Abstract Background Low 5-minute Apgar scores remain an important indicator of compromised neonatal status and may assist in identifying high-risk newborns in resource-constrained or high-volume labour ward settings. Accurate prediction of newborns at risk could guide timely intrapartum and immediate postpartum interventions. Because risk factors vary by maternal parity, prediction models may benefit from a parity-specific approach. This study aimed to develop and internally validate two prognostic models for predicting low 5-minute Apgar scores, stratified by parity. Methods The analysis used data from 124,376 singleton births at or beyond 28 weeks of gestation, recorded between July 2021 and December 2023 across 16 hospitals in Benin, Malawi, Tanzania and Uganda. Model predictors were selected using a knowledge-based approach, and multivariable logistic regression was performed. Model performance was assessed through calibration and discrimination with internal validation conducted using bootstrapping. The predicted outcome was the 5-minute Apgar score, categorised as low (< 7) or normal (≥ 7). Results In the overall study population, 6.3% of newborns received a low Apgar score. The final nulliparous and parous models included 14 and 19 predictor parameters, respectively, with country included as an additional fixed effect. The models demonstrated moderate optimism-adjusted performance, with C-statistics of 0.663 for the nulliparous model (95% CI: 0.654–0.675) and 0.732 for the multiparous model (95% CI: 0.724–0.740). Calibration was excellent in both models, with calibration-in-the-large (CITL) values of 0.000–0.001 and calibration slopes of 0.989–0.995. Antepartum haemorrhage and severe anaemia were the strongest contributors in both models. Conclusions Two prediction models for low 5-minute Apgar scores, one for nulliparous and one for parous women, demonstrated moderate predictive ability. External validation and further testing are necessary to assess the generalisability and clinical utility of these models.

Abstract Background Multimorbidity during pregnancy, the coexisting of two or more chronic health conditions, is linked to negative impacts on foetal development, adverse birth outcomes, and increased risk of future health problems for mother and child. While existing research has explored single chronic conditions in relation to pregnancy outcomes, there remains a significant gap in understanding how multimorbidity influence maternal and neonatal health. This review aims to identify, assess, and synthesise literature on multimorbidity during pregnancy and its adverse perinatal and neonatal clinical outcomes to inform future research and public health interventions. Methods We conducted a systematic review of perinatal and neonatal outcomes, following the PRISMA 2020 guidelines. Embase, Web of Science, and Medline databases were searched to find relevant cohort and case-control studies published (January 1, 2015-March 3, 2025). There were no restrictions on setting or language. A narrative synthesis was conducted to summarise the existing findings between multimorbidity during pregnancy and adverse outcomes in offspring. Results Of 7,531 publications screened, 54 articles were included. Most studies (n = 28) reported on pregnant women with multiple physical non-communicable diseases (NCDs), followed by those with infectious diseases (n = 11), two or more mental health conditions (n = 5), environmental exposures (n = 3), comorbid physical NCDs and mental health conditions (n = 5), and substance use (n = 2). The most common outcomes reported were preterm birth (n = 30), neonatal intensive care unit admission (n = 15), low Apgar scores (n = 13), neonatal mortality (n = 13), and small-for-gestational age (n = 13). This systematic review also revealed that there is variance in how multimorbidity is defined and how neonatal outcomes are measured and recorded, including the terminology used, values for adverse outcomes, and the points at which the outcomes were measured. Conclusions This review identified adverse outcomes associated with multimorbidity during pregnancy and highlighted the need to shift research priorities towards multimorbidity research, especially in lower-income countries. A concrete definition of multimorbidity and a globally standard set of measurements to be recorded at birth are needed to facilitate research that is generalisable across contexts. By identifying pregnancy outcomes in women with multimorbidity, vulnerable populations can be targeted for more effective interventions.

OBJECTIVE:To describe the Appropriate Use of Cesarean Section Through Quality Decision-Making (QUALI-DEC) intervention-a multifaceted strategy to optimize the use of cesarean section in low- and middle-income countries-using the Template for Intervention Description and Replication (TIDieR) checklist to enable replication and scale-up. METHODS:The QUALI-DEC intervention was implemented between July 2022 and April 2024 in 32 hospitals among Argentina, Burkina Faso, Thailand, and Viet Nam. Following the 12-item TIDieR checklist, we report in detail the four components of the intervention: (i) opinion leaders to promote evidence-based practices, (ii) audit and feedback using the Robson Ten Group Classification System, (iii) a Decision Analysis Tool to support informed decision-making by women, and (iv) companionship during labor and childbirth. Implementation processes, training, resources, and contextual adaptations were systematically documented. RESULTS:Opinion leaders were pivotal in training staff, leading audits, and sustaining implementation. Healthcare workers from participating facilities were trained in using clinical algorithms, the Ten Group Classification System, audit report forms, the Decision Analysis Tool, and the World Health Organization model of companionship. The intervention was coupled with online technology to facilitate training, data collection, and feedback loops. Overall, the QUALI-DEC intervention was feasible across diverse contexts, with variations reflecting local culture, infrastructure, and policy. CONCLUSION:Appropriate cesarean section use is shaped by women, providers, and organizational factors, making behavioral change complex. The QUALI-DEC intervention provided a pragmatic, team-based strategy to empower women and engage healthcare providers in evidence-based and patient-centered decision-making. Using the TIDieR checklist ensured a detailed description, supporting replication, implementation, and monitoring in other maternity units in low- and middle-income countries. TRIAL REGISTRATION:ISRCTN67214403.

OBJECTIVE:To explore women's expectations and experiences of care and support from pregnancy to childbirth in Burkina Faso, with a focus on the role and impact of companions and providers. DESIGN:An exploratory qualitative study based on in-depth interviews with purposively sampled participants and employing reflexive thematic analysis. SETTING:Two public hospitals in urban Burkina Faso having implemented the 'QUALIty DECision-making by women and providers for appropriate use of caesarean section' intervention. PARTICIPANTS:24 purposively selected postpartum women with variation in terms of parity, mode of birth, labour companionship experiences, education level and occupation were interviewed before discharge from the hospital. RESULTS:The two themes generated from the analysis elucidate how women rely on providers and companions to navigate uncertainty and vulnerability experienced during pregnancy and childbirth. Women viewed providers as essential for managing the biomedical risks of childbirth and voiced their need for care at critical moments. They expected companions to enhance the non-clinical aspects of their experiences by providing spiritual support and alleviating feelings of loneliness. However, participants also expressed ambivalence about companions witnessing intimate aspects of their birth experience and valued the ability to choose a companion as means to preserve personal integrity. CONCLUSIONS:Both providers and labour companions play an essential role in enhancing women's experiences of pregnancy and childbirth in Burkina Faso. Additional research and programmatic efforts are needed to support women's equitable participation in patient-provider interactions and operationalise the notion of choice of a labour companion in a contextually appropriate manner.

Misinformation increasingly undermines trust in childhood immunization among both the public and healthcare workers. Innovative, scalable educational approaches are needed to strengthen vaccine confidence across diverse settings. Objectives: To describe and evaluate a global initiative delivering asynchronous online vaccination courses, focusing on participant reach, completion, and qualitative experiences. We conducted a pilot evaluation using descriptive analysis of enrollment and completion data, combined with qualitative content analysis of voluntarily submitted open-text feedback. Courses were fully online, self-paced, accredited for continuing professional development, and implemented through international, local, and institutional partnerships. Between April 2024 and December 2025, seven courses were delivered. A total of 3,018 participants from 75 countries completed at least one course, with an overall completion rate of 31.5%. Sixty feedback entries from low-, middle-, and high-income settings were analyzed. Nine themes emerged, with differing emphases across contexts. Asynchronous online vaccination education can decentralize knowledge at scale, support trust-building and empowerment, and complement traditional immunization communication strategies.

We developed the facility-based, four-component A ction L everaging E vidence to r educe perinatal Mor t ality and Morbidity (ALERT) intervention, which combined co-design, training, quality improvement and leadership mentoring of maternity units’ heads addressing high perinatal mortality and morbidity in Benin, Malawi, Tanzania and Uganda. ALERT was implemented to promote essential practices of intrapartum childbirth and evaluated using a stepped-wedge cluster-randomized trial with five six-month periods across 16 hospitals. Primary outcomes were in-facility fresh stillbirths and the composite indicator of early perinatal mortality (fresh stillbirth and 24-hour neonatal mortality). Secondary outcomes were hypoxic-ischemic events (Apgar score <7), Cesarean section rate, responsiveness, and respectful care. We estimated separate hospital-specific mixed-effects regression models for binary outcomes and continuous variables to account for heterogeneity across hospitals and countries. All models included treatments status, time period, and random intercepts for randomization groups. We combined effects across hospitals using random-effects meta-analysis with the DerSimonian-Laird estimator. Among 134,630 women (139,300 neonates), the intervention was associated with 12% lower odds of fresh stillbirth (adjusted odds ratio AOR 0.88, 95% CI 0.68-1.13) and 22% lower odds of the composite outcome early perinatal mortality (AOR 0.78, 95% CI 0.65-0.94). The odds of hypoxic-ischemic events were reduced by 19% (AOR 0.81, 95% CI 0.69-0.95). Cesarean section rates increased (AOR 1.14 95% CI 1.01-1.27). We saw no statistically significant effects on our responsiveness or respectfulness measurements. The observed reduction in early perinatal mortality and morbidity underscores the value of investing in routine intrapartum care and multi-faceted interventions supporting context-specific strategies to build maternity provider capacities. (Funded through European Union No 847824, PACTR registration number 202006793783148)

Background: Maternal and child health in sub-Saharan Africa (SSA) is threatened by rising temperatures and critically low caesarean delivery rates. We assessed whether daily Heat Index (HI) exposure is associated with increased caesarean delivery risk across SSA. Methods: We conducted a two-stage case time series analysis using DHS birth records from 14 countries (175 668 births; 8050 caesarean deliveries) linked to CHIRTS-ERA5 daily HI data at 7991 cluster locations (2010–2020). Country-specific conditional quasi-Poisson models with distributed lag non-linear models (DLNM; lag 0–3 days) and cluster × year-month fixed effects were pooled via random-effects meta-analysis. Population attributable fractions (PAF) were estimated using the backward-perspective attributable risk method. Sensitivity analyses included restricting the analyses to emergency caesarean section. Findings: At country-specific 90th percentile of HI (reference: 26·7°C), the pooled incidence rate ratio (IRR) was 1·31 (95% CI 1·18–1·45; I2=0) by univariate meta-analysis, and 1·67 (1·05–2·66) at the global 90th percentile (39·1°C) by multivariate pooling. The full-year PAF for heat-attributable caesarean deliveries was 13·3% (95% CI 1·3–22·9%), corresponding to approximately 1,073 (102–1,844) deliveries in the study sample. Estimates strengthened during the hottest months: IRR 2·08 (1·11–3·89; I2=20·7%) and 2·54 (0·93–6·94), with a hot-season PAF of 28·0% (−8·8 to 46·9%). A sensitivity analysis restricted to emergency caesarean section yielded a directionally consistent but imprecise result (univariate IRR 1·14 [95% CI 0·87–1·51]; I2=26% and multivariate IRR 1·53 [0·82–2·83]). Interpretation: Heat exposure is associated with increased caesarean delivery risk across SSA with stronger effects during hotter seasons suggesting that annual estimates may underestimate the true burden at peak heat. Approximately 400 000 (95% CI 38 000–687 000) caesarean deliveries will be attributed to heat annually by 2030 in SSA. These findings support integration of heat-health early warning into maternal health services and climate-informed obstetric workforce planning.

Extreme high temperatures pose a growing threat to perinatal health, which is expected to intensify with accelerating climate change. While there is a growing body of evidence documenting heat-perinatal health outcomes, comparing studies worldwide poses multiple challenges, including heterogeneity in study designs and heat metrics. Furthermore, evidence from low-and-middle income countries is particularly underrepresented in the global evidence base. Using over 5 million births from hospital (11 locations), regional (two locations) and national (three countries) registry data across Africa, Europe and Latin America and the Caribbean (LAC), we employed a time-stratified case-crossover design to evaluate the association between short-term (<7 days) heat exposure comparing different heat metrics (temperature, Wet Bulb Globe Temperature, Universal Thermal Climate Index (UTCI), and heat index) and birth outcomes (preterm birth [PTB], stillbirth and low Apgar score). Here we show that compared to the 75th percentile of maximum UTCI, the 99th percentile was associated with 1.10-fold higher odds of PTB [95%CI: 1.07-1.14], with stronger heat-exposure associations in hospital-based registries in Africa (OR=1.22 [95%CI:1.05-1.42]) and LAC (OR=1.27 [95%CI :0.90-1.79]) than population-based registries in Europe (OR=1.10 [95%CI: 1.08-1.11]). We observed a 1.09-fold increase in the odds of stillbirth [95%CI: 0.92-1.27] and 1.08-fold increase in low Apgar score [95%CI: 0.99-1.18], with higher risks in Africa compared to Europe. All heat exposure metrics were highly correlated, with similar effect estimates observed, but slightly higher effects using UTCI in more humid countries. As one of the largest studies using harmonised statistical approaches, we provide robust estimates of the detrimental associations of heat on multiple birth outcomes, with stronger associations in low- and middle-income settings, highlighting the disproportionate vulnerability of these populations.

Maternal mortality, defined as the death of a woman during pregnancy or shortly after childbirth, is a key target of the sustainable development goals. Yet, in many low- and middle-income countries, accurate measurement of maternal mortality remains a major challenge. Reliable death registration systems are often incomplete or absent, making it difficult to calculate the maternal mortality ratio. However, opportunities exist to improve measurement. In about two thirds of low- and middle-income countries, more than 80% of births now occur in health facilities. This shift means that health facilities can serve as a valuable source of data not only for local quality improvement but also for informing population mortality estimates. However, this requires high-quality data. To improve the quality of facility-based data, we propose four simple quality metrics: (i) plausibility of reported national and subnational levels and patterns; (ii) the ratio of reported stillbirths to maternal deaths; (iii) the distribution of causes of death; and (iv) the share of deaths among women aged 35 years and older. Using data from the United Republic of Tanzania as an example, we show how these metrics can be applied to assess the completeness and internal consistency of routine health data systems. Our example aims to encourage quality assessment of facility-based data in other countries, alongside: (i) individual death reporting using standardized classification of causes of death; (ii) centralized data quality assessment based on the proposed metrics; and (iii) regular national on-site assessment of the completeness and accuracy of maternal and perinatal death reporting.

Introduction Health management information systems are crucial for a country’s health service planning and monitoring. Research findings indicate however that data produced within this system is often of low quality or not used for decision-making in low-resource settings like Tanzania. Policymaking and -implementation towards efficient data processes and use take place in an environment challenged by limited availability of human and other resources, low levels of supervision and feedback on data quality despite national and international guidance. To better understand how this complexity affects system governance, it is crucial to analyse perceptions and practices of national policymakers and subnational healthcare managers responsible for policy implementation. We therefore aimed to understand how policymakers and health care managers perceive and practice governance of health management information data systems and processes including the introduction of digital technology in Tanzania. Methods We conducted 16 interviews with policymakers and healthcare managers experienced in governance and use of health management information systems in two districts, two regions and at national level in Tanzania between October 2022 and January 2023. Reflexive thematic analysis grounded in constructivism was used. Themes were developed through reflexive sessions underpinned by complexity theory and Lipsky’s theory of street-level bureaucracy. Results Health management information system governance took place in a complex environment characterized by unpredictable funding and human capacity impairing policy agenda setting and its implementation. Policymakers at national level and healthcare managers at subnational level resorted to different power practices to ensure implementation of national policies and agendas. While policymakers mainly governed data processes using institutionalized means, e.g. international tools and guidance or formal communication platforms, healthcare managers governed implementation by making discrete, contextualized choices on managing relations with other actor groups through negotiation and connection.This led to transformed agendas in some cases but also allowed for innovations to make policies work. Conclusions A new perspective may be needed to understand how governance of routine health information, which is central to health system strengthening, is implemented in policy environments characterized by unpredictability, where governments strive for efficient data use. Drawing on the concept of complex adaptive systems, we propose expanding the definition of Health Management Information System governance to include not only process management but also the relationship management of interdependent actor groups, especially healthcare providers, the primary data collectors.

Background Facility readiness, or the staff, supplies, equipment, and infrastructure available and operational in health facilities, is a pre-requisite for high-quality care. We examined facility readiness for maternal and newborn care alongside location of births by facility type in four African countries to track readiness-adjusted coverage and supply and demand dynamics for delivery services. Methods We used 42 health facility surveys in Burkina Faso, Ethiopia, Kenya, and Nigeria to construct maternal and newborn intrapartum care readiness scores. Geospatial small area models estimated readiness trends from 2008 to 2023 by facility type and region. We estimated location of births by facility type from population surveys and multiplied these by readiness scores to estimate readiness-adjusted coverage. Linear regression assessed the association between changes in facility delivery and readiness. Findings In 2023, readiness was highest in public hospitals (76.9%–93.5%) in all four countries. Readiness scores increased from 2008 to 2023 in Ethiopia, Kenya, and Nigeria but declined in Burkina Faso. Readiness-adjusted coverage varied widely across regions and was higher in more densely populated areas on average. Facility delivery was positively associated with readiness in Kenya and Ethiopia but negatively associated in Burkina Faso and Nigeria. Interpretation Facility readiness rose substantially in three of four countries since 2008, though improvement is still needed, particularly outside densely populated areas. The readiness-utilisation relationship is context-dependent. Policies that increase facility delivery should be paired with investments in facility capacity and strategies to ensure women deliver in adequately prepared facilities. Funding The Gates Foundation.

Objective The aim is to explore co-design facilitators’ perspectives and experiences of using co-design to improve intrapartum care in four sub-Saharan African settings. The inquiry focuses particularly on how they fostered engagement, built trust and mitigated unintended consequences during the co-design process.Design Qualitative interview study with reflexive thematic analysis.Setting Sixteen public and private not-for-profit hospital-based maternity units in Benin, Malawi, Tanzania and Uganda (four per country).Participants A total population sample of 10 co-design facilitators involved in a hospital-based co-design project implemented in maternity units in Benin, Malawi, Tanzania and Uganda were interviewed. Semistructured interviews were conducted between December 2022 and January 2023.Results Co-design facilitators viewed co-design as a collaborative process to develop contextually relevant solutions. Our findings elucidate their role in facilitating consensus-building and fostering stakeholder ownership amidst significant power divides. They described approaches co-design facilitators take to maintain ongoing stakeholder engagement and manage misaligned expectations in a trusting and collaborative environment, while being mindful of existing tensions and power imbalances. They also highlighted key challenges faced, including navigating norms, power imbalances and unintended consequences.Conclusions This study underscores the importance of power-sharing, fostering ownership and engaging end users equitably and continuously in co-design efforts, while also being aware of how to address its potential unintended consequences. Further research is needed to understand co-design facilitators’ impact on co-design and how to address unintended consequences for stakeholders during and after co-design activities in intrapartum interventions in low-resource settings.

Multimorbidity during pregnancy, defined as the co-occurrence of two or more physical or psychological conditions, is an emerging global health concern associated with adverse birth outcomes. This systematic review addresses gaps in research by determining the global pooled prevalence of mental health-related multimorbidity amongst pregnant women and identifying key populations at higher risk of this type of multimorbidity. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered with PROSPERO (ID: CRD420251023056). A systematic search was conducted across MEDLINE, EMBASE, and Web of Science for peer-reviewed articles from January 1, 2015 to February 10, 2025, to capture the current landscape of mental health-related multimorbidity during pregnancy. Two independent reviewers screened titles and abstracts, full texts, extracted data, and assessed study quality using Covidence software. A proportional random-effects meta-analysis was conducted to calculate the global pooled prevalence of mental health-related multimorbidity during pregnancy. The original search across databases yielded 5,989 studies. The global pooled prevalence of mental-health related multimorbidity during pregnancy across the eligible 92 studies representing over 357 million pregnant women was 1.90

Access to higher education is a human right and central to SDGs 4, 5, and 10. In Iran, Bahá’ís have long faced systematic exclusion from formal higher education, leading to the creation of the Bahá’í Institute for Higher Education (BIHE). We describe a pilot fully online, generative AI-assisted basic biostatistics course using R for eight Master of Public Health students at BIHE. Delivered synchronously from October 2025 to January 2026, the course used project-based learning as the main assessment method. Each student completed an individual applied project based on a unique GenAI-generated dummy dataset to protect privacy. Most students had no prior experience in programming or biostatistics, yet all were able to apply key concepts and make steady progress. Students reported that GenAI supported learning by clarifying concepts, assisting with R questions, identifying packages, and resolving coding errors. With structured instructional support, this approach appears feasible for strengthening analytical capacity and promoting equitable access to higher education in vulnerable educational settings.

Objective:To assess the variations and quality of maternal and neonatal outcomes reported in studies on vacuum devices vs second-stage caesarean section through a systematic review. Methods:We searched major databases were searched from inception to January 2025. Two reviewers independently screened studies and extracted data. We grouped maternal and perinatal outcomes were grouped into mortality or morbidity and process or care-related categories, with 33 predefined categories and 62 subcategories. Frequencies were summarised as proportions, and outcome reporting quality was assessed using a modified Harman's questionnaire. We determined the associations between study characteristics and reporting quality through multilevel mixed-effects models. The protocol was registered (PROSPERO CRD42024469164). Results:Twenty-three studies including over 2.6 million women reported 352 outcomes (132 primary; 220 secondary). The frequently reported maternal outcomes were urogenital tract injury (40/137, 29.2%) and postpartum haemorrhage (32/137, 23.4%), while Apgar score (24/215, 7%) and musculoskeletal injury (22/215, 6%) were the most common neonatal outcomes. Most outcomes scored 2/3 on the modified Harman's questionnaire, with no significant improvement in reporting quality over time. Maternal outcomes had significantly higher quality scores than neonatal outcomes (β = 0.18, p = 0.002, 95% CI 0.06-0.29). Study setting was significantly associated with total quality scores, with studies from middle-income countries showing lower scores compared with those from high-income countries (β = -1.73, p = 0.003, 95% CI -2.88 to -0.57). There was no association between reporting quality and study size, outcome type (primary or secondary), or journal impact factor. Conclusions:Outcomes reporting quality varied considerably. Standardisation through a core outcome set is needed to improve comparability, evidence synthesis, and research quality on outcomes of vacuum-assisted births.

INTRODUCTION:Implementing shared decision-making (SDM) in maternity care remains challenging in low-income and middle-income countries (LMICs). Decision aids can support SDM, but evidence on their effectiveness in such settings is limited. We assessed the impact of a decision analysis tool (DAT) for pregnant women on mode of birth (MOB) within the QUALIty DECision-making project, a multisite, multicountry pragmatic trial to reduce unnecessary caesarean sections. METHODS:We conducted a cross-sectional survey among postpartum women considered at low risk for caesarean section in early pregnancy and who delivered in 32 hospitals across Argentina, Burkina Faso, Thailand and Viet Nam. Associations between DAT exposure and selected outcomes were analysed using multilevel, multivariate regression models adjusting for confounders and cluster effects. RESULTS:Of 2368 women included, 249 (11%) had used it outside antenatal care visits, 212 (9%) had heard of but not used it, and 1907 (80%) had never heard of the DAT. Compared with women who had never heard of the DAT, users were more likely to identify at least three risks/benefits of each MOB (adjusted OR (aOR) 1.9; 95% CI 1.3 to 2.8; p=0.001) and to communicate their preferred MOB to providers (aOR 2.3; 95% CI 1.5 to 3.6; p<0.001). DAT users were less likely to prefer caesarean section in late pregnancy (aOR 0.4; 95% CI 0.2 to 0.8; p=0.006) and reported higher birth experience and satisfaction scores (adjusted β=1.9; 95% CI 0.5 to 3.3; p=0.006). CONCLUSIONS:The use of the DAT was associated with improved knowledge, communication of birth preferences, lower caesarean preference and greater satisfaction, without adverse outcomes. Findings suggest that decision aids can strengthen SDM and promote respectful, women-centred maternity care in LMICs. TRIAL REGISTRATION NUMBER:ISRCTN67214403.

Importance: As the cultural, scientific, and legal landscape surrounding psychedelics continues to shift toward greater access and acceptability, it is likely that increasing numbers of women of reproductive age may be exposed to these substances. Despite this, the evidence on antenatal exposure has not been systematically reviewed. Objective To synthesize the human literature on child and maternal outcomes following antenatal exposure to classic psychedelics. Evidence review: A systematic literature search was conducted in Medline, Embase, Web of Science, PsycInfo and CENTRAL for original peer-reviewed studies published from inception to 15 July, 2025, that reported on antenatal exposure to psychedelics. Two independent reviewers conducted title and abstract screening, full text screening, data extraction and risk of bias assessment. The Joanna Briggs Institute (JBI) critical appraisal tools were used for risk of bias assessment. As significant heterogeneity in outcome reporting and study design precluded meta-analysis, the findings were qualitatively synthesized. The protocol was pre-registered on PROSPERO (CRD420251082910). Findings: A total of 42 studies met the inclusion criteria, encompassing 251 women who were exposed to a psychedelic substance during pregnancy or prior to pregnancy from across 9 countries. Almost all studies were conducted in high-income countries (k = 38, 90.5%), of which most were conducted in the US (k = 29, 69.0%). LSD was the most commonly reported psychedelic substance (k = 38, 90.5%), more than half of the articles were case reports (k = 23, 54.8%), and most studies were published prior to the year 2000 (k = 31, 73.8%). In terms of child and maternal outcomes, two articles (4.8%) reported on the outcome of spontaneous abortions, no articles reported on maternal deaths, one (2.4%) on stillbirth, 16 (38.1%) on neonatal mortality, 17 (40.5%) on preterm birth, 15 (35.7%) on birthweight and 26 (61.9%) on congenital malformations. The certainty of evidence for all outcomes was deemed to be very low using the GRADE approach. Conclusions and relevance: The current literature on child and maternal outcomes following antenatal exposure to psychedelics is notably sparse, mainly consisting of case reports or small sample sizes drawn almost entirely from high-income countries. These findings highlight that contemporary, methodologically robust research on psychedelics during pregnancy is urgently needed.

Background Cervical cancer causes morbidity and mortality among women worldwide, particularly in low- and middle-income countries (LMICs). Human Papillomavirus (HPV) vaccine is crucial for cervical cancer prevention, yet the vaccination rates remain suboptimal in Ethiopia. Studies identified cultural and religious factors as key barriers. While evidence suggests that faith leaders can effectively promote public health interventions, their potential role in HPV vaccination efforts has largely been overlooked and remains inadequately understood. Objective This study aimed to explore the perspectives of faith leaders in Addis Ababa to identify factors influencing HPV vaccination among girls. Methods This study employed qualitative methods, using in-depth interviews with purposively selected faith leaders. The faith leaders employed by the Inter-Religious Counsel of Ethiopia (IRCE) were excluded. A total of 13 faith leaders participated in the interviews. The 5C framework informed the data collection tool, and data analysis was conducted using inductive reflexive thematic analysis (RTA). Result Faith leaders are navigating between modern medicine and their religious beliefs, face distrust of Western vaccine aid intentions and local HPV vaccine providers, and receive fragmented or inconsistent information. These challenges make it difficult for them to act as champions for the vaccination, but with clear, well-organized information, there is an opportunity to involve them more effectively. Conclusion Faith leaders face several challenges that limit their role in promoting HPV vaccination. This study recommends providing clear, culturally relevant materials and communication strategies to support faith leaders and their communities. With these tools, faith leaders have the opportunity to engage and become effective advocates for the elimination of cervical cancer.

Abstract Introduction Maternal mortality remains a critical global health issue with profound psychosocial consequences that extend beyond the deceased woman to her family and the healthcare professionals (HCP) involved in her care. While substantial progress has been made in reducing maternal mortality worldwide, its social and psychological sequelae remain insufficiently studied, particularly in high-income countries. Methods This narrative review is based on a structured literature search conducted in PubMed and Google Scholar for studies published between 2000 and 2025. Study selection was guided by predefined inclusion criteria, and relevant articles were identified through keyword searches and snowballing. Data were extracted and analyzed using a narrative thematic approach focusing on psychosocial outcomes in families and HCP. Results The available evidence, predominantly derived from qualitative and mixed-methods studies in low- and middle-income countries—especially sub-Saharan Africa—demonstrates consistent patterns of psychological distress, social disruption, and long-term adverse outcomes among affected families. Children are particularly vulnerable to educational, emotional, and economic disadvantages following maternal death. For HCP, particularly midwives, maternal mortality is associated with significant emotional burden, including guilt, grief, and professional self-doubt, as well as social and occupational consequences. Discussion Despite the global relevance of maternal mortality, there is a marked lack of data from high-income settings. Existing findings suggest that both families and HCP experience substantial and enduring psychosocial impacts, yet structured institutional support systems are often lacking. Conclusion Maternal mortality has far-reaching psychosocial consequences for families and HCP alike. The findings highlight the urgent need for targeted support interventions, structured training, and further research, particularly in high-income countries, to better understand and mitigate these effects.