Decision Sciences

Abstract Background Clinical guidelines in the United States (U.S.) recommend a patient-centered approach to healthcare for pregnant people with substance use disorders (SUD); however, pregnant people with SUD often describe experiencing stigmatization and shame when seeking prenatal care. We explored the perspectives of pregnant and parenting people engaged with SUD treatment regarding their experiences with healthcare providers during the perinatal period to improve guidance for patient-centered care. Materials and methods Using an adapted phenomenological approach, we conducted in-depth interviews with 22 pregnant and parenting people recruited from inpatient or outpatient substance use treatment centers in the U.S. state of Colorado. We developed an interview guide to explore participants’ experiences during pregnancy, childbirth, and postpartum. We audio recorded, transcribed, and validated interviews for analyses. A codebook was developed using an iterative process. Three coders analyzed the data and synthesized data into thematic memos. Results Participants reported challenges within the healthcare system, including barriers to receiving services, connection to or education on resources, challenges in and reasons for sharing their history of substance use with healthcare providers, provider reactions to this information, and the impact of providers’ response to knowing about their substance use history. Participants described shame regarding their substance use but also a strong desire to ensure the health of their infants. This desire motivated them to share their history of substance use with healthcare providers. When participants perceived nonjudgmental and empathetic responses, they reported feeling pride and empowerment. Participants who reported judgmental responses from providers stated that it made them less likely to share and engage with other healthcare providers in the future. Conclusion The perspectives and experiences of people engaged in SUD treatment can inform the implementation of clinical guidelines for patient-centered care for pregnant and parenting people in perinatal healthcare settings. Learnings from this study addresses ongoing challenges to compassionate care during this critical window, leading to disengagement of patients. Support through connection of resources can be helpful for ongoing recovery. Recommendations are made to establish trust through transparency and non-judgmental care and to reinforce receipt of appropriate healthcare services.

Abstract Background Every two minutes a woman dies from complications of pregnancy and childbirth. Most maternal deaths occur within the first 24 hours following birth, highlighting the importance of immediate postnatal care (iPNC). Self-care strategies are increasingly being employed to promote women-centred, continuous care provision. Despite international calls for development of strategies promoting self-care, none have been developed for self-monitoring in the immediate postnatal period. Fundamental to the development of a self-monitoring strategy, is an understanding of which signs and symptoms are predictive of maternal morbidity and mortality and can be easily assessed by mothers and birth companions, in health facilities, without the need for equipment. The objective of this study was to develop and achieve international consensus on the key signs and symptoms. Methods A multi-step approach involving a systematic scoping review, two- round Delphi Survey, and expert consensus was employed to identify key signs and symptoms that can be self- assessed and predict morbidity and mortality in the immediate postnatal period. Results A comprehensive list of 351 key signs and symptoms was identified from 44 clinical practice guidelines. Subsequently, 134 signs and symptoms were reviewed by Delphi respondents and international expert consensus was achieved for 19 key signs and symptoms across seven condition categories. The signs that were considered both important and able to be self-assessed by mothers and birth companions in the first 24 hours following birth included change in consciousness, seizure, severe headache, persistent visual impairment, urinary incontinence, chest pain, shortness of breath, severe pallor, fast heartbeat, rejection of baby, suicidal/infanticidal, fever, heavy blood loss, soft flabby uterus, unable to urinate easily, foul smelling discharge, rigors, syncope/dizziness, abnormal coloured urine. Conclusion This study identified key signs and symptoms which can be easily assessed by mothers and birth companions in the immediate postnatal period to identify those most at risk of morbidity and mortality. Further work is needed to validate this screening tool, and adapt it regionally and nationally.

Abstract Background This retrospective study aimed to examine the influence of hormonal and metabolic parameters across varying body mass index (BMI) levels on embryo quality and pregnancy outcomes in fresh embryo transfer cycles using assisted reproductive technology (ART) in patients diagnosed with polycystic ovary syndrome (PCOS). Methods A total of 167 women diagnosed with PCOS and 266 women without PCOS (control group) were included. Metabolic and hormonal parameters was compared between the two groups to evaluate their relationship with embryo quality and pregnancy outcomes. Subgroup analyses were performed to assess these effects in patients with normal and high BMI. Results In the PCOS group, hormonal and metabolic parameters such as insulin, blood lipids, luteinizing hormone (LH), anti-Müllerian hormone (AMH) and antral follicle counting (AFC) were significantly higher than in the control group. The PCOS group also produced more blastocysts and a higher proportion of high-quality blastocysts. However, pregnancy rate and clinical pregnancy rates were similar between the two groups, regardless of BMI. Among the high-BMI PCOS patients, the miscarriage rate was significantly higher compared to the control group, and its rate showed a positive correlation with BMI, LH, and total testosterone (TSTO) levels. Conclusion Hormonal imbalances and glucose-lipid metabolism have minimal influence on embryo development in PCOS patients. However, hormonal factors-particularly in PCOS patients with high BMI—significantly influence pregnancy outcomes, with elevated BMI and androgen levels increasing the risk of miscarriage. These findings underscore the importance of addressing metabolic and hormonal factors in the management of PCOS patients undergoing ART.