Despite the importance of quality prenatal care, a relatively small percentage of mothers or fathers invest in their health and well-being before becoming pregnant. This cross-sectional study, which included 445 mothers, aimed to investigate the impact or association of various maternal and paternal factors on infant health. This study revealed that around 145 (32.6%) of infants had disease; according to the ICD-10, the most common diseases in descending order were malnutrition, followed by diseases that occurred within the first month after birth, congenital defects, other unspecified conditions, and then chronic respiratory and cardiovascular. This study highlights the importance of socioeconomic factors, healthy parental lifestyle, preconception, antenatal, and antenatal care, in improving infant health outcomes.
Demographic factors and their associated with infants’health
The average maternal and paternal ages were 27.72 ± 6.35 and 32.35 ± 7.25 years, respectively. Most mothers were Palestinian (34.8%), Egyptian (26.7%), or Yemeni (15.7%). Residency was predominantly urban (62.7%), while 37.3% lived in rural areas. Income levels varied, with 69% reporting their income as”enough,”16% as”more than enough,”and 23% as”not enough.”These findings align with those of Alfayez et al. [33], who examined Saudi women’s attitudes toward newborn screening programs.
Maternal nationality showed a significant association with infant health, with Palestinian mothers reporting higher rates of poor infant health, potentially reflecting disparities in healthcare access and socioeconomic conditions. Lower income levels were also strongly correlated with adverse child health outcomes [34], as 55.2% of parents covered medical expenses out of pocket. These findings highlight the role of financial stability in infant health and the need for supportive policies.
Parental substance use, including smoking (P = 0.042), cannabis (P = 0.006), and alcohol consumption (P = 0.003), significantly impacted child health. Maternal smoking during pregnancy is a well-documented risk factor for miscarriage, low birth weight, prematurity, and perinatal mortality [35,36,37,38,39], emphasizing the need for public health interventions.
Chronic parental illnesses, such as diabetes and hypertension, were also linked to poorer infant health [45], likely due to their impact on caregiving and overall family well-being [46]. Conversely, factors such as residence, smoking cessation, hookah use, addiction status, immune and neuropsychiatric conditions, and family history of cancer showed no significant association with infant health, possibly due to confounding variables.
Parental lifestyle factors and their associations with infants’health
A majority of mothers (71.0%) had no prior smoking history, indicating a predominantly non-smoking population. Former smoking was reported by 8.5% of mothers and 16.2% of fathers, with higher cessation rates among fathers. Current smoking showed a pronounced gender disparity, with 1.8% of mothers and 40.2% of fathers actively smoking, consistent with global trends of higher male smoking prevalence, particularly in certain cultural contexts.
Addiction-related issues were minimal, with 96.9% of mothers reporting no substance dependence. Cultural perceptions and question phrasing may have influenced responses, particularly regarding non-substance-related behaviors.
Chronic diseases were reported in 6.7% of mothers and 18.4% of fathers, suggesting potential lifestyle influences on health. Biological, cultural, and socioeconomic factors may contribute to the observed gender disparity. Immune-related conditions, including multiple sclerosis, lupus, and rheumatoid arthritis, were reported by 2.0% of participants, potentially reflecting regional variations in incidence. Neuropsychiatric disorders were also low (2.0%), possibly due to underreporting, lack of diagnosis, or cultural stigma.
A family history of cancer was noted in 7.6% of participants, with maternal history (3.4%) being more prevalent than paternal history (1.1%), suggesting potential hereditary risks. Additionally, 4.0% reported the same type of tumor within their family, while 2.2% had a personal history of tumors. Despite genetic predispositions, 96.0% remained cancer-free, highlighting the potential role of environmental and protective factors in mitigating risk.
Associations of dietary intake and nutritional supplementation with infant health
The consumption of milk and dairy products was significantly associated with reduced infant disease prevalence (P = 0.014). Dairy products provide essential nutrients, including calcium, vitamin D, and protein, which support fetal bone and nervous system development [42, 43]. However, the study found no significant associations for other dietary groups like cereals, bread, fruits, vegetables, or water intake, indicating that these foods may have a less direct impact on infant health.
The most consumed supplements were in descending order: folic acid (75%), iron (72%), calcium (64%), and vitamin D (53.3%), with no significant associations with the frequency of infant disease. They used these supplements for preventative and medicinal immunological enhancement to promote the health of both infants and mothers. The price, accessibility, and acceptability of dietary supplements may account for the significant variations in usage frequency across different studies [40].
Regarding the consumption of diet or sugar-free beverages containing aspartame, 13.3% of participants reported consuming these drinks, while 71.9% indicated they did not. The limited consumption of aspartame-sweetened beverages suggests a preference for traditional sugary drinks or a shift toward natural sweeteners due to taste preferences, health consciousness, or emerging trends favoring healthier alternatives.
Antenatal and natal factors and their association with infant health
The results suggest that high-risk pregnancies identified by medical professionals are associated with increased child morbidity as Mothers who received a doctor’s warning during pregnancy reported a significantly higher incidence of infant diseases (66.6% vs. 31.6%, P = 0.02). Similarly, folic acid deficiency before or during early pregnancy was significantly associated with child disease (P = 0.003), highlighting the protective role of folic acid in preventing neural tube defects and other congenital abnormalities [32, 42].
A delayed awareness of pregnancy was also linked to higher infant disease risk (16.6%, P = 0.04), possibly due to postponed prenatal care or lifestyle adjustments. Non-prescription drug use during pregnancy was another significant factor (P = 0.008), emphasizing the need for healthcare professionals to educate pregnant women on the safe use of medications. Routine prenatal visits were associated with improved infant health outcomes (P = 0.03), reinforcing the importance of consistent antenatal care in reducing neonatal mortality and promoting maternal and infant health [33, 41, 44].
Pregnancy-related hyperemesis (P = 0.030) and chronic infections (P < 0.00005) were significantly associated with increased infant illness. Hyperemesis can lead to maternal malnutrition and dehydration, affecting fetal development, while chronic infections may involve direct pathogen transmission or immunological responses [45]. Mode of delivery also played a role, with cesarean sections associated with poorer infant health outcomes (P < 0.05), potentially due to complications such as delayed breastfeeding or neonatal respiratory issues.
Admission to neonatal intensive care units (NICUs) was strongly associated with infant disease (P < 0.00002), as premature birth or underlying health conditions often necessitate incubation. Low birth weight, delayed motor development, and impaired social or mental development significantly correlated with child illness, with P -values ranging from 0.00002 to 0.00000001.
Associations of parental SARS-CoV-2 infection and COVID-19 vaccination with infant health
Exposure to COVID-19 during pregnancy showed a significant association with higher infant illness frequency (P = 0.05). The results indicate a significant association between SARS-CoV-2 exposure during pregnancy and infant disease (P = 0.05), suggesting that maternal infection during pregnancy may pose risks to infant health. parents who were not vaccinated had a higher prevalence of infant disease (P = 0.02). These findings underscore the relevance of both parental COVID-19 exposure and vaccination status in influencing infant health. Potential mechanisms include maternal inflammation, fever, or vertical transmission of the virus, all of which could impact fetal development. In agreement with other studies [46, 47]. Further research is guaranteed to understand these relationships fully.
Strengths and limitations
This study has many strengths, including a multi-national, targeted, relatively large sample of mothers from four low- to middle-income countries (Egypt, Jordan, Yemen, and Palestine). Researchers are increasingly focusing on identifying maternal risk factors associated with adverse birth outcomes. The impact of paternal factors on birth outcomes has received significantly less attention. This study is one of the few studies to examine the influence of multiple parental factors, including paternal lifestyle factors, SARS-CoV-2 virus exposure, and COVID-19 vaccination on infant health.
Moreover, this study also had many limitations, e.g., the cross-sectional design prevents establishing causality, and reliance on self-reported data introduces recall bias. Mothers reported paternal factors rather than fathers explicitly, which is particularly concerning. One of the limitations is that there are significant variations in the sample size collected from different nationalities; for example, Palestinian mothers constituted the largest group, followed by Egyptian and Yemeni mothers. The variability may be attributed to the flow rate in the selected primary care centers, in addition to the long waiting time that facilitates face-to-face interviews for data collection. Furthermore, the findings may not be generalized beyond the study’s specific cultural and geographical context and include only mothers who meet the specified inclusion and exclusion criteria attending PHCCs. Although we selected investigators or researchers to collect data from their institutions or nearby PHCCs e.g. Ahmed A. Amer, Mohamed SH. Ramadan, Mahmoud T. Hefnawy and Hanaa S. Said from Egypt; Hamza A. Abdul-Hafez from Palestine; Batool Turki Gharaibeh from Jordan; and Muna Ali Mugibel from Yemen. They chose a random sample of mothers who meet the selection criteria from the accessible or nearby PHCCs, but this study cannot be called population based.
Implications for clinical practice
The findings of this study emphasize the critical need for integrating comprehensive maternal and paternal health assessments into routine antenatal care. By identifying and addressing modifiable risk factors such as smoking, improper folic acid intake, and chronic infections early in pregnancy, healthcare providers can significantly reduce adverse infant health outcomes. Additionally, the study underscores the importance of prioritizing maternal COVID-19 vaccination as a preventive measure during pregnancy. Clinicians should adopt a holistic approach that includes dietary counseling, stress management support, and guidance on safe medication used to optimize maternal health and, by extension, infant well-being. These insights call for the incorporation of targeted education and screening protocols in clinical settings to mitigate preventable risks and enhance neonatal health outcomes.
