Women

Young women from urban Egypt are in a context of nutrition transition with a high prevalence of being overweight, excessive energy and sodium intakes, and insufficient iron, vitamin D, and folate intakes. This study, funded by Danone Nutricia Research, investigated the acceptability of dietary recommendations in young urban Egyptian women that have the potential to improve iron intake and nutrient adequacy. Individual interviews and focus groups were conducted in Cairo with 80 middle-class women aged 18–35 years (students, active women, and housewives). Perceived benefits and drawbacks for each recommended food were examined. Motivations and barriers to improving dietary practices were classified into major emerging themes. Analysis of the interviews showed that promoting the recommended foods would be met with both positive and negative feedback (e.g., a positive impact of fruit, vegetables, milk, or yogurt consumption on hair, nails, and skin appearance, and bad taste of vegetables). Motivations for improving dietary practices included the pursuit of aesthetical (e.g., attaining/maintaining body shape, clear skin, bright teeth, strong nails, silky and thick hair) and psychological (e.g., improved self-confidence and self-esteem) benefits. However, the “curative behavior” of the population targeted (i.e., changing dietary practices only when they face a serious issue), some life-stage-related factors (e.g., students and active women consuming most of their meals out-of-home), and sociocultural and economic factors (e.g., social gatherings, the high price of red meat) can constitute barriers for implementing a set of dietary recommendations. This work highlighted that, beyond socio-cultural and economic factors or curative or life-stage-motivated dieting, the pursuit of aesthetical and psychological benefits are essential factors that shape the acceptability of dietary changes. Full article

Despite the well-established benefits of antenatal education (ANE) and breastfeeding for mothers, there is a paucity of evidence about the uptake of ANE and breastfeeding amongst women from refugee backgrounds or its associations with sociodemographic factors. The current study is a cross-sectional survey at two time points examining the prevalence of ANE attendance, breastfeeding, and intimate partner violence (IPV) amongst 583 women refugees resettled in Australia and a control group of 528 Australian-born women. Multi-logistic regression was used to explore bivariate associations between ANE attendance, breastfeeding, IPV, and sociodemographic characteristics (parity, maternal employment, and education). Refugee-background women compared to Australian-born women have lower ANE utilization (20.4% vs. 24.1%), higher rates of breastfeeding on hospital discharge (89.3% vs. 81.7%), and more IPV reports (43.4% vs. 25.9%). Factors such as nulliparity, higher level of education, and employment predict higher rates of ANE and breastfeeding adoption. In contrast, IPV is a risk factor for ANE underutilization. Further, of the women from refugee backgrounds who accessed ANE services, 70% attended clinics designed for women from non-English-speaking backgrounds. These findings support the need to ensure effective screening and interventions for IPV during antenatal care and to better understand the role of culture as a protective or risk factor for breastfeeding initiation. Full article

Italian occupational physicians (OPs) are instrumental in promoting vaccination practice in occupational settings, and this study aims to characterize their attitudes, knowledge, and practices (collectively, KAP) towards immunization practice in women of childbearing age. A convenience sample of 120 OPs (50.8% males, mean age of 48.2 ± 5.9 years old) completed a structured online questionnaire (potential recipients: 2034; response rate: 5.9%) assessing their understanding of official recommendations, their general knowledge of vaccine practice, their attitudes towards vaccines, and their risk perception about vaccine-preventable infectious diseases. The sampled OPs exhibited a good understanding of official recommendations, and they were largely favorable towards vaccination of pregnant women. Knowledge status was relatively good (potential range 0 to 100%, average score 22 74.5% ± 18.2), while risk perception towards sampled disorders was heterogenous: the greatest was the one for SARS-CoV-2 (52.7% ± 32.9), followed by seasonal influenza (45.3% ± 31.6), and pertussis (37.8% 24 ± 28.2). The main predictors for promoting vaccination were higher knowledge about seasonal influenza vaccine (SIV; adjusted Odds Ratio [aOR] 102.2, 95% Confidence Interval [95%CI] 9.68–1080.26), tetanus-diphtheria-acellular pertussis vaccine (Tdap; aOR 12.34, 95%CI 2.62; 58.22) 27 and SARS-CoV-2 vaccine (aOR 14.76, 95%CI 2.74–79.69). A better attitude towards SIV was positively associated with previous vaccination of the respondent (aOR 4.90, 95%CI 1.19–20.14), while higher risk perception towards SIV was characterized as a negative predictor (aOR 0.04, 95%CI 0.01–0.35), as was working as an OP in healthcare facilities (aOR 0.03, 95%CI 0.01–0.43). Tdap was positively associated with male gender of respondents (aOR 10.22, 95%CI 2.60 to 40.24) and higher risk perception about pertussis (aOR 10.38, 95%CI 1.47 to 73.47). Overall, our data suggest that improving the understanding of OPs about the health burden of frequently encountered pathogens could be instrumental in increasing their involvement in the promotion of vaccine practice. Because of the low rate of response to our survey, our conclusions remain tentative. Full article

The aim of the present study was to propose a quality prenatal (PN) care assessment model combining use and visit content (both adjusted for the weeks of gestation) to estimate inadequate PN care and associated factors in Rio Branco, Acre. A cross-sectional study was conducted using a population-based cohort of 1030 women in the city of Rio Branco in 2015. The use of PN care was classified according to the adapted Kotelchuck index by combining the performance of clinical-obstetric procedures adjusted for weeks of gestation. Levels of adequacy were built according to PN care use and content. Gross and adjusted odds ratios were estimated by using a logistic regression. The prevalence rates of inadequate prenatal care quality were 25.9% (Level-1), 54.8% (Level-2), 68.8% (Level-3), and 78.6% (Level-4). The factors associated with Level-1 were age ≤ 34 years (ORaj:3.74), not having a partner (ORaj:1.62), unplanned pregnancy (ORaj:1.73), and multiparity (ORaj:2.25); those for Level-2 comprised not having a partner (ORaj:1.82) and multiparity (ORaj:1.33); those for Level-3 were age ≤ 34 years (ORaj:3.31), not having a partner (Oraj:1.71), unplanned pregnancy (Oraj:1.45), PN in the private sector (Oraj:3.08), and multiparity (ORaj:2.17); those for Level 4 comprised not having a partner (ORaj:2.33), family income < 1 MW (ORaj:2.05), unplanned pregnancy (ORaj:1.41), PN in the private sector (ORaj:6.80), and multiparity (ORaj:1.49). The Kotelchuck index was proven efficient in assessing the combined effect of use and content in assessing PN care quality. Full article

Body image is understudied in aging women. The present perspective article reviews body image, body composition, and aging in women. Sarcopenia, a condition of low muscle mass, is associated with aging, and sarcopenia in combination with excessive body fat causes sarcopenic obesity. Findings of improved health in people with a higher body mass index, known as the obesity paradox, are due to misclassifying healthy people as overweight according to height and body weight instead of according to fat mass and fat-free mass. Body fat infiltrates internal organs in aging adults as increasing levels of body fat are redistributed into the trunk, especially in the abdomen, while subcutaneous fat in the appendages decreases. Accuracy of body image perceptions can determine an individual’s control of body weight. Aging women can protect against sarcopenic obesity by increasing fat-free mass with resistance training and by lowering body fat levels with weight management knowledge and skills. Healthy dietary patterns are low in ultra-processed foods that stimulate excessive consumption of calories and increase body fat levels. In combination with the phosphate additives in ultra-processed food which increase sarcopenia and aging, the present article proposes an etiological pathway in which ultra-processed food consumption eventually leads to aging-related sarcopenic obesity. Full article

The presence of medical comorbidities in women with psychotic disorders can lead to poor medical and psychiatric outcomes. Of all comorbidities, cardiovascular disease is the most frequent, and the one most likely to cause early death. We set out to review the evidence for cardiovascular risk factors (CRFs) in women with schizophrenia-related disorders and for interventions commonly used to reduce CRFs. Electronic searches were conducted on PubMed and Scopus databases (2017–2022) to identify papers relevant to our aims. A total of 17 studies fulfilled our inclusion criteria. We found that CRFs were prevalent in psychotic disorders, the majority attributable to patient lifestyle behaviors. We found some inconsistencies across studies with regard to gender differences in metabolic disturbances in first episode psychosis, but general agreement that CRFs increase at the time of menopause in women with psychotic disorders. Primary care services emerge as the best settings in which to detect CRFs and plan successive intervention strategies as women age. Negative symptoms (apathy, avolition, social withdrawal) need to be targeted and smoking cessation, a heart-healthy diet, physical activity, and regular sleep routines need to be actively promoted. The goal of healthier hearts for women with psychotic disorders may be difficult, but it is achievable. Full article

Almost a third of bariatric surgery patients present suboptimal weight loss or important weight regain in the first five postoperative years. While the reasons underlying this are not fully understood, it is known that pathological eating styles (such as emotional or binge eating) can thwart efforts to maintain weight loss. However, detailed characterization and understanding of these eating styles have yet to be achieved. In particular, research on gender differences in pathological eating styles and psychiatric symptoms before bariatric surgery is lacking. To characterize gender differences in eating styles and their association with clinical symptoms, we prospectively enrolled 110 bariatric surgery candidates, collecting eating styles and clinical scores. Women displayed a higher frequency of emotional eating as compared to men (x² = 9.07, p = 0.003), while men showed a higher frequency of quantitative eating behavioral style (x² = 4.58, p = 0.044). Binge eating style was associated with higher Difficulties in Emotion Regulation Scale (DERS), Hamilton Depression Scale (HAM-D), and Hamilton Anxiety Scale (HAM-A) scores (p < 0.05). Emotional eating style was associated with higher HAM-D and HAM-A scores (p < 0.05). The present findings highlight the importance of understanding the role of gender differences in emotion regulation processes involved in the development and maintenance of pathological eating styles in bariatric surgery candidates. This paves the way to gender- and symptoms-specific interventions on eating behaviors to improve surgery long-term outcomes. Full article

Maternal mortality ratios in sub-Saharan Africa remain high and worrisome. Moreover, maternal health indicators have remained poor despite large efforts in the last two decades. This study assesses maternal mortality patterns by age and country. The demographic and health survey data were used for the study. Based on the results, countries with the lowest adult female mortality rate include Senegal, Comoros, Rwanda, Mauritania, Sao Tome and Principe, Gambia, and Ethiopia. In addition, Chad (44.7%), Niger (38.7%), the Congo Democratic Republic (34.8%), Nigeria (34.2%), Mauritania (32.0%), Senegal (29.2%), Liberia (28.8%), Benin (27.8%), and Guinea (27.5%), respectively, reported the highest female deaths that are pregnancy-related. Overall, Lesotho (1024; 95% CI: 731–1318), Liberia (913; 95% CI: 638–1189), Chad (860; 95% CI: 728–993), Congo Democratic Republic (846; 95% CI: 690–1003), Sierra Leone (796; 95% CI: 632–960) and Guinea (724; 95% CI: 531–916) had the leading pregnancy-related mortality ratio per 100,000 live births. The study found that the patterns of death vary across different countries. There is a need for concerted efforts to reduce pregnancy-related deaths in sub-Saharan countries. Full article

The available evidence indicates a correlation between owning consumer electronics, such as cellphones and televisions, and a higher risk of obesity and increased adiposity. However, such studies are sparse in South Africa. Thus, the aim of this study is to examine the dietary and sociodemographic factors associated with various BMI categories, including the possession of consumer electronics, among women of reproductive age in South Africa. This is a secondary study of a population registry that includes dietary, BMI, and digital use items among women of reproductive age. The data is from the South Africa Demographic Health Survey (SADHS, 2016). Of the 3363 participants included in the analysis, women of normal weight were (35.5%), pre-obese (34.5%), obese (27.1%) and underweight (2.9%). Age was found to be significantly associated with pre-obesity at a <0.05 confidence interval. Owning a cellphone was significantly associated with being underweight and had 55% increased odds (1–0.45) (OR = 0.45; 95% CI 0.26–0.77, p = 0.004). Using internet almost daily was statistically significant with being underweight and had 55% (1–0.45) increased odds of being underweight (OR = 0.45; 95% CI 0.20–1.01, p = 0.054). Owning a cellphone and internet use was found to be significantly associated with being underweight. More research is needed to understand why cellphone ownership and using internet almost daily are significantly associated with being underweight. Full article

Several pregnancy-related complications resulting in maternal mortality in low-income countries may be due to inaccessible or under-utilized antenatal healthcare services. This study aims to assess the sociodemographic characteristics of Haitian women and how these may affect their access to and use of antenatal care services (ANC) during pregnancy. Multi-logistic regression was used to analyze sociodemographic factors associated with ANC access and use among a cross-section of Haitian women (N = 4890) from the Demographic and Health Survey Haiti (2016–2017). Approximately 18.2% of the women had no education, 40.2% had secondary education, and 4.0% had higher education. About 45.6% of women with no education, 95% with higher education, and 76% of urban dwellers made four or more ANC visits. Only 3% of those who used public sector ANC had a higher education, and over 64.2% of those who used private sector ANC lived in urban areas. Rich women (OR = 2.49, 95% CI = 2.02–3.08) vs. poor women and mature mothers (OR = 1.97, 95% CI = 1.42–2.73) vs. teenage mothers both had higher odds of using ANC services four or more times. Women with higher education (OR = 0.19, 95% CI = 0.12–0.30) and those who were rich (OR = 0.67, 95% CI = 0.5–0.89) had lower odds of using public sector ANC vs. private sector ANC. Wealth and education are protective of ANC access and use by Haitian women. As over half the population has home births, public health education interventions targeting traditional birth attendants are recommended. Interventions training traditional birth attendants to provide better ANC during pregnancy and at the time of birth and to access skilled help during emergency deliveries is recommended. Full article

This study sought to investigate the macro determinants of maternal mortality in Southern African Development Community (SADC) states. The study drew on the fact that maternal mortality remains a major public health issue in developing countries. The Millennium Development Goals (MDGs) were adopted by UN member states in 2000, and one of them was to reduce maternal deaths by three-quarters by 2015. While the Millennium Development Goals increased efforts, the goal was not met in the countries with the highest death rates. The World Health Organisation (WHO) estimates that every single day about 810 women die from pregnancy or childbirth-related complications around the world. This is despite several international initiatives being adopted to reduce maternal mortality. The study was quantitative, and it used secondary data to achieve its objective. A panel data estimation (Generalized Method of Moments) covering the period from 2005–2019 was used to examine how various factors affect maternal mortality. The analysis included the following variables: education, fertility, GDP per capita, institutional quality, health expenditure and HIV infection. The econometric analysis reveals a significant positive impact of fertility, GDP per capita and HIV on maternal mortality. This implies that when fertility, GDP per capita and HIV are increasing, maternal mortality also increases. The analysis also showed that education has a negative relationship with maternal mortality. This implies that when literacy levels (education) increase, maternal mortality decreases. Based on the results, this study emphasizes that, in order to improve maternal health and consequently reduce maternal mortality, access to family planning (to reduce fertility), access to early prenatal care and promoting women’s access to education should be a priority in government policies. Full article

The perinatal period may represent a particularly challenging time for expecting parents. Previous studies have highlighted an association between several perinatal risk conditions (e.g., childhood maltreatment, poor social support, and stress levels) and the development of psychopathological symptoms in pregnant women, especially depression symptoms. The current study examined the effects of psychosocial risk factors (childhood maltreatment, poor social support, and stressful events) on anxiety, depression, perceived stress, irritability/anger, relationship problems, psychosomatic symptoms, specific physiological problems, and addiction/at-risk behaviors. Sixty-one pregnant women (age range = 24–45) participating in a larger study completed questionnaires about childhood maltreatment (CECA Q.), Maternity Social Support Scale (MSSS), questionnaire on stressful events, and the Perinatal Assessment of Maternal Affectivity (PAMA) during their pregnancy. Results from regression analysis indicated that the presence of childhood maltreatment predicted elevated depressive symptoms, elevated irritability and anger, and elevated relationship problems. Further, stressful events in the year prior to pregnancy predicted elevated psychosomatic symptoms during pregnancy. No other significant associations were found. In this study, traumatic childhood events were strongly associated with mental health symptoms during pregnancy. This is an important finding that suggests the importance of screening and targeting psychotherapeutic interventions for vulnerable women during pregnancy. Full article

Women with schizophrenia require health interventions that differ, in many ways, from those of men. The aim of this paper is to review male and female care needs and describe a newly established care unit for the treatment of women with schizophrenia. After reviewing the literature on the differentiated needs of men and women with schizophrenia, we describe the new unit’s assessment, intervention, and evaluation measures. The program consists of (1) individual/group patient/family therapy, (2) therapeutic drug monitoring and adherence checks, (3) perinatal mental health, (4) medical liaison, (5) suicide prevention/intervention, (6) social services with special focus on parenting, domestic abuse, and sexual exploitation, (7) home-based services, (8) peer support, (9) occupational therapies (physical activity and leisure programs), and (10) psychoeducation for both patients and families. Still in the planning stage are quality evaluation of diagnostic assessment, personalized care, drug optimization, health screening (reproductive health, metabolic syndrome, cardiovascular health, cancer, menopausal status), and patient and family satisfaction with services provided. Woman-specific care represents an important resource that promises to deliver state-of-the-art treatment to women and, ideally, prevent mental illness in their offspring. Full article

Support needs for pregnancy-related anxiety among low-risk pregnant women remain unclear. This study aimed to clarify the kinds of support for anxiety that women seek during pregnancy in Japan. Data were collected in a semi-structured focus group interview involving five pregnant women who were not in specific risk groups, recruited from three facilities in Tokyo. We generated themes using inductive thematic analysis. This paper adhered to the consolidated criteria for reporting qualitative research. From the data on support needs for anxiety during pregnancy, three themes were derived: (1) seeking tailored professional support; (2) seeking continuous support within informal relationships; and (3) seeking others’ success stories in the same situation. These three types of support gave participants a sense of reassurance or raised concern, depending on the situation. We proposed a model comprising the three derived themes using social cognitive theory. We discussed how these three types of support influenced pregnant women’s self-efficacy, which is the core concept of the social cognitive theory. Our findings may help to plan theory-based research and effective interventions to provide support for women’s anxiety during pregnancy using a population approach. Our results also demonstrated the importance of collaboration with pregnant women in developing further research and interventions. Full article

Endometriosis Awareness Month (EAM) is a global movement that seeks to increase awareness of endometriosis. There is a paucity of peer-reviewed research that explores the social media activity of EAM, making it difficult to draw conclusions about what information is being shared. To address this gap, we performed inductive thematic analysis to investigate the visual and written content of images (n = 879 images), as well as post captions of N = 600 posts. that contained the hashtag “#endometriosisawarenessmonth”. Results show that written content within the images most frequently contained features of the disease. Caption content featured general/vague knowledge about the disease and general awareness of endometriosis, such as ‘pain (general/unspecified)’. The mental health impact of the disease was underrepresented in Instagram posts. Moving forward, the #endometriosisawarenessmonth campaign could be strengthened by communicating specific diagnostic and prevalence information, and harnessing conversations about the impact of the disease on mental health. Full article

A new coronavirus, SARS-CoV-2, was identified at the end of 2019. It swiftly spread all over the world, affecting more than 600 million people and causing over 6 million deaths worldwide. Different COVID-19 vaccines became available by the end of 2020. Healthcare workers and more vulnerable people (such as the elderly and those with comorbidities) were initially prioritized, followed by the entire population, including pregnant and breastfeeding women. Despite the safety and efficacy of COVID-19 vaccines, a certain level of skepticism was expressed, including among pregnant and breastfeeding women. There were several reasons for this reluctancy, among them, fear of side-effects for both women and fetuses. Nevertheless, acceptance, as well as hesitancy, were time, country and vaccine specific. This review will collect available evidence assessing knowledge, attitudes, behaviour, practice and acceptance/hesitancy of pregnant/breastfeeding women in relation to the COVID-19 vaccination. The PubMed/MEDLINE, Scopus and EMBASE databases will be consulted. A predefined search strategy that combines both free text and MESH terms will be used. The systematic review will adhere to the PRISMA guidelines and the results will be reported in both narrative and summary tables. A meta-analysis will be conducted if data are available. Full article

Child marriage, defined as union before age 18 years, has detrimental health and socioeconomic consequences. This study examines whether women married as children have a disproportionately higher risk of being obese at adulthood compared to their peers married as adults. Using data from the 2012 and 2017 waves of the Tajikistan Demographic and Health Survey, we matched women aged 25 to 49 years by birth year and month to create four birth cohorts. We fitted multivariable logistic regressions to assess the differential odds of being obese and estimated simultaneous quantile regression models to examine the differences in average body mass index (BMI) between women married as adults and as children within birth cohorts. We found that the adjusted odds of being obese for women married as children were 1.5 (CI: 1.3–1.7) times those of those who were married as adults, after controlling for sociodemographic correlates along with birth cohort and survey wave fixed effects. Results of the quantile regression analyses suggest higher expected BMI levels among women married as children compared to those of women married as adults across different quantiles of BMI. The differences though were more pronounced in the younger cohorts than in the older cohorts. Full article

Most times, pregnancy is considered a joyous event, but it also heightens a woman’s emotional and psychological state. Globally, some women suffer mental disorders, especially in developing nations. In Nigeria, there is evidence for a high prevalence of depression, anxiety, and stress during pregnancy. Therefore, this study aimed to estimate the severity and factors associated with depression, anxiety, and stress among pregnant women in Port Harcourt, Nigeria. A facility-based cross-sectional survey was carried out in the two tertiary hospitals in Port Harcourt city between September and October 2022 using the Depression Anxiety and Stress Scale-21 (DASS-21). Univariate, bivariate, and multivariate analyses were performed using STATA 16. The proportional odds model (POM) was used, and the statistical significance was set at p ≤ 0.05. A total of 413 respondents participated in the study, of whom 9.5%, 26.6%, and 17.3% had at least moderate depression, anxiety, and stress, respectively. Marital status, educational levels, and employment status were significantly associated with depression. Marital status, religion, and trimester were significantly associated with anxiety, while age, marital status, educational level, religion, income, trimester, and previous abortions/miscarriages were significantly related to stress. This study showed evidence of moderate-to-extremely severe anxiety, stress, and depression, as well as factors associated with these disorders. Our findings have implications for strengthening mental health policies as they pertain to antenatal care. Full article