Impact of armed conflict on maternal and neonatal health and birth weight: a cross-sectional study in the Gaza-Strip

Impact of armed conflict on maternal and neonatal health and birth weight: a cross-sectional study in the Gaza-Strip | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of armed conflict on maternal and neonatal health and birth weight: a cross-sectional study in the Gaza-Strip Belal Aldabbour, Samah Elamassie, Saher Mahdi, Haytham Abuzaid, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5865169/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Conflict and Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background Women who experience armed conflict during pregnancy are at significantly higher risk of maternal and neonatal complications and having low-birth-weight (LBW) babies due to factors such as violence, stress, food insecurity, and health inaccessibility. This study aims to explore the implications of the 2023–2025 armed conflict in the Gaza Strip on maternal and neonatal health and its effect on birth weight and maternal access to antenatal care (ANC). Methods This cross-sectional study included 500 consecutive women and neonates delivered in three obstetric centers in different areas of the Gaza Strip in October and November 2024. The study collected sociodemographic information, maternal obstetric history, maternal nutrition, maternal stress and other impacts of the conflict, and neonatal outcomes, including birth weight. Frequencies, percentages, and median and interquartile range (IQR) were used to describe the data. Correlations between nonparametric continuous variables were tested with the Spearman correlation test. Mann-Whitney test was used to compare birth weight between populations based on residence and sex. Results The median age was 28. Nearly half (52.63%) had a normal baseline BMI. Most (84.03%) had a very low monthly income. The prevalence of maternal anemia was 50.4%. Most participants (62.73%) reported insufficient food quantity and 73.6% insufficient diversity. Over half consumed only two full meals daily on average, and the diet largely lacked animal protein. Only 36.68% had eight or more ANC visits, and only 58.4% could establish the first ANC contact during the first trimester. The commonest cause for the lack of ANC was the inability to afford transportation. Also, 69.46% adhered to folic acid and iron supplementation. Most (90.42%) participants reported moderate to high stress levels, with 40.92% and 33.93% feeling almost always or often endangered. The prevalence of LBW was 10.8%, and the median weight was 3100 gm. Discussion This study demonstrates the vulnerability of pregnant women during conflicts. It reveals the significant impacts of the 2023–2025 armed conflict in the Gaza Strip on maternal and neonatal health, including an increased LBW rate compared to pre-war data. Armed Conflicts Birth Weight Health Services Accessibility Gaza Strip Maternal Health Newborn Health 1. Introduction Armed conflicts pose a significant threat to the health of affected populations. Besides the risk of harm due to violence, conflicts promote social instability, weaken health systems, undermine support networks, and hamper access to essential services and necessities ( 1 , 2 ). The war in the Gaza Strip, which started in October 2023, was notorious not only for the excessive violence and mounting casualties but also for the immense civilian suffering, displacement, and poor humanitarian situation it induced ( 3 , 4 ). In January 2025, the number of Palestinians killed in the war ranged from 46000 to 64000, in addition to more than 110000 wounded and 1.9 million, nearly 90% of the population, displaced ( 5 , 6 ). Furthermore, due to the humanitarian situation and collapse of the healthcare system, it is feared that the war may have claimed four additional indirect deaths for every traumatic death recorded ( 7 ). Maternal health is defined as women’s health during pregnancy, childbirth, and the postpartum period ( 8 ). It is an important indicator of the health of a population and the state of its health services. Low birth weight (LBW) is another core public health indicator of maternal health and nutrition and the adequacy of healthcare delivery ( 9 ). Improving maternal and neonatal health outcomes is imperative to achieving the Sustainable Development Goals (‎SDGs)‎ by 2030. According to the WHO, an estimated 830 women worldwide die each day from complications related to pregnancy or childbirth, with nearly 99% occurring in low- and middle-income countries and over half in regions experiencing armed conflict or humanitarian crises ( 10 ). The war in Gaza had several potentially catastrophic effects on pregnant women and their children. Vital infrastructure, including hospitals and healthcare facilities, were destroyed, and medical supply chains were disrupted, prompting the WHO to describe the situation as a “systematic dismantling of healthcare.”( 11 ) Additionally, hundreds of healthcare workers were killed, and many others have been wounded or detained ( 12 ). Furthermore, severe food and drinking water shortages have exacerbated the impacts of mass displacement on the population of the Gaza Strip ( 4 ). The conditions associated with mass displacement and instability also impact maternal health-seeking behavior (MHSB) and further degrade pregnant women’s access to available healthcare ( 10 , 13 ). Despite the abundance of violent conflicts around the globe, only a handful of studies attempted to robustly quantify the impact of conflict on maternal and neonatal health ( 14 ). At the same time, the health information system in the Gaza Strip has been severely compromised during the war. For instance, the central server for health data collection was destroyed in November 2023 ( 15 ). The war’s impact on maternal health in Gaza raises significant concerns ( 15 ). Addressing this critical gap in the literature, the present study aims to explore the implications of the war on maternal and neonatal health and the effect of this armed conflict on birth weight and maternal access to antenatal care (ANC). Documenting these variables can inform immediate healthcare interventions and guide long-term maternal and child health policies in conflict zones. 2. Methods 2.1. Study settings, participants, and data collection This cross-sectional study included all mothers who delivered their neonates between 26 October and 12 November 2024 at three major hospitals: Sahaba Hospital in the Gaza Governorate, Al-Awda Hospital in the Middle Governorate, and Nasser Medical Complex in Khan Younis Governorate. Each hospital represented the largest obstetric center in its respective governorate at the time of data collection. The study included all mothers who delivered a singleton neonate during the study period. Exclusion criteria were mothers with multiple pregnancies, pregnant women with preterm premature rupture of membranes “PPROM,” and neonates with congenital or chromosomal abnormalities. There were 57,442 live births in the Gaza Strip in 2022, the last full year before the war ( 16 ). The minimal sample size was thus 382, calculated using the Raosoft online calculator, with the settings set at a margin of error of 5%, a confidence interval (CI) of 95%, and a response distribution of 50%. To increase the power of the study, the authors increased the target sample size to 500. Senior medical students prospectively collected the data from patients and medical records. 2.2. Study instrument and variables A data sheet was used for data collection. It comprised five sections. The first collected maternal and neonatal variables: mother’s age, residence, education, family income (based on the average governmental employee’s salary during the war of 800 NIS “roughly 220 USD”), maternal weight, height, blood hemoglobin (Hb), blood pressure at delivery, previous pregnancies, and abortions/stillbirths. It also noted the neonate’s sex, birth weight, gestational age, and the mother’s smoking status. The second section focused on the current pregnancy, recording the delivery mode, vaginal bleeding history, comorbidities, the number and timing of antenatal care (ANC) visits, and reasons for ANC absence. The third section assessed the mother’s nutritional status, including food quantity and diversity, daily meal availability, animal protein sources, drinking water access, and consumption of iron and folic acid supplements during pregnancy. The fourth documented the neonates’ condition, including the one- and five-minute Apgar score ( 17 ), which obstetric centers in Gaza customarily use, and the need for resuscitation and neonatal ICU “NICU” admission. The fifth section examined the war's direct impacts on the mother’s physical and psychological well-being, including injuries, loss of family members, self-rated stress levels, and other factors. Questions with over 10% missing data were excluded from the analysis. The study defined full-term (FT) babies as those born at ≥ 37 weeks of gestation. Preterm (PT) was < 37 weeks. Late, moderate, and very PT were born at 34–37, 32-<34, and 28–32 weeks, respectively. Extreme PT was 4000 gm, Appropriate birth weight was 2500–4000 gm, Low Birth Weight (LBW) < 2500 gm, Very Low Birth Weight (VLBW) 1000–1500 gm, and Extremely Low Birth Weight (ELBW) 26 weeks. Anemia in pregnancy is defined as Hb < 11 g/dL, with severe anemia at Hb < 7 g/dL ( 18 ). Normal blood pressure at delivery was defined as systolic and diastolic pressures under 140 and 90 mmHg, respectively ( 19 ). 2.3. Ethical considerations The study was approved by the Institutional Review Board (IRB) at the Islamic University of Gaza (IUG). The research was performed as per the norms of the Helsinki Declaration. Participants gave informed written consent. Confidentiality and security of the data were maintained throughout the data collection and analysis phases, and no identifying data were collected. 2.4. Statistical analysis The data was analyzed using SPSS version 27. First, descriptive statistics were reported as frequencies and percentages rounded to two decimal points. Continuous variables (maternal age, Hb, maternal weight, parity, gravida, gestational age, and birth weight) were tested with the Shapiro–Wilk test. The p-value was < 0.05, indicating a non-parametric data distribution. Therefore, the median and interquartile range (IQR) were used to describe the data. Correlations between nonparametric continuous variables were tested with the Spearman correlation test. Mann-Whitney test was used to compare birth weight between populations based on residence and sex. Statistical significance was set at p-values < 0.05. 3. Results 3.1. Maternal sociodemographic information and obstetric history Five hundred seventeen women gave birth during the study period in the study hospitals. Seventeen were excluded for the following reasons: nine due to multiple pregnancies, four due to intrauterine fetal death (IUFD), and four due to PPROM. Consequently, the study included 500 women and their neonates. The median age was 28 ( 10 ), with the youngest being 16 and the oldest 46. Nearly half (52.63%) had a normal baseline BMI. Most (84.03%) belonged to the lowest monthly income category of < 800 NIS monthly. Table 1 further illustrates the information on sociodemographic characteristics. Table 1 Maternal sociodemographic information and past obstetric history Variables Characteristic N* % Hospital Sahaba (Gaza Governorate) 138 27.60 Al-Awda (Middle Governorate) 175 35.00 Nasser (Khan Younis Governorate) 187 37.40 Mother age (quartile) Median 28 (IQR 10), range ( 16 – 46 ) Less than 23 142 28.40 23–28 126 25.20 29–33 123 24.60 More than 33 109 21.80 Body mass index (BMI) Median BMI 24.44 (IQR 4.52) Under weight 9 1.82 Normal BMI 260 52.63 Overweight 186 37.65 Class one obesity 35 7.09 Class two obesity 4 0.81 Education Basic 28 5.60 Secondary 249 49.80 Diploma or Bachelor 219 43.80 Master or Ph.D. 4 0.80 Average family income during the war (NIS)* 1600 19 3.80 Smoker Yes 2 0.40 No 498 99.40 *Variation in totals is due to missing data The median number of previous pregnancies and deliveries was three (Table 2 ). Around 50.4% of pregnant women were anemic (Hgb < 11 g/dl). Nearly a third suffered medical complications or comorbidities, with UTIs, symptomatic anemia, and gestational hypertension, respectively, being the most common. The vast majority of 97.60% presented for ANC visits during their pregnancy. However, only 58.40% had their first ANC visit during the first trimester, and 24.18% had less than four visits. The most frequently cited reason for the lack of ANC visits was the inability to afford clinic transportation to the healthcare facility. Table 2 Past and current obstetric history Variables Characteristic N* % Gravida (quartiles) Median 3 (IQR 3), range ( 1 – 11 ) 1–2 196 39.20 3 84 16.80 4–5 120 24.00 ≥ 6 100 20.00 Parity (quartiles)* Median 3 (IQR 3), range ( 1 – 10 ) 1 125 25.35 2–3 174 35.29 4 78 15.82 ≥ 5 116 23.53 Previous abortions or still births Yes 127 25.35 No 373 74.45 Delivery mode Normal vaginal delivery 374 74.65 Assisted vaginal delivery 10 2.00 Caesarean sections 116 23.15 Maternal Hb (g/dl) Median 10.90 (IQR 1.50), range (6.90–14.30) ≥ 11 g/dl 248 49.60 < 11 g/dl 252 50.40 < 7 g/dl 1 0.20 Blood pressure at delivery Normal blood pressure 460 92.00 High blood pressure 19 3.80 Not documented 21 4.20 Medical comorbidities (reported by mothers)* Symptomatic anemia 37 7.39 Asthma 1 0.20 Chronic diabetes mellitus 3 0.60 Chronic hypertension 5 1.00 Gestational diabetes 6 1.20 Gestational hypertension 11 2.20 Preeclampsia 5 1.00 Renal disease and UTIs 83 16.57 Others 16 3.19 No disease 326 65.07 Vaginal bleeding Yes 24 4.80 Trimester of vaginal bleeding (n = 24)* First trimester 11 45.83 Second trimester 8 33.33 Third trimester 3 12.50 Timing of the first antenatal care (ANC) visit First trimester 285 58.40 Second trimester 168 34.43 Third trimester 35 7.17 No visits 12 2.40 Number of ANC visits < 4 118 24.18 5–7 191 39.14 ≥ 8 179 36.68 ANC setting(s) Hospitals 122 24.35 Primary health care 169 33.73 Private clinic 172 34.33 Others 22 4.39 Reason(s) for having no antenatal care (n = 12)^ No money for transportation 11 68.75 No desire 1 6.25 Had other important things to do 1 6.25 Other reasons 5 31.25 *Variation in totals is due to missing data ^ Participants can report more than one answer 3.2. Impacts of the war on maternal nutrition and physical and psychological wellbeing Most participants perceived their diet as insufficient in terms of food quantity and diversity. Furthermore, half (50.69%) said they consumed two meals on an average day during their pregnancy, and 7.98 consumed only one meal. Meanwhile, 40.12% reported that their diet was nearly completely devoid of animal protein sources. A majority of 69.46% adhered to daily iron and folic acid supplementation for at least 12 weeks (Table 3 ). Table 3 Maternal nutrition during pregnancy Variables Characteristics N % Appetite during pregnancy Good 239 47.80 Poor 261 52.20 Food quantity during pregnancy Sufficient 186 37.13 Insufficient 313 62.73 Food diversity during pregnancy Sufficient 132 26.40 Insufficient 368 73.60 Accessibility to clean drinking water Sufficient 264 52.80 Insufficient 236 47.20 Number of full meals in the average day 1 meal 40 7.98 2 meals 254 50.69 ≥ 3 meals 206 41.20 Average frequency of eating food that contains animal protein Mostly none 201 40.12 1/month 53 10.58 2–3/month 66 13.17 1/week 139 27.74 > 1/week 41 8.18 Iron and folic acid supplementation None or less than once/week 54 10.78 At least once/week but not daily 98 19.56 Daily for at least 12 weeks 348 69.46 Only one in five participants (19.76%) lived in a separate house (Table 4 ). Nineteen (3.79%) were injured in the war while pregnant, 28.2% said a family member was killed. Furthermore, 40.92% reported feeling constantly in danger, and 62.08% rated their subjective levels of stress during the pregnancy as high. A significant proportion of 43.20% said they were mostly worried about the delivery, while 20.80% were primarily worried about their personal safety. Table 4 War's impact on the mothers’ physical and psychological wellbeing Variables Characteristics N % Current residence Separated house 99 19.76 Shared house 169 33.73 Shelter 37 7.39 Tent 195 38.92 Individuals sharing the living space 2 89 17.76 3–4 79 15.77 5–8 189 37.72 More than 8 143 28.54 Injured while pregnant Yes 19 3.79 No 481 96.01 If injured, at which trimester (N = 19) First trimester 6 31.58 Second trimester 7 36.84 Third trimester 6 31.58 A family member was killed Yes 141 28.20 Saw dead bodies Yes 43 8.60 A place the mother was in was bombed or targeted Yes 28 5.60 Feeling endangered Almost always 205 40.92 Often 170 33.93 Occasionally 93 18.56 Rarely 32 6.39 Subjectively rated stress level during pregnancy High 311 62.08 Moderate 142 28.34 Low 39 7.78 Mostly absent 8 1.60 During this pregnancy, I was mostly worried about : Delivery and labor Yes 216 43.20 Personal safety Yes 104 20.80 Forced displacement Yes 48 9.60 Losing family members Yes 44 8.80 Having an abortion Yes 26 5.20 Nothing Yes 26 5.20 The health of my fetus Yes 24 4.80 Death Yes 15 3.00 Securing my baby’s needs Yes 14 2.80 My finances Yes 12 2.40 Securing food Yes 8 1.60 3.3. Impacts of the war on birth weight and neonatal health The median gestational age was 39 (IQR 2) weeks. The median birth weight was 3100 (IQR 500) grams. LBW was recorded at 10.80%, with VLBW and ELBW recorded at 0.6% and 0.2% of the total cohort, respectively. The difference in birth weights between those born in the Northern and the Southern Governorates was statistically significant (p = 0.04). However, the difference between male and female newborns was insignificant (p = 0.33). Only 5.39% of newborns in the study needed resuscitation, and 8.58% were admitted to the NICU. More information is provided in Table 5 . Table 5 Birth weight and neonatal outcomes Variables Characteristic N % Newborn’s sex Male 276 55.09 Female 224 44.71 Gestational age Median 39 weeks (IQR 2), (Range 27–42 weeks) Less than 37 weeks 45 8.98 37 weeks and more 454 91.02 Birth weight (gm) Median 3100 (IQR 500)(range 900–5600) Male median 3200 (IQR 538) Females median 3100 (IQR 600) > 4000 12 2.40 2500–4000 443 88.60 < 2500 54 10.80 < 1500 3 0.60 < 1000 1 0.20 Underweight newborns’ sex (n = 53) Male 28 52.83 Female 25 47.17 Apgar score at one minute 0 1 0.20 5 3 0.60 6 4 0.80 7 28 5.60 8 175 35.00 9 287 57.40 10 2 0.40 Apgar score at five minutes 0 1 0.20 5 1 0.20 6 1 0.20 7 3 0.60 8 27 5.40 9 165 33.00 10 302 60.40 Resuscitation was needed Yes 27 5.39 Admission to NICU Yes 43 8.58 Birth weight was correlated to maternal weight, gestational age, and the number of previous pregnancies but not to maternal age, Hgb, or systolic blood pressure (Table 6 ). Table 6 Correlations between birth weight and different variables Variables r p Maternal age 0.018 0.684 Maternal Hgb -0.081 0.072 Maternal weight 0.108 0.016 Gravida 0.089 0.047 Gestational age 0.372 0.001 Systolic blood pressure 0.033 0.464 4. Discussion This study examined the impact of the war in the Gaza Strip on maternal well-being and neonatal health. A majority of 62.73% of participants rated their food supply during pregnancy as insufficient, and 73.6% as not diverse. Furthermore, 62.04% of participants reported suffering severe stress, with 40.92% worrying about their safety almost always and 33.93% worrying often. Around half of the study participants (50.4%) were anemic, and 24.18% had less than four ANC visits. The median birth weight was 3100 (IQR 500), and the prevalence of LBW was 10.8%. Factors positively correlated with the incidence of LBW were maternal weight, gestational age, and the number of previous pregnancies. Research shows that women who experience armed conflict during pregnancy are at significantly higher risk of having LBW babies. This has been confirmed in various studies across different conflicts ( 2 , 20 – 22 ). Mothers in this study endured over a year of armed conflict in the Gaza Strip, which led to severe violence, displacement of around 90% of the population, and extreme food insecurity and undernutrition ( 4 , 23 , 24 ). A recent study indicated an average weight loss of about 18 kilograms among the northern Gaza Strip population ( 4 ). Along this line, in 2020, overweight and obesity prevalence was reported at 64.1% among mothers aged 18 to 50 in the Gaza Strip, but this has decreased to 45.5% in the present study ( 25 ). This difference is still significant despite different study designs and potential recall bias. In 2022, the Palestinian Ministry of Health reported an LBW prevalence of 8.0% in the Gaza Strip ( 16 ). From 2012 to 2021, studies indicated LBW ranged from 5.5–7.8% ( 26 ). Thus, a higher LBW rate of 10.8% is expected, aligning with Le and Nguyen’s findings of a 3.2% average increase in LBW across 53 conflict-affected regions over three decades ( 22 ). Similarly, a previous study showed a mean birth weight of 3291.17 ± 599.84 grams in Gaza, while the current study's median is 3100 (IQR 500) grams ( 27 ). Moreover, before the current war, the incidence of LBW varied between the Gaza Strip and the West Bank. In 2022, LBW was 8.0% in the Gaza Strip and 6.4% in the West Bank, signifying that socioeconomic, security, and health conditions affect pregnancy outcomes ( 16 ). Despite being part of the Occupied Palestinian Territories, the Gaza Strip and the West Bank are geographically separated. This implies that geopolitical factors in Gaza, such as movement restrictions, siege, poverty, and conflict, may primarily cause the LBW incidence before the war ( 2 ). Global LBW prevalence is about 14.6%, but varies by country: 4.2% in Iceland, 7% in the UK, 8% in the USA, and up to 27.8% in Bangladesh in 2015 ( 28 ). LBW rates are higher in deprived areas and among disadvantaged mothers during armed conflicts ( 22 , 28 ). Even short conflicts without food insecurity affected birth weights ( 2 , 29 , 30 ). Though the exact mechanisms are unclear, potential stressors include fear and environmental factors ( 29 , 30 ). In the study, 90.42% of participants reported moderate to high stress levels, with 40.92% and 33.93% feeling almost always or often endangered. This aligns with a recent Gaza survey showing a 90.56% prevalence of stress symptoms among young adults ( 31 ). Consequently, against this backdrop of chronic conflict, an increase in the incidence of LBW from 8.0–10.8% is notable and highlights the correlation between a rising incidence of LBW and intensified armed conflict, which tracks back to stressors such as fear in addition to displacement, food insecurity, and poor access to healthcare ( 2 , 4 , 20 , 21 , 29 ). Indeed, the under-five mortality rate in the Gaza Strip has demonstrated a steady decline from 44.9 in 1990 to 14.3 in 2022. However, in 2014, during a prolonged armed conflict in the area, the trend was interrupted, and the under-five mortality rate rose to 21.3 ( 32 ). Similar trends were observed in the effects of recurring armed conflict on maternal mortality ( 33 ). Thus, it is not surprising that armed conflicts seem to have a significant impact on maternal and neonatal health in this region, and this study confirms this observation regarding this war in 2023–2025. LBW is significantly associated with a range of poor outcomes, including developmental delays in childhood and an increased risk of chronic diseases, such as type 2 diabetes and cardiovascular disease in adulthood ( 21 , 34 ). It also heightens the risk of adverse pregnancy outcomes, such as preterm birth and neonatal death. Moreover, maternal exposure to famine, stress, and conflict can impact health later in life, even when birth weight remains within normal limits. Adults exposed to such stressors in utero have been found to face higher risks of type 2 diabetes, cardiovascular disease, and obesity, emphasizing the profound effects that these experiences can have as they grow and transition into adulthood ( 21 , 34 ). Therefore, the full implications for survivors will only become evident over their lifetimes and may affect their health in adulthood well after the initial conflict has settled. Previous studies have demonstrated that inadequate food supply was associated with a higher incidence of LBW ( 35 , 36 ). Pregnant women are at higher risk of food insecurity due to the nutritional needs of the developing fetus ( 37 ). To avoid food insecurity, the quality and quantity of food supply must be adequate ( 4 , 38 ). Most participants reported inadequate nutrition, with 62.73% rating their food supply during pregnancy as insufficient in quantity and 73.6% as lacking in diversity. Furthermore, more than half of the participants consumed only two full meals each day, and their diet largely lacked animal protein. These observations were based on women's self-assessments rather than objective measurements. However, the fact that 50% of the Gaza population faced catastrophic food insecurity, along with significant weight loss across the population during the same time period, suggests that a large proportion of pregnant women also encountered food insecurity and insufficient food supply during their pregnancies ( 4 , 39 , 40 ). Food insecurity in the Gaza Strip during the different phases of the war has been pervasive and comprehensive ( 4 , 39 – 44 ). In this context, the present study found a significant difference in birth weight between newborns in the Northern and Southern Governorates, with lower birth weight among those born in the South. This suggests that while starvation in the North received particular attention, food insecurity and the poor humanitarian conditions caused by mass displacement in the South were no less impactful ( 39 – 42 , 45 ). Interventions that have been shown to improve food security include diet planning, micronutrient supplementation, food fortification, nutritional counseling, and monitoring weight gain. The existing literature reveals a lack of evidence for successful interventions addressing food insecurity in armed conflict ( 1 ). General food distribution is the most common intervention in areas of armed conflict ( 1 , 37 ). Nonetheless, a lack of resources, shortages of nutritional supplies, security challenges, inadequate reporting, limited collaboration, and difficulties in accessing and following up with beneficiaries hinder effective delivery in conflict-affected areas ( 1 , 37 ). Anemia during pregnancy is closely associated with food insecurity. Worldwide, an estimated 36.4% of pregnant women experience anemia, with much higher prevalence rates in low-income countries compared to high-income countries ( 46 , 47 ). In this study, 50.4% of women who gave birth had anemia, which is higher than previous reports ( 26 , 47 ). Research has indicated that the prevalence of anemia among pregnant women in the Gaza Strip ranges from 35.7–44.9%, with one study reporting a prevalence of 42.8% during the second and third trimesters ( 26 ). This is despite the relatively high proportion of nearly 70% of our participants adhering to folic acid and iron supplements during their pregnancy. The lack of correlation between anemia and the incidence of LBW has been noted in a previous local study and could be due to the fact that “baseline” rates of anemia, prior to the current war, have always been elevated ( 26 , 27 , 47 ). Daily folic acid and iron supplementation may have also played a mitigating role and could, therefore, be an essential strategy to support maternal and newborn health during conflicts ( 1 ). The World Health Organization (WHO) recommends eight ANC visits during pregnancy, with the first occurring in the first trimester ( 48 ). The present study found that only 36.68% of participants had eight or more visits, and 58.4% could establish the first ANC contact during the first trimester. A recent study on ANC coverage in Palestine found that 70.9% of participants from Gaza reported eight or more ANC visits, and 87.1% of the cohort had initiated ANC contact during their first trimester ( 48 ). The striking decline in ANC visits found in the present study testifies to the impacts the war had on pregnant women’s access to healthcare and mirrors findings from other hot conflict zones such as Sudan ( 13 ). Strengths, limitations, and future research directions The present study has several strengths. It collected data from several hospitals and geographical locations in the Gaza Strip. It robustly included all women who gave birth in those hospitals during the data collection period, permitting reasonable result generalizability. Also, the sample size was well above the calculated minimal size necessary to achieve statistical power. Moreover, senior medical students collected data from both the women and the medical files, which minimized data loss. Finally, the study collected an assortment of data relevant to the study subject in a bid to reflect the diversity of the war’s impacts on mothers and newborns. However, the study has limitations. Most importantly, several collected variables relied on the subjective estimation of the participants, especially those related to nutrition and rated stress, which is subject to recall bias. Also, the cross-sectional design limits the possibility of establishing causality. Moreover, not all factors that impact maternal and neonatal health in this situation could be considered in this study, and it might be challenging to assess the extent of the impact of individual factors. Future studies are encouraged to follow longitudinal designs to investigate the lasting impacts of the armed conflict on mothers and neonates. 5. Conclusions This study reveals the significant impacts of the Gaza War on maternal and neonatal health, noting increased low birth weight (LBW) rates compared to pre-war data. It demonstrates the vulnerability of pregnant women during conflicts, linking LBW increases to food insecurity and stressors like fear. The research highlights how ongoing chronic conflicts further reduce the reproductive rights of both women and men, limiting access to antenatal care and safe delivery options while exposing them to acute stress. It highlights the duty of parties involved in conflicts to enable sufficient food supply to civilians to reduce the risk of negative impact on pregnant women, newborns, and their future development and health ( 2 ). Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board (IRB) at the Islamic University of Gaza (IUG). The research was performed as per the norms of the Helsinki Declaration. Participants gave informed written consent. Confidentiality and security of the data were maintained throughout the data collection and analysis phases, and no identifying data were collected. Consent for publication Not Applicable. Competing interests The authors declare that they have no competing interests. Funding The study was not funded. Author Contribution BA: Conceptualization. All authors: literature review. BA, ME, SA: study design and tool development. BA: Supervision. SM, HA, TA, YT, KS, YZ, AE, MA, AA, AA, HA: Data collection. BA, SE, SA, and BB: data analysis and interpretation. BA, SE, BB: Writing the study manuscript. All authors contributed to the manuscript revision and have approved the final version. Acknowledgement The authors acknowledge Dr. Ahmed Elhissi, MD, MSc, for contributing to designing and interpreting the statistical analysis. Data Availability Available from the corresponding author upon reasonable request. References Shah S, Padhani ZA, Als D, Munyuzangabo M, Gaffey MF, Ahmed W, et al. Delivering nutrition interventions to women and children in conflict settings: a systematic review. BMJ Global Health. 2021;6(4):e004897. Keasley J, Blickwedel J, Quenby S. Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Global Health. 2017;2(4):e000377. OCHAOPT. Reported impact snapshot | Gaza Strip (29 October 2024). 2024 29 Oct 2024. Alnabih A, Alnabeh N-A, Aljeesh Y, Aldabbour B. Food insecurity and weight loss during wartime: a mixed-design study from the Gaza Strip. J Health Popul Nutr. 2024;43(1):222. GISHA. Gaza Now: Current facts and figures. GISHA. 2024 October 9, 2024. Jamaluddine Z, Abukmail H, Aly S, Campbell OMR, Checchi F. Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis. Lancet. 2025. Khatib R, McKee M, Yusuf S. Counting the dead in Gaza: difficult but essential. Lancet. 2024;404(10449):237–8. Callister LC, Edwards JE. Sustainable Development Goals and the Ongoing Process of Reducing Maternal Mortality. J Obstet Gynecol Neonatal Nurs. 2017;46(3):e56–64. Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C et al. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017;35(48 Pt A):6492 – 500. Tingkai Z, Qiwei H, Sol R, Kun T. Does armed conflict lead to lower prevalence of maternal health-seeking behaviours: theoretical and empirical research based on 55 683 women in armed conflict settings. BMJ Global Health. 2023;8(8):e012023. Qureshi YA, Dawas K, Maynard ND. Excess deaths in Gaza. Lancet Global Health. 2024;12(9):e1395. WHO, WHO/GAZA HEALTH, SITUATION. 2024 4 October 2024. Miskeen E. The impact of the military conflict in Sudan on maternal health: a mixed qualitative and quantitative study. PeerJ. 2024;12:e17484. Jawad M, Hone T, Vamos EP, Cetorelli V, Millett C. Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019. PLoS Med. 2021;18(9):e1003810. UNFPA. Impact of War on the Maternal Health in Gaza. 2024 2/10/2024. MoH P. Health Annual Report 2022. 2023 June 2023. Simon LV, Shah M, Bragg BN. APGAR Score. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024. StatPearls Publishing LLC.; 2024. James AH. Iron Deficiency Anemia in Pregnancy. Obstet Gynecol. 2021;138(4):663–74. Agrawal A, Wenger NK. Hypertension During Pregnancy. Curr Hypertens Rep. 2020;22(9):64. Mansour H, Rees DI. Armed conflict and birth weight: Evidence from the al-Aqsa Intifada. J Dev Econ. 2012;99(1):190–9. Almond D, Currie J. Killing Me Softly: The Fetal Origins Hypothesis. J Econ Perspect. 2011;25(3):153–72. Le K, Nguyen M. Armed conflict and birth weight. Econ Hum Biol. 2020;39:100921. OCHAOPT. Reported impact snapshot | Gaza Strip (5 June 2024)2024 7 June 2024. Available from: https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip-5-june-2024 Warch HR. Hopeless, Starving, and Besieged Israel’s Forced Displacement of Palestinians in Gaza. 2024 14/11/2024. El Kishawi RR, Soo KL, Abed YA, Muda WAMW. Prevalence and predictors of overweight and obesity among women in the Gaza strip-Palestine: a cross-sectional study. BMC Public Health. 2020;20(1):864. Assaf E, Al Sabbah H, Al-Jawadleh A. Analysis of the nutritional status in the Palestinian territory: a review study. Front Nutr. 2023;10:1206090. Halileh S, Abu-Rmeileh N, Watt G, Spencer N, Gordon N. Determinants of birthweight: gender based analysis. Matern Child Health J. 2008;12(5):606–12. Blencowe H, Krasevec J, de Onis M, Black RE, An X, Stevens GA, et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Global Health. 2019;7(7):e849–60. Torche F, Shwed U. The Hidden Costs of War: Exposure to Armed Conflict and Birth Outcomes. Sociol Sci. 2015;2. Maric NP, Dunjic B, Stojiljkovic DJ, Britvic D, Jasovic-Gasic M. Prenatal stress during the 1999 bombing associated with lower birth weight—a study of 3,815 births from Belgrade. Arch Women Ment Health. 2010;13:83–9. Aldabbour B, Abuabada A, Lahlouh A, Halimy M, Elamassie S, Sammour AA-K, et al. Psychological impacts of the Gaza war on Palestinian young adults: a cross-sectional study of depression, anxiety, stress, and PTSD symptoms. BMC Psychol. 2024;12(1):696. UNICEF. State of Palestine 2024 [17/1/2025]. Available from: https://data.unicef.org/country/pse/ Bӧttcher B, Abu-El-Noor N, Aldabbour B, Naim FN, Aljeesh Y. Maternal mortality in the Gaza strip: a look at causes and solutions. BMC Pregnancy Childbirth. 2018;18(1):396. Risnes KR, Vatten LJ, Baker JL, Jameson K, Sovio U, Kajantie E, et al. Birthweight and mortality in adulthood: a systematic review and meta-analysis. Int J Epidemiol. 2011;40(3):647–61. Jyoti S, Kaur MV, Jasbir K. Effect of Prenatal Malnutrition on Fetus and Newborn Baby: A Comprehensive Review. 2018:2319–7064. Apostolopoulou A, Tranidou A, Tsakiridis I, Magriplis E, Dagklis T, Chourdakis M. Effects of Nutrition on Maternal Health, Fetal Development, and Perinatal Outcomes. Nutrients. 2024;16(3):375. McKay FH, Spiteri S, Zinga J, Sulemani K, Jacobs SE, Ranjan N, et al. Systematic review of interventions addressing food insecurity in pregnant women and new mothers. Curr Nutr Rep. 2022;11(3):486–99. Fiandrino S, Dowd C, Martini G, Mejova Y, Omodei E, Paolotti D et al. Impact of food-related conflicts on self-reported food insecurity. Front Sustainable Food Syst. 2023;7. IPCInfo, GAZA STRIP. : Famine is imminent as 1.1 million people, half of Gaza, experience catastrophic food insecurity2024 7 June 2024. Available from: https://www.ipcinfo.org/ipcinfo-website/alerts-archive/issue-97/en/ Classification IFSP. Gaza Strip: Acute Food Insecurity Situation for 15 February – 15 March 2024 and Projection for 16 March – 15 July 2024. IPCInfo; 2024 February 2024. Council NR. Israel’s siege now blocks 83% of food aid reaching Gaza, new data reveals. 2024 16 September 2024. Watch HR, Gaza. Israel’s Imposed Starvation Deadly for Children2024 9 April 2024. Available from: https://www.hrw.org/news/2024/04/09/gaza-israels-imposed-starvation-deadly-children UNICEF. Children’s lives threatened by rising malnutrition in the Gaza Strip2024 6 June 2024. Available from: https://www.unicef.org/press-releases/childrens-lives-threatened-rising-malnutrition-gaza-strip UNICEF. Statement by UNICEF on the risk of famine in the Gaza Strip2023 6 June 2024. Available from: https://www.unicef.org/press-releases/statement-unicef-risk-famine-gaza-strip Initiative IG, IPC ACUTE FOOD INSECURITY ANALYSIS MAY -. SEPTEMBER 2024 2024 10 July 2024. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis. Matern Child Health J. 2022;26(7):1473–87. Srour MA, Aqel SS, Srour KM, Younis KR, Samarah F. Prevalence of anemia and iron deficiency among Palestinian pregnant women and its association with pregnancy outcome. Anemia. 2018;2018(1):9135625. Horino M, Massad S, Ahmed S, Abu Khalid K, Abed Y. Understanding coverage of antenatal care in Palestine: Cross-sectional analysis of Palestinian Multiple Indicator Cluster Survey, 2019–2020. PLoS ONE. 2024;19(2):e0297956. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jul, 2025 Read the published version in Conflict and Health → Version 1 posted Editorial decision: Revision requested 27 May, 2025 Reviews received at journal 27 May, 2025 Reviews received at journal 27 Mar, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviewers agreed at journal 07 Feb, 2025 Reviewers invited by journal 03 Feb, 2025 Editor assigned by journal 20 Jan, 2025 Submission checks completed at journal 20 Jan, 2025 First submitted to journal 20 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5865169","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405510388,"identity":"173a3ec8-87c4-4ea2-ba79-8680b543fce1","order_by":0,"name":"Belal Aldabbour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACAwbmBoYHFRIMDMcbQFwLYrQwNjAknLFhYDhzAMSVIFJLYlsaA8ONBBCfCC3m7I2NHxLbDkfz3Xx+dcOPAgkG/vbuBLxaLHsONksknDucO/N2TtnNHqDDJM6c3YDfYTcSGyQSyg7nbridk3aDB6jFQCKXgJb7D5t/JLABtdw8k3bzD1FabjC2SSS0peVuuMF+7DZRtlj2JLZZAAM5d+aZHLbbMgYSPAT9Ys5++PCNDxUSuX3Hjz+7+eaPjRx/ey9+LUiAxwBMEqscBNgfkKJ6FIyCUTAKRhAAAL1OU9ob40CnAAAAAElFTkSuQmCC","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":true,"prefix":"","firstName":"Belal","middleName":"","lastName":"Aldabbour","suffix":""},{"id":405510389,"identity":"27dd0560-b249-421a-92f2-920dcccc86bc","order_by":1,"name":"Samah Elamassie","email":"","orcid":"","institution":"United Nations Relief and Works Agency for Palestine Refugees in the Near 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Gaza","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Eid","suffix":""},{"id":405510402,"identity":"e9426434-4276-42c2-8ca6-79ddcf124298","order_by":14,"name":"Shireen Abed","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Shireen","middleName":"","lastName":"Abed","suffix":""},{"id":405510403,"identity":"f8292438-936c-486a-8b1e-c2b200001c4f","order_by":15,"name":"Bettina Bottcher","email":"","orcid":"","institution":"University of Nottingham Health Services","correspondingAuthor":false,"prefix":"","firstName":"Bettina","middleName":"","lastName":"Bottcher","suffix":""}],"badges":[],"createdAt":"2025-01-20 10:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5865169/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5865169/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13031-025-00687-9","type":"published","date":"2025-07-17T15:56:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88506114,"identity":"ab3038ef-a860-45a6-8ce0-c64af2deb949","added_by":"auto","created_at":"2025-08-07 07:31:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1640004,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5865169/v1/30a5cf5f-7343-44ea-ab6f-fa08f00e7b0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of armed conflict on maternal and neonatal health and birth weight: a cross-sectional study in the Gaza-Strip","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eArmed conflicts pose a significant threat to the health of affected populations. Besides the risk of harm due to violence, conflicts promote social instability, weaken health systems, undermine support networks, and hamper access to essential services and necessities (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The war in the Gaza Strip, which started in October 2023, was notorious not only for the excessive violence and mounting casualties but also for the immense civilian suffering, displacement, and poor humanitarian situation it induced (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In January 2025, the number of Palestinians killed in the war ranged from 46000 to 64000, in addition to more than 110000 wounded and 1.9\u0026nbsp;million, nearly 90% of the population, displaced (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, due to the humanitarian situation and collapse of the healthcare system, it is feared that the war may have claimed four additional indirect deaths for every traumatic death recorded (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMaternal health is defined as women\u0026rsquo;s health during pregnancy, childbirth, and the postpartum period (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It is an important indicator of the health of a population and the state of its health services. Low birth weight (LBW) is another core public health indicator of maternal health and nutrition and the adequacy of healthcare delivery (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Improving maternal and neonatal health outcomes is imperative to achieving the Sustainable Development Goals (\u0026lrm;SDGs)\u0026lrm; by 2030. According to the WHO, an estimated 830 women worldwide die each day from complications related to pregnancy or childbirth, with nearly 99% occurring in low- and middle-income countries and over half in regions experiencing armed conflict or humanitarian crises (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe war in Gaza had several potentially catastrophic effects on pregnant women and their children. Vital infrastructure, including hospitals and healthcare facilities, were destroyed, and medical supply chains were disrupted, prompting the WHO to describe the situation as a \u0026ldquo;systematic dismantling of healthcare.\u0026rdquo;(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Additionally, hundreds of healthcare workers were killed, and many others have been wounded or detained (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, severe food and drinking water shortages have exacerbated the impacts of mass displacement on the population of the Gaza Strip (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The conditions associated with mass displacement and instability also impact maternal health-seeking behavior (MHSB) and further degrade pregnant women\u0026rsquo;s access to available healthcare (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the abundance of violent conflicts around the globe, only a handful of studies attempted to robustly quantify the impact of conflict on maternal and neonatal health (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). At the same time, the health information system in the Gaza Strip has been severely compromised during the war. For instance, the central server for health data collection was destroyed in November 2023 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The war\u0026rsquo;s impact on maternal health in Gaza raises significant concerns (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Addressing this critical gap in the literature, the present study aims to explore the implications of the war on maternal and neonatal health and the effect of this armed conflict on birth weight and maternal access to antenatal care (ANC). Documenting these variables can inform immediate healthcare interventions and guide long-term maternal and child health policies in conflict zones.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study settings, participants, and data collection\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included all mothers who delivered their neonates between 26 October and 12 November 2024 at three major hospitals: Sahaba Hospital in the Gaza Governorate, Al-Awda Hospital in the Middle Governorate, and Nasser Medical Complex in Khan Younis Governorate. Each hospital represented the largest obstetric center in its respective governorate at the time of data collection. The study included all mothers who delivered a singleton neonate during the study period. Exclusion criteria were mothers with multiple pregnancies, pregnant women with preterm premature rupture of membranes \u0026ldquo;PPROM,\u0026rdquo; and neonates with congenital or chromosomal abnormalities. There were 57,442 live births in the Gaza Strip in 2022, the last full year before the war (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The minimal sample size was thus 382, calculated using the Raosoft online calculator, with the settings set at a margin of error of 5%, a confidence interval (CI) of 95%, and a response distribution of 50%. To increase the power of the study, the authors increased the target sample size to 500. Senior medical students prospectively collected the data from patients and medical records.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study instrument and variables\u003c/h2\u003e \u003cp\u003eA data sheet was used for data collection. It comprised five sections. The first collected maternal and neonatal variables: mother\u0026rsquo;s age, residence, education, family income (based on the average governmental employee\u0026rsquo;s salary during the war of 800 NIS \u0026ldquo;roughly 220 USD\u0026rdquo;), maternal weight, height, blood hemoglobin (Hb), blood pressure at delivery, previous pregnancies, and abortions/stillbirths. It also noted the neonate\u0026rsquo;s sex, birth weight, gestational age, and the mother\u0026rsquo;s smoking status. The second section focused on the current pregnancy, recording the delivery mode, vaginal bleeding history, comorbidities, the number and timing of antenatal care (ANC) visits, and reasons for ANC absence. The third section assessed the mother\u0026rsquo;s nutritional status, including food quantity and diversity, daily meal availability, animal protein sources, drinking water access, and consumption of iron and folic acid supplements during pregnancy. The fourth documented the neonates\u0026rsquo; condition, including the one- and five-minute Apgar score (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), which obstetric centers in Gaza customarily use, and the need for resuscitation and neonatal ICU \u0026ldquo;NICU\u0026rdquo; admission. The fifth section examined the war's direct impacts on the mother\u0026rsquo;s physical and psychological well-being, including injuries, loss of family members, self-rated stress levels, and other factors. Questions with over 10% missing data were excluded from the analysis.\u003c/p\u003e \u003cp\u003eThe study defined full-term (FT) babies as those born at \u0026ge;\u0026thinsp;37 weeks of gestation. Preterm (PT) was \u0026lt;\u0026thinsp;37 weeks. Late, moderate, and very PT were born at 34\u0026ndash;37, 32-\u0026lt;34, and 28\u0026ndash;32 weeks, respectively. Extreme PT was \u0026lt;\u0026thinsp;28 weeks. Large birth weight was birth weight\u0026thinsp;\u0026gt;\u0026thinsp;4000 gm, Appropriate birth weight was 2500\u0026ndash;4000 gm, Low Birth Weight (LBW)\u0026thinsp;\u0026lt;\u0026thinsp;2500 gm, Very Low Birth Weight (VLBW) 1000\u0026ndash;1500 gm, and Extremely Low Birth Weight (ELBW)\u0026thinsp;\u0026lt;\u0026thinsp;1000 gm. The first trimester is 0\u0026ndash;13 weeks, the second 14\u0026ndash;26 weeks, and the third\u0026thinsp;\u0026gt;\u0026thinsp;26 weeks. Anemia in pregnancy is defined as Hb\u0026thinsp;\u0026lt;\u0026thinsp;11 g/dL, with severe anemia at Hb\u0026thinsp;\u0026lt;\u0026thinsp;7 g/dL (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Normal blood pressure at delivery was defined as systolic and diastolic pressures under 140 and 90 mmHg, respectively (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Ethical considerations\u003c/h2\u003e \u003cp\u003e The study was approved by the Institutional Review Board (IRB) at the Islamic University of Gaza (IUG). The research was performed as per the norms of the Helsinki Declaration. Participants gave informed written consent. Confidentiality and security of the data were maintained throughout the data collection and analysis phases, and no identifying data were collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e \u003cp\u003eThe data was analyzed using SPSS version 27. First, descriptive statistics were reported as frequencies and percentages rounded to two decimal points. Continuous variables (maternal age, Hb, maternal weight, parity, gravida, gestational age, and birth weight) were tested with the Shapiro\u0026ndash;Wilk test. The p-value was \u0026lt;\u0026thinsp;0.05, indicating a non-parametric data distribution. Therefore, the median and interquartile range (IQR) were used to describe the data. Correlations between nonparametric continuous variables were tested with the Spearman correlation test. Mann-Whitney test was used to compare birth weight between populations based on residence and sex. Statistical significance was set at p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Maternal sociodemographic information and obstetric history\u003c/h2\u003e \u003cp\u003eFive hundred seventeen women gave birth during the study period in the study hospitals. Seventeen were excluded for the following reasons: nine due to multiple pregnancies, four due to intrauterine fetal death (IUFD), and four due to PPROM. Consequently, the study included 500 women and their neonates. The median age was 28 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), with the youngest being 16 and the oldest 46. Nearly half (52.63%) had a normal baseline BMI. Most (84.03%) belonged to the lowest monthly income category of \u0026lt;\u0026thinsp;800 NIS monthly. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e further illustrates the information on sociodemographic characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal sociodemographic information and past obstetric history\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSahaba (Gaza Governorate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAl-Awda (Middle Governorate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNasser (Khan Younis Governorate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMother age (quartile)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 28 (IQR 10), range (\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u0026ndash;33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eBody mass index (BMI)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian BMI 24.44 (IQR 4.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal BMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass one obesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass two obesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma or Bachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster or Ph.D.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAverage family income during the war (NIS)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e800\u0026ndash;1600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSmoker\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Variation in totals is due to missing data\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe median number of previous pregnancies and deliveries was three (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Around 50.4% of pregnant women were anemic (Hgb\u0026thinsp;\u0026lt;\u0026thinsp;11 g/dl). Nearly a third suffered medical complications or comorbidities, with UTIs, symptomatic anemia, and gestational hypertension, respectively, being the most common. The vast majority of 97.60% presented for ANC visits during their pregnancy. However, only 58.40% had their first ANC visit during the first trimester, and 24.18% had less than four visits. The most frequently cited reason for the lack of ANC visits was the inability to afford clinic transportation to the healthcare facility.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePast and current obstetric history\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eGravida (quartiles)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 3 (IQR 3), range (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eParity (quartiles)*\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 3 (IQR 3), range (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePrevious abortions or still births\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDelivery mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssisted vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaesarean sections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMaternal Hb (g/dl)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 10.90 (IQR 1.50), range (6.90\u0026ndash;14.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;11 g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 11 g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;7 g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBlood pressure at delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot documented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003eMedical comorbidities (reported by mothers)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSymptomatic anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic diabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGestational diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGestational hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreeclampsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenal disease and UTIs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaginal bleeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTrimester of vaginal bleeding (n\u0026thinsp;=\u0026thinsp;24)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eTiming of the first antenatal care (ANC) visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNumber of ANC visits\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eANC setting(s)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eReason(s) for having no antenatal care (n\u0026thinsp;=\u0026thinsp;12)^\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo money for transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo desire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHad other important things to do\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e*Variation in totals is due to missing data\u003c/p\u003e \u003cp\u003e^ Participants can report more than one answer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Impacts of the war on maternal nutrition and physical and psychological wellbeing\u003c/h2\u003e \u003cp\u003eMost participants perceived their diet as insufficient in terms of food quantity and diversity. Furthermore, half (50.69%) said they consumed two meals on an average day during their pregnancy, and 7.98 consumed only one meal. Meanwhile, 40.12% reported that their diet was nearly completely devoid of animal protein sources. A majority of 69.46% adhered to daily iron and folic acid supplementation for at least 12 weeks (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal nutrition during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAppetite during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFood quantity during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFood diversity during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAccessibility to clean drinking water\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNumber of full meals in the average day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAverage frequency of eating food that contains animal protein\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMostly none\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1/month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3/month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eIron and folic acid supplementation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone or less than once/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt least once/week but not daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily for at least 12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly one in five participants (19.76%) lived in a separate house (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Nineteen (3.79%) were injured in the war while pregnant, 28.2% said a family member was killed. Furthermore, 40.92% reported feeling constantly in danger, and 62.08% rated their subjective levels of stress during the pregnancy as high. A significant proportion of 43.20% said they were mostly worried about the delivery, while 20.80% were primarily worried about their personal safety.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWar's impact on the mothers\u0026rsquo; physical and psychological wellbeing\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eCurrent residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShared house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShelter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eIndividuals sharing the living space\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eInjured while pregnant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIf injured, at which trimester\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA family member was killed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSaw dead bodies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA place the mother was in was bombed or targeted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFeeling endangered\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eSubjectively rated stress level during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMostly absent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuring this pregnancy, I was mostly worried about\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery and labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForced displacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLosing family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving an abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe health of my fetus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecuring my baby\u0026rsquo;s needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy finances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecuring food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Impacts of the war on birth weight and neonatal health\u003c/h2\u003e \u003cp\u003eThe median gestational age was 39 (IQR 2) weeks. The median birth weight was 3100 (IQR 500) grams. LBW was recorded at 10.80%, with VLBW and ELBW recorded at 0.6% and 0.2% of the total cohort, respectively. The difference in birth weights between those born in the Northern and the Southern Governorates was statistically significant (p\u0026thinsp;=\u0026thinsp;0.04). However, the difference between male and female newborns was insignificant (p\u0026thinsp;=\u0026thinsp;0.33). Only 5.39% of newborns in the study needed resuscitation, and 8.58% were admitted to the NICU. More information is provided in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBirth weight and neonatal outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNewborn\u0026rsquo;s sex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGestational age\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 39 weeks (IQR 2), (Range 27\u0026ndash;42 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 37 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 weeks and more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eBirth weight (gm)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian 3100 (IQR 500)(range 900\u0026ndash;5600)\u003c/p\u003e \u003cp\u003eMale median 3200 (IQR 538)\u003c/p\u003e \u003cp\u003eFemales median 3100 (IQR 600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2500\u0026ndash;4000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUnderweight newborns\u0026rsquo; sex (n\u0026thinsp;=\u0026thinsp;53)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eApgar score at one minute\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eApgar score at five minutes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResuscitation was needed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdmission to NICU\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBirth weight was correlated to maternal weight, gestational age, and the number of previous pregnancies but not to maternal age, Hgb, or systolic blood pressure (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between birth weight and different variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal Hgb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study examined the impact of the war in the Gaza Strip on maternal well-being and neonatal health. A majority of 62.73% of participants rated their food supply during pregnancy as insufficient, and 73.6% as not diverse. Furthermore, 62.04% of participants reported suffering severe stress, with 40.92% worrying about their safety almost always and 33.93% worrying often. Around half of the study participants (50.4%) were anemic, and 24.18% had less than four ANC visits. The median birth weight was 3100 (IQR 500), and the prevalence of LBW was 10.8%. Factors positively correlated with the incidence of LBW were maternal weight, gestational age, and the number of previous pregnancies.\u003c/p\u003e \u003cp\u003eResearch shows that women who experience armed conflict during pregnancy are at significantly higher risk of having LBW babies. This has been confirmed in various studies across different conflicts (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Mothers in this study endured over a year of armed conflict in the Gaza Strip, which led to severe violence, displacement of around 90% of the population, and extreme food insecurity and undernutrition (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). A recent study indicated an average weight loss of about 18 kilograms among the northern Gaza Strip population (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Along this line, in 2020, overweight and obesity prevalence was reported at 64.1% among mothers aged 18 to 50 in the Gaza Strip, but this has decreased to 45.5% in the present study (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This difference is still significant despite different study designs and potential recall bias.\u003c/p\u003e \u003cp\u003eIn 2022, the Palestinian Ministry of Health reported an LBW prevalence of 8.0% in the Gaza Strip (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). From 2012 to 2021, studies indicated LBW ranged from 5.5\u0026ndash;7.8% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Thus, a higher LBW rate of 10.8% is expected, aligning with Le and Nguyen\u0026rsquo;s findings of a 3.2% average increase in LBW across 53 conflict-affected regions over three decades (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Similarly, a previous study showed a mean birth weight of 3291.17\u0026thinsp;\u0026plusmn;\u0026thinsp;599.84 grams in Gaza, while the current study's median is 3100 (IQR 500) grams (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, before the current war, the incidence of LBW varied between the Gaza Strip and the West Bank. In 2022, LBW was 8.0% in the Gaza Strip and 6.4% in the West Bank, signifying that socioeconomic, security, and health conditions affect pregnancy outcomes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Despite being part of the Occupied Palestinian Territories, the Gaza Strip and the West Bank are geographically separated. This implies that geopolitical factors in Gaza, such as movement restrictions, siege, poverty, and conflict, may primarily cause the LBW incidence before the war (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobal LBW prevalence is about 14.6%, but varies by country: 4.2% in Iceland, 7% in the UK, 8% in the USA, and up to 27.8% in Bangladesh in 2015 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). LBW rates are higher in deprived areas and among disadvantaged mothers during armed conflicts (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Even short conflicts without food insecurity affected birth weights (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Though the exact mechanisms are unclear, potential stressors include fear and environmental factors (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In the study, 90.42% of participants reported moderate to high stress levels, with 40.92% and 33.93% feeling almost always or often endangered. This aligns with a recent Gaza survey showing a 90.56% prevalence of stress symptoms among young adults (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsequently, against this backdrop of chronic conflict, an increase in the incidence of LBW from 8.0\u0026ndash;10.8% is notable and highlights the correlation between a rising incidence of LBW and intensified armed conflict, which tracks back to stressors such as fear in addition to displacement, food insecurity, and poor access to healthcare (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Indeed, the under-five mortality rate in the Gaza Strip has demonstrated a steady decline from 44.9 in 1990 to 14.3 in 2022. However, in 2014, during a prolonged armed conflict in the area, the trend was interrupted, and the under-five mortality rate rose to 21.3 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Similar trends were observed in the effects of recurring armed conflict on maternal mortality (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Thus, it is not surprising that armed conflicts seem to have a significant impact on maternal and neonatal health in this region, and this study confirms this observation regarding this war in 2023\u0026ndash;2025.\u003c/p\u003e \u003cp\u003eLBW is significantly associated with a range of poor outcomes, including developmental delays in childhood and an increased risk of chronic diseases, such as type 2 diabetes and cardiovascular disease in adulthood (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). It also heightens the risk of adverse pregnancy outcomes, such as preterm birth and neonatal death. Moreover, maternal exposure to famine, stress, and conflict can impact health later in life, even when birth weight remains within normal limits. Adults exposed to such stressors in utero have been found to face higher risks of type 2 diabetes, cardiovascular disease, and obesity, emphasizing the profound effects that these experiences can have as they grow and transition into adulthood (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Therefore, the full implications for survivors will only become evident over their lifetimes and may affect their health in adulthood well after the initial conflict has settled.\u003c/p\u003e \u003cp\u003ePrevious studies have demonstrated that inadequate food supply was associated with a higher incidence of LBW (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Pregnant women are at higher risk of food insecurity due to the nutritional needs of the developing fetus (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). To avoid food insecurity, the quality and quantity of food supply must be adequate (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Most participants reported inadequate nutrition, with 62.73% rating their food supply during pregnancy as insufficient in quantity and 73.6% as lacking in diversity. Furthermore, more than half of the participants consumed only two full meals each day, and their diet largely lacked animal protein. These observations were based on women's self-assessments rather than objective measurements. However, the fact that 50% of the Gaza population faced catastrophic food insecurity, along with significant weight loss across the population during the same time period, suggests that a large proportion of pregnant women also encountered food insecurity and insufficient food supply during their pregnancies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Food insecurity in the Gaza Strip during the different phases of the war has been pervasive and comprehensive (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40 CR41 CR42 CR43\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In this context, the present study found a significant difference in birth weight between newborns in the Northern and Southern Governorates, with lower birth weight among those born in the South. This suggests that while starvation in the North received particular attention, food insecurity and the poor humanitarian conditions caused by mass displacement in the South were no less impactful (\u003cspan additionalcitationids=\"CR40 CR41\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterventions that have been shown to improve food security include diet planning, micronutrient supplementation, food fortification, nutritional counseling, and monitoring weight gain. The existing literature reveals a lack of evidence for successful interventions addressing food insecurity in armed conflict (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). General food distribution is the most common intervention in areas of armed conflict (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Nonetheless, a lack of resources, shortages of nutritional supplies, security challenges, inadequate reporting, limited collaboration, and difficulties in accessing and following up with beneficiaries hinder effective delivery in conflict-affected areas (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnemia during pregnancy is closely associated with food insecurity. Worldwide, an estimated 36.4% of pregnant women experience anemia, with much higher prevalence rates in low-income countries compared to high-income countries (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). In this study, 50.4% of women who gave birth had anemia, which is higher than previous reports (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Research has indicated that the prevalence of anemia among pregnant women in the Gaza Strip ranges from 35.7\u0026ndash;44.9%, with one study reporting a prevalence of 42.8% during the second and third trimesters (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This is despite the relatively high proportion of nearly 70% of our participants adhering to folic acid and iron supplements during their pregnancy. The lack of correlation between anemia and the incidence of LBW has been noted in a previous local study and could be due to the fact that \u0026ldquo;baseline\u0026rdquo; rates of anemia, prior to the current war, have always been elevated (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Daily folic acid and iron supplementation may have also played a mitigating role and could, therefore, be an essential strategy to support maternal and newborn health during conflicts (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) recommends eight ANC visits during pregnancy, with the first occurring in the first trimester (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). The present study found that only 36.68% of participants had eight or more visits, and 58.4% could establish the first ANC contact during the first trimester. A recent study on ANC coverage in Palestine found that 70.9% of participants from Gaza reported eight or more ANC visits, and 87.1% of the cohort had initiated ANC contact during their first trimester (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). The striking decline in ANC visits found in the present study testifies to the impacts the war had on pregnant women\u0026rsquo;s access to healthcare and mirrors findings from other hot conflict zones such as Sudan (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths, limitations, and future research directions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe present study has several strengths. It collected data from several hospitals and geographical locations in the Gaza Strip. It robustly included all women who gave birth in those hospitals during the data collection period, permitting reasonable result generalizability. Also, the sample size was well above the calculated minimal size necessary to achieve statistical power. Moreover, senior medical students collected data from both the women and the medical files, which minimized data loss. Finally, the study collected an assortment of data relevant to the study subject in a bid to reflect the diversity of the war\u0026rsquo;s impacts on mothers and newborns.\u003c/p\u003e \u003cp\u003eHowever, the study has limitations. Most importantly, several collected variables relied on the subjective estimation of the participants, especially those related to nutrition and rated stress, which is subject to recall bias. Also, the cross-sectional design limits the possibility of establishing causality. Moreover, not all factors that impact maternal and neonatal health in this situation could be considered in this study, and it might be challenging to assess the extent of the impact of individual factors. Future studies are encouraged to follow longitudinal designs to investigate the lasting impacts of the armed conflict on mothers and neonates.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study reveals the significant impacts of the Gaza War on maternal and neonatal health, noting increased low birth weight (LBW) rates compared to pre-war data. It demonstrates the vulnerability of pregnant women during conflicts, linking LBW increases to food insecurity and stressors like fear. The research highlights how ongoing chronic conflicts further reduce the reproductive rights of both women and men, limiting access to antenatal care and safe delivery options while exposing them to acute stress. It highlights the duty of parties involved in conflicts to enable sufficient food supply to civilians to reduce the risk of negative impact on pregnant women, newborns, and their future development and health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study was approved by the Institutional Review Board (IRB) at the Islamic University of Gaza (IUG). The research was performed as per the norms of the Helsinki Declaration. Participants gave informed written consent. Confidentiality and security of the data were maintained throughout the data collection and analysis phases, and no identifying data were collected.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot Applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was not funded.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBA: Conceptualization. All authors: literature review. BA, ME, SA: study design and tool development. BA: Supervision. SM, HA, TA, YT, KS, YZ, AE, MA, AA, AA, HA: Data collection. BA, SE, SA, and BB: data analysis and interpretation. BA, SE, BB: Writing the study manuscript. All authors contributed to the manuscript revision and have approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors acknowledge Dr. Ahmed Elhissi, MD, MSc, for contributing to designing and interpreting the statistical analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAvailable from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShah S, Padhani ZA, Als D, Munyuzangabo M, Gaffey MF, Ahmed W, et al. Delivering nutrition interventions to women and children in conflict settings: a systematic review. BMJ Global Health. 2021;6(4):e004897.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeasley J, Blickwedel J, Quenby S. Adverse effects of exposure to armed conflict on pregnancy: a systematic review. 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PLoS ONE. 2024;19(2):e0297956.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Armed Conflicts, Birth Weight, Health Services Accessibility, Gaza Strip, Maternal Health, Newborn Health","lastPublishedDoi":"10.21203/rs.3.rs-5865169/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5865169/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWomen who experience armed conflict during pregnancy are at significantly higher risk of maternal and neonatal complications and having low-birth-weight (LBW) babies due to factors such as violence, stress, food insecurity, and health inaccessibility. This study aims to explore the implications of the 2023\u0026ndash;2025 armed conflict in the Gaza Strip on maternal and neonatal health and its effect on birth weight and maternal access to antenatal care (ANC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included 500 consecutive women and neonates delivered in three obstetric centers in different areas of the Gaza Strip in October and November 2024. The study collected sociodemographic information, maternal obstetric history, maternal nutrition, maternal stress and other impacts of the conflict, and neonatal outcomes, including birth weight. Frequencies, percentages, and median and interquartile range (IQR) were used to describe the data. Correlations between nonparametric continuous variables were tested with the Spearman correlation test. Mann-Whitney test was used to compare birth weight between populations based on residence and sex.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe median age was 28. Nearly half (52.63%) had a normal baseline BMI. Most (84.03%) had a very low monthly income. The prevalence of maternal anemia was 50.4%. Most participants (62.73%) reported insufficient food quantity and 73.6% insufficient diversity. Over half consumed only two full meals daily on average, and the diet largely lacked animal protein. Only 36.68% had eight or more ANC visits, and only 58.4% could establish the first ANC contact during the first trimester. The commonest cause for the lack of ANC was the inability to afford transportation. Also, 69.46% adhered to folic acid and iron supplementation. Most (90.42%) participants reported moderate to high stress levels, with 40.92% and 33.93% feeling almost always or often endangered. The prevalence of LBW was 10.8%, and the median weight was 3100 gm.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThis study demonstrates the vulnerability of pregnant women during conflicts. It reveals the significant impacts of the 2023\u0026ndash;2025 armed conflict in the Gaza Strip on maternal and neonatal health, including an increased LBW rate compared to pre-war data.\u003c/p\u003e","manuscriptTitle":"Impact of armed conflict on maternal and neonatal health and birth weight: a cross-sectional study in the Gaza-Strip","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 17:54:25","doi":"10.21203/rs.3.rs-5865169/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-27T09:38:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-27T08:58:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-27T22:43:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"89781750225315848588832744622827793895","date":"2025-02-17T08:21:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313724340515237843756242288049216904465","date":"2025-02-07T09:46:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-03T14:39:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-21T04:22:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-21T04:20:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Conflict and Health","date":"2025-01-20T10:45:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"conflict-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"conf","sideBox":"Learn more about [Conflict and Health](http://conflictandhealth.biomedcentral.com/)","snPcode":"13031","submissionUrl":"https://submission.nature.com/new-submission/13031/3","title":"Conflict and Health","twitterHandle":"@Conflict_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e47210d2-2210-4fe9-9283-f644c94a9c6a","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:13:51+00:00","versionOfRecord":{"articleIdentity":"rs-5865169","link":"https://doi.org/10.1186/s13031-025-00687-9","journal":{"identity":"conflict-and-health","isVorOnly":false,"title":"Conflict and Health"},"publishedOn":"2025-07-17 15:56:58","publishedOnDateReadable":"July 17th, 2025"},"versionCreatedAt":"2025-01-29 17:54:25","video":"","vorDoi":"10.1186/s13031-025-00687-9","vorDoiUrl":"https://doi.org/10.1186/s13031-025-00687-9","workflowStages":[]},"version":"v1","identity":"rs-5865169","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5865169","identity":"rs-5865169","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}