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Most new parents will experience changes to their sexual relationship during the perinatal period, yet no accessible prevention programs exist to support couples in navigating these changes. Our aim was to assess the feasibility of the introductory modules of an online couple-based program (STORK) designed to promote perinatal sexual well-being. The program is grounded in empirically established risk and protective factors associated with couples' perinatal sexual well-being. We conducted a single-group feasibility study with eleven couples (22 individuals) expecting their first child (mean gestation 20 weeks). Couples completed the orientation and first STORK modules during a 2-h online session with a researcher. Participants then completed an online survey evaluating the program's feasibility and content. Qualitative semi-structured interviews and online questionnaires assessed participants' experiences with the platform, focusing on usability, acceptability, clarity, relevance, and overall satisfaction. Participants reported high acceptability, rating both modules as clear and logical (mean = 5.6-5.9/7), enjoyable (mean = 4.7-6.1/7), helpful (mean = 5.0-5.7/7), and relevant (mean = 6.1/7). The platform was rated as easy to navigate (mean = 5.6/7) and highly inclusive (mean = 6.0-6.1/7). Most participants found the time commitment reasonable (95.5%), and 91% considered weekly completion with their partner feasible. Qualitative feedback highlighted usability, well-structured content, inclusivity, and support for personal and relationship reflection. The findings suggest that the STORK program is a feasible and acceptable resource to support couples' perinatal sexual well-being, warranting further evaluation of its effectiveness. A pilot randomized controlled trial is warranted and may facilitate a shift toward couple-focused perinatal prevention programs. The STORK program has the potential to fill a critical gap in perinatal healthcare by providing an accessible, evidence-based prevention program to support couples navigating sexual changes during pregnancy and postpartum. This feasibility study was prospectively registered on June 17, 2025 (reg #2023-6719), and the registration can be found here: https://clinicaltrials.gov/study/NCT07036484.

The perinatal period is a time of significant change for parents, characterized by higher risks of mental health issues that can have long-lasting consequences on family wellbeing. The Quebec government's perinatal action plan aims to increase parental awareness of resources to support their mental health. We therefore reviewed publicly available and accessible information on perinatal mental health services in Quebec, including where they are delivered, by whom, their target populations, and how they address perinatal parental mental health. This commentary summarizes our findings, while highlighting missed opportunities for access to care, lessons learned, and ways forward for perinatal mental health.

To evaluate perinatal outcomes in twin pregnancies, comparing different gestational diabetes mellitus (GDM) subgroups with pregnancies without GDM. A retrospective cohort study of twin pregnancies was performed from January 2014 to December 2022. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria for the 2-h 75-g oral glucose tolerance test. Women with twin pregnancies were divided into four groups: healthy control, impaired fasting glucose (IFG), gestational impaired glucose tolerance (GIGT), and IFG + GIGT. Poisson regression models were performed to compare perinatal outcomes between these groups, including large for gestational age, small for gestational age, gestational hypertension, preeclampsia, hypertensive disorders of pregnancy, neonatal unit admission, neonatal jaundice, and neonatal respiratory distress syndrome. Generalized estimation equation models were utilized to address intertwin correlation. A total of 2162 women with twin pregnancies were eligible for analysis. IFG was associated with an increased risk of having large for gestational age infants (adjusted risk ratio (aRR): 2.62, 95% confidence interval (CI): 1.31-5.24 in the IFG; and aRR: 2.09, 95% CI: 1.19-3.66 in the IFG + GIGT group, respectively). An increased risk of preeclampsia (aRR: 1.78, 95% CI: 1.05-3.03) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.85, 95% CI: 1.05-3.27) was observed in the IFG + GIGT group. Conversely, GIGT was not associated with any adverse perinatal outcomes. The present findings revealed differences in perinatal outcomes between women with twin pregnancies with subgroups of GDM and without GDM. Classification of GDM by fasting glucose and post-load glucose may benefit risk stratification in the perinatal management of twin pregnancies.

To describe teachers' perceptions and children's attitudes and behaviours in response to a perinatal and death education workshop conducted by midwives in primary school classrooms. This descriptive qualitative study employed a phenomenological approach. The workshop addressed pregnancy, birth, death -including perinatal death-, and related care. It was grounded in the perinatal ecosystemic model and the reconstruction of bonding and meaning in mourning. A three-stage sampling strategy was used: convenience, snowball, and purposive. The sample included 30 teachers and 606 students from nine primary schools in a region of northern Spain. Data collection involved semi-structured, in-depth interviews with participating teachers and field notes documenting children's attitudes and behaviours. Teachers highlighted: a) the naturalness with which the topics were addressed; b) the workshop's effectiveness in helping children understand and cope with the perinatal period and the death of loved ones; c) the resources used were very age-appropriate; and d) their own insufficient training to talk about death. The students remained attentive and participatory, even when the topic of death was addressed. They were also unaware of the role of the midwife during pregnancy. Midwives could be trained to deliver this workshop, as their professional expertise offers a unique contribution to perinatal and death education. Integrating this content into the school curriculum may promote emotional resilience and health literacy from an early age.

Intimate partner violence (IPV) and substance use are closely linked and pose significant risks during the perinatal period. American Indian and Alaska Native (AI/AN) women experience disproportionately high rates of IPV and inequities related to perinatal substance use outcomes, yet research is limited regarding timing of IPV exposure and how it relates to perinatal substance use. This study examined associations between IPV exposure before and during pregnancy and patterns of alcohol use and cigarette smoking across the perinatal and postpartum periods among AI/AN women. We analyzed pregnancy risk assessment monitoring system (PRAMS) data from 2016 to 2022 in a cross-sectional design. IPV exposure was categorized as occurring before pregnancy, during pregnancy, or both. Outcomes included alcohol use frequency, heavy drinking (&#x2265;&#x2009;8 drinks per week), and cigarette smoking before pregnancy, during pregnancy, and postpartum. Survey-weighted ordinal logistic and logistic regression models were used, adjusting for sociodemographic and pregnancy-related factors. Predicted probabilities were calculated. Exploratory analyses examined associations between partner race and IPV. AI/AN women reported higher prevalence of IPV before and during pregnancy (p&#x2009;<&#x2009;0.001). In adjusted models, IPV before pregnancy was not associated with alcohol use frequency but was associated with higher odds of heavy drinking (aOR&#x2009;=&#x2009;1.75, 95% CI 1.07-2.85). AI/AN women had higher odds of heavy drinking compared with Non-Hispanic White (NHW) women (aOR&#x2009;=&#x2009;1.80, 95% CI 1.31-2.46), with the highest predicted probabilities observed among AI/AN women experiencing IPV (12.1%). IPV before pregnancy was also associated with higher odds of cigarette smoking before pregnancy, during late pregnancy, and postpartum (aORs 1.45-1.89), while IPV during pregnancy was associated with postpartum smoking (aOR&#x2009;=&#x2009;2.82, 95% CI 1.23-6.44). Predicted probabilities indicated higher smoking across periods among those with IPV exposure, particularly among AI/AN women. In exploratory analyses, partner racial concordance was associated with lower odds of reported IPV among AI/AN women. IPV exposure was associated with more severe and persistent patterns of perinatal substance use, with the highest predicted probabilities of heavy drinking and persistent smoking observed among AI/AN women experiencing IPV. These findings underscore the importance of trauma-informed, culturally grounded harm reduction approaches that address both IPV and substance use across the perinatal period. Efforts should be situated within the broader context of structural and historical inequities while recognizing Indigenous communities strengths and resilience.

Intimate partner violence (IPV) during the perinatal period poses serious risks to maternal and infant health. Women with disabilities and those from racially and ethnically minoritized groups experience disproportionately high rates of IPV, yet little is known about how these identities intersect to shape risk. To examine the association between race, ethnicity, disability, and perinatal IPV in a nationally representative sample of U.S. This cross-sectional study analyzed 2018-2021 Pregnancy Risk Assessment Monitoring System data, including respondents with known IPV, race, ethnicity, and disability status. IPV was defined as self-reported violence in the 12 months prior to pregnancy and during pregnancy; given conceptual differences in timing, these periods were examined separately. Disability was assessed using the Washington Group Short Set. Logistic regression models estimated odds of IPV by race, ethnicity, and disability, with and without covariate adjustment for maternal age, insurance payer, and education. Our analysis included 39,914 respondents, with 2744 (7.0%) respondents reporting a disability. In adjusted models, disability remained a strong predictor of IPV in the 12 months prior to pregnancy and during pregnancy across all racial and ethnic groups. In the 12 months prior to pregnancy, compared to non-disabled respondents, Non-Hispanic American Indian/Alaska Native (aOR&#x202f;=&#x202f;3.35; 95% CI 1.85-6.08), non-Hispanic White (aOR&#x202f;=&#x202f;3.04; 95% CI 2.19-4.23), Hispanic (aOR&#x202f;=&#x202f;2.75; 95% CI 1.62-4.66), and non-Hispanic Black (aOR&#x202f;=&#x202f;2.77; 95% CI 1.83-4.19) respondents with disabilities faced a higher risk of IPV. During pregnancy, compared to non-disabled respondents, Non-Hispanic American Indian/Alaska Native (aOR&#x202f;=&#x202f;4.13; 95% CI 2.19-7.78), non-Hispanic White (aOR&#x202f;=&#x202f;2.97; 95% CI 1.92-4.57), Hispanic (aOR&#x202f;=&#x202f;2.52; 95% CI 1.29-4.93), and non-Hispanic Black (aOR&#x202f;=&#x202f;3.51; 95% CI 2.34, 5.26) respondents with disabilities faced a higher risk of IPV. Respondents with disabilities experienced substantially higher risk of IPV across all racial and ethnic groups. Findings highlight the need for accessible, trauma-informed IPV screening and intervention strategies that address both ableism and racism within perinatal care systems.

Describe health-harming legal needs of families supported by a perinatal medical-legal partnership (MLP). Retrospective descriptive study of a fetal care program (FCP) and neonatal intensive care unit (NICU) MLP at an academic medical center in the Pacific Northwest from 2020 to 2024. Sociodemographic, clinical, and legal data were collected for newborns and their families. 110 families, including 123 newborns, received MLP services. A total of 183 legal needs were addressed. Of those referred during NICU admission (n&#x2009;=&#x2009;83 families), legal issues were identified over the course of hospitalization (hospital day 3-250). Nearly half of families (44%) identified more than one legal issue. The most frequent legal needs centered around family stability (e.g., custody, establishing parentage, divorce, and personal safety), followed by needs related to housing stability. Perinatal MLPs offer a unique, upstream opportunity to mitigate social determinants of health at the earliest moments of a child's life.

Professional psychological help can significantly improve outcomes for women with perinatal depression (PND), yet many delay or avoid seeking it. Spouses significantly influence women's help-seeking decisions. However, comprehensive reviews synthesizing factors affecting both women's and their spouses' intentions, particularly regarding spousal support, remain lacking. This scoping review synthesises current evidence on the factors influencing the psychological help-seeking intentions of women with PND and their spouses. This scoping review adhered to the framework by Arksey and O'Malley and followed the reporting guidelines specified in the PRISMA-ScR checklist. A systematic search was performed in May 2025, across five databases: CINAHL, Web of Science, PubMed, Embase, and PsycINFO. To capture a multi-method evidence base, qualitative, quantitative, and mixed-method studies were included. Study methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). 35 studies met the criteria, forming a multi-method evidence pool (13 qualitative, 19 quantitative, 3 mixed) spanning 16 countries, mainly in North America, Europe, and Asia. Participants were primarily perinatal women, with fewer involving spouses and couples. Five key factors were found to influence the intention of women with PND and their spouses to seek professional psychological help, including: (1) demographic factors; (2) knowledge factors (knowledge of PND and psychotherapy); (3) attitude factors (perspectives on PND screening, psychotherapy, and the responsibilities of the obstetric team); (4) social psychological factors (three types of stigma, and self-efficacy); and (5) psychological service provider-related factors. For women with PND and their spouses, intentions to seek professional help are shaped by a complex interplay of knowledge, attitudes, social-psychological factors, and the accessibility and competence of service providers. Future interventions should prioritize comprehensive mental health education, obstetric team training, and standardized medical procedures. Theory-driven longitudinal research is needed to disentangle causal mechanisms and test multi-component interventions targeting these determinants.

The objective of this study is to assess outcomes of pregnancies complicated by trisomy 13(T13) or trisomy 18(T18) and infants with T13 and T18, who were managed in a center with a perinatal palliative care program. This is a single center retrospective cohort study of neonates with T13 or T18 and pregnancies complicated by T13 or T18 in which families opted to continue the pregnancy, that were followed at Columbia University Irving Medical Center(CUIMC) between 2008 and 2024. There were 109 pregnancies that resulted in 68 liveborn infants. Of those who met with the Neonatal Comfort Care Program(NCCP) prior to delivery, 69.9% opted for comfort care. There was no trend toward more intervention over a span of 17 years. Differing from other institutions, the lack of trend toward more intervention in patients with T13 and T18 at CUIMC, may be due to the consistency of consultation practice by the NCCP.

Iron deficiency anemia (IDA) during the perinatal period, including pregnancy and postpartum, is a significant public health challenge among Egyptian women. Although its prevalence has improved, there are still gaps in screening, diagnosis, and management, which negatively impact maternal and child health. This expert consensus offers a broad view of risk factors, preventive measures, early screening, diagnosis, and commits to deliver actionable recommendations for managing perinatal and pregnancy-related IDA in our setting, with applicability to resource-limited societies. A comprehensive systematic search in PubMed, Scopus, and the Cochrane Library on IDA in pregnancy, including risk factors, prevention, diagnosis, management, and follow-up, was conducted from January to February 2024. The Delphi technique was applied over three rounds with 12 experts, and statements were retained at &#x2265;80% agreement level. The literature search yielded 56 studies. Forty-seven open-ended questions were formulated, generating 54 statements, refined to 53 final statements. The consensus emphasized the importance of early screening of at-risk women through regular hemoglobin (Hb) and ferritin tests to encourage early interventions. Pregnant women should have at least one IDA screening every trimester, with frequency adjusted as per the clinical severity. IDA was diagnosed using Hb thresholds in combination with red blood cell indices, serum ferritin levels < 30&#x2009;&#x3bc;g/L, and additional tests when indicated. Diagnostic Hb cutoffs vary by pregnancy trimester: <12&#x2009;g/dL in nonpregnant women, <11&#x2009;g/dL in the first and third trimesters, <10.5&#x2009;g/dL in the second trimester, and <10&#x2009;g/dL postpartum. IDA severity is classified into three categories: mild (Hb 10-10.4&#x2009;g/dL), moderate (9-9.9&#x2009;g/dL), and severe (<9&#x2009;g/dL). Oral iron is the first-line treatment for mild and moderate IDA. Intolerant patients, those suffering from severe anemia, or requiring rapid correction should receive intravenous iron formulations, with ferric carboxymaltose having proven efficacy and safety. Blood transfusion is the last resort for patients with very severe states with cardiovascular instability. The consensus emphasizes the importance of counseling, diet, and micronutrient supplementation for IDA prevention. This expert consensus provided a comprehensive approach and a systematic framework for IDA management in Egypt. It guaranteed a timely diagnosis and prompt intervention to mitigate complications for both the mother and the fetus. Further research is needed to optimize screening and analyze treatment options and their impact over time.

Perinatal depression (PD) actually affects 10-15% of pregnant women and represents one of the most debated topics as potentially implicated in offspring neurodevelopmental disorders etiology, particularly Autism Spectrum Disorder (ASD). Scientific evidence supports the role of Human Endogenous Retroviruses (HERVs) in ASD, as a link among environmental stimuli, epigenetic remodeling and biological processes. The aim of the present study was to characterize the expression profile of different HERVs and selected cytokines in peripheral blood mononuclear cells from women who have experienced PD in comparison to women without history of PD and their respective children stratified according to ASD diagnosis, by RT Real-Time PCR. We showed that ASD children and their PD mothers share abnormal expression of pHERV-W, syncytin-2 and IL-6 likely influenced by the common environment, maternal status, genetic predisposition, or postnatal factors. Of note, mothers with a history of PD were also evaluated at the time of blood sampling using the Hamilton Depression Rating Scale, and a positive correlation with pHERV-W levels was observed. Together with previous results in preclinical models and human studies, our results support the role of HERVs in autism as a contributing factor in creating an adverse environment for normal neurodevelopment, strengthening the view of a mother-child association in the context of autism. PD being associated with the altered activity of HERVs could be considered to be an additional risk factor in the pathogenesis of autism.

Mitochondrial gene expression is essential for oxidative phosphorylation that generates the bulk of the cellular ATP, and mitochondrial dysfunction is a common cause of human metabolic diseases. Recently, the first pathogenic variants in the only known mitochondrial RNA polymerase (POLRMT) were described in patients presenting with a wide variety of clinical manifestations, including hypotonia, short stature, and developmental delay. Here, we modeled two human pathogenic POLRMT variants by creating the corresponding substitutions in mice: the dominant S582F and the recessive R984C variant. Mice homozygous for the R984C variant showed perinatal lethality without apparent embryonic developmental defects, a finding consistent with a failure to adapt to the metabolic transition to oxidative metabolism at birth. Mice carrying the S582F variant were viable and exhibited decreased mitochondrial transcript levels due to impaired de novo transcription. However, mtDNA levels and in organello mtDNA replication remained normal, which recapitulates the molecular phenotypes observed in patients. Altogether, our findings indicate that the conserved arginine near the active site is essential for POLRMT function, while the serine in the intercalating hairpin of the N-terminal domain is required for near-genome length transcription but not primase activity. This study highlights genotype-phenotype differences and provides new insights into POLRMT function.

Emerging studies suggest that antibiotics can disrupt the gut microbiome and alter vaccine-induced immune responses. However, the specific consequences of early-life exposure on neonatal immune development remain poorly understood. Here, we examined how two antibiotics frequently used in perinatal care, broad-spectrum ampicillin (AMP) and the extended-spectrum combination amoxicillin/clavulanate (AMOX/CLAV), administered during gestation and lactation, influence neonatal gut microbiome composition, fecal metabolome profiles, and responses to the 20-valent pneumococcal conjugate vaccine (PCV20). Maternal treatment with AMOX/CLAV, but not AMP, significantly reduced PCV-specific IgG titers at 4 and 6 weeks post-prime immunization compared to untreated controls. Exclusive exposure to AMOX/CLAV also impaired neutrophil-mediated opsonophagocytic killing, indicating reduced antibody functionality. These effects were transient, with immune parameters normalizing by 8 weeks post-prime immunization. Metabolomic and microbiome profiling revealed that maternal AMP and AMOX/CLAV differentially perturbed specific metabolite classes, including bile acids, N-acyl lipids, and indole derivatives. Key commensal taxa, including Bacteroidales and Coriobacteriales were also impacted within the gut microbiota. Together, these findings reveal a previously underappreciated maternal-offspring route of antibiotic influence that is transiently associated with neonatal vaccine responsiveness and microbiome and metabolome alterations. These results highlight maternal antibiotic exposure as a possible modifiable factor shaping early-life immunity.

Extracellular vesicles (EVs) are lipid bilayer-delimited nanoparticles released by cells to act as mediators of intercellular communication during organ development, injury, and repair. EVs carry cargo (bioactive proteins, lipids, and nucleic acids) that reflects the status of the parent cell and is transferred to recipient cells to regulate biological processes, such as inflammation, immune responses, and tissue regeneration. These properties have made EVs promising tools for investigating disease pathogenesis, improving diagnostic and prognostic accuracy, and developing cell-free regenerative therapies for conditions characterized by dysregulation of multiple biological pathways. EVs are particularly relevant in diseases that affect the pediatric population where pathogenesis often remains poorly understood, access to affected tissues is limited, and treatment options are frequently inadequate. This review summarizes current evidence on EV applications in fetal and neonatal disorders, including necrotizing enterocolitis, congenital diaphragmatic hernia, and bronchopulmonary dysplasia, and highlights emerging data in biliary atresia, spina bifida, short bowel syndrome, and Hirschsprung's disease. In this age group, human milk and amniotic fluid represent particularly attractive biologically accessible sources of EVs, combining therapeutic potential with feasibility of clinical application. Building on robust preclinical evidence, the field is now advancing toward clinical translation, but several aspects still need to be addressed such as cargo heterogeneity, scalability of production, dosing, biodistribution, safety, and regulatory standardization. Herein, we discuss the translational challenges and future directions that will shape the clinical application of EVs in perinatal conditions.

Autism spectrum disorder (ASD) has been linked to immune dysregulation during early development, yet few studies jointly examine maternal pregnancy and cord blood (CB) cytokines in relation to later diagnosis. In a nested case-control design within the Peri/Postnatal Epigenetic Twins Study, we measured 19 cytokines in maternal pregnancy serum (~28 weeks) and CB at birth. Participants included autism cases (n&#x2009;=&#x2009;15), controls (n&#x2009;=&#x2009;72), mothers of autism cases (n&#x2009;=&#x2009;11), and control mothers (n&#x2009;=&#x2009;36). In this exploratory pilot study, CB cytokine-autism associations were analyzed using generalized estimating equations, maternal cytokines using logistic regression, and maternal-cord associations using linear mixed-effects models. False discovery rate (FDR) correction was applied. Elevated CB IL-1&#x3b1; (p&#x2009;=&#x2009;0.038), IL-5 (p&#x2009;=&#x2009;0.036), IL-12p40 (p&#x2009;=&#x2009;0.016), and GM-CSF (p&#x2009;=&#x2009;0.016) were significantly associated with autism following FDR correction. Combined, these cytokines demonstrated apparent discriminatory ability (AUC&#x2009;=&#x2009;0.93; 95% CI 0.85-1.0) within the study sample. No maternal pregnancy cytokines were independently associated with autism. Maternal-cord analyses revealed cytokine&#x2011;specific coupling differences, particularly for IL-1&#x3b1; and IL-5 (both p&#x2009;=&#x2009;0.008, FDR corrected). Selective CB cytokine differences at birth are associated with later ASD diagnosis, supporting a role for perinatal immune signaling in neurodevelopment. Replication in larger cohorts is recommended for further validation. In twins, cord blood cytokine signatures at birth are associated with autism diagnosis at 6 years. Elevated IL&#x2011;1&#x3b1;, IL&#x2011;5, IL&#x2011;12p40 and GM&#x2011;CSF characterize autism cases and show strong individual&#x2011;level discriminative performance. Combined cord blood cytokines can discriminate autism from controls, highlighting potential biomarker utility. Different maternal-cord cytokine coupling suggests disrupted late&#x2011;gestation immune signaling relevant to neurodevelopment.

Maternal exposure to a traditional farming lifestyle during pregnancy is associated with protection against allergic disease in childhood; however, the mechanism remains unclear. Pre-clinical work has demonstrated a role for the maternal gut microbiome in fetal immune programming. Given the diverse microbial exposure on farms, we sought to assess whether the maternal gut microbiome may mediate the relationship between maternal farm exposure and protection against offspring allergic disease. Deep shotgun metagenomic analysis of the perinatal fecal microbiome showed that women from an Old Order Mennonite traditional farming community (OOM, n&#x2009;=&#x2009;68) harbored a more diverse gut microbiome relative to women from urban/suburban Rochester, NY (ROC, n&#x2009;=&#x2009;55). We identified several bacterial species differentially abundant between lifestyle groups, including those from Dorea, Anaerobutyricum, Bifidobacterium, and Bacteroides genera, which translated to marked differences in microbiome functional capacity. These differences in the gut microbiome composition were accompanied by targeted metabolite findings indicating higher serum acetate and isobutyrate levels in OOM women that were positively correlated with cord plasma levels and infant systemic IgA concentrations. Among urban women, maternal microbiome composition was associated with early childhood atopic disease outcomes. Specifically, Dorea longicatena and Segatella copri were least abundant in urban mothers whose infants developed atopic disease (atopic dermatitis) or IgE-mediated food allergy alone, respectively, and were most abundant in the OOM mothers. Together, these findings highlight the maternal gut microbiome and metabolites as potential contributors to prenatal farming lifestyle protection against early childhood allergic disease.

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The United States is experiencing a high societal burden of pregnancy-related and infant morbidity and mortality during the postnatal year. These trends are inherently linked because the 2 members of the parent-infant dyad are interdependent for their well-being. Several systemic factors contribute to suboptimal health outcomes, including health care siloes under the medical specialization paradigm, multiple care transitions, and lack of care coordination during the postnatal year. Despite the clear positive impact of breastfeeding on parent and child health outcomes, as a dyadic specialty, lactation care does not have an obvious home within the siloed United States health care system. The objective of this article is to propose implementation of a comprehensive dyadic care model for birthing parents and infants during the postnatal year, including a focus on provider-level lactation management. Practical issues, such as clinic workflows, financial sustainability, workforce development solutions, and scope of practice issues are discussed. Midwives are ideally positioned to be leaders in the provision of dyadic perinatal care during the postnatal year, with long-term implications for parent and infant health.

Maternal age at childbirth shows a bimodal risk distribution worldwide. While adolescent pregnancy remains common in many areas, the rate of advanced maternal age is rising in high-income countries. Both extremes are associated with adverse outcomes through different pathways. This study tests the hypothesis that adolescent (<&#x2009;19 years) and older (>&#x2009;35 years) mothers face higher obstetric and neonatal risks than young adults (19-35 years), regardless of key confounders. A retrospective cohort study was conducted from 2019 to 2023 at a tertiary-care center. A total of 19,728 mother-neonate dyads were included and stratified by maternal age: adolescents (n&#x2009;=&#x2009;1,570), young adults (n&#x2009;=&#x2009;14,707), and older adults (n&#x2009;=&#x2009;3,451). We analyzed maternal demographics, antenatal care, and maternal-neonatal outcomes. Multivariable logistic regression was adjusted for confounders, including socioeconomic status, parity, prenatal care, and comorbidities. Primary outcomes included mode of delivery, preterm birth, low birth weight, preeclampsia, and neonatal intensive care unit (NICU) admission. Older adult mothers showed the highest adjusted risks: preeclampsia (aOR&#x2009;=&#x2009;3.15, 95% CI: 2.82-3.52), cesarean delivery (aOR&#x2009;=&#x2009;1.89, 1.72-2.08), and preterm birth (aOR&#x2009;=&#x2009;2.94, 2.68-3.22). Adolescent mothers had lower cesarean rates but significantly higher adjusted odds of low birth weight (aOR&#x2009;=&#x2009;1.72, 1.45-2.04) and preterm birth (aOR&#x2009;=&#x2009;1.48, 1.25-1.75). The likelihood of NICU admission increased for both groups. Socioeconomic disadvantage was most apparent among adolescents, while medical comorbidities characterized the older group. This study confirms a U-shaped risk curve, with both adolescent and advanced maternal ages remaining associated with increased risk after adjustment for measured confounders for adverse pregnancy outcomes. The findings highlight the need for specific, age-tailored clinical and public health strategies: targeted social support and early prenatal care for adolescents, and careful monitoring and management of medical comorbidities for older mothers.