Somaliland faces persistently high burdens of maternal and perinatal mortality, with limited population-based data on pregnancy complications, sociocultural influence on maternal and perinatal health, and women’s reproductive health needs across the continuum of pregnancy, childbirth, and postpartum. Also, available health materials, such as for assessing maternal near misses (MNM) or strengthening healthcare literacy, often appear unfit in the contextual realities. In response, the objective of this study is to unfold the physical, cultural, and psychosocial strengths and challenges experienced by women in Somaliland during pregnancy, childbirth, and the postpartum period; to examine how these factors as well as the woman’s health-seeking behaviour influence pregnancy outcomes and women’s ability to achieve future reproductive health goals; and to pilot how these insights can inform the co-creation of context-appropriate health materials. The PROMISE study is a community-based longitudinal pregnancy cohort in Hargeisa, Somaliland, including approximately 800 pregnant women <28 weeks of gestation recruited from randomly selected sub-districts. Women will be followed up at three time points (<28 weeks of gestation, >36 and one-three months postpartum) using questionnaires and clinical measurements. An MNM tool will be adapted through a Delphi process, and its validity will be tested using the cohort. The cohort findings will inform a co-creation process to develop postpartum contraceptive counselling materials to be pilot-tested for feasibility, acceptability, and preliminary effects. This protocol responds to major evidence gaps in fragile and low-resource settings, and aims to generate contextually grounded evidence and co-created interventions to strengthen maternal health agency in Somaliland and beyond.

This study explored depressive symptoms across pregnancy and the postpartum period among women with gestational diabetes mellitus (GDM) in Vietnam. One hundred ninety-five women were recruited from 2 health care facilities in the Thai Binh Province, Northern Vietnam. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 3 time points: before GDM diagnosis (24-28 weeks), at 36 weeks' gestation, and 12 weeks postpartum. Mixed-effects linear models guided by a directed acyclic graph were used to examine associations. The EPDS scores remained stable during pregnancy but were significantly lower postpartum than at prediagnosis (mean difference [MD] = -2.94; 95% CI, -3.59 to -2.29) and 36 weeks' gestation (MD = -3.16; 95% CI, -3.72 to -2.61). Differences in EPDS trajectories were observed across sociodemographic characteristics, with women who were not living with their showing the greatest reductions in EPDS scores. Maternal mental health in GDM follows a nonlinear trajectory. Integrated GDM care should include mental health screening and social support.

Objective To assess the feasibility of randomising a sufficiently large number of pregnant women who screen positive for intimate partner violence (IPV) to perform a full-scale effectiveness trial. Methods This pilot randomised trial was nested within a cohort of IPV-positive pregnant women who accepted an e-health package in Spain and Denmark. This study was co-designed with patient input using a modified Zelen’s design and a qualitative evaluation. Eligible women were randomised to an intervention (received the e-health package) or to a control (received it with a delay). The primary outcome was the proportion of women screened positive for IPV who consented to be randomised to receive an e-health package with a delay. Results Twenty-nine of the 51 women in the cohort were randomised. Of these, 12 were allocated to the control group, and 7 (58.3%) consented to receive the e-health package with a delay, i.e., 24.1% of the total randomised and 13.7% of the total cohort. The proportion of randomized women who adhered to treatment was 31.03% (9/29). Complete outcome data were obtained in 7/17 (41.17%) and 2/12 (16.66%) women in the intervention and control groups, respectively. Qualitative interviews indicated that the women perceived the intervention as beneficial and that delaying it was not acceptable. Conclusions This pilot randomised trial indicated that a future full-scale randomised study would likely be unfeasible based on our a priori criteria to stop the trial. If a future large trial is launched, it should include an internal pilot with strict go/no-go criteria monitored by an independent committee. Trial registration NCT04978064. E-health Psychological Intervention in Pregnant Women Exposed to Intimate Partner Violence (eIPV). Registered 15 July 2021, https://clinicaltrials.gov/study/NCT04978064

Objectives To investigate the association between social support and self-care agency with maternal health behaviors among pregnant women in Thai Binh, Vietnam. Study design This study employed a cross-sectional design with self-reported data from pregnant women. Methods The study was conducted among 812 pregnant women. Quantitative data were collected using the Multidimensional Scale of Perceived Social Support and the Appraisal of Self-Care Agency - Revised scale, alongside questions regarding self-care behaviors (diet, exercise and micronutrient supplement intake). Logistic regression models were used to calculate odds ratios (ORs) of self-care agency (overall and three subcategories: having power, and developing power, and lacking power) and self-care behaviors in pregnancy as outcomes of social support (overall, from spouse, family or friends), adjusting for demographic, socioeconomic and pregnancy-related covariates. Results Overall social support, social support from spouse, family or friends were positively associated with the overall and all three subcategories of self-care agency (ORs from 1.53 to 2.53). Overall social support and social support from friends were negatively associated with self-care behaviors related to diet (OR=0.84; 95%CI:0.76-0.94; and OR=0.80;95%CI: 0.72-0.90, respectively). Overall social support and social support from spouses were positively associated with micronutrient supplement intake (OR=1.33; 95%CI: 1.04-1.72; and OR=1.57; 95%CI: 1.14-2.17, respectively), while social support from spouses may influence exercise (OR=1.14; 95%CI: 0.99-1.32). Of the women, 97.5% reported a confidant to be one of their children. Conclusions Social support appears to influence self-care agency and behaviors of pregnant women though their adherence to healthy diet is more complex.

Antenatal depression (AD) causes serious consequences to both mothers and their babies. This study aimed to estimate the prevalence and contributing factors, focusing on obstetric history and psychosocial factors of depression among pregnant women in northern Vietnam. A cross-sectional study was conducted at a maternity hospital and a private clinic in Thai Binh province, targeting women between 24 and 28 weeks of gestation from January to August 2023. The Edinburgh Postnatal Depression Scale assessed depressive symptoms, and Firth logistic regression identified associated factors. Out of 859 participants, 22.9% (95%CI: 20.2-25.9) showed signs of depressive symptoms. We did not find a significant association between obstetric historical factors and AD. However, we found various factors associated with high risk of AD among pregnant women, including history of depression (AOR = 61.46, 95%CI: 3.06 – 9133.33), anxiety (AOR = 30.93, 95%CI: 20.12 – 48.69), exposure to second hand smoke (AOR = 1.91, 95%CI: 1.22 – 2.99), and unwanted pregnancy (AOR = 2.21, 95%CI: 1.31 – 3.73). The prevalence of AD was high in our study. The findings highlight the need for greater awareness and early intervention for maternal depression in Northern Vietnam.

Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent health problem in low- and middle-income countries. In the majority of cases, the condition can be managed non-pharmacologically through changes in nutrition and exercise. As the global prevalence rises, it becomes imperative to explore self-care intervention for GDM as an alternative support beyond pharmacological treatments. This study assessed the feasibility of a co-createddigital self-care and social support intervention– the VALID II intervention. Methods: The intervention entailed several different components including educational materials (leaflets and videos) and digital supportive and educative elements via Zalo, private Facebook group, and Zoom meetings. Mixed methods were used to assess the feasibility of the VALID II intervention. We used an explanatory sequential design with a merging integration mixed method approach first collecting quantitative data, followed by the qualitative data and then co-analysing and comparing the data from various methods. Feasibility was assessed as a composite outcome through the following outcome measures: Recruitment rate, retention rate, and acceptability scores. Further, in-depth data on feasibility was collected through ethnographic interviews. The stop-go rules were pre-defined as 60% of recruitment rate and retention rate, and a median acceptability score of 3.0 or above. Results: A total of 202 women were diagnosed with GDM and invited to participate in the VALID II intervention group. All approached women gave informed consent to participate, achieving a 100% recruitment rate. A total of 154 women participated in the delivery and postpartum interviews, resulting in a retention rate of 76.2%. The medians of the acceptability score were 4.0. Both the recruitment, retention and acceptability rate satisfied the pre-registered stop-go rules. Furthermore, 21 women participated in the qualitative interviews, which revealed that despite challenges, the intervention was perceived as satisfactory and well-accepted. Conclusions: The VALID-II self-care and social support intervention targeted Vietnamese women with GDM was feasible, and has potential for a larger trial. Trial registration: NCT05744856. Trial status: Recruitment complete.

BACKGROUND:Gestational diabetes mellitus (GDM) is a transitory form of diabetes that presents during pregnancy with frequent adverse maternal and neonatal health consequences if left untreated. The prevalence of GDM is rapidly increasing in low- and middle-income countries such as Vietnam, and early sustainable interventions are important. The overall aim of this study-henceforth referred to as VALID-II-is to assess the feasibility of a co-created self-care and informal support intervention targeted at pregnant women with GDM. Further, the aim is to assess the potential efficacy of the intervention in reducing maternal and neonatal health complications compared with standard care. METHODS:VALID-II is a two-site, two-arm, non-randomised feasibility intervention study in Thai Binh Province in northern Vietnam with a delayed start for the intervention group. The intervention study is nested in a larger cohort. In total, 2000 pregnant women will be screened for GDM, with an estimated 400 women screening positive according to the World Health Organisation-International Association of Diabetes and Pregnancy Study Group diagnostic criteria. First, 200 women who screen positive for GDM will be assigned to a control group that will receive standard care. Among the 200 women, 20 will take part in an in-depth ethnographic study along with their family members, and the intervention will be co-created with them. Second, once the intervention has been created, 200 women will be assigned to the intervention group, which will receive the intervention plus standard care. Twenty women and their families from the intervention group will also take part in an ethnographic study. The primary outcome is to evaluate how feasible the self-care intervention is (composite outcome: recruitment, retention, and acceptability). Other secondary outcomes include the number of new-borns born large for gestational age, prevalence and risk factors for GDM, self-care agency, self-care, and breastfeeding practices. DISCUSSION:This study provides knowledge of the feasibility of informal/self-care and social support interventions and their preliminary impact on maternal and child health outcomes among women with GDM in northern Vietnam. Furthermore, it will inform parameters such as effect size and variance, which are essential for calculating the sample size needed to achieve the desired power in a future full-scale trial. This may guide decision makers in how to optimise the management of GDM in low- and middle-income contexts. TRIAL REGISTRATION:NCT05744856. TRIAL STATUS:Recruiting.

INTRODUCTION:Adverse birth outcomes, such as preterm birth, low birthweight, and small for gestational age, are critical indicators of neonatal health. While the impact of biomedical risk factors is well established, the role of psychosocial stressors, including intimate partner violence, remains less understood. This study investigates the association between intimate partner violence among pregnant women and adverse birth outcomes in a Danish context. MATERIAL AND METHODS:Based on routinely collected Patient-Reported Outcomes, we conducted a cohort study, including 28 697 pregnant individuals. Enrolled in the period from November 2019 to September 2022, the women were followed until childbirth, leading to 22 799 mothers-offspring pairs with valid data. Data on IPV exposure were collected through the Abuse Assessment Screen, detecting physical, psychological, and sexual violence and fear of partner. Birth outcomes were obtained from the Danish registries, including the Danish medical birth registry. Generalized linear models (GLMs) were used to calculate risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for confounders, such as maternal age, socioeconomic position, smoking status, and psychiatric disorders. RESULTS:Of the 22 799 mothers, 5.3% screened positive for intimate partner violence, and 1.9% reported intimate partner violence within the last year. Intimate partner violence was positively associated with preterm birth and low birthweight, with an increased risk of preterm birth (adjusted RR: 1.24, 95% CI 1.06, 1.45) and increased risk for low birthweight (adjusted RR: 1.35, 95% CI 1.04, 1.75) but showed no significant association with small for gestational age (adjusted RR: 0.93, 95% CI 0.78, 1.11). CONCLUSIONS:Our analysis demonstrates a significantly heightened risk of preterm birth and low birthweight among pregnant women who screened positive for intimate partner violence. These results underscore the need for targeted intimate partner violence screening and intervention strategies during prenatal care to reduce the burden of adverse birth outcomes.

Background Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods. Objective This study aims to assess the feasibility of implementing the World Health Organization’s 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders. Methods From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (n = 16) and healthcare providers and stakeholders (n = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner’s Social Ecological Model, supplemented with inductive subcategories from the transcripts. Results Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation. Conclusion WHO’s 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.

BACKGROUND:Gestational diabetes mellitus (GDM) increases adverse neonatal and maternal outcomes. Understanding the prevalence and risk factors of GDM is necessary to plan health care interventions and policy. OBJECTIVE:To determine the prevalence and risk factors of GDM in Thai Binh, Vietnam. METHODS:A cross-sectional study was conducted in two health facilities in Thai Binh, Vietnam, with the participation of 1,106 pregnant women. Women were recruited at their first antenatal care visit where face-to-face interviews about socioeconomic and reproductive factors were performed. A 2-hour 75 g oral glucose tolerance test was conducted at 24-28 weeks of gestation. GDM was diagnosed according to the World Health Organization 2013 criteria. Logistic regression analyses were used to assess the factors associated with GDM. RESULTS:The prevalence rate of GDM was 27.1%. Multivariate logistic regression analysis showed maternal age from 25 to 34 (adjusted OR 2.0; 95%CI 1.3-2.9), maternal age ≥ 35 (adjusted OR 3.0; 95%CI 1.7-5.4), pregestational body mass index ≥ 23 (adjusted OR 1.6; 95%CI 1.1-2.3), family history of diabetes (adjusted OR 1.9; 95%CI 1.3-2.9), fertility treatment (adjusted OR 2.3; 95%CI 1.3-3.8), and previous GDM (adjusted OR 3.1; 95%CI 1.4-6.9) were associated with increased odds of GDM. CONCLUSIONS:More than one-fourth of pregnant women in Thai Binh, Vietnam, may have GDM. Advanced maternal age, high pregestational body mass index, family history of diabetes, and previous GDM were associated with increased risk of GDM. Additionally, fertility treatment appears to be strongly associated with an increased risk of GDM.

Purpose: Uterosacral ligament suspension (USLS) intends to restore suspension of the vaginal apex to the sacrouterine ligaments and can be done by either laparoscopic (L-USLS) or vaginal (V-USLS) route. The aim of this study was to compare recurrence, reoperation rate, and symptoms of prolapse, incontinence and pain in women undergoing L-USLS or V-USLS. Methods: Our prospective cohort study included 63 women. All patients were included during 2015-2019. Women were examined by Pelvic Organ Prolapse Quantification system (POP-Q) at baseline and at a follow-up after one to five years. VAS-score and validated questionnaires (POPDI-6, UDI-6) were used. Objective recurrence was defined as POP-Q stage ≥2 at follow-up and subjective recurrence as patient-reported symptomatic recurrence and/or the need for retreatment by vaginal pessary or new prolapse surgery. Results: A total of 18 (58.1%) in the L-USLS group had POP-Q stage ≥2 at follow-up compared to 26 (81.3%) in the V-USLS group (p=0.045). The vaginal apex (POP-Q point C) was -5cm (-6-(-4.5)); median and (IQR) following L-USLS and -3.5cm (-5(-3)) following V-USLS (p=0.003). Total vaginal length was 7 cm (7-8) in the L-USLS group compared to 6 cm (6-7) in the V-USLS group (p<0.001). No difference was found in subjective recurrence, retreatment, POPDI-6, UDI-6 or VAS score. Conclusions: L-USLS seems to be associated with better outcomes in relation to objective recurrence, vaginal length and vaginal apex, but had no impact on subjective recurrence.

Postpartum urinary incontinence (UI) is common and a concern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women. A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI. A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95

OBJECTIVE:To understand barriers and facilitators for participation in digital IPV screening and a digital supportive intervention among pregnant women. METHODS:Pregnant women attending standard antenatal care in the Region of Southern Denmark were systematically screened for IPV through a digital questionnaire. Those who screened positive were offered 3-6 video consultations with midwives and access to safety planning app. Semi-structured qualitative interviews were conducted with pregnant women who screened positive for IPV and participated in a digital supportive intervention. RESULTS:Twenty pregnant women were interviewed, and the following facilitators for participation were highlighted: The digital systematic screening approach was acceptable and helped acknowledge IPV exposure as women experienced it as more private and allowed for reflection time compared to risk-based, face-to-face screening. Video counselling was highly acceptable, as the digital approach eased conversations on sensitive topics and the flexibility boosted participation. Trust in the healthcare system, having a trained midwife as a counsellor, and familiarity with the digital tool enhanced participation. Barriers included concerns about disclosing IPV, technological issues, and the need for a private space for counselling. Additionally, women who had experienced digital violence were uncomfortable with the digital nature of the intervention. The safety app was perceived as being inefficient as it did not meet the needs of the women. CONCLUSION:Systematic digital screening and supportive video counselling for IPV within antenatal care is well-received among pregnant women as it offers increased privacy and flexibility and facilitating discussions on sensitive topics. To enhance participation, barriers such as confidentiality concerns, technological challenges, and the need for private counselling spaces must be addressed. Incorporating digital tools into antenatal care can supplement other support services and increase the proportion of pregnant women who receive help.

INTRODUCTION:Intimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health-related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools. MATERIAL AND METHODS:A cross-sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen. RESULTS:A total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (n = 913) and 13.7% (n = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence. CONCLUSIONS:Prevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings.

INTRODUCTION AND OBJECTIVE:Intimate Partner Violence (IPV) during pregnancy is a significant public health concern associated with adverse maternal and fetal health outcomes, including increased risk of depression. This study aimed to assess the effectiveness of a digital empowerment-based intervention in reducing symptoms of depression among IPV-exposed pregnant women. STUDY DESIGN:This intervention study was nested within a cohort study conducted in Denmark and Spain. Pregnant women attending antenatal care were digital screened for IPV using the Abuse Assessment Screen (AAS) and the Women's Abuse Screening Tool (WAST). Those screening positive were offered a digital intervention comprising 3-6 video consultations with trained IPV counsellors and access to a safety planning app. Changes in depression scores from baseline to follow-up were evaluated using mixed model regression. RESULTS:From February 2021-October 2022, 1,545 pregnant women (9.6 %) screened positive for IPV within our population (8.5 % in Denmark and 17.0 % in Spain) with 485 (31.4 %) meeting the criteria for the intervention. Of those eligible, 104 (21.4 %) accepted the intervention, and 55 completed it (13.1 %). Post-intervention, a significant reduction in Edinburgh Postnatal Depression Scale (EPDS) was found, with a mean difference of -3.9 (95 % CI: -5.3; -2.4), compared to the average pre-intervention score of 11.3. Stratifying the analyses across sociodemographic variables did not alter the overall result, indicating a reduction in EPDS scores irrespective of setting or sociodemographic factors. Notably, the intervention was most effective for women initially presenting with EPDS scores above the depression cut-off. CONCLUSION:The findings suggest that a brief digital intervention is associated with a reduction in depression symptoms among pregnant women exposed to IPV, particularly among those with high depressive scores. This highlights the potential of digital interventions in delivering counseling and shows efficacy when administered by both midwives and psychologists in diverse settings. However, the absence of a control group underscores the need for caution in interpreting the results.

OBJECTIVES:This study from Northern Vietnam aims to assess the association between social support and symptoms of depression among pregnant women screened for gestational diabetes mellitus (GDM). METHODS:A cross-sectional study was conducted among 823 pregnant women in Thai Binh, Vietnam. The women were screened for GDM and structured questionnaire were used to collect data on social support factors, GDM factors, and symptoms of depression. The diagnosis of GDM was based on the 2-hour 75-g OGTT according to WHO 2013 criteria. The Edinburg Postpartum Depression Scale (EPDS) with a cut-off of 10 and the Multidimensional Perceived Social Support Scale (MSPSS) were used to assess depression symptoms and perceived social support, respectively. Logistic regression analysis was conducted to measure the associations between social support, GDM-related factors, and symptoms of depression. The relationship between social support score and symptoms of depression was evaluated using Spearman's correlation. The strength of the associations were measured by adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS:The prevalence rates of GDM and symptoms of depression were 22.2% (95%CI: 19.4-25.2) and 23.0% (95%CI: 20.1-26.0), respectively. Women who had moved away from their commune of birth and women who reported another person than their husband to be the primary person to confide in had increased odds of depression (aOR = 1.74; 95%CI:1.19-2.56 and aOR = 2.36; 95%CI:1.48-3.75, respectively). A reported lack of social support was strongly associated with increased odds of depression symptoms among both women with gestational diabetes mellitus (aOR = 6.16, 95% CI:2.35-16.12) and without gestational diabetes mellitus (aOR = 2.81; 95%CI: 1.67-4.75). When analysing the correlation between social support and depression symptoms, a negative correlation was found, with decreasing depression scores as the social support score increased. CONCLUSION:The prevalence of symptoms of depression was high in our study, and women in Northern Vietnam who feel well-supported socially are less likely to report symptoms of depression. This finding applies both to women with and without GDM.