Prenatal diet affects maternal and child health; however, adherence to dietary guidelines in pregnancy is low. This cross-sectional study aimed to describe overall diet quality and to examine relationships between socioeconomic factors and diet quality in a sample of Australian pregnant women. Participants (n = 1580) completed an online survey and self-reported usual dietary intake (via a food frequency questionnaire [FFQ]) and socioeconomic factors, including highest educational attainment, income, perception of overall financial situation, residential postcode for area-level socioeconomic status (SES), stressful life events, and perceived social support. FFQ responses were converted to an overall diet quality score using the Dietary Guidelines Index 2013 (DGI-13) criteria. Latent class analysis was used to identify groups of stressful life events, and multiple linear regression models examined associations between the socioeconomic factors and DGI-13 score. Overall, adherence to dietary guidelines and prenatal diet quality were low. The mean DGI-13 score was 76.1 (SD 13.7) out of a maximum possible score of 130. All socioeconomic factors were significantly associated with DGI-13 score. For all socioeconomic factors except the perceived social support score, the lowest/most disadvantaged categories and middle/medium categories were associated with clinically important reductions of 5-9 points and 3-6 points, respectively, indicating a social gradient in diet quality. There is a need to improve prenatal diet quality among all women. However, there is an urgent need for systems-level interventions and policy change that target those with lower SES backgrounds to reduce dietary and health inequities.

Abstract Introduction Pregnant women are advised to sleep laterally from 28-weeks of gestation, due to increased risk of stillbirth in those who report “going-to-sleep” in the supine position. Historically, objectively-measured sleep position during pregnancy was classified as supine or lateral, potentially missing important subtleties regarding the mechanisms behind sleeping position and fetal wellbeing. This study aimed to characterise sleep position during pregnancy with precise measurement techniques and assess the impact of discretisation of supine sleep on infant birthweight. Methods A tri-axial accelerometer was worn around the abdomen for 7 nights, between 32-36 weeks of pregnancy. Body position was measured continuously in degrees of roll. Supine was defined crudely as 0°= fully supine to 45° left or right tilt versus more precisely as 0-15°, 15-30° and 30-45°. Birthweights were converted into customised centiles. Results A total of 368 nights were recorded across 56 women. The median (IQR) proportion of supine positioning (0-45°) across the week was 15.6% (4.9,26.5), equivalent to 74.5 (24.0,128.6) minutes per night. Of time spent supine, 32% was within 0-15°, compared to 28% and 41% in more tilted positions of 15-30° and 30-45° respectively. Birthweight centile was not related to supine (0-45°) time overnight (β=0.01, p=.85) or when constrained to 0-15° (β=0.17, p=.07). Discussion Half the women studied spent over an hour in the supine position overnight, although a 30-45° lateral tilt was favoured. Supine sleep was not associated with birthweight, suggesting that, at this supine exposure, the fetus is minimally impacted from aortocaval compression potentially impacting uteroplacental supply.

Background:Physical inactivity and suboptimal diet in pregnancy are important modifiable risk factors for gestational diabetes, a major contributor to pregnancy complications. Objectives:We aimed to assess the effects of physical activity and/or diet-based lifestyle interventions during pregnancy on gestational diabetes and if these vary by maternal (body mass index, age, parity, ethnicity, education) and intervention characteristics using individual participant data meta-analysis of randomised trials, and a cost-effectiveness analysis. Data sources:International Weight Management in Pregnancy Collaborative Network database was updated by searching major databases from February 2017 to March 2022. Review methods:The main outcomes were gestational diabetes by any criteria and by the National Institute for Health and Care Excellence. Other outcomes were gestational diabetes as per International Association of Diabetes in Pregnancy Study Group and maternal and perinatal outcomes. We performed a two-stage random-effects individual participant data meta-analysis to obtain summary estimates (odds ratio) with 95% confidence intervals. Study quality of included trials was assessed, and heterogeneity summarised using τ2. Where possible, we added the aggregate data from non-individual participant data trials to the meta-analysis. We ranked interventions by effectiveness using network meta-analysis and undertook model-based economic evaluation to assess cost-effectiveness. The cost-effectiveness analysis took an NHS cost perspective compared an overall lifestyle intervention versus usual care with a time horizon covering the beginning of pregnancy until the discharge of the mother and infant from the hospital following delivery. Results:Ninety-two trials (32,284 women) were included; 54 (23,698 women) provided individual participant data. Lifestyle interventions reduced the odds of gestational diabetes (any criteria) by 10% in individual participant data trials (odds ratio 0.90, 95% confidence interval 0.80 to 1.02, 54 studies, 23,361 women), and the findings reached statistical significance when non-individual participant data were included (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, 92 studies, 31,947 women). Physical activity significantly reduced the odds of gestational diabetes by 36% (odds ratio 0.64; 95% confidence interval 0.48 to 0.84), and diet by 19% (odds ratio 0.81; 0.69 to 0.96), but not mixed interventions. Women with middle (odds ratio 0.68, 95% confidence interval 0.51 to 0.90) and high educational level (odds ratio 0.71, 95% confidence interval 0.54 to 0.93) benefited more than those with low educational status, and no differences by maternal body mass index, age, parity or ethnicity. There was no significant reduction in gestational diabetes defined by National Institute for Health and Care Excellence criteria (odds ratio 0.98, 95% confidence interval 0.84 to 1.13) in individual participant data trials. For gestational diabetes defined using International Association of Diabetes in Pregnancy Study Group criteria, interventions reduced gestational diabetes by 14% (odds ratio 0.86, 95% confidence interval 0.75 to 0.97, τ2 = 0.00, 16 studies, 6174 women) in individual participant data trials and by 17% (odds ratio 0.83, 95% confidence interval 0.72 to 0.95, τ2 = 0.01, 25 studies, 7883 women) when non-individual participant data trials were added. Overall, physical activity reduced caesarean section (odds ratio 0.83; 0.72 to 0.96), small-for-gestational age (odds ratio 0.72; 0.56 to 0.92) and large-for-gestational age babies (odds ratio 0.81; 0.71 to 0.94); diet-based interventions reduced any preterm birth (odds ratio 0.37; 0.20 to 0.68) compared to controls. No differences were observed for other outcomes. Lifestyle interventions were on average more expensive and more effective at averted gestational diabetes and major outcome averted compared to usual care. Limitations:We could not identify the specific intervention components and delivery methods associated with improved outcomes, due to variations in reporting. Conclusion:Lifestyle interventions in pregnancy prevent gestational diabetes, and the effects vary according to the definition of gestational diabetes. Physical activity-based interventions may be the most effective. Future work:Lifestyle interventions should be implemented and evaluated in routine clinical practice to prevent gestational diabetes, with additional support for women with low socioeconomic status. Study registration:This study is registered as PROSPERO CRD42020212884. www.crd.york.ac.uk/PROSPERO/view/CRD42020212884. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129715) and is published in full in Health Technology Assessment; Vol. 30, No. 39. See the NIHR Funding and Awards website for further award information.

Pregnancy markedly increases micronutrient demands; however bariatric surgery can compromise dietary micronutrient intake and absorption. International Consensus Guidelines recommend additional micronutrient supplementation during pregnancy following bariatric surgery to prevent deficiencies; however, their efficacy is unknown. This study examined whether women met recommended micronutrient supplementation during pregnancy and explored the relationship between micronutrient intake and deficiency during pregnancy. Pregnant women who had bariatric surgery prior to conception, aged 18–45 years were recruited prospectively before 23 weeks’ gestation and followed until birth. Multiple pass 24-hour diet recalls assessed dietary micronutrient intake. Micronutrient supplementation and adherence was reported pre-pregnancy, at enrollment, and at 28- and 36-weeks gestation. Maternal blood values were obtained from medical records after birth. Logistic regression examined the role of micronutrient intake in the development of biochemical iron, zinc, copper, selenium, folate, and vitamins A, B12, D, and E deficiencies. Sixty-nine women, aged 31 ± 4.8 years, participated. Multivitamin use increased from 38/69 (55

OBJECTIVE:To explore the relationship between different definitions of objectively measured supine sleep position during late pregnancy and customised birthweight centile, as a marker of fetal wellbeing. DESIGN:Prospective cohort study. SETTING:Australian public hospital antenatal clinic. POPULATION:Eighty-four pregnant women from 32-36 weeks of gestation. METHODS:Body position was measured in degrees of roll using a tri-axial accelerometer worn around the abdomen for seven sequential nights. Supine was defined as 'broad supine' (0° = fully supine to 45° left/right tilt), and 'supine low-tilt' (0°-15°). Two additional Risk Indices capturing risk proportional to duration spent in each degree of supine-to-lateral tilt were developed. Birthweights were converted into customised centiles using GROW software. MAIN OUTCOME MEASURES:The primary outcome was customised birthweight centile. Secondary outcomes included birthweight, gestational age at delivery, and fetal growth trajectory. RESULTS:Across 556 nights of data, the median nightly duration of broad supine positioning was 65.9 [25.0, 125.7] minutes compared to only 9.1 [0.7, 24.4] minutes of supine low-tilt. There was no relationship between customised birthweight centile and time spent in broad supine (R2 = 0.0027, F(1,82) = 0.22, p = 0.64) or supine low-tilt (R2 = 0.0029, F(1,82) = 0.24, p = 0.63); nor with any supine risk index and customised birthweight centile, birthweight, gestational age at delivery, or fetal growth trajectory. CONCLUSION:In this cohort, there was no evidence of an association between objectively measured supine sleep and customised birthweight centile. Yet to be identified mechanisms unrelated to fetal growth may be responsible for supine going-to-sleep position being a risk factor for late stillbirth. Further prospective investigation is needed to untangle cause and effect; however, given the low rate of stillbirth, such a study may not be feasible.

Background/Objectives: Consensus guidelines recommend delaying conception for at least 12 months following bariatric surgery to achieve maternal weight stability; however, the impact this has on perinatal outcomes is poorly understood. The aim of this study was to explore the impact of bariatric surgery-to-conception interval and maternal preconception weight change on birth weight and gestational age at birth. Methods: Women aged 18-45 years with singleton pregnancies after bariatric surgery were recruited to a prospective, observational study before 23 weeks' gestation. Participants self-reported the surgery-to-conception interval and weight change in the six months before conception. Preconception weight change was calculated as a percentage of difference compared to weight at conception. Linear regression assessed predictors of birth weight and gestational age. Results: Data from 68 participants (mean age 32 ± 4.8 years) were analyzed. The median birth weight was 3368 (514) g with 7% (5/68) SGA infants. Women with SGA infants had greater preconception weight loss (12% vs. 0%, p = 0.029), while surgery-to-conception intervals were similar (p = 0.255). Preconception weight change and gestational age were independent predictors of birth weight (p < 0.001), accounting for 58% of its variance. Surgery-to-conception interval did not predict birth weight (p = 0.986). The median gestational age at birth was 39 (2.1) weeks, with 7% (5/68) preterm births. Neither preconception weight change nor surgery-to-conception interval predicted gestational age at birth. Conclusions: Preconception weight change appears to be more influential than surgery-to-conception interval for birth weight and birth of an SGA infant. This suggests a need for individualized counseling regarding timing of pregnancy after bariatric surgery.

Background Engaging fathers in perinatal research (pregnancy to one year postpartum) is difficult due to factors such as work commitments and societal norms. Factors impacting perinatal healthcare provider research participation include practitioner gender, interest, time constraints and poor compensation. Participation varies by geographical location, and culture may also play a role. Two fathering-focused PhD projects in Australia and Indonesia presented a unique opportunity to compare recruitment processes and examine how cross-country and cultural factors influence participation. Methods Both studies employed mixed methods to recruit perinatal parents and healthcare providers – nationally in Australia, through healthcare provider networks and social media, and in an Indonesian health district using in-person and digital pathways. Findings Despite recruitment efforts, in Australia, survey responses were low: 141 healthcare providers, 29 fathers, and 22 mothers/birthing parents. Twenty healthcare providers, twelve fathers and eight mothers/birthing parents, completed interviews, providing well-considered responses. In Indonesia, 188 healthcare providers, 478 pregnant women, and 253 fathers completed questionnaires. Twenty fathers were interviewed, providing thoughtful but brief responses, often needing prompting. Conclusions Researcher communications directly with potential participants are an effective recruitment strategy, while using service providers as ‘recruiters’ is an appropriate alternative. Social media and word-of-mouth may be preferable to broad, passive advertising in large-scale projects. Socio-cultural factors likely influenced participation, with higher survey response rates and shorter interviews in Indonesia possibly reflecting more collectivist values, higher compliance and social desirability. Future studies should incorporate appropriate empirical designs to explore how socio-cultural factors impact participation in fathering research.

The COVID-19 pandemic placed unprecedented pressures on maternity and neonatal services, disrupting models of care and amplifying existing stressors for healthcare staff. While much of the literature has focused on doctors and midwives, less is known about the emotional well-being of the broader multidisciplinary maternity and neonatal workforce, including neonatal nurses, sonographers, allied health, and administrative staff. Understanding the collective impact of workplace and personal factors on emotional well-being across this multidisciplinary group is essential for developing effective, inclusive workforce support strategies. A cross-sectional survey was conducted among maternity and neonatal staff, including doctors, midwives, nurses, sonographers, allied health, and administrative staff, from one tertiary and two secondary Australian hospitals. Survey responses were analysed using exploratory factor analysis to identify subscales representing key dimensions of emotional well-being, as well as workplace-related and personal factors influencing it. These subscales were then used in multiple hierarchical regression analyses to determine predictors of emotional well-being among staff. The strongest predictor of emotional well-being was the subscale ‘Impact of COVID-19 on the Workplace’ (β = -0.345, p < 0.001), encompassing factors such as perceived risk of contracting COVID-19, staff ability to perform duties, and adverse patient outcomes. Other significant predictors included average sleep duration (β = -0.230, p < 0.001), substance use (β = -0.210, p < 0.001), and time spent on outdoor activities (β = -0.130, p < 0.001). The predictive model explained 35.1

OBJECTIVES:To assess the effects of lifestyle interventions on gestational diabetes, determine whether the effects vary by maternal body mass index, age, parity, ethnicity, education level, or intervention, and rank interventions by effectiveness. DESIGN:Individual participant data (IPD) and network meta-analysis. DATA SOURCES:Major electronic databases (January 1990 to April 2025). METHODS:This meta-analysis included randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes. Main outcomes were gestational diabetes defined by any criteria and by UK NICE (National Institute for Health and Care Excellence) criteria; other outcomes included IADPSG (International Association of Diabetes in Pregnancy Study Group) and modified IADPSG defined gestational diabetes. A two stage IPD meta-analysis estimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates. Aggregate data from non-IPD trials were added to the meta-analysis when possible. Intervention effects were ranked using network meta-analysis. RESULTS:104 randomised trials (35 993 women) were included, with IPD for 68% of participants (24 391 women; 54 studies). Lifestyle interventions reduced gestational diabetes defined by any criteria by 10% in IPD trials (odds ratio 0.90, 95% confidence interval (CI) 0.80 to 1.02; absolute risk reduction 1.3%, 95% CI -0.3% to 2.6%), and by 20% when combining IPD and non-IPD trials (odds ratio 0.80, 95% CI 0.73 to 0.88; absolute risk reduction 2.6%, 95% CI 1.6% to 3.6%), and no reduction was observed using NICE criteria (odds ratio 0.98, 95% CI 0.84to 1.13). Lifestyle interventions reduced gestational diabetes defined using IADPSG criteria by 14% in IPD trials (odds ratio 0.86, 95% CI 0.75 to 0.97; absolute risk reduction 2.7%, 95% CI 0.6% to 5.0%) and by 18% when combining IPD and non-IPD trials (odds ratio 0.82, 95% CI 0.72 to 0.93; absolute risk reduction 3.5%, 95% CI 1.3% to 5.7%). Effects did not vary by maternal characteristics, except for education. Although women of all educational levels benefited from the intervention, the benefit was less in those with low education (low v middle interaction: odds ratio 0.68, 95% CI 0.51 to 0.90; low v high interaction: odds ratio 0.71, 95% CI 0.54 to 0.93). Benefits did not vary by intervention characteristics, except for greater effectiveness with group format (odds ratio 0.81, 95% CI 0.68 to 0.97; absolute risk reduction 2.5%, 95% CI 0.4% to 4.3%) and newly trained facilitators (odds ratio 0.82, 95% CI 0.69 to 0.96; absolute risk reduction 2.4%, 95% CI 0.5% to 4.2%). Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes. CONCLUSIONS:Lifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria. Implementation strategies should address inequalities by maternal education, and consider group formats, provider training, and physical activity based interventions to prevent gestational diabetes. STUDY REGISTRATION:PROSPERO CRD42020212884.

Accurately screening fathers for perinatal mental health problems requires well-validated screening instruments that assess the expression of paternal perinatal mental distress. This study aimed to identify and describe the psychometric properties of perinatal mental health screening instruments administered to paternal cohorts within the past two decades. A scoping review was conducted following Arksey and O’Malley’s scoping review framework and is reported in line with the PRISMA-ScR guidelines. A systematic search of Embase, PsycINFO, Medline, and ProQuest databases identified peer-reviewed literature published within the past 20 years that implemented a screening instrument for fathers’ perinatal mental health within the first 12 months of their child’s birth. Twenty-eight instruments used to screen fathers’ perinatal mental health were identified across 36 studies. The instruments most frequently assessed symptoms of depression. Only five were explicitly developed for fathers and while these instruments produced promising results, further evaluation is necessary before they can be considered a superior screening method compared to existing instruments.

Problem Research about first-time fathers’ inclusion in, and engagement with, perinatal primary care is limited. Background Globally, fathers’ engagement with perinatal healthcare services is low. First-time fathers experience more distress, have unique support needs and are more willing to engage with perinatal healthcare than experienced fathers. Yet, primary care’s role in supporting perinatal first-time fathers has received little research attention. Aim To examine first-time fathers’ inclusion in, and engagement with, perinatal primary care and the feasibility of engaging them through primary care pathways. Methods Integrative review of international peer-reviewed and grey literature. Findings Thirty-three studies (16 quantitative, 13 qualitative, 4 mixed-methods) were included, comprising 3,712 first-time fathers. Almost half (46%) of the fathers in 19 suitable studies were first-time fathers. Parents’ perceived barriers to father engagement included providers being mother-focused and fathers’ mistrust of providers. Provider barriers included father absence, perceived father disinterest, workload and low managerial support. Promising strategies for engagement included provider-initiated interactions with fathers and postnatal home visits. Systemic barriers received limited attention. Discussion The lack of complete father-specific data in several studies hindered the review process and limited the strength of conclusions. Since first-time fathers may comprise about half of fathers in perinatal primary care, universal services risk overlooking their specific needs. While strategies like postnatal home visits show promise for father engagement, limited consensus about engagement strategies and unaddressed systemic issues may limit their effectiveness. Conclusion Further research exploring parents’ and providers’ views is required to guide more effective father-inclusive care. Engaging first-time fathers in primary care must go beyond practical strategies and address deeper systemic issues.

BACKGROUND:Queensland maternity services are provided by institutions of varying sizes, that are classified according to the Clinical Services Capability Framework. Obesity is more common in more remote areas. We aimed to identify factors associated primary and secondary general anesthesia in Queensland, Australia. METHODS:Data were obtained from the Anaesthesia Benchmarking System and Mater Health Services between January 2019 and July 2022. The Accessibility/Remoteness Index of Australia Plus classification was used to describe remoteness and the institutional Clinical Services Capability Framework level documented. Associations of individual characteristics, cesarean characteristics and remoteness category with the outcomes of primary and secondary GA, were explored using chi-square tests and modelled using binary logistic regression. RESULTS:Of 35,227 cases, 22,780 (64.7%) resided in major cities with a median (IQR) body mass index of 29.0 kg m-2 (25.0-34.5). Primary general anesthesia occurred in 1562 (4.4%) and secondary general anesthesia in 1336 (3.8%). Primary general anesthesia occurred more commonly in category 1 cesarean (adjusted odds ratio, aOR 31.49, 95% CI 27.00-36.84) and those with a mental health condition (aOR 1.82, 95% CI 1.57-2.10), both p < 0.001. Primary GA occurred less commonly in nulliparous women (aOR 0.56, 95% CI 0.49-0.63, p < 0.001). Secondary general anesthesia was more likely in those with category 1 surgical urgency (aOR 12.62, 95% CI 10.58-15.07), post-partum hemorrhage (aOR 2.74, 95% CI 2.32-3.23), lowest BMI category (aOR 2.13, 95% CI 1.44-3.07), highest BMI category (aOR 1.71, 95% CI 1.41-2.07) and presence of a mental health condition (aOR 1.57, 95% CI 1.35-1.82), all variables p < 0.001. Clinical Services Capability Framework level 4 and 5 institutions cared for significantly more women with body mass index ≥ 40 kg m-2 however more women with body mass index ≥ 40 kg m-2 resided in remote/very remote locations. CONCLUSION:Anesthetists may use these results to anticipate secondary general anesthesia or modify primary techniques. Institutions located in remote areas and with fewer resources cared for more women with obesity, with implications for women and healthcare services.

Background: Bariatric surgery is increasingly offered to women of childbearing age and significantly reduces food intake and nutrient absorption. During pregnancy, associated risks, including micronutrient deficiency, are accentuated. This study describes maternal dietary intake and adherence to dietary recommendations in pregnant women with a history of bariatric surgery. Methods: Women aged 18–45 with singleton pregnancies post-bariatric surgery were recruited at <23 weeks of gestation and followed until birth. Dietary intake was measured using three non-consecutive 24 h recalls at enrolment and at 28 and 36 weeks using the standardized tool ASA24-Australia. Micronutrient supplementation dose and adherence was reported using the Brief Medication Adherence Questionnaire. Mean macronutrient intake was calculated from all diet recalls. Micronutrient intake was determined from diet recalls and from supplementation. Intake was compared to the recommended daily intakes for pregnancy. Results: Sixty-three women participated in the study. The participants met 65 ± 17.3% (mean ± SD) of estimated energy requirements, 53(23)% (median(IQR)) of fiber requirements, and exceeded fat and saturated fat recommendations. Dietary intake levels of iron, folate, zinc, calcium, and vitamin A were below recommended levels. Gastric bypass recipients consumed significantly less folate (p = 0.008), vitamin A (p = 0.035), and vitamin E (p = 0.027) than women post-gastric sleeve or gastric band. Multivitamins were used by 80% (n = 55) of participants at study enrolment, which increased their mean intake of all micronutrients to meet recommendations. Conclusions: Women who conceive post-bariatric surgery may require targeted support to meet the recommended nutrient intake. Micronutrient supplementation enables women to meet nutrient recommendations for pregnancy and is particularly important for gastric bypass recipients.

BACKGROUND:The "Sleep on Side" policy was recently introduced in Australian antenatal clinics to reduce the risk of late stillbirth associated with going-to-sleep on the back. AIM:To assess knowledge of side sleeping recommendations in pregnancy and explore feelings of anxiety in relation to this policy, and how these feelings may impact sleep. METHODS:Cross-sectional study of sleep position measured for seven nights between 32 and 36 weeks of pregnancy. Participants completed a sleep diary each morning, and at the end of the week completed a survey regarding knowledge and anxiety around sleeping position. FINDINGS:Sleep position data was collected in 80 participants, with 43 participants completing anxiety surveys. Almost all participants (95 %) reported receiving side sleeping advice during pregnancy, the most common source being their antenatal care provider. Twenty-three percent of women reported "moderate" or "very much" anxiety around their sleeping position or waking on their back overnight. Anxiety towards sleeping position was associated with self-reported supine sleep (p < .001), and use of additional pillows to support behind the back (p < .001). Overall self-reported sleep quality was not affected by anxiety, apart from alertness upon awakening (p = .001). DISCUSSION:In this cohort, the Sleep on Side policy has been disseminated widely with women understanding the rationale for encouraging a safe sleeping position. While many women receive this advice with minimal worry, almost a quarter of women may experience anxiety that may potentially affect their sleeping behaviour. CONCLUSION:Advice on sleeping position should be carefully balanced with potential harms to maternal sleep and mental health.

Background/Objectives: Weight loss following bariatric surgery can improve fertility. Current guidelines recommend delaying pregnancy for at least 12 months post-surgery for weight stabilization and to support healthy gestational weight gain (GWG). However, evidence supporting this recommendation is limited. This study investigated the impact of preconception weight stability and the surgery-to-conception interval on GWG and examined risk factors for GWG above or below recommendations. Methods: Women aged 18-45 years with singleton pregnancies post-bariatric surgery were recruited before 23 weeks' gestation and followed until delivery. Participants self-reported their weight for the 6 months preceding conception and again at 36 weeks' gestation via an online survey. Weight change (as a percentage of pre-pregnancy weight) was analyzed using stepwise linear and multivariate logistic regression. Results: Sixty-nine participants completed the study. The percentage of body weight change in the 6 months before conception ranged from -34% to +21%, with significantly greater preconception weight loss observed in those who conceived within 12 months of surgery (p < 0.001). The pre-pregnancy BMI and preconception weight change together explained 24% of the variation in GWG (p < 0.001), while the surgery-to-conception interval was not a significant predictor (p = 0.502). While 70% (34/49) of participants experienced weight gain outside of recommendations, no significant risk factors could be identified. Conclusions: Weight trajectory prior to conception is a key factor to predict GWG rather than the surgery-conception interval. These findings have important implications for family planning and clinical guidance following bariatric surgery.

AIM:This study aimed to explore the 'real time' expectations, experiences and needs of men who attend maternity services to inform the development of strategies to enhance men's inclusion. METHODS:A qualitative descriptive design was adopted for the study. Semi-structured face-to-face or telephone interviews were conducted with 48 men attending the Royal Brisbane and Women's Hospital before and after their partner gave birth. Data were coded and analysed thematically. RESULTS:Most respondents identified their role as a support person rather than a direct beneficiary of maternity services. They expressed the view that if their partner and baby's needs were met, their needs were met. Factors that contributed to a positive experience included the responsiveness of staff and meeting information needs. Factors promoting feelings of inclusion were being directly addressed by staff, having the opportunity to ask questions, and performing practical tasks associated with the birth. CONCLUSION:Adopting an inclusive communication style promotes men's feelings of inclusion in maternity services. However, the participants' tendency to conflate their needs with those of their partner suggests the ongoing salience of traditional gender role beliefs, which view childbirth primarily as the domain of women.

Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = −1.9, −3.6, and −5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = −0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49–0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19–0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.

Background Although associations between maternal exposure to adverse childhood experiences (ACEs) and perinatal anxiety and depression are established, there is a paucity of information about the associations between ACEs and perinatal trauma and perinatal post-traumatic stress outcomes. For the purposes of this article, perinatal trauma is defined as a very frightening or distressing event that may result in psychological harm. The event must have been related to conception, pregnancy, birth, and up to 12 months postpartum. Methods Women recruited at an antenatal appointment ( n = 262) were invited to complete online surveys at two-time points; mid-pregnancy and eight weeks after the estimated date of delivery. The ACE Q 10-item self-reporting tool and a perinatal trauma screen related to the current and/or a previous perinatal period were completed. If the perinatal trauma screen was positive at either time point in the study, women were invited to complete a questionnaire examining symptoms of perinatal post-traumatic stress disorder and, if consenting, a clinical interview where the Post-traumatic Symptoms Scale was administered. Results Sixty women (22.9%) reported four or more ACEs. These women were almost four times more likely to endorse perinatal trauma, when compared with those who either did not report ACEs (OR = 3.6, CI 95% 1.74 – 7.36, p < 0.001) or had less than four ACEs (OR = 3.9, CI 95% 2.037.55, p < 0.001). A 6–sevenfold increase in perinatal trauma was seen amongst women who reported having at least one ACE related to abuse (OR = 6.23, CI 95% 3.32–11.63, p < 0.001) or neglect (OR = 6.94, CI 95% 2.95–16.33, p < 0.001). The severity of perinatal-PTSD symptoms for those with perinatal trauma in pregnancy was significantly higher in those women exposed to at least one ACE related to abuse. Conclusions Awareness of maternal exposure to childhood adversity/maltreatment is critical to providing trauma-informed approaches in the perinatal setting. Our study suggests that routine screening for ACEs in pregnancy adds clinical value. This adds to previous research confirming the relationship between ACEs and mental health complexities and suggests that ACEs influence perinatal mental health outcomes.