Maternal Complications and Care Utilization Before and After Delivery in Iraq: A Cross-Sectional Study
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Objective: To assess maternal complications and utilization of maternal healthcare services before and after delivery among women attending a primary healthcare center in Ramadi, Iraq.
Methods and Materials: A cross-sectional study (non-probability sampling) was conducted at Al-Andallus Primary Healthcare Center, Ramadi (Anbar Governorate), from February to June 2022. Two independent groups were interviewed: 300 third-trimester pregnant women and 300 postpartum women. A structured questionnaire captured sociodemographic characteristics, antenatal/postnatal conditions (e.g., hypertension, diabetes, bleeding, anemia, urinary/vaginal infections, BMI), and service utilization (number of visits; place of delivery). Data were analyzed using descriptive statistics and bivariate tests (chi-square and correlation), with p<0.05.
Findings: Most participants were aged 18–35 years (mean 27.5±1.5), urban residents, and housewives; 29% had college education. During pregnancy, hypertension (30%), diabetes (20%), bleeding (40%), urinary/vaginal infections (55%), anemia (60%), and BMI>25 (70%) were reported; obesity correlated with infections and bleeding. Only about half attended two antenatal visits, and visit coverage was associated with sociodemographic factors and complications. Postpartum, hypertension (20%), diabetes (10%), bleeding (55%), urinary/vaginal infections (70%), BMI>25 (60%), anxiety/sleep disturbance (70%), and depression (40%) were reported. Many delivered outside hospitals and sought postnatal care late (around four months).
Conclusion: Maternal healthcare utilization before and after delivery was suboptimal and co-occurred with multiple complications linked to age, education, occupation, residence, and delivery site. Strengthening health education, timely ANC/PNC follow-up, and referral pathways is recommended.
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Al Janabi, T. (2023). Barriers to the utilization of primary health centers (PHCs) in Iraq. Epidemiologia, 4(2), 121-133. https://doi.org/10.3390/epidemiologia4020013
Alshikh Ahmad, H., Alkhatib, A., & Luo, J. (2021). Prevalence and risk factors of postpartum depression in the Middle East: a systematic review and meta–analysis. BMC pregnancy and childbirth, 21(1), 542. https://doi.org/10.1186/s12884-021-04016-9
Bateman, B. T., Shaw, K. M., Kuklina, E. V., Callaghan, W. M., Seely, E. W., & Hernández-Díaz, S. (2012). Hypertension in women of reproductive age in the United States: NHANES 1999-2008. PloS one, 7(4), e36171. https://doi.org/10.1371/journal.pone.0036171
Catalano, P., Presley, L., de Mouzon, S. H., & Kalhan, S. (2018). Longitudinal changes in amino acid (AA) turnover in pregnancy in women with normal glucose tolerance (NGT) and GDM—relationship to fetal growth. Diabetes, 67(Supplement_1), 1406-P. https://doi.org/10.2337/db18-1406-P
Catalano, P. M., Huston, L., Amini, S. B., & Kalhan, S. C. (1999). Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. American journal of obstetrics and gynecology, 180(4), 903-916. https://doi.org/10.1016/S0002-9378(99)70662-9
de Koning, E. J., & Rabelink, T. J. (2002). Endothelial function in the post-prandial state. Atherosclerosis Supplements, 3(1), 11-16. https://doi.org/10.1016/S1567-5688(01)00008-3
Diana, L., Glaucia, L., Adriana, C., & Israel Jr, F. (2018). Out-of-hospital deliveries: A case-control study. Turkish Archives of Pediatrics/Türk Pediatri Arşivi, 53(2), 87. https://doi.org/10.5152/TurkPediatriArs.2018.6269
Fegita, P., Hikmah, M., & Malik, R. (2022). Relationship Between Education Level, Age and Knowledge of Pregnant Women with Antenatal Care Status. Scientific Journal, 1(2), 158-166. https://doi.org/10.56260/sciena.v1i2.41
Feig, D. S., & Palda, V. A. (2002). Type 2 diabetes in pregnancy: a growing concern. The Lancet, 359(9318), 1690-1692. https://doi.org/10.1016/S0140-6736(02)08599-9
Gebreslassie Gebrehiwot, T., Mekonen, H. H., Hailu Gebru, T., Kiros, K. G., Gebresilassie, B., Teklu, G., Tesfay Tadese, H., & Haileslassie, Y. (2020). Prevalence and associated factors of early postnatal care service use among mothers who had given birth within the last 12 months in Adigrat town, Tigray, Northern Ethiopia, 2018. International Journal of Women's Health, 869-879. https://doi.org/10.2147/IJWH.S266248
Humphry, R. W., Cameron, A., & Gunn, G. J. (2004). A practical approach to calculate sample size for herd prevalence surveys. Preventive veterinary medicine, 65(3-4), 173-188. https://doi.org/10.1016/j.prevetmed.2004.07.003
Iyengar, S. D., Iyengar, K., & Gupta, V. (2009). Maternal health: a case study of Rajasthan. Journal of health, population, and nutrition, 27(2), 271. https://doi.org/10.3329/jhpn.v27i2.3369
Jakovljevic, M., Pallegedara, A., Vinayagathasan, T., & Kumara, A. S. (2022). Inequality in healthcare utilization and household spending in developing countries. In (Vol. 10, pp. 970819): Frontiers Media SA. https://doi.org/10.3389/fpubh.2022.970819
Karkee, R., & Khanal, V. (2016). Postnatal and neonatal care after home birth: A community-based study in Nepal. Women and Birth, 29(3), e39-e43. https://doi.org/10.1016/j.wombi.2015.10.003
Kearns, A., Onda, S., Caglia, J., Tuncalp, O., & Langer, A. (2014). Postnatal care in Nepal: Components of care, implementation challenges and success factors. Boston, MA: Harvard School of Public Health. https://content.sph.harvard.edu/wwwhsph/sites/2413/2014/09/HSPH-Nepal6.pdf
Lavrinenko, a., tishkambayev, y., serbo, y., shambilova, n., azizov, i., sandle, t., gyurka, a. g., & cheæcã, a. (2016). Prevalence of urinary tract infections on pregnant women. Archives of the Balkan Medical Union, 51(3), 316-319. https://www.researchgate.net/profile/Tim-Sandle/publication/307547181_prevalence_of_urinary_tract_infections_on_pregnant_women/links/57c8197b08ae28c01d518e1e/prevalence-of-urinary-tract-infections-on-pregnant-women.pdf
Lisonkova, S., Muraca, G. M., Potts, J., Liauw, J., Chan, W.-S., Skoll, A., & Lim, K. I. (2017). Association between prepregnancy body mass index and severe maternal morbidity. Jama, 318(18), 1777-1786. https://doi.org/10.1001/jama.2017.16191
Matar, M., Yared, G., Massaad, C., & Ghazal, K. (2025). Vaginal bleeding during pregnancy: a retrospective cohort study assessing maternal and perinatal outcomes. Journal of International Medical Research, 53(2), 03000605251315349. https://doi.org/10.1177/03000605251315349
Mosley, W. H., Koblinsky, M. A., & Reed, H. E. (2000). The consequences of maternal morbidity and maternal mortality: report of a workshop. doi: 10.1093/hropen/hoae017. eCollection 2024.
Nair, M., Churchill, D., Robinson, S., Nelson‐Piercy, C., Stanworth, S. J., & Knight, M. (2017). Association between maternal haemoglobin and stillbirth: a cohort study among a multi‐ethnic population in England. British Journal of Haematology, 179(5), 829-837. https://doi.org/10.1111/bjh.14961
Namutebi, M., Nalwadda, G. K., Kasasa, S., Muwanguzi, P. A., & Kaye, D. K. (2024). Prevalence of postpartum complications and associated factors among postpartum women in Uganda, a cross-sectional study. BMC pregnancy and childbirth, 24(1), 640. https://doi.org/10.1186/s12884-024-06827-y
Nodine, P. M., & Hastings-Tolsma, M. (2012). Maternal obesity: improving pregnancy outcomes. MCN: The American Journal of Maternal/Child Nursing, 37(2), 110-115. https://doi.org/10.1097/NMC.0b013e3182430296
Organization, W. H. (1998). DALYs and Reproductive Health: Report of an informal consultation, 27-28 April 1998. https://doi.org/10.1016/S0968-8080(99)90012-5
Organization, W. H. (2003). The world health report 2003: shaping the future. World Health Organization. https://books.google.com/books?id=Vv-rOQZs_e0C&lpg=PR7&ots=2Co2gRa2af&dq=Organization%2C%20W.%20H.%20(2003).%20The%20world%20health%20report%202003%3A%20shaping%20the%20future.%20World%20Health%20Organization.&lr&pg=PR7#v=onepage&q&f=false
Organization, W. H. (2014). WHO recommendations on postnatal care of the mother and newborn. World Health Organization. https://www.who.int/publications/i/item/9789241506649
Organization, W. H. (2018). The Work of WHO in the African Region-Report of the Regional Director: 2017-2018. https://iris.who.int/server/api/core/bitstreams/ceddf4dd-d450-4812-85c0-6eac40de78a0/content
Pierpont, M. E., Brueckner, M., Chung, W. K., Garg, V., Lacro, R. V., McGuire, A. L., Mital, S., Priest, J. R., Pu, W. T., & Roberts, A. (2018). Genetic basis for congenital heart disease: revisited: a scientific statement from the American Heart Association. Circulation, 138(21), e653-e711. https://doi.org/10.1161/CIR.0000000000000606
Platner, M. H., Ackerman, C. M., Howland, R. E., Illuzzi, J., Reddy, U. M., Bourjeily, G., Xu, X., & Lipkind, H. S. (2021). Severe maternal morbidity and mortality during delivery hospitalization of class I, II, III, and super obese women. American journal of obstetrics & gynecology MFM, 3(5), 100420. https://doi.org/10.1016/j.ajogmf.2021.100420
Qrg, A. (2021). Antepartum haemorrhage initial management: MFAU antepartum hemorrhage. North Metro, politan Health Service, 1, 17. https://pmc.ncbi.nlm.nih.gov/articles/PMC3263934/
Sacks, E., Finlayson, K., Brizuela, V., Crossland, N., Ziegler, D., Sauvé, C., Langlois, É. V., Javadi, D., Downe, S., & Bonet, M. (2022). Factors that influence uptake of routine postnatal care: Findings on women’s perspectives from a qualitative evidence synthesis. PloS one, 17(8), e0270264. https://doi.org/10.1371/journal.pone.0270264
Vogel, J. P., Souza, J., Mori, R., Morisaki, N., Lumbiganon, P., Laopaiboon, M., Ortiz‐Panozo, E., Hernandez, B., Pérez‐Cuevas, R., & Roy, M. (2014). Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: An International Journal of Obstetrics & Gynaecology, 121, 76-88. https://doi.org/10.1111/1471-0528.12633
Whitfield, P. M. (2020). Genetic Screening and Methylation Support During Pregnancy for Prevention of Preeclampsia. Nutritional Perspectives: Journal of the Council on Nutrition, 43(3). https://openurl.ebsco.com/EPDB%3Agcd%3A9%3A15027529/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A145069017&crl=c&link_origin=scholar.google.com
Zong, X. n., Wang, H., Yang, L., Guo, Y., Zhao, M., Magnussen, C. G., & Xi, B. (2022). maternal pre-pregnancy body mass index categories and infant birth outcomes: a population-based study of 9 million mother–infant pairs. Frontiers in Nutrition, 9, 789833. https://doi.org/10.3389/fnut.2022.789833
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