOWS scores decreased significantly from baseline to midpoint (12.3 vs. 8.4, p <.001). Infants were more likely to be discharged to their mothers (75.9
To synthesize the available evidence on the effects of discontinuing oxytocin after the onset of the active phase of induced labour. An overview of seven systematic reviews (SRs) and meta-analyses was conducted. Maternal and neonatal outcomes were extracted, and the methodological quality of reviews was assessed using AMSTAR. Primary study overlap among systematic reviews was quantified using the corrected covered area (CCA). Discontinuation of oxytocin after the active phase was associated with a reduction in cesarean delivery in six SRs. Uterine tachysystole was significantly reduced across all SRs. Nonreassuring fetal heart rate (FHR) patterns were more frequent in the oxytocin continuation groups. Findings for postpartum hemorrhage were inconsistent. Neonatal outcomes, including Apgar score < 7 at 5 min, cord blood pH < 7.10, neonatal asphyxia, and NICU admission, showed no significant differences between groups. Discontinuation was also associated with a modest prolongation of the active phase. Using the AMSTAR tool, all SRs demonstrated high methodological quality (mean score 9.2; range 8–11). However, the seven systematic reviews were highly redundant, largely analyzing the same 15 unique primary RCTs (corrected covered area = 64.4
Posttraumatic stress disorder (PTSD) is an underrecognized contributor to maternal morbidity, infant health complications, and rising healthcare costs. This narrative review synthesizes interdisciplinary evidence on the pathways linking structural inequities, trauma exposure, and maternal PTSD to adverse maternal and infant outcomes, with particular attention to the disproportionate burden experienced by Black women. Structural racism and systemic inequities increase exposure to chronic stress and trauma, which in turn elevate risk for PTSD during the perinatal period. Maternal PTSD functions as a central mechanism linking upstream inequities to downstream health outcomes. Through dysregulation of stress-responsive biological systems and associated behavioral pathways, PTSD increases the risk of adverse maternal outcomes, including hypertensive disorders, preterm birth, and severe maternal morbidity, as well as infant outcomes such as low birth weight, neurodevelopmental and emotional regulation difficulties, and impaired mother–infant attachment. These relationships are bidirectional, with adverse pregnancy and birth experiences further contributing to the onset or exacerbation of PTSD symptoms, reinforcing a cycle of psychological and physiological vulnerability. These interconnected maternal and infant outcomes contribute to substantial healthcare utilization and economic burden at individual and societal levels. The cumulative impact of perinatal mental health conditions exceeds 14 billion annually in the United States, driven in part by adverse birth outcomes and downstream developmental consequences. Addressing this cycle requires trauma-informed, integrated care models that incorporate universal screening, improve access to evidence-based treatment, and address structural barriers to care. Developing scalable, culturally responsive interventions may help reduce disparities, improve maternal and infant outcomes, and mitigate long-term societal costs.
High-quality intra-partum care is crucial for all expectant mothers to ensure safe delivery and favourable postpartum recovery. Vaginal delivery when associated with perineal trauma makes postpartum period painful and increases risk of long-term morbidity. Perineal trauma has been reported to be more common among Asian women. Interventions which minimise the perineal trauma will enhance the experience of motherhood. Various strategies have been explored but there is no firm consensus on their usage. We conducted this study to evaluate the effectiveness of perineal massage during the second stage of labor in reducing perineal trauma. A randomised controlled study was conducted at a referral centre. Four hundred and fifty women were randomised into two groups of 225 women. Second stage of labor was managed with perineal massage along with fetal head flexion and perineal support in group A and only fetal head flexion and perineal support was given in group B. The rate of intact perineum, episiotomy, perineum tears, duration of second stage and acceptability of perineal massage were compared between the 2 groups. Group A showed a significantly higher rate of intact perineum (p = 0.03) and a lower rate of episiotomies (p = 0.04). Overall rates of perineal tears between groups were not statistically different (p = 0.95). The duration of the second stage of labor was significantly shorter in Group A (p < 0.001). Women experienced significant perineal discomfort but 81.8
Current Doppler and functional ultrasound parameters, such as the cardiovascular profile score, umbilical artery pulsatility index, and ductus venosus pulsatility index, are valuable for detecting advanced fetal cardiac decompensation; however, they have limited ability in identifying subtle hemodynamic changes. This critical gap in current fetal assessment highlights the need for reliable markers that can identify subtle cardiac stress before overt failure. In this study, we aimed to identify fetal ultrasound parameters associated with umbilical venous N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, a biomarker associated with fetal cardiac load. We conducted a single-center, cross-sectional study at a tertiary perinatal medical center, recruiting women with singleton pregnancies undergoing cesarean delivery at ≥22 weeks of gestation. Fetal ultrasonographic examinations were performed within 7 days before delivery, and NT-proBNP levels were measured in umbilical venous blood collected immediately after birth. NT-proBNP values were natural log-transformed (Ln NT-proBNP) to address the non-normality of the residuals in the regression models, and gestational age-adjusted linear regression analyses were performed. A total of 202 pregnant women were included in the analyses. A higher left to right cardiac output (LCO/RCO) ratio was significantly associated with lower Ln NT-proBNP levels (estimate: −0.206; 95
Neonatal adenylosuccinate lyase (ADSL) deficiency is a rare neurodegenerative disorder that is associated with epileptic encephalopathy, diffuse hypotonia, and respiratory failure. Loss of enzymatic function of ADSL leads to toxic buildup of succinylaminoimidazole carboxamide riboside (SAICAr) and succinyladenosine (S-Ado). We describe a female term neonate who presented with respiratory failure and encephalopathy. Neuroimaging revealed microencephaly, a simplified gyral pattern, and diffuse white matter edema. Genetic testing showed novel homozygous loss of function mutations of ADSL, the adenylosuccinate lyase gene, consistent with fatal neonatal ADSL deficiency. We find this to be one of less than a dozen cases reported of the fatal neonatal phenotype of ADSL deficiency. The case highlights ADSL deficiency as a rare cause of neonatal encephalopathy and respiratory failure. Clinical recognition of epileptic encephalopathy, pertinent findings on MRI, and testing for S-Ado can confirm the diagnosis and support discussions about goals of care.
Cross-national comparability of fetal mortality indicators is limited by heterogeneous definitions and denominators. Mexico’s official fetal death indicators include all gestational ages and use live births as the denominator, diverging from international standards. We recalculated late fetal death rates using ICD-11 criteria and compared them with published national and international data. We conducted a retrospective analysis of national fetal death data from Mexico (2013-2023). Publicly available statistics on fetal deaths and registered live-birth datasets were used. All procedures followed ICD-11 recommendations for international reporting standards. Recalculated rates were compared with official Mexican publications, PAHO/WHO estimates for Mexico, and United States (US) rates. From 2013 to 2023, 254,567 fetal deaths were recorded in Mexico. The recalculated ICD-11 late fetal death rate averaged 4.9 per 1,000 total births, increasing from 4.5 (2013-2015) to 5.5 (2020-2023). However, this increase should be interpreted with caution, as it is largely driven by a decline in the number of registered live births over the study period. Official Mexican fetal death rates ranged from 10.1 to 15.5 per 1,000. PAHO/WHO estimates for Mexico (2013-2023) were 7.0-7.9 per 1,000, and US rates (2014-2023) were 2.7-2.9 per 1,000. Most fetal deaths occurred before 28 weeks, with increasing proportions among cases ≤499 g. Most deaths were classified as antepartum (84
Congenital uterine anomalies (CUA) are structural abnormalities resulting from disrupted Müllerian duct development and have been associated with adverse reproductive and obstetric outcomes. However, the magnitude of these risks and variation across anomaly subtypes remain incompletely defined. To evaluate the association between CUA and adverse maternal and fetal outcomes and to examine subtype-specific risk patterns using contemporary evidence. We conducted a systematic review and meta-analysis of studies identified from MEDLINE, Web of Science, and Cochrane CENTRAL. Eligible studies compared women with imaging- or surgically confirmed CUA to those with normal uterine anatomy and reported at least one predefined obstetric outcome. Random-effects meta-analyses were used to estimate pooled odds ratios (ORs) with 95
The Eat, Sleep, Console (ESC) model of care offers a patient-centered approach for managing neonatal opiate withdrawal syndrome (NOWS), reducing hospital stay, need for pharmacologic treatment, and costs compared to the traditional Finnegan scoring system. Favorable nursing knowledge, attitudes, and practices (KAP) are critical to successful ESC implementation. A prior pilot survey in our neonatal intensive care unit (NICU) revealed inconsistent understanding and application of ESC, indicating a need for targeted education. This study assesses changes in NICU nursing KAP scores following a three-month multiphase educational intervention, and identifies behavioral shifts, barriers, and opportunities to optimize ESC integration. We conducted a pre-post quasi-experimental study in a Level IV NICU using anonymous 11 point surveys completed by NICU nurses assessing knowledge, attitudes, and perceptions towards ESC before and after the collaborative educational intervention. The intervention included (1) a didactic session with open discussion, (2) an ESC poster displayed in the NICU, and (3) a one-page ESC reference guide. Statistical analyses utilized analysis of variance (ANOVA). Thirty-three NICU nurses completed the pre- and post-intervention surveys; samples were independent and unmatched with an unknown degree of overlap. The increase in mean total KAP scores from 14.8 ± 2.2 to 15.3 ± 2.5 was not statistically significant (p = 0.40). Nurses with less than five years of experience showed the greatest improvement in knowledge and total KAP scores, increasing from 6.3 ± 1.5 to 8.3 ± 1.0 and from 14.3 ± 3.4 to 16.5 ± 1.9, respectively. Perceived safety and effectiveness of ESC improved slightly post-intervention. Didactic attendance did not significantly influence KAP (p > 0.80). Reported barriers to ESC implementation included staff and workflow constraints, limited family presence and parental involvement, lack of interdisciplinary support and system-level resources, and subjectivity and limitations of ESC assessments. Nurses emphasized the importance of greater social and family support, followed by increased nursing education, provider education, and improved lactation support. Collaborative education was not associated with statistically significant changes in NICU nursing KAP scores related to the ESC approach for NAS and may be insufficient as a stand-alone measure. Additional system-level support strategies may be needed to support ESC implementation fidelity and facilitate favorable nursing perceptions and practices towards ESC. Additionally, minimizing barriers affecting families and staff through tailored interventions may promote feasibility of ESC practices, also leading to improved nursing KAP.
Postpartum depression and parenting both play a role in shaping children’s future behavior. However, there is limited understanding of the interaction and the evolving relationship between depressive symptoms and parenting practices. This study aimed to investigate the bidirectional associations between maternal depressive symptomatology and parenting (maternal self-efficacy, maternal warmth, and maternal hostile-reactive behaviors) in the postpartum period and to assess the moderating effect of breastfeeding and partner support on these associations. Latent growth curve and multigroup analyses were estimated in a sample of 1551 mothers of the 3D pregnancy cohort. Maternal depressive symptomatology and parenting practices were concurrently associated. Bidirectional associations were found between maternal depressive symptomatology and maternal self-efficacy, but not for warmth or hostile-reactive behaviors. Mothers with high perceived partner support showed a significant association between increased maternal warmth and lower depressive symptoms at 24 months. In contrast, mothers with lower perceived partner support demonstrated stronger associations between early hostile-reactive parenting and later depressive symptoms, as well as a greater impact of declining self-efficacy on maternal depressive symptoms. Breastfeeding showed limited moderating effects, with no significant buffering impact on the associations between depressive symptoms and parenting practices. These findings highlight the protective role of partner support in mitigating the adverse effects of depressive symptoms on parenting and vice versa, emphasizing the need for interventions that strengthen maternal self-efficacy and partner involvement to promote maternal mental health.
In the first days after childbirth, women often sleep less and have poorer sleep because of physiological and psychological changes and their new responsibilities. Given the side effects of chemical medications, herbal remedies are increasingly considered. This study aimed to determine the effect of fenugreek oral capsules on the sleep quality of primiparous women during the postpartum period. This two-group, triple-blind, randomized controlled trial was conducted in 2023 on 60 primiparous women attending health centers in Sabzevar. Eligible women took either a 700 mg fenugreek seed extract capsule or a 700 mg placebo capsule containing Avicel powder once daily, starting on postpartum day 3,4, or 5 and continuing until day 60. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) before the intervention and on the 15th, 30th, and 60th days postpartum. Data were analyzed using SPSS (version 22) with descriptive and inferential statistical tests. A p-value of less than 0.05 was considered significant. Before the intervention, the mean sleep quality score was 12.7 ± 1.7 in the fenugreek group and 11.3 ± 2.1 in the placebo group. This difference was statistically significant (p = 0.009), indicating that the two groups were not fully comparable at baseline. On the 15th day postpartum, sleep quality scores were 11.3 ± 1.9 in the fenugreek group and 12.1 ± 1.4 in the placebo group, demonstrating no significant difference between the two groups. However, after adjusting for baseline differences using analysis of covariance, the difference in mean sleep quality score between the two groups became statistically significant (F = 17.1, df = 2, p < 0.001). The average sleep quality scores in the intervention and placebo groups were 8.1 ± 1.5 and 10.0 ± 1.5, respectively, on the 30th day postpartum and 5.1 ± 1.4 and 8.9 ± 1.5, on the 60th day postpartum. The scores were significantly lower in the intervention group compared to the placebo group (p < 0.001). Because the two groups differed in sleep quality scores before the intervention, analysis of covariance was performed. This analysis confirmed significant differences between the groups on postpartum days 30 and 60 (day 30: F = 21.4, df = 2, p < 0.001; day 60: F = 54.6, df = 2, p < 0.001). Fenugreek oral capsule improved self-reported sleep quality of primiparous women during the postpartum period. Therefore, fenugreek may be an effective herbal option for improving sleep quality in primiparous postpartum women. However, future studies should use objective methods to assess sleep. The current study has been registered in the Iran registry of clinical trials ( http://www.irct.ir/ ) on the date 14-03-2023 with registration no. IRCT20230306057640N1.
Accurate estimation of fetal weight is a crucial component of pregnancy management and plays a key role in reducing maternal and neonatal complications. Although ultrasonography is considered the gold standard, its limited availability and cost emphasize the need to assess alternative clinical methods. This cross-sectional study included 132 term pregnant women (37to 41 weeks) selected via non-probability sampling. Fetal weight was estimated prior to childbirth using three methods: ultrasonography (performed within the last two weeks of the third trimester to minimize the impact of rapid fetal weight gain closer to term), Johnson’s formula, and Insler’s formula and was compared with the actual birth weight immediately after childbirth. Data were analyzed using SPSS version 24, with descriptive statistics and regression. The mean ± SD of estimated fetal weights (EFW) obtained via third-trimester ultrasonography and based on the Johnson and Insler formulas were 3164 ± 382.95 g, 3161.27 ± 302.90 g, and 3309.35 ± 374.05 g, respectively. Regarding diagnostic accuracy, the Johnson formula showed a precision of 69.70
BACKGROUND:Pharmacologic mydriasis is essential for retinopathy of prematurity (ROP) screening; however, conventional ophthalmic drops substantially exceed neonatal conjunctival sac volume, leading to systemic absorption and potential adverse effects. Microdrop administration may reduce drug exposure while preserving adequate pupillary dilation. This study aimed to determine whether microdrop administration of phenylephrine and tropicamide is noninferior to standard drops in achieving adequate mydriasis for ROP screening via a bottle adapter. METHODS:This single-center, randomized, parallel-group noninferiority trial was conducted in a tertiary neonatal unit in Chennai, India. Preterm infants undergoing routine ROP screening were randomized to receive either microdrops (10.26 µL) or standard drops (26.58 µL) of 2.5% phenylephrine and 0.8% tropicamide. Three doses were administered at 10-minute intervals. The primary outcome was the mean pupil diameter at 45 min after the first instillation. The secondary outcomes included physiological parameters (heart rate, oxygen saturation, and blood pressure), systemic and local adverse events, and the adequacy of ROP examination. A noninferiority margin of - 0.5 mm was prespecified. RESULTS:Among the 127 infants assessed for eligibility, 102 were randomized (microdrop group, n = 52; standard group, n = 50), and all completed the study. Baseline characteristics were comparable between the groups. At 45 min, mean pupil diameter was 6.54 ± 0.52 mm in the microdrop group and 6.38 ± 0.63 mm in the standard-drop group (mean difference, 0.16 mm; 95% CI, - 0.07 to 0.38 mm; p for noninferiority < 0.001). As the lower bound of the 95% CI (- 0.07 mm) was above the prespecified noninferiority margin of - 0.5 mm, noninferiority was established. Physiological parameters, including heart rate, oxygen saturation, and blood pressure, remained stable and comparable between the groups. Systemic adverse events were rare and similar across groups, and no local ocular complications were observed. ROP examination was successfully completed in all infants. CONCLUSION:Microdrop administration of phenylephrine and tropicamide achieved mydriasis comparable to standard drops, with no significant difference in adverse effects between the groups. This approach may represent a safer, clinically feasible and more physiologically appropriate strategy for ROP screening by reducing drug exposure in vulnerable preterm infants. TRIAL REGISTRATION:The study protocol was approved by the Institutional Ethics Committee of Madras Medical College, Chennai (IEC No. MMC/Approval/12052025). The trial was registered with the Clinical Trials Registry of India (CTRI/REF/2025/03/101681)on 10-03-2025.
Abstract Objective This research aims to verify the Arabic version of the Coronavirus Anxiety Scale (CAS) and to evaluate its association with maternal mental health among mothers of infants in the time of COVID-19 widespread in Saudi Arabia. Methods A cross-sectional study was performed among the mothers of 1-month- to 1-year-old infants. Data collection was conducted between June and July 2020. Participants completed the Arabic CAS, Barkin Index of Maternal Functioning, Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder Scale. Descriptive statistics, Cronbach’s alpha, Pearson’s correlations and exploratory factor analysis (EFA), were applied. Results Among 648 participants, the Arabic CAS showed better internal reliability. With the item loadings varying from 0.56 to 0.7, EFA validated a single-factor structure accounting 65.5% of overall variance. The Arabic CAS then demonstrated high internal consistency (Cronbach’s α = 0.89). CAS scores correlated negatively with Barkin Index of Maternal Functioning (BIMF) and positively with Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7) supporting construct validity. Conclusion The Arabic CAS shown adequate validity and reliability for evaluating COVID-19 linked anxiety among mothers of infants in Saudi Arabia. This tool can be used to detect the distress related to pandemic in postpartum individuals.
