Decision aids (DA) are effective for engaging pregnant women in decisions about prenatal screening yet not implemented at scale.We evaluated the impact of scaling a DA about prenatal screening on the extent to which pregnant women were involved in the decision-making process.We completed a pragmatic stepped-wedge cluster randomized controlled trial in the province of Quebec. We randomly assigned 32 clinics to four clusters of eight units. Eligible participants were all women in early pregnancy receiving prenatal care. Clinics changed practice from usual care (control period) to scaling of a DA (intervention period): delivering of paper based DA every 10 weeks, digital version of the DA, online training module for clinicians and monthly reminders. The primary outcome was the extent to which pregnant women were involved in the decision-making process about prenatal screening using SDM-Q9. We performed intention-to-treat. We used a linear mixed-effects model with clustering at the clinic level and adjusted for time. This trial is registered with ClinicalTrials.gov, NCT05859139.From July 2022 to January 2024, with follow up until July 2024, we enrolled 32 clinics with 886 pregnant women of whom 673 (76.0%) were included in the primary analysis (333 in the intervention group and 340 in the control group). Participants had a mean age of 31.5 years (SD 4.5), 70.3 % reported white ethnicity, 61.4 % university-educated and 86.3 % were Canadian citizen by birth. The adjusted mean difference in SDM-Q9 scores between the intervention and control groups was 4.22 (95% CI: -1.67 to 10.10).In clinical settings exposed to scaling of a DA compared to clinical settings not exposed to scaling of a DA, pregnant women were more involved in the decision-making process about prenatal screening but this was not statistically significant.Scaling of a DA about prenatal screening showed a non-statistically significant increase in the extent to which pregnant women were involved in the decision-making process. Further research should identify what may cause a reduction of a DA effectiveness and effect size at the population-level during its scaling across multiple clinics.

Progress in reducing infant mortality in England has stalled, with widening inequalities driven by socioeconomic deprivation. Infants and pregnant people living in the most deprived areas experience substantially poorer outcomes, including preterm birth, stillbirth, and maternal mortality. Pregnancy represents a critical opportunity for community interventions addressing the wider determinants of health, including social prescribing and Family Hubs.To evaluate a proactive approach aimed at improving access to community-based support services for pregnant people in socioeconomically disadvantaged communities, focusing on implementation, engagement, health outcomes, and transferable learning for reducing inequalities.A one-year mixed-methods service evaluation was conducted using a structure–process–outcome framework. Pregnant people living in the two most deprived neighbourhood quintiles were identified using maternity booking data. The intervention involved proactive outreach, with trained call handlers identifying non-clinical needs and facilitating referral to community support services, including Family Hubs, welfare advice, and social prescribing. Quantitative data included programme activity, referral uptake, and maternity indicators, with pre- and post-pilot comparisons. Qualitative data were collected through Ripple Effects Mapping workshops with multi-agency stakeholders and maternity service user representatives and analysed thematically.A total of 1,239 pregnant people were identified and contacted; 355 (29%) onward referrals were completed to community support services including Family Hubs and social prescribing. Engagement with family support services increased substantially compared with the pre-intervention period. There was a marked rise in uptake of the offer among pregnant people from the 20% most deprived areas, rising from 28% to 95%. Common reasons for referral included infant feeding, parenting groups, housing, finances, and mental health. Case examples demonstrate improvements in financial stability, housing safety, and overall wellbeing. Qualitative analysis highlighted strengthened cross-sector collaboration, enhanced understanding of social determinants, and earlier identification of needs.Challenges included individuals who were unreachable and the associated unknown and unmet needs of those not referred or contacted. Strengths included a data-driven population health management approach to proactively identify unmet support needs.This pilot demonstrates that targeted, proactive outreach can boost engagement with community support services in deprived communities, creating opportunities to address social needs and improve maternal and infant health outcomes.

Pregnancy is a stressful experience, which can affect different aspects of a woman's life. Yet, women with a supportive network of friends and family may experience lower stress and improved self-care behavior.The study aimed to investigate the relationship between perceived stress and pregnancy distress with the self-care of pregnant women, as well as the mediating role of social support.This cross-sectional study was conducted from February to May 2022 in Babol, Iran. A total of 157 pregnant women participated in the study. The participants completed five questionnaires, including a demographic and obstetric questionnaire, a Self-care questionnaire, Perceived Social support (PSS), Perceived Stress Inventory (PSI), and Pregnancy Specific Distress. Structural equation modeling was used to test the hypothesis relationships among the variables.We found that Perceived stress (β = −0.221, p = 0.012β) and pregnancy distress (β = −0.203, p = 0.002β) had a negative and significant effect on the self-care of pregnant women. Also, perceived stress (β = −0.429, p < 0.001β) and pregnancy distress (β = −0.381, p < 0.001β) had a negative and significant effect on the social support of pregnant women. The results exhibited a significant specific indirect effect between pregnancy distress, perceived stress, and pregnancy self-care, with social support as the mediator: standardized indirect effect = −0.068, −0.076, respectively.The results of this study showed that perceived stress, pregnancy distress, and impaired social support have a negative and significant effect on pregnant women's self-care, while social support played a mediating roleTherefore, providing strategies and measures to improve perceived social support by maternal health professionals may be expected to reduce the impact of stress on pregnant women's self-care. The implementation of policies and social interventions to improve the social support of pregnant women can be one of the applications of the findings.

Pregnancy in girls under 14 years is a sentinel event of sexual violence, as XXX law defines any sexual act in this age group as statutory rape. Primary health care is often the first point of contact, playing a strategic role in identifying violence, ensuring compulsory notification, and activating protection and care pathways.To analyze how violence involving pregnant girls aged ≤14 years is documented and managed within XXX health services, identifying gaps relevant to primary care and child protection.A descriptive ecological study used national data from the XXX Notifiable Diseases Information System (SINAN) from 2010 to 2017. All notifications involving pregnant girls aged ≤14 years were included. Live Birth Information System (SINASC) data contextualized under-recognition. Analysis focused on notification completeness, recurrence, care procedures, referrals, and access to legally guaranteed interventions.Between 2010 and 2017, 10,864 cases of violence against pregnant girls ≤14 years were recorded, compared to over 212,000 live births in the same age group. Despite legal presumption of sexual violence, documentation was often incomplete, particularly regarding referrals and follow-up. Nearly half of the cases involved recurrent violence, mostly occurring in households and perpetrated by known individuals. Essential primary care interventions - post-exposure prophylaxis for STIs, emergency contraception, referral for legal abortion, and psychosocial support - were rarely documented, indicating limited activation of protection pathways.Pregnancy in young girls is frequently treated as an obstetric or social issue rather than as evidence of sexual violence. This highlights gaps in professional training, normalization of child pregnancy, and weak coordination between primary care, health surveillance, and child protection services, resulting in missed opportunities for early intervention.Recognizing pregnancy in girls under 14 as a sentinel event of sexual violence is essential to strengthen primary care responses. Empowering family physicians and primary care teams to identify violence, ensure notification, and coordinate rights-based intersectoral care is critical to prevent recurrent abuse and protect children’s sexual and reproductive rights.

Smoking during pregnancy remains a significant public health concern due to its association with adverse maternal and neonatal outcomes.To analyse the sociodemographic characteristics and tobacco consumption patterns in the study population. To identify the relationship between smoking, mode of delivery, and gestational age.This study is part of the TOBBGEST project, which evaluates the effectiveness of the TobbStop mobile application in reducing tobacco use among pregnant smokers. A multicentre randomised clinical trial and community-based intervention was conducted in Catalonia (Spain) between 2022 and 2025. Pregnant women under 28 weeks of gestation who were motivated to quit smoking were included. The control group (CG) received standard counselling, while the intervention group (IG) additionally accessed the TobbStop app. Main variables were mode of delivery and gestational age. Tobacco consumption data were collected during follow-up visits. Secondary variables included sociodemographic characteristics and lifestyle habits. Student’s t-tests or Mann-Whitney U tests were used for continuous variables, and Pearson’s chi-square for categorical variables.A total of 43 women participated (22 CG; 21 IG). No relevant differences were observed between groups in education level, household composition, or cultural context. The mean age of smoking initiation was 16 years, and more than half had previously attempted cessation; 90% had done so without pharmacological treatment. A total of 91% of the CG and 76% of the IG lived with smokers. Among pregnant women exposed to tobacco, 46.2% experienced dystocic deliveries. Those who smoked during the third trimester had a higher dystocic delivery rate (85.7%) compared with those who remained abstinent for more than 90 days (38.5%). Preterm births accounted for 20.9% of deliveries. No statistically significant differences were found between the CG and IG. *The sample will be expanded to 105 participants by the time of the conference.Findings align with evidence that continued smoking during pregnancy increases dystocic and preterm delivery risks. Although no statistically significant differences between groups were observed, trends suggest that earlier cessation may reduce obstetric complications.Smoking during pregnancy increases the risk of dystocic and preterm delivery. Encouraging smoking cessation before the third trimester may reduce these risks.

Primary health care (PHC) constitutes the first point of contact for patients within the national health service. Increasing waiting times for hospital appointments make collaboration between PHC and hospital care (HC) essential to ensure timely access and high-quality services.To evaluate the impact of monthly consultation meetings between a specialist in family medicine and a gynecology specialist on the number of referrals to hospital gynecology consultations from two family health units.We conducted an observational, descriptive, cross-sectional study. The meetings were held monthly, lasted approximately one hour, and took place between October 2024 and July 2025. All cases discussed during the consultancy meetings within this period were analyzed. Data collected and reviewed included age, diagnosis, procedures performed, type of consultation, and the need for referral to hospital consultation.Eight meetings were held during the aforementioned period. Meetings scheduled for March and June 2025 did not occur due to scheduling conflicts between the specialists involved. A total of 69 cases were discussed, of which 16 patients were evaluated in face-to-face consultations. The mean age of patients was 48.4 years (minimum=15; maximum=79). The main themes discussed were the management of various gynecological symptoms (n=15, 22%); management of ultrasound abnormalities (n=12, 17%), namely fibroids; management of scheduling evaluation consultations after abnormalities detected in cervical cancer screening (n=10, 14%); and urinary incontinence (n=9, 13%). 18 referrals to hospital consultation were made (26%).The implementation of monthly consultancy meetings between specialists in family medicine and gynecology reduced the referrals to HC in 74%, proving to be an effective strategy for the management of clinical cases in PHC. Furthermore, these meetings promoted knowledge sharing, continuous professional development, and strengthened coordination between levels of care, leading to improved quality of care provided to patients.Joint discussion between family and gynecology specialists optimized diagnostic and therapeutic approaches, reducing unnecessary referrals to HC, demonstrating a positive impact on triage and the rational use of available resources. Thus, this collaborative model is a useful and replicable tool, contributing to greater efficiency within the health system.

Pregnancy is a critical life stage in which healthy lifestyle behaviors strongly influence maternal and fetal outcomes. Many pregnant women experience challenges such as low physical activity, suboptimal nutrition, and increased stress. Primary care offers the most accessible setting for lifestyle counseling; however, routine visits may provide limited time for comprehensive education. Video-based digital interventions offer a scalable, low-cost approach to support behavior change during pregnancy.The primary objective was to evaluate the effect of a video-based lifestyle modification intervention on pregnant women’s quality of life. Secondary objectives were to assess its impact on healthy lifestyle behaviors and depressive symptoms.This open-label, parallel-group randomized controlled trial enrolled pregnant women receiving routine antenatal care in primary care. Participants were randomly assigned (1:1) to intervention or control groups. The intervention group received a structured 12-week video-based lifestyle program beginning between gestational weeks 20 and 24, while the control group received standard antenatal care. Outcomes were assessed using the EQ-5D-3L for quality of life, the Health-Promoting Lifestyle Profile II (HPLP-II) for lifestyle behaviors, and the Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms.The intervention group demonstrated a statistically significant improvement in EQ-5D-3L quality-of-life scores compared with controls (p<0.05). HPLP-II total and all subscale scores—including health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management—were significantly higher in the intervention group (p<0.001). EPDS scores decreased significantly, indicating reduced depressive symptoms.The intervention produced consistent behavioral and psychological benefits, supporting the feasibility of structured digital content in antenatal care. Strengthening lifestyle habits during pregnancy may promote healthier maternal weight gain, better birth outcomes, reduced postpartum complications, and improved early childhood development. Integrating scalable digital tools within primary care could enhance maternal–child health services and reduce disparities in access to lifestyle support.A 12-week video-based lifestyle education program significantly improved quality of life, enhanced healthy lifestyle behaviors, and reduced depressive symptoms in pregnant women. Incorporating digital education into primary care antenatal services may offer a sustainable and accessible strategy to support maternal well-being. MeSH: Pregnancy, Quality of Life, Video-Based Education, Healthy Lifestyle, Depression