Background: Dietary quality has been linked to adequate nutrient intake and women’s health. However, the relationships among dietary diversity, pregnancy outcomes and environmental sustainability remain uncertain. Methods: This study evaluated the associations between adherence to the Minimum Dietary Diversity for Women (MDD-W), pregnancy outcomes, and the environmental footprints of maternal diets. This was a multicentre prospective cohort that included 1,318 low-risk nulliparous women in Brazil and used 24-hour dietary recall (24hR). Maternal diets were classified according to adherence to the Minimum Dietary Diversity for Women (MDD-W) guidelines. Associations between MDD-W adherence and pregnancy outcomes were assessed via logistic regression. The environmentalimpacts of maternal diets were estimated via the Footprints of Foods and Culinary Preparations Consumed in the Brazil database. Results: In the total sample, 904 women achieved MDD-W adequacy (≥5 food groups), whereas 414 were classified in the non-adequacy group (<5 food groups). MDD-W adequacy was not associated with adverse pregnancy outcomes(OR = 0.90, 95% CI: 0.69–1.17). Although the main differencein dietary intake between groups was predominantly plant-based, the adequacy group had greater environmental impacts, even after adjustment per 1,000 kcal, in terms of the ecological footprint(eco-score/day), carbon emissions (g/day) and water use (L/day). The MDD-W is a useful indicator of adequate micronutrient intake. However, dietary intake ofcalcium, iron, folate, and vitamin A was below the recommended levelin approximately 80% of individuals in both groups. Conclusions: Our findings suggest that although MDD-W adherence is a useful tool for dietary micronutrient intake, it is not associated with pregnancy outcomes and that achieving dietary diversity may entail a greaterenvironmental footprint, revealing trade-offs between nutritional adequacy indicators and sustainability goals. This underscores the need for integrated food and nutrition policies that simultaneously address maternal health and environmental sustainability. Pregnant women sit at the nexus of human and planetary futures, highlighting the need for a “double future” perspective linking maternal health and planetary boundaries.

Objective:to analyze the prevalence of congenital anomalies among women who had preterm births, their association with gestational age, characteristics of pregnancy termination and perinatal outcomes. Methods:A secondary analysis of the Brazilian Multicenter Study on Preterm Birth (EMIP), a multicenter cross-sectional study in 20 maternity hospitals, comparing cases of preterm birth with and without anomalies. A random sample of term births served as controls. The risk of malformations was estimated by maternal age, gestational age, type of onset of labour, mode of delivery, and neonatal outcomes using OR (95%CI) for categorical variables. Results:Among 4,150 preterm births and 1,146 selected term controls, congenital anomalies were found in 7.21% of cases (8.36% in preterm vs. 3.1% in term). Preterm birth increased the risk of anomalies by 2.89-fold (95% CI: 2.03-4.13). Cardiovascular anomalies were most common (19.1%), followed by central nervous system anomalies (18.8%) and abdominal wall defects (12.5%). The highest risk was observed at 28-31 weeks (OR 4.57, 95%CI 3.01-6.94). Elective cesarean delivery was more frequent among neonates with abnormalities (40.1% vs. 32.1%, OR 1.41, 95% CI: 1.13-1.77). Neonates with abnormalities had a higher risk of low 5th minute Apgar scores (OR 2.68, 95% CI: 2.01-3.56), birth weight <1.5 kg (OR 1.46, 95% CI: 1.14-1.87), and adverse outcomes such as NICU admission, sepsis, and neonatal mortality (OR 6.0, 95% CI: 4.58-7.85). Conclusion:Prematurity is associated with congenital anomalies, leading to increased neonatal morbidity, mortality, and admission to NICU.

OBJECTIVE:To describe the use of the WOICE tool for assessing non-severe maternal morbidities among pregnant and postpartum women with hypertensive disorders. METHODS:Secondary analysis of a previously published cross-sectional study performed in Brazil, with the inclusion of women with hypertensive disorders (pre-eclampsia, chronic hypertension, and gestational hypertension), comparing them in the antenatal and postpartum periods. The WOICE tool was applied during 28 weeks of gestational age and in the 40th day after delivery. The study was conducted at a referral maternity hospital between November 2017 and December 2018. Descriptive and comparative analyses were performed using appropriate statistical tests. Prevalence ratio (PR) identified factors associated with functional impairment were assessed through multivariable analysis. RESULTS:Of 1046 women, 238 had hypertensive disorders and were included (99 pregnant, 139 postpartum). The mean age was 30 years old in both groups. Most participants had completed secondary education and were married. Among women in the postpartum period, there was a significant decrease in the frequency of employed women (P = 0.009). Functional impairment was reported in 40.4% versus 12.2% (P < 0.001); anxiety affected 31.3% versus 14.4% (P < 0.001); depressive symptoms were present in 13.1% versus 4.3% (P < 0.001), respectively, ante- and postpartum. Substance use was similar (13.1% vs. 14.4%). Risk of violence was reported by 7.1% of pregnant and 5.0% of postpartum women (P = 0.581). Having pre-existing conditions (PR 2.40, confidence interval [CI]: 1.28-4.51, P = 0.006) and anxiety (PR 2.75, CI: 1.31-5.77, P = 0.008) were associated with impaired functioning in prenatal care. Breastfeeding protected women from impaired functioning in the postpartum period (PR 0.12, CI: 0.02-0.69, P = 0.017), while having pre-existing conditions (PR 4.40, CI: 2.29-8.74, P < 0.001) increased the risk during the postpartum period. CONCLUSION:Anxiety, depression, and functional impairment were frequent among women with hypertensive disorders during pregnancy, occurring during antenatal and postpartum care. These findings highlight the need of routine maternal mental health screening and multidisciplinary care to identify and properly treat women affected by those conditions.

OBJECTIVE:This study conduct viral genome sequencing among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant and postpartum individuals, and investigates disease severity and maternal and perinatal outcomes considering variant of concern (VOC) and non-VOC groups. METHODS:The study was designed as a prospective cohort study of unvaccinated pregnant and postpartum women with SARS-CoV-2 infection diagnosed by quantitative reverse transcription polymerase chain reaction between May 2020 and April 2021 at a maternal referral center. Initially, 111 participants were identified, and 50 presented with conditions for genome sequencing and further analysis. The SARS-CoV-2 genome was subjected to next-generation sequencing in eligible cases. Sociodemographic characteristics, background, and clinical and obstetric outcomes were compared according to the SARS-CoV-2 genomic data (VOC vs. non-VOC). RESULTS:Among the sequenced cases, 18 were classified as VOC, among which 14 were Gamma cases and four Alpha. Oxygen desaturation, hospitalization, intensive care unit admission, invasive ventilation, and maternal death were significantly higher in SARS-CoV-2 VOC-infected than in non-VOC-infected cases. All three cases of maternal death were classified as VOC, including two Gamma and one Alpha. CONCLUSION:Pregnant and postpartum people presented with an increased morbidity and mortality due to COVID-19 caused by SARS-CoV-2 VOC, especially Gamma. The increased risk of clinical severity in the unvaccinated obstetric population underscores the importance of addressing the repercussions of the SARS-CoV-2 genomic evolution.

Objective:To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries. Design:Individual participant data meta-analyses. Data sources:PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021). Eligibility criteria for selecting studies:Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions. Results:The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ2=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes. Conclusions:These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health. Review registration:PROSPERO CRD42023432836.

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.

BackgroundSpontaneous preterm birth (SPTB) is the leading cause of perinatal and early childhood mortality worldwide. Studies have generally suggested that mid-trimester transvaginal sonographic cervical length <25 mm is an important predictor of SPTB. Aggregate data meta-analyses are limited by data availability and reporting in the primary literature. The purpose of this individual participant data meta-analysis (IPDMA) was to quantify the prognostic value of mid-trimester cervical length for SPTB in asymptomatic women with singleton pregnancy, and to assess other factors which may modify this association.Methods and findingsThe project was prospectively registered with PROSPERO (CRD42020146987). We searched Medline, Embase, CINAHL, LILACS, Database of Abstracts of Reviews of Effects (DARE), Cochrane database, JBI Database of Systematic Reviews, ClinicalTrials.gov, and Google Scholar. We included cohort studies and non-treatment arms of randomized controlled trials which assessed an association between mid-trimester transvaginal sonographic cervical length and SPTB in asymptomatic women with singleton pregnancy. The search was performed on 30/9/2020, with an update performed on 4/11/2025. The primary outcome was STPB <37 weeks. Two reviewers screened all studies for inclusion and performed risk of bias assessments using QUIPS. We performed a two-stage IPDMA in a logistic regression model using cervical length as a continuous variable (the primary analysis) with restricted cubic splines to explore non-linear associations. IPD of 27 eligible studies were obtained and included (n = 91,404). Mean cervical length was 40 mm (standard deviation [SD] 9 mm) at about 20 weeks' gestation. SPTB <37 weeks occurred in 4,442 (5.2%) participants. An L-shape non-linear association between cervical length and SPTB was observed. A longer cervical length was associated with steeply lower odds of SPTB until it reached 40 mm, beyond which the odds of SPTB became stable. This means that compared to a woman with a cervical length of 40 mm, those with a cervical length of 20 and 30 mm were associated 6.22 and 2.10 higher odds of SPTB (95% confidence intervals [4.76, 8.13] and [1.85, 2.38]), respectively. Limitations included suboptimal data retrieval rate (51% of all eligible participants) and a lack of comprehensive co-predictors of SPTB across all datasets.ConclusionWe found a non-linear association between cervical length and SPTB. We found a non-linear association between cervical length and SPTB. Shorter cervix is associated with progressively higher risk of SPTB when length is less than 40 mm, but probability of term birth is high when cervical length is over 40 mm.

Objective:This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes. Methods:This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses. Results:A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 - 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 - 0.853); P=0.002]. Conclusion:The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.

Despite global progress and a marked reduction in maternal mortality ratio worldwide, the burden of maternal death and morbidity remains a huge challenge, especially among low- and middle-income settings. Maternal mortality is determined by multiple components. As a result, sustainable strategies require not only the implementation of effective health policies but also social development. In this narrative review, we discuss strategies to improve the maternal mortality ratio based on recent advances in public health. Primary care plays a key role in identifying background conditions, risk factors and early signs of some major causes of maternal mortality and morbidity. Antenatal care also addresses other conditions that influence outcomes: unwanted pregnancies, nutrition, sexually transmitted illnesses, family planning, immunization, and child health. Therefore, awareness about major causes of maternal mortality, direct and indirect targeted interventions to adequately identify risk factors, implement prophylactic interventions when available and guarantee early diagnosis, can certainly impact outcomes.

INTRODUCTION:A generic research protocol was developed for a prospective cohort study to allow systematic, harmonized data collection of the impact of SARS-CoV-2 infection and vaccination during pregnancy on maternal, obstetric, and neonatal outcomes across different settings. This article describes the study conception, development, implementation, challenges, and key lessons learned within study sites across the world. METHODS:The protocol was implemented in 43 facilities in 10 countries during the pandemic, involving consecutive recruitment of over 16,000 pregnant or postpartum women. We evaluated selection of study sites, ethical approvals, staff recruitment and training, recruitment and follow-up, and incorporation of new elements over the course of the pandemic across the study sites. RESULTS:Study implementation in multiple LMIC settings was feasible; however, major challenges included delays in study implementation due to ethical approval procedures and availability of testing for exposure assessment. Implementation of research during a constantly evolving pandemic context led to the need for amended protocols, adjusted sample sizes, new outcomes and variables, repeated review by the Ethical Committees and adapted laboratory protocols. For example, the first COVID-19 vaccines became available after the study had started, with the need to modify the data collection forms and serologic testing algorithm to allow incorporation of this information in the study structure and analysis. CONCLUSION:Study implementation during a pandemic in different countries and periods was challenging but is not only expected to provide important information on the effects of SARS-CoV-2 infection and vaccination on pregnancy, but also on conducting research during future outbreaks. More streamlined ethics reviews during pandemics, availability of generic protocols in advance, and sites in LMICs ready to activate in an outbreak, as opposed to triggering processes during a crisis, would be highly beneficial.

[This corrects the article DOI: 10.3389/fnut.2025.1619844.].

Objective:To compare maternal and perinatal outcomes in pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection among admissions in public and private maternity hospitals before COVID-19 vaccination. Methods:We performed a secondary analysis of the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative, a national multicenter cohort study in Brazil, considering pregnant and postpartum women with suspected or confirmed SARS-CoV-2 infections (from February 2020 to February 2021) in 15 maternity centers (2 private and 13 public facilities). Sociodemographic and obstetric characteristics were compared according to the type of hospital care. The clinical and laboratory findings and maternal and perinatal outcomes were compared between the two groups. The prevalence ratio and its 95% confidence interval for each predictor and outcome were calculated. Results:Of the 559 symptomatic cases tested, 289 confirmed COVID-19 cases were included, with 213 (72.7%) and 76 (27.3%) women in public and private hospitals, respectively. The frequency of SARS-CoV-2 infection did not differ significantly between the groups. Women treated at public hospitals had lower education levels (p<0.001), and 50% declared that their pregnancy was unplanned. We recorded 13 maternal deaths among women treated at public hospitals and no maternal deaths among pregnant women treated at private hospitals (p=0.024). Pregnant women in public hospitals had higher rates of fever (p=0.041), tachypnea (p=0.003), abnormal laboratory findings of liver enzymes (p=0.005), and severe acute respiratory syndrome (SARS) (p=0.014), and their neonates presented with more neonatal respiratory distress (p=0.020). Conclusion:Adverse maternal and perinatal outcomes were worse in the public hospital group, with increased rates of SARS and neonatal respiratory distress. The alarming difference in the number of deaths between patients treated in the public and private sectors highlights the urgency of better understanding the social determinants of health and calls the attention of leaders and policymakers to take action in mitigating their impact.

Objectives To analyze maternal and perinatal outcomes and serum levels of the preeclampsia (PE) biomarkers sFlt-1 and PlGF in pregnant women with hypertensive disorders vaccinated against SARS-CoV-2, with or without confirmed COVID-19 during pregnancy. Methods Multicenter (two-center) prospective cohort study secondary analysis. The cohort comprised pregnant women with hypertensive disorders who received SARS-CoV-2 vaccination, assessed from August 2021 to December 2022. Key variables included sociodemographic information, clinical background, maternal and perinatal outcomes, and biomarkers serum concentrations. A sFlt-1/PlGF ratio ≥ 38 was the threshold for predicting PE. The study compared outcomes based on the timing of SARS-CoV-2 infection and PE clinical onset. Results For biomarker analysis, 170 women provided serum samples: 31 had a confirmed COVID-19 during pregnancy, while 139 did not. Among these 170 women, 86 had chronic hypertension, and 100 developed PE. There were no significant differences in sociodemographic characteristics and gestational outcomes between the groups. The dynamics of the sFlt-1/PlGF ratio were similar regardless of COVID-19. Cesarean delivery was the most common delivery method in both groups, and there was a high rate of preterm births. No neonatal or maternal deaths were recorded. Conclusions The study suggests that pregnant women with hypertensive disorders who have been vaccinated against SARS-CoV-2 and subsequently infected show comparable maternal and perinatal outcomes and PE biomarker levels to those who were not infected. These results suggest that SARS-CoV-2 vaccination is protective for pregnant women, potentially reducing the association with a PE-like syndrome in severe cases of COVID-19 among those who are unvaccinated.

OBJECTIVE:The aim of our study was to assess the associated factors of planned and unplanned pregnancies (UPs) among pregnant women in São Paulo, Brazil. METHODS:We conducted a cross-sectional study from March 2023 to June 2024 and invited pregnant women aged 18 to 49 years. We used the Brazilian-validated version of the London Measure of Unplanned Pregnancy to assess pregnancy intentions. We estimated absolute and relative frequencies of planned and UPs by sociodemographic and reproductive characteristics. Bivariate and multiple regression analysis were performed to evaluate the associated factors for UPs. RESULTS:We included 534 participants; 65.7% reported an UP. Black or Biracial vs White women (74% vs. 57%, p < 0.001), with 0 to 9 years vs. those with >9 of schooling (77% vs. 51%, p < 0.001), and single vs married women (85% vs. 48%, p < 0.001) were associated with UPs. Parous women or those reporting a younger age at their sexual debut were more commonly reported UPs. The associated factors to UPs were being Black or Biracial (Odds ratio [OR] 1.68, 95% Confidence Interval [CI] 1.11;2.57), reporting fewer schooling years (OR 1.61, 95% CI 1.01;2.54), not being married [(OR 2.41, 95% CI 1.53;3.84) for cohabiters and OR 5.23, 95% CI 2.93;9.74) for single] and reporting additional births (OR 1.28, 95% CI 1.07;1.56). CONCLUSION:Black or Biracial, with fewer years of schooling, not married, and parous women were at a higher risk of UPs. These women tend to face structural barriers to planning the size and timing of their families, requiring actions like increasing tertiary education access and guaranteeing universal modern contraceptive availability to leverage these disadvantages and fulfil their sexual and reproductive rights.

Objective: The current study aimed to describe risk factors for adverse perinatal outcomes (APOs) among pregnant women nonvaccinated for COVID-19 who had respiratory symptoms. Methods: A nested case-control study was performed within the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative. Women were recruited during pregnancy in 15 maternity hospitals in Brazil from February 1, 2020, to February 28, 2021, while seeking medical care for respiratory symptoms, and were followed up until childbirth regardless of confirmation of COVID-19. For this analysis, women were divided into two groups: (1) those with APOs, defined as the occurrence of fetal or neonatal death, preterm delivery, 5-min Apgar score <7, neonatal respiratory distress, neonatal mechanical ventilation, admission to the neonatal intensive care unit, small-for-gestational-age newborn, or any neonatal morbidity; and (2) those without APOs. Results: The total number of women included in this analysis was 481, with 210 having APOs (43.7%). The characteristics independently associated with APOs were a composite outcome of severe acute respiratory syndrome, maternal admission at the intensive care unit, or maternal death (relative risk [RR], 3.30 [95% confidence interval (CI), 1.38-7.89]), living in the North and Northeastern regions of Brazil (RR, 3.09 [95% CI, 1.13-8.41]), and pre-eclampsia (RR, 2.77 [95% CI, 1.19-6.43]). Conclusion: Severe maternal illness was strongly associated with APO regardless of COVID-19 confirmation. It is essential to provide sufficient and timely health care for women who have respiratory symptoms compatible with COVID-19.

This paper details the integration of open-source databases on food production and consumption, pesticide use, water and land use, and nutrient supply, segmented by year and region. The process of extracting, transforming, and loading information was divided into four phases: 1) water and land use, harvest, and nutrient metrics; 2) pesticide and crop records; 3) pesticide residues with legal limits and their environment risk; 4) food acquisition and consumption by region and year. This effort resulted in 48 years of agrifood system data from 114 datasets across eight public platforms, providing a comprehensive view of the variations in agricultural production and consumption in Brazil.