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Prenatal maternal stress alters maternal-fetal heart rate coupling, as demonstrated by the Fetal Stress Index derived from bivariate phase-rectified signal averaging. Here, we extend this framework using information-theoretical measures to elucidate underlying mechanisms. In 120 third-trimester pregnancies (58 stressed, 62 control), we computed transfer entropy (TE), entropy rate (ER), and sample entropy (SE) under multiple conditioning paradigms, employing mixed linear models for repeated measures. We identify dual coupling mechanisms at the short-term (0.5 - 2.5 s), but not long-term (2.5 - 5 s) time scales: (1) stress-invariant state-dependent synchronization, with maternal decelerations exerting approximately 60% coupling strength on fetal heart rate complexity - a fundamental coordination conserved across demographics; and (2) stress-sensitive temporal information transfer (TE), showing exploratory associations with maternal cortisol that require replication. A robust sex-by-stress interaction emerged in TE from mixed models, with exploratory female-specific coupling patterns absent in males. Universal acceleration predominance was observed in both maternal and fetal heart rat

While machine learning shows promise for maternal health risk prediction, clinical adoption in resource-constrained settings faces a critical barrier: lack of explainability and trust. This study presents a hybrid explainable AI (XAI) framework combining ante-hoc fuzzy logic with post-hoc SHAP explanations, validated through systematic clinician feedback. We developed a fuzzy-XGBoost model on 1,014 maternal health records, achieving 88.67% accuracy (ROC-AUC: 0.9703). A validation study with 14 healthcare professionals in Bangladesh revealed strong preference for hybrid explanations (71.4% across three clinical cases) with 54.8% expressing trust for clinical use. SHAP analysis identified healthcare access as the primary predictor, with the engineered fuzzy risk score ranking third, validating clinical knowledge integration (r=0.298). Clinicians valued integrated clinical parameters but identified critical gaps: obstetric history, gestational age, and connectivity barriers. This work demonstrates that combining interpretable fuzzy rules with feature importance explanations enhances both utility and trust, providing practical insights for XAI deployment in maternal healthcare.

The ability to provide trustworthy maternal health information using phone-based chatbots can have a significant impact, particularly in low-resource settings where users have low health literacy and limited access to care. However, deploying such systems is technically challenging: user queries are short, underspecified, and code-mixed across languages, answers require regional context-specific grounding, and partial or missing symptom context makes safe routing decisions difficult. We present a chatbot for maternal health in India developed through a partnership between academic researchers, a health tech company, a public health nonprofit, and a hospital. The system combines (1) stage-aware triage, routing high-risk queries to expert templates, (2) hybrid retrieval over curated maternal/newborn guidelines, and (3) evidence-conditioned generation from an LLM. Our core contribution is an evaluation workflow for high-stakes deployment under limited expert supervision. Targeting both component-level and end-to-end testing, we introduce: (i) a labeled triage benchmark (N=150) achieving 86.7% emergency recall, explicitly reporting the missed-emergency vs. over-escalation trade-off; (i

Maternal health literacy is associated with greater odds of positive pregnancy outcomes. There is an increasing proliferation of websites dedicated to maternal health education, but the scope and quality of their content varies widely. In this study, we analyzed the main topics covered on maternal health websites that offer content in the low-resource Kinyarwanda language (mainly spoken by 12 million Rwandans). We used web scraping to identify maternal health websites. We utilized a topic modeling, using the Non-Negative Matrix Factorization (NMF) algorithm, to identify the topics. We found five main topics: (1) pregnancy danger signs, (2) child care, (3) intimacy (sex), (4) nutrition, and (5) the importance of doctor consultations. However, the articles were short and did not cater to fathers, pregnant adolescents, or those experiencing gender-based violence (GBV) or mental health challenges. This is despite 12.5\% women of reproductive age in Rwanda being victims of GBV and one in five women in low- and middle-income countries experiencing mental illness during the perinatal period. We recommend three automated tools, a topic recommender tool, culturally relevant automated articl

This report presents a statistical analysis of the impact of key maternal characteristics, including age, smoking status, parity, height, weight, and gestation period, on newborn birth weight. A realworld dataset comprising 1,236 observations was utilized for this investigation. The methodology involved comprehensive data cleaning, exploratory data analysis (EDA), and a series of parametric statistical tests, specifically the One-Sample t-test, Two-Sample t-test, Chi-Square tests, and Analysis of Variance (ANOVA). All analyses were conducted within the SAS programming environment. The study's findings indicate a statistically significant negative impact of maternal smoking on birth weight, a finding consistent with broader public health literature. Gestation period emerged as the strongest positive predictor of birth weight within this dataset. While the analyses using broad categories of maternal age and parity did not reveal significant differences in mean birth weight, a review of existing literature suggests more intricate, potentially non-linear relationships and nuanced effects of these factors. Similarly, maternal pre-pregnancy weight, though showing a weak linear correlatio

Maternal and child health is a critical concern around the world. In many global health programs disseminating preventive care and health information, limited healthcare worker resources prevent continuous, personalised engagement with vulnerable beneficiaries. In such scenarios, it becomes crucial to optimally schedule limited live-service resources to maximise long-term engagement. To address this fundamental challenge, the multi-year SAHELI project (2020-2025), in collaboration with partner NGO ARMMAN, leverages AI to allocate scarce resources in a maternal and child health program in India. The SAHELI system solves this sequential resource allocation problem using a Restless Multi-Armed Bandit (RMAB) framework. A key methodological innovation is the transition from a traditional Two-Stage "predict-then-optimize" approach to Decision-Focused Learning (DFL), which directly aligns the framework's learning method with the ultimate goal of maximizing beneficiary engagement. Empirical evaluation through large-scale randomized controlled trials demonstrates that the DFL policy reduced cumulative engagement drops by 31% relative to the current standard of care, significantly outperform

In recent years, LLM-based maternal health chatbots have been widely deployed in low-resource settings, but they often ignore real-world contexts where women may not own phones, have limited literacy, and share decision-making within families. Through the deployment of a WhatsApp-based maternal health chatbot with 48 pregnant women in Lahore, Pakistan, we examine barriers to use in populations where phones are shared, decision-making is collective, and literacy varies. We complement this with focus group discussions with obstetric clinicians. Our findings reveal how adoption is shaped by proxy consent and family mediation, intermittent phone access, silence around asking questions, infrastructural breakdowns, and contested authority. We frame barriers to non-use as culturally conditioned rather than individual choices, and introduce the Relational Chatbot Design Grammar (RCDG): four commitments that enable mediated decision-making, recognize silence as engagement, support episodic use, and treat fragility as baseline to reorient maternal health chatbots toward culturally grounded, collective care.

Mammalian gut microbiomes are essential for host functions like digestion, immunity, and nutrient utilization. This study examines the gut microbiome of horses, donkeys, and their hybrids, mules and hinnies, to explore the role of microbiomes in hybrid vigor. We performed whole-genome sequencing on rectal microbiota from 18 equids, generating detailed microbiome assemblies. Our analysis revealed significant differences between horse and donkey microbiomes, with hybrids showing a pronounced maternal resemblance. Notably, Firmicutes were more abundant in the horse-maternal group, while Fibrobacteres were richer in the donkey-maternal group, indicating distinct digestive processes. Functional annotations indicated metabolic differences, such as protein synthesis in horses and energy metabolism in donkeys. Machine learning predictions of probiotic species highlighted potential health benefits for each maternal group. This study provides a high-resolution view of the equid gut microbiome, revealing significant taxonomic and metabolic differences influenced by maternal lineage, and offers insights into microbial contributions to hybrid vigor.

Maternal mortality in Sub-Saharan Africa remains critically high, accounting for 70% of global deaths despite representing only 17% of the world population. Current digital health interventions typically deploy artificial intelligence (AI), Internet of Things (IoT), and blockchain technologies in isolation, missing synergistic opportunities for transformative healthcare delivery. This paper presents IyaCare, a proof-of-concept integrated platform that combines predictive risk assessment, continuous vital sign monitoring, and secure health records management specifically designed for resource-constrained settings. We developed a web-based system with Next.js frontend, Firebase backend, Ethereum blockchain architecture, and XGBoost AI models trained on maternal health datasets. Our feasibility study demonstrates 85.2% accuracy in high-risk pregnancy prediction and validates blockchain data integrity, with key innovations including offline-first functionality and SMS-based communication for community health workers. While limitations include reliance on synthetic validation data and simulated healthcare environments, results confirm the technical feasibility and potential impact of co

We present the design, implementation, and in-situ deployment of a smartphone-based voice-enabled AI system for generating electronic medical records (EMRs) and clinical risk alerts in maternal healthcare settings. Targeted at low-resource environments such as Pakistan, the system integrates a fine-tuned, multilingual automatic speech recognition (ASR) model and a prompt-engineered large language model (LLM) to enable healthcare workers to engage naturally in Urdu, their native language, regardless of literacy or technical background. Through speech-based input and localized understanding, the system generates structured EMRs and flags critical maternal health risks. Over a seven-month deployment in a not-for-profit hospital, the system supported the creation of over 500 EMRs and flagged over 300 potential clinical risks. We evaluate the system's performance across speech recognition accuracy, EMR field-level correctness, and clinical relevance of AI-generated red flags. Our results demonstrate that speech based AI interfaces, can be effectively adapted to real-world healthcare settings, especially in low-resource settings, when combined with structured input design, contextual med

The Neomycin resistance cassette (Neo+) is commonly inserted in the genome of mice to generate knock-out (KO) models. The effect of gene deletion on social behaviors in mice is controversial between studies using different Neo+ and Neo-mouse lines, particularly Arc/Arg3.1 KO lines. In this study, we identified severe maternal behavior impairments in Neo+, but not Neo-Arc/Arg3.1 KO dams. These deficits resulted from reduced sociability and abnormal social information processing in Neo+ Arc/Arg3.1 KO dams, exacerbated by social communication impairments in pups. The expression of the Neo cassette product did not cause cytotoxicity, but led to altered ERK signaling, gene expression, and oxytocin system. However, oxytocin administration did not improve social impairments in Neo+ Arc/Arg3.1 KO animals. Interestingly, early social environment enrichment enhanced social interaction with familiar, but not unfamiliar conspecifics or maternal behavior. Overall, our findings reveal a major impact of the Neo cassette on behaviors, particularly social behaviors, in Arc/Arg3.1 KO mice, underscoring the need to re-examine phenotypes of animal models carrying the Neo cassette in neuroscience resea

Mobile health (mHealth) programs utilize automated voice messages to deliver health information, particularly targeting underserved communities, demonstrating the effectiveness of using mobile technology to disseminate crucial health information to these populations, improving health outcomes through increased awareness and behavioral change. India's Kilkari program delivers vital maternal health information via weekly voice calls to millions of mothers. However, the current random call scheduling often results in missed calls and reduced message delivery. This study presents a field trial of a collaborative bandit algorithm designed to optimize call timing by learning individual mothers' preferred call times. We deployed the algorithm with around $6500$ Kilkari participants as a pilot study, comparing its performance to the baseline random calling approach. Our results demonstrate a statistically significant improvement in call pick-up rates with the bandit algorithm, indicating its potential to enhance message delivery and impact millions of mothers across India. This research highlights the efficacy of personalized scheduling in mobile health interventions and underscores the po

The study investigated the impact of healthcare system efficiency on the delivery of maternal, newborn, and child services in Africa. Data Envelopment Analysis and Tobit regression were employed to assess the efficiency of 46 healthcare systems across the continent, utilizing the Variable Returns to Scale model with Input orientation to evaluate technical efficiency. The Tobit method was utilized to explore factors contributing to inefficiency, with inputs variables including hospital, physician, and paramedical staff, and outputs variables encompassing maternal, newborn, and child admissions, cesarean interventions, functional competency, and hospitalization days. Results revealed that only 26% of countries exhibited efficiency, highlighting a significant proportion of 74% with inefficiencies. Financial determinants such as current health expenditures, comprehensive coverage index, and current health expenditure per capita were found to have a negative impact on the efficiency of maternal-child services. These findings underscore a marginal deficiency in technical efficiency within Africa's healthcare systems, emphasizing the necessity for policymakers to reassess the roles of bot

Civil registration vital statistics (CRVS) data are used to produce national estimates of maternal mortality, but are often subject to substantial reporting errors due to misclassification of maternal deaths. The accuracy of CRVS systems can be assessed by comparing CRVS-based counts of maternal and non-maternal deaths to those obtained from specialized studies, which are rigorous assessments of maternal mortality for a given country-period. We developed a Bayesian bivariate random walk model to estimate sensitivity and specificity of the reporting on maternal mortality in CRVS data, and associated CRVS adjustment factors. The model was fitted to a global data set of CRVS and specialized study data. Validation exercises suggest that the model performs well in terms of predicting CRVS-based proportions of maternal deaths for country-periods without specialized studies. The new model is used by the UN Maternal Mortality Inter-Agency Group to account for misclassification errors when estimating maternal mortality using CRVS data.

Malnutrition among pregnant women is a major public health challenge in Ethiopia, increasing the risk of adverse maternal and neonatal outcomes. Traditional statistical approaches often fail to capture the complex and multidimensional determinants of nutritional status. This study develops a predictive model using ensemble machine learning techniques, leveraging data from the Ethiopian Demographic and Health Survey (2005-2020), comprising 18,108 records with 30 socio-demographic and health attributes. Data preprocessing included handling missing values, normalization, and balancing with SMOTE, followed by feature selection to identify key predictors. Several supervised ensemble algorithms including XGBoost, Random Forest, CatBoost, and AdaBoost were applied to classify nutritional status. Among them, the Random Forest model achieved the best performance, classifying women into four categories (normal, moderate malnutrition, severe malnutrition, and overnutrition) with 97.87% accuracy, 97.88% precision, 97.87% recall, 97.87% F1-score, and 99.86% ROC AUC. These findings demonstrate the effectiveness of ensemble learning in capturing hidden patterns from complex datasets and provide t

Automated voice calls with health information are a proven method for disseminating maternal and child health information among beneficiaries and are deployed in several programs around the world. However, these programs often suffer from beneficiary dropoffs and poor engagement. In previous work, through real-world trials, we showed that an AI model, specifically a restless bandit model, could identify beneficiaries who would benefit most from live service call interventions, preventing dropoffs and boosting engagement. However, one key question has remained open so far: does such improved listenership via AI-targeted interventions translate into beneficiaries' improved knowledge and health behaviors? We present a first study that shows not only listenership improvements due to AI interventions, but also simultaneously links these improvements to health behavior changes. Specifically, we demonstrate that AI-scheduled interventions, which enhance listenership, lead to statistically significant improvements in beneficiaries' health behaviors such as taking iron or calcium supplements in the postnatal period, as well as understanding of critical health topics during pregnancy and inf

Maternal mortality remains a significant global public health challenge. One promising approach to reducing maternal deaths occurring during facility-based childbirth is through early warning systems, which require the consistent monitoring of mothers' vital signs after giving birth. Wireless vital sign monitoring devices offer a labor-efficient solution for continuous monitoring, but their scarcity raises the critical question of how to allocate them most effectively. We devise an allocation algorithm for this problem by modeling it as a variant of the popular Restless Multi-Armed Bandit (RMAB) paradigm. In doing so, we identify and address novel, previously unstudied constraints unique to this domain, which render previous approaches for RMABs unsuitable and significantly increase the complexity of the learning and planning problem. To overcome these challenges, we adopt the popular Proximal Policy Optimization (PPO) algorithm from reinforcement learning to learn an allocation policy by training a policy and value function network. We demonstrate in simulations that our approach outperforms the best heuristic baseline by up to a factor of $4$.

Harnessing the wide-spread availability of cell phones, many nonprofits have launched mobile health (mHealth) programs to deliver information via voice or text to beneficiaries in underserved communities, with maternal and infant health being a key area of such mHealth programs. Unfortunately, dwindling listenership is a major challenge, requiring targeted interventions using limited resources. This paper focuses on Kilkari, the world's largest mHealth program for maternal and child care - with over 3 million active subscribers at a time - launched by India's Ministry of Health and Family Welfare (MoHFW) and run by the non-profit ARRMAN. We present a system called CHAHAK that aims to reduce automated dropouts as well as boost engagement with the program through the strategic allocation of interventions to beneficiaries. Past work in a similar domain has focused on a much smaller scale mHealth program and used markovian restless multiarmed bandits to optimize a single limited intervention resource. However this paper demonstrates the challenges in adopting a markovian approach in Kilkari; therefore CHAHAK instead relies on non-markovian time-series restless bandits, and optimizes mu

In the evolving world, we require more additionally the young era to flourish and evolve into developed land. Most of the population all around the world are unaware of the complications involved in the routine they follow while they are pregnant and how hospital facilities affect maternal health. Maternal Mortality is the death of a pregnant woman due to intricacies correlated to pregnancy, underlying circumstances exacerbated by the pregnancy or management of these situations. It is crucial to consider the Maternal Mortality Rate (MMR) in diverse locations and determine which human routines and hospital facilities diminish the Maternal Mortality Rate (MMR). This research aims to examine and discover the countries which are keeping more lavish threats of MMR and countries alike in MMR encountered. Data is examined and collected for various countries, data consists of the earlier years' observation. From the perspective of Machine Learning, Unsupervised Machine Learning is implemented to perform Cluster Analysis. Therefore the pairs of countries with similar MMR as well as the extreme opposite pair concerning the MMR are found.