Maternal and Newborn Health Research Roundup – November 2024

1.

Global, regional, and national stillbirths at 20 weeks’ gestation or longer in 204 countries and territories, 1990–2021: findings from the Global Burden of Disease Study 2021

The Global Burden of Disease Study 2021 reveals a significant yet uneven decline in stillbirths worldwide from 1990 to 2021, with the global stillbirth rate at 20 weeks’ gestation or longer decreasing by 39.8%, from 5.08 million in 1990 to 3.04 million in 2021. Despite this progress, the reduction in stillbirths lagged behind the 45.6% decline in neonatal deaths over the same period. The study highlights stark regional disparities, with South Asia and sub-Saharan Africa accounting for 77.4% of global stillbirths in 2021, up from 60.3% in 1990. The findings underscore the need for targeted interventions in these regions to address the persistent high rates of stillbirths, particularly those occurring between 20 and 28 weeks’ gestation, which constituted 30.5% of the global total in 2021. The study emphasizes the importance of improving access to quality maternal healthcare, addressing socioeconomic disparities, and enhancing data collection and reporting systems to better monitor and prevent stillbirths. (16 November 2024)  

2.

Prevalence of group B Streptococcus colonisation in mother–newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study 

A prospective, observational study examined rectovaginal Group B Streptococcus (GBS) colonization in 6,922 pregnant women at the time of labor across nine low- and middle-income countries in Africa and South Asia. The findings report a high overall prevalence of maternal GBS colonization at 24.1%, with the highest rates in Mali and the lowest in Ethiopia. The study also reported a concerning 72.3% rate of vertical transmission from colonized mothers to their newborns, with Mozambique showing the highest transmission rates. The most common GBS serotypes identified were Ia, V, and III, although there was notable geographical variation in serotype distribution, with certain serotypes more prevalent in specific regions. These findings raise concerns about the current multivalent capsular-polysaccharide GBS vaccines, as serotypes not covered by these vaccines are common in some areas. The study underscores the need for vaccine efficacy and post-licensure effectiveness studies to consider the potential for non-vaccine serotype replacement and its impact on maternal GBS colonization. (20 August 2024) 

3.

Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 

This systematic analysis of antimicrobial resistance (AMR) in 204 countries and territories from 1990 to 2021 reveals critical trends and future forecasts. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than five years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than five years in all super-regions, whereas AMR mortality in people five years and older increased in all super-regions. The study estimates that in 2021, there were approximately 4.71 million deaths associated with bacterial AMR. Forecasts predict that by 2050, AMR could result in 1.91 million attributable deaths and 8.22 million associated deaths, particularly in South Asia, Latin America and the Caribbean. The findings emphasize the need for comprehensive interventions, combining infection prevention, vaccination, reduction of inappropriate antibiotic use, and research, to address the rising AMR burden and mitigate the projected deaths for 2050. (28 September 2024)  

4.

Safety of hepatitis E vaccine in pregnancy: an emulated target trial following a mass reactive vaccination campaign in Bentiu internally displaced persons camp, South Sudan  

A recent study conducted in Bentiu internally displaced persons camp in South Sudan provides reassuring evidence on the safety of the hepatitis E vaccine during pregnancy. Conducted in 2022, the study involved 2,741 pregnant women, with 74.3% vaccinated during pregnancy. Using an emulated target trial framework to minimize biases, the researchers found no significant increase in the risk of fetal loss among vaccinated women compared to their unvaccinated counterparts. Specifically, the cumulative risk of fetal loss was 7.2% for vaccinated women and 6.1% for unvaccinated women, yielding a risk ratio of 1.2, which is not statistically significant. These findings support the safety of the hepatitis E vaccine for pregnant women, emphasizing its potential to protect against the high mortality risks associated with hepatitis E during pregnancy. (November 2024) 

5.

Parental participation in newborn care in the view of health care providers in Uganda: a qualitative study 

A recent qualitative study from Uganda sheds light on the complex dynamics of parental involvement in neonatal care. Conducted in two high-volume maternity units, the study reveals that while healthcare providers encourage parental participation primarily to alleviate their own workload, this involvement is often limited and controlled. Parents are typically assigned tasks deemed non-critical, effectively positioning them as assistants rather than equal partners in care. This approach contrasts sharply with the principles of family-centered care, which advocate for parents to be integral participants in the caregiving process. The study underscores the need for a paradigm shift towards genuine family-centered care, which would require comprehensive training for healthcare providers and the development of structured guidelines to support meaningful parental involvement in neonatal care. (29 October 2024) 

6.

Initiation and continued use of oral pre-exposure prophylaxis among pregnant and postpartum women in South Africa (PrEP-PP): a demonstration cohort study 

A recent study from South Africa highlights significant challenges in the sustained use of PrEP among this demographic. Conducted in Cape Town, the study found that while initial uptake of PrEP was high during antenatal care, with many women starting the regimen, less than one-third continued its use at the 12-month mark. Key barriers to continued use included side effects, stigma, and lack of support from partners and healthcare providers. The study underscores the urgent need for integrating PrEP more effectively into antenatal and postpartum care, alongside developing targeted interventions to support adherence and address the identified barriers, to better protect both maternal and infant health from HIV. (November 2024)