Hypertensive disorders of pregnancy (HDP) and diabetes in pregnancy (DIP) are leading contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa, yet effective management depends on health workers having the knowledge, attitudes, and practices to screen, diagnose, and treat these conditions. Evidence on these provider-level factors remains limited in Uganda. We conducted a descriptive cross-sectional survey among health workers in Uganda (November–December 2025), disseminating a structured questionnaire on HDP and DIP knowledge, attitudes, practices, prescribing, and task shifting via WhatsApp-based Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) networks and professional association platforms, hosted on REDCap. We analysed data in STATA 17 using descriptive statistics and comparisons across health worker groups. Of the 690 eligible health workers, 577 completed the survey (83.5

BACKGROUND:Labor is induced in 20-30% of pregnancies. Mechanical induction, using a single or double cervical balloon, has shown comparable effectiveness to pharmacological methods while reducing foetal distress due to hyperstimulation. Therefore, mechanical labour induction is a promising option for outpatient management. We aim to compare clinical outcomes and maternal satisfaction following induction of labour (IOL) using a cervical double-balloon in an outpatient versus inpatient setting. DESIGN:Randomised controlled trial. SETTING:Four Maternity Hospitals in Belgium. POPULATION:Women with an uncomplicated singleton pregnancy undergoing IOL for low-risk indications including post-term gestational age, macrosomia and patient's request (≥38 0/7 of gestational age). METHODS:Participants were randomly allocated by an online randomisation system (1:1 ratio). Because of the nature of the intervention, the study was not blinded. The primary outcome was suboptimal CTG rate after insertion and after removal of the balloon (12 h after insertion or earlier). Secondary outcomes were mode of delivery, C-section rates, time from balloon insertion to birth and from removal to birth, need for additional medications for labour induction and optimisation of labour, pain management and maternal satisfaction. Analysis was performed on an intention-to-treat basis. FINDINGS:Between May 2017 and November 2023, 178 women were randomised to a balloon outpatient group and 180 to a balloon inpatient group. Due to slow recruitment and low event rates in the primary endpoint, enrolment was stopped at 358 patients in November 2023 and secondary endpoints were prioritized. No statistically significant difference was observed in terms of suboptimal CTG rates at balloon insertion (0.6 % vs 1.2 %, P = 1) and balloon removal in the outpatient versus inpatient group (0.6 % vs 3 %; P = 0.21). There were no statistically significant differences in delivery methods (P = 0.22), time from balloon placement to delivery (21.4 ± 6.4 vs 21.8 ± 7.4 h, P = 0.31) and time from balloon removal to delivery (10.1 ± 5.9 vs 10.6 ± 6.9 h, P = 0.64). Maternal satisfaction rates were significantly different and in favour of the outpatient group, in terms of perceived duration of labour (P = 0.039), perceived length of stay in the delivery room (P = 0.037), preference for the same method and setting of induction for future pregnancies (P = 0.034) and as advice to others (P = 0.026). INTERPRETATION:Our findings suggest that balloon catheters are generally safe and effective for induction of labor in both inpatient and outpatient settings, although this study did not reach the planned sample size. Patients' satisfaction with induction and labour is higher when cervical ripening is performed in outpatient setting.

Non-communicable diseases (NCDs) are increasingly prevalent among women of reproductive age and may pose significant risks to maternal and perinatal health. Despite their growing burden, data on their impact in low-resource settings remains limited. This study aimed to investigate the impact of pre-pregnancy NCDs on severe maternal and adverse perinatal outcomes among pregnant women admitted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. We prospectively enrolled pregnant women admitted to the maternity ward of MRRH from July 2022 to October 2023. We consecutively included all women with one or more NCDs and next two admissions without NCDs. Baseline sociodemographic and clinical documentation of pre-pregnancy NCDs including chronic hypertension, pre-gestational diabetes, cardiac disease, chronic kidney disease, sickle cell disease, asthma, and epilepsy. Participants were followed from admission through delivery, puerperium, and post-discharge with phone calls at 2, 4, and 6 weeks, and severe maternal and adverse perinatal outcomes were documented. We compared outcomes between women with and without NCDs and performed multivariable logistic regression analyses to determine the association between NCDs and these outcomes, adjusting for potential confounders, including maternal age, gravidity, employment status, HIV serostatus and delivery mode. We enrolled a cohort of 300 pregnant women (100 with NCDs and 200 without NCDs) with a mean age of 27.8 ± 5.9 years. Severe maternal outcomes occurred in 80/300 participants (26.7

BACKGROUND:Lifestyle interventions prior to conception hold potential to reduce pregnancy-related complications, although this has been constrained due to challenges in reaching preconception women. OBJECTIVE:We aim to study the effectiveness of the interpregnancy and pregnancy lifestyle intervention (INTER-ACT) lifestyle intervention spanning through the interpregnancy and subsequent pregnancy periods in women with a history of excessive gestational weight gain on reducing pregnancy complications. STUDY DESIGN:The Interpregnancy Coaching for a Healthy Future (INTER-ACT) study is a prospective, multicenter randomized controlled trial. METHODS:Participants were recruited within 6 weeks after a previous pregnancy from a combination of primary and secondary healthcare facilities across 6 Flemish hospitals in Belgium. The INTER-ACT intervention involved face-to-face coaching sessions and an E-Health application aimed at promoting healthy behaviors, including nutrition, physical activity, and mental wellbeing. The primary outcome was a composite of pregnancy complications including pregnancy-induced hypertension, gestational diabetes, cesarean section, and large for gestational age infants. To identify a significant difference between the intervention and control group in the incidence of composite outcome, with a statistical power of 80% and significance level of 0.05, 250 women with subsequent delivery in each group needed to be recruited. RESULTS:Participants were recruited from May 2017 through April 2019. Of 8897 women with excessive gestational weight gain, 1450 were randomized. Three hundred and ninety subsequently experienced singleton pregnancy, with 193 in the intervention group and 197 in usual care. Baseline sociodemographics were generally comparable between groups. The lifestyle intervention did not significantly reduce the composite outcome (odds ratio, 1.29; 95% confidence interval, 0.85-1.96; P=.23) or secondary outcomes. In a post hoc subanalysis, we found that adherence to follow-up during the subsequent pregnancy was associated with a reduced risk of the composite outcome in both study arms (intervention group: odds ratio, 0.50, 95% confidence interval, 0.26-0.98, P=.04; control group: odds ratio, 0.48, 95% confidence interval, 0.26-0.90, P=.02), suggesting a potential benefit of continued engagement regardless of allocation. CONCLUSION:The INTER-ACT intervention did not result in a lower composite outcome rate in women with previous excessive gestational weight gain. However, adherence during pregnancy was key, halving risks in both study arms. Future trials should focus on improving adherence and exploring the impact of lifestyle interventions on pregnancy outcomes in women across diverse body mass index ranges, particularly in the preconception and interpregnancy periods.

It is a shortcoming of traditional cardiotocography (CTG) classification table formats that CTG traces are frequently classified differently by different users, resulting in poor interobserver agreements. A fast-and-frugal tree (FFTree) flow chart may help provide better concordance because it is straightforward and has clearly structured binary questions with understandable “yes” or “no” responses. The initial triage to determine whether a fetus is suitable for labor when utilizing fetal ECG ST analysis (STAN) is very important, since a fetus with restricted capacity to respond to hypoxic stress may not generate STAN events and therefore may become falsely negative. This study aimed to compare physiology-focused FFTree CTG interpretation with FIGO classification for assessing the suitability for STAN monitoring. A retrospective study of 36 CTG traces with a high proportion of adverse outcomes (17/36) selected from a European multicenter study database. Eight experienced European obstetricians evaluated the initial 40 minutes of the CTG recordings and judged whether STAN was a suitable fetal surveillance method and whether intervention was indicated. The experts rated the CTGs using the FFTree and FIGO classifications at least 6 weeks apart. Interobserver agreements were calculated using proportions of agreement and Fleiss’ kappa ( κ ). The proportions of agreement for “not suitable for STAN” were for FIGO 47% (95% confidence interval [CI] 42%–52%) and for FFTree 60% (95% CI 56–64), ie a significant difference; the corresponding figures for “yes, suitable” were 74% (95% CI 71–77) and 70% (95% CI 67–74). For “intervention needed” the figures were 52% (95% CI 47–56) vs 58% (95% CI 54–62) and for “expectant management” 74% (95% CI 71–77) vs 72% (95% CI 69–75). Fleiss’ κ agreement on “suitability for STAN” was 0.50 (95% CI 0.44–0.56) for the FIGO classification and 0.57 (95% CI 0.51–0.63) for the FFTree classification; the corresponding figures for “intervention or expectancy” were 0.53 (95% CI 0.47–0.59) and 0.57 (95% CI 0.51–0.63). The proportion of agreement among expert obstetricians using the FFTree physiological approach was significantly higher compared with the traditional FIGO classification system in rejecting cases not suitable for STAN monitoring. That might be of importance to avoid false negative STAN recordings. Other agreement figures were similar. It remains to be shown whether the FFTree simplicity will benefit less experienced users and how it will work in real-world clinical scenarios.

Abstract Disclosure: C. De Herdt: None. K. Clotman: None. D. Ysebaert: None. Y. Jacquemyn: None. C. De Block: None. Background: Primary aldosteronism (PA) is the most common etiology of secondary hypertension in the nonpregnant population but is only sporadically (< 80 case reports) reported in pregnancy. We present a case of PA diagnosed during pregnancy and performed a review of the literature concerning the clinical characteristics, treatment and outcome of women diagnosed with PA during pregnancy. Methods: A structured search was conducted combining terms of PA and pregnancy. Articles in English published between 1991-2023 describing PA diagnosed during pregnancy were included. Diagnostic criteria for PA during pregnancy were: hypertension AND increased aldosterone level AND suppressed renin level or normal renin level in the presence of hypokalemia. Case reports concerning PA diagnosed prior to pregnancy were excluded. Results: Twelve articles were included. With the inclusion of our case report a total of 13 cases with a mean age of 29 ± 5 years are described. Three cases had hypertension prior to pregnancy. All cases had hypokalemia and the majority (8/13) had proteinuria. Eight cases had a suppressed renin level and saline perfusion test was performed in 3 cases. In 11 cases diagnosis of PA was suspected in the second trimester. MRI was performed in 9 cases of which all showed a unilateral adrenal nodule. Three cases were treated with eplerenone in association with safe antihypertensives at a dose of 100-200 mg per day, which resulted in improvement of potassium level but did not result in normotension. Five cases underwent unilateral adrenalectomy as a first line treatment in the second trimester and 2 cases as second line treatment after failure of eplerenone, resulting in normalization of potassium level but no normotension in all except for 1 case. Nine cases had a caesarean section and the median gestational age at delivery was 34 weeks. Three out of 13 newborns deceased (1 case was treated with safe antihypertensives and 2 cases underwent adrenalectomy). Conclusion: PA is a very rare etiology of secondary hypertension during pregnancy. Due to the physiological changes during pregnancy with an increase of all the components of the renin angiotensin aldosterone system, diagnosis of PA is difficult. Saline perfusion test is not recommended. Suggestive features are hypertension before 20 weeks of gestation, worsening of hypertension as pregnancy progresses and hypokalemia. Suppressed renin levels may direct to the diagnosis of PA, but are not mandatory. MRI is the preferred imaging method but only indicated if blood pressure is not well controlled during pregnancy. There are no guidelines for the treatment of PA during pregnancy. The benefit of adrenalectomy is unclear and evidence supporting the choice of medical treatment with eplerenone is anecdotal. This review revealed a poor outcome as despite treatment, blood pressure was only controlled in 3 (/13) cases and the death of 3 (/13) newborns. Presentation: 6/1/2024

Background: Postpartum weight retention (PPWR) has many health risks. Digital self-monitoring of weight can potentially make postpartum weight management easier. We aim to test to what extent the self-monitoring of weight, steps and mental health through an mHealth application increases postpartum weight loss and reduces the odds of substantial PPWR (≥5 kg). Methods: Participants were mothers in the intervention arm of the INTER-ACT multicenter randomized controlled trial (RCT), an inter-pregnancy lifestyle intervention among mothers with excessive gestational weight gain. Participants (n=288) had access to an mHealth application to log their weight, steps and mental health between 6 weeks and 6 months postpartum. A linear multiple regression model and a logistic regression model were run to test to what extent self-monitoring via the app increases postpartum weight loss and reduces the risk of substantial PPWR. Results: Women who logged their weight more often lost more weight (B=0.03, β=0.26, CIB =[0.01,0 .05], P<0.01), and had reduced odds of substantive PPWR (OR=0.99, CIOR =[0.98, 0.999], P<.05). Mental health logging reduced the odds of substantive PPWR (OR=0.98, CIOR =[0.97, 1.00], P<0.05), but was unrelated to the amount of weight loss. Steps logging was unrelated to either weight loss or substantive PPWR. Conclusion: Mothers with excessive gestational weight gain can benefit from app-based lifestyle interventions to reduce PPWR by self-monitoring their weight. More attention to mental health in PPWR interventions is needed.

OBJECTIVE:Non-communicable diseases (NCDs) increasingly contribute to maternal morbidity and mortality. We determined the association between NCDs and obstetric complications at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS:In this retrospective records review, we randomly selected records of women admitted for delivery at MRRH each month from January to December 2022, and extracted their socio-demographic and clinical histories. We defined a history of NCDs as chronic hypertension, pre-gestational diabetes, cardiac disease, anemia, or asthma. We performed a multivariate robust Poisson regression analysis to assess the association between NCDs and obstetric complications, including preeclampsia, gestational diabetes, venous thromboembolic disease, obstetric hemorrhage, and preterm labor. Models were adjusted for maternal age, gravidity, referral status, employment status, and human immunodeficiency virus (HIV) serostatus. RESULTS:We extracted data for 2,336 women with a mean age of 26±5.9 years. At least one NCD was present in 6.4% (n=149) of the patients, including anemia (n=77, 3.3%), chronic hypertension (n=35, 1.5%), pre-gestational diabetes (n=16, 0.7%), asthma (n=9, 0.4%), and cardiac disease (n=6, 0.3%). Overall, 542 (23.2%) women had obstetric complications, including preeclampsia (n=265, 11.3%), preterm labor (n=67, 2.9%), placental abruption (n=29, 1.2%), postpartum hemorrhage (PPH) (n=54, 2.3%), and gestational diabetes (n=5, 0.2%). Women with NCDs had an increased likelihood of having an obstetric complication compared to women without (overall proportion 33.6% vs 22.5% respectively); adjusted prevalence ratio (aPR) was 1.8 (95% CI: 1.4-2.3) overall, 1.8 (95%CI: 1.2-2.8) for preeclampsia, 12.0 (95%CI: 2.0-72.7) for gestational diabetes, 6.0 (95%CI: 1.3-27.1) for deep venous thrombosis, 4.4 (95%CI: 1.5-12.6) for placenta abruption, and 4.3 (95%CI: 2.2-8.3) for PPH. CONCLUSIONS:We found that NCDs were associated with a nearly two-fold increase in the risk of obstetric complications. Our findings highlight the need for further research to understand the impact of this risk, particularly on maternal and fetal outcomes. Additionally, these findings suggest strengthened NCD surveillance, as a means of increasing preparedness, and management of potential obstetric complications among pregnant women in Uganda.

Background Coarctation of the aorta (CoA) is a common congenital heart defect that affects about 3-4 in every 10 000 live births. Despite clear signs on clinical examination, the diagnosis is sometimes not made until adulthood. An increasing number of patients with CoA are reaching child-bearing age. Unrepaired CoA or severe recurrent stenosis during pregnancy is a significant concern, as it poses a high risk of maternal and foetal complications and even death.Case summary A 21-year-old woman was referred to the cardiology department at 17 weeks' gestation for management of arterial hypertension and unexplained systolic murmur. She had been diagnosed with hypertension elsewhere the year before presentation, but unfortunately, this remained unexplored. She had been started on labetalol early in the pregnancy. Clinical examination showed a loud systolic heart murmur extending from parasternal to subclavicular and scapular areas. Pulses in the lower extremities were very weak, and blood pressure was slightly elevated with a significant gradient between the upper and lower extremities. Echocardiography showed remarkable absence of pulsatile flow in the abdominal aorta and narrowing just distal to the subclavian artery with typical diastolic tail pattern on suprasternal imaging. Cardiac magnetic resonance confirmed the presence of a severe coarctation distal to the subclavian artery and presence of multiple collaterals allocating this patient in the extremely high-risk category with a risk of up to 40%-100% of maternal cardiac event during pregnancy. An extensive multidisciplinary team meeting was convened. After initial medical optimization, increased claudication and signs of placental hypoperfusion necessitated an endovascular procedure under general anaesthesia at 23 weeks' gestation. A Bentley BeGraft Plus stent (16 x 38 mm) was successfully placed. Postoperative ultrasound showed biphasic placental perfusion and normalization of blood pressure and ankle-brachial indices. At 36 weeks' gestation, the patient gave birth to a healthy child.Discussion Coarctation of the aorta should be considered in any young patient with arterial hypertension. Altered maternal haemodynamics during pregnancy resulted in severe symptomatic CoA and reduced placental flow necessitating percutaneous intervention during pregnancy. A multidisciplinary pregnancy heart team is essential for optimal treatment management in these high-risk patients.

AimsTo determine the impact of breastfeeding on the risk of postpartum glucose intolerance in women with gestational diabetes.MethodsSub-analysis of two multi-centric prospective cohort studies (BEDIP-N and MELINDA) in 1008 women with gestational diabetes. Data were collected during pregnancy and at a mean of 12 weeks postpartum. Multivariate logistic regression was used to estimate the effect of breastfeeding on glucose intolerance, with adjustment for ethnicity, education, income, professional activity and BMI.ResultsOf all participants, 56.3% (567) breastfed exclusively, 10.1% (102) gave mixed milk feeding and 33.6% (339) did not breastfeed. Mean breastfeeding duration was 3.8 ± 2.4 and 3.7 ± 2.1 months in the breastfeeding and mixed milk feeding groups (p=0.496). The rate of glucose intolerance was lower in both the breastfeeding [22.3% (126)] and mixed milk feeding [25.5% (26)] groups compared to the no breastfeeding group [29.5% (100)], with an adjusted OR of 0.7 (95% CI 0.5–1.0) for glucose intolerance in the breastfeeding group compared to no breastfeeding group and an adjusted OR of 0.7 (95% CI 0.4–1.2) for the mixed milk feeding group compared to the no breastfeeding group. Postpartum, breastfeeding women had a lower BMI, less often postpartum weight retention, lower fasting triglycerides, less insulin resistance and a higher insulin secretion-sensitivity index-2 than the mixed milk feeding and no breastfeeding group. The mixed milk feeding group was more often from an non-White background, had a lower blood pressure and lower fasting triglycerides compared to the no breastfeeding group.ConclusionsBreastfeeding (exclusive and mixed milk feeding) is associated with less glucose intolerance and a better metabolic profile in early postpartum in women with gestational diabetes.

Introduction Twin pregnancies have a high risk of extreme preterm birth (PTB) at less than 28 weeks of gestation, which is associated with increased risk of neonatal morbidity and mortality. Currently there is a lack of effective treatments for women with a twin pregnancy and a short cervix or cervical dilatation. A possible effective surgical method to reduce extreme PTB in twin pregnancies with an asymptomatic short cervix or dilatation at midpregnancy is the placement of a vaginal cerclage.Methods and analysis We designed two multicentre randomised trials involving eight hospitals in the Netherlands (sites in other countries may be added at a later date). Women older than 16 years with a twin pregnancy at <24 weeks of gestation and an asymptomatic short cervix of ≤25 mm or cervical dilatation will be randomly allocated (1:1) to both trials on vaginal cerclage and standard treatment according to the current Dutch Society of Obstetrics and Gynaecology guideline (no cerclage). Permuted blocks sized 2 and 4 will be used to minimise the risk of disbalance. The primary outcome measure is PTB of <28 weeks. Analyses will be by intention to treat. The first trial is to demonstrate a risk reduction from 25% to 10% in the short cervix group, for which 194 patients need to be recruited. The second trial is to demonstrate a risk reduction from 80% to 35% in the dilatation group and will recruit 44 women. A cost-effectiveness analysis will be performed from a societal perspective.Ethics and dissemination This study has been approved by the Research Ethics Committees in the Netherlands on 3/30/2023. Participants will be required to sign an informed consent form. The results will be presented at conferences and published in a peer-reviewed journal. Participants will be informed about the results.Trial registration number ClinicalTrials.gov, NCT05968794.

Key clinical messageMicrobiological diagnosis of endometritis and appropriate antibiotic treatment based on the antibiogram is essential. We should remain critical about the potential etiologic pathogens, especially when traveling abroad and during pregnancy. Therefore, it is essential to obtain cultures prior to the administration of antibiotics.AbstractWe present a case of postoperative endometritis in a patient with incomplete miscarriage, who underwent dilatation and curettage. Blood, cervical and stool cultures revealed the presence of Salmonella hvittingfoss. Gynecological postoperative infections with Salmonella spp. are rare according to the current literature.

To monitor fetal size and identify predictors for birthweight in women with gestational diabetes (GDM) and normal glucose tolerance (NGT). Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile. Of the total cohort, 231 (12.5 https://clinicaltrials.gov/ct2/show/NCT02036619 .

Of women with symptomatic prolapse, 13–39% experience voiding dysfunction (VD). The aim of our observational cohort study was to determine the effect of prolapse surgery on voiding function. Retrospective analysis of 392 women who underwent surgery between May 2005 and August 2020. All had a standardized interview, POP-Q, uroflowmetry and 3D/4D transperineal ultrasound (TPUS) pre-and postoperatively. Primary outcome was change in VD symptoms. Secondary outcomes were changes in maximum urinary flow rate (MFR) centile and post-void residual urine (PVR). Explanatory measures were change in pelvic organ descent as seen on POP-Q and TPUS. Of 392 women, 81 were excluded due to missing data, leaving 311. Mean age and BMI were 58 years and 30 kg/m2, respectively. Procedures performed included anterior repair (n = 187, 60.1%), posterior repair (n = 245, 78.8%), vaginal hysterectomy (n = 85, 27.3%), sacrospinous colpopexy (n = 170, 54.7%) and mid-urethral sling (MUS) (n = 192, 61.7%). Mean follow-up was 7 (1–61) months. Pre-operatively, 135 (43.3%) women reported symptoms of VD. Postoperatively, this decreased to 69 (22.2%) (p < 0.001), and of those, 32 (10.3%) reported de novo VD. The difference remained significant after excluding concomitant MUS surgery (n = 119, p < 0.001). Postoperatively, there was a significant decrease in mean PVR (n = 311, p < 0.001). After excluding concomitant MUS surgery, there was a significant increase in mean MFR centile (p = 0.046). Prolapse repair significantly reduces symptoms of VD and improves PVR and flowmetry.

We assess whether the INTER-ACT postpartum lifestyle intervention influences symptoms of depression and anxiety, sense of coherence and quality of life during the first year after childbirth. A total of 1047 women of the INTER-ACT RCT were randomized into the intervention (n = 542) or control arm (n = 505). The lifestyle intervention consisted of 4 face-to-face coaching sessions, supported by an e-health app. Anthropometric and mental health data were collected at baseline, end of intervention and 6-months follow-up. We applied mixed models to assess whether the evolution over time of depressive symptoms, anxiety, sense of coherence and quality of life differed between the intervention and control arm, taking into account the women's pre-pregnancy BMI. There was no statistical evidence for a difference in evolution in anxiety or quality of life between intervention and control arm. But an improvement in symptoms of depression and sense of coherence was observed in women who received the intervention, depending on the mother's pre-pregnancy BMI. Women with normal/overweight pre-pregnancy BMI, reported a decrease in EPDS between baseline and end of intervention, and the decrease was larger in the intervention arm (control arm: -0.42 (95% CI, -0.76 to -0.08); intervention arm: -0.71 (95% CI, -1.07 to -0.35)). Women with pre-pregnancy obesity showed an increase in EPDS between baseline and end of intervention, but the increase was less pronounced in the intervention arm (control arm: +0.71 (95% CI, -0.12 to 1.54); intervention arm: +0.42 (95% CI -0.42 to 1.25)). Women with a normal or obese pre-pregnancy BMI in the intervention arm showed a decrease in sense of coherence between baseline and end of intervention (-0.36) (95% CI, -1.60 to 0.88), while women with overweight pre-pregnancy showed an increase in sense of coherence (+1.53) (95% CI, -0.08 to 3.15) between baseline and end of intervention. Receiving the INTER-ACT postpartum lifestyle intervention showed improvement in depressive symptoms, in normal weight or overweight women on the short run, as well as improvement in sense of coherence in women with pre-pregnancy overweight only. Trial registration: ClinicalTrials.gov;NCT02989142.

Mental health problems and obesity are two common complications during pregnancy and postpartum. The preconception period is considered an appropriate period for prevention. Therefore, insights into interpregnancy mental health and the impact on weight and body composition are of interest to developing effective weight management strategies. The primary aim of this study is to assess the difference in women's mental health during the interpregnancy period and the association with pre-pregnancy body mass index (BMI) and body composition. The secondary aim is to study whether this association is affected by socio-demographic factors, interpregnancy interval and sleep. The study is a secondary analysis of the INTER-ACT e-health-supported lifestyle trial. Women were eligible if they had a subsequent pregnancy and mental health measurements at 6 weeks after childbirth and at the start of the next pregnancy (n = 276). We used univariate analyses to assess differences in mental health and performed regression analysis to assess their association with pre-pregnancy BMI and body composition at the start of the next pregnancy. Our results show a statistically significant increase in anxiety and depressive symptoms between 6 weeks after childbirth and the start of the next pregnancy (sSTAI-6 ≥ 40: +13%, p =≤ 0.001; GMDS ≥ 13: +9%, p = 0.01). Of the women who were not anxious at 6 weeks after childbirth (sSTAI < 40), more than one-third (39%) developed anxiety at the start of the next pregnancy (p =≤ 0.001). Regression analysis showed that sense of coherence (SOC-13) at the start of the next pregnancy was independently associated with women's pre-pregnancy BMI and fat percentage. We believe that the development of preconception lifestyle interventions that focus on both weight reduction and support in understanding, managing and giving meaning to stressful events (sense of coherence) may be of added value in optimizing women's preconception health.

( Acta Obstet Gynecol Scand . 2023;102:82–91) The risks of maternal, fetal and neonatal adverse outcomes have a wide variance within the window of full-term gestation, 37+0/7 to 41+6/7 weeks. For uncomplicated pregnancies, the prevalence of complications is generally low. However, the optimal timing of delivery especially for pregnancies with added risk factors is open to debate. The strategy of expectant management has been challenged by studies showing increased favorable outcomes (fewer occurrences of stillbirth, adverse neonatal outcomes, cesarean deliveries, hypertensive events, and increased maternal satisfaction) when elective induction was employed between 39 and 41 weeks. This study examined the relationship between per week gestational age and adverse perinatal, neonatal and maternal outcomes, with regard to balancing risks and benefits of expectant management versus interventions at term.