Background

Armed conflicts are associated with increased maternal and perinatal mortality, particularly due to sepsis. However, evidence on the impact of warfare on pregnant women and neonates hospitalized with septic conditions remains limited.

Objectives

The aim of our study was to improve the prediction and prevention of early-onset neonatal infection (EONS) based on a clinical and epidemiological analysis of maternal risk factors under conditions of martial law.

Material and methods

A comparative analysis was conducted of two cohorts of “mother–newborn” pairs, formed according to the chronological period – pre-war and during martial law in Ukraine.

Results

Maternal socio-demographic profile and comorbidities significantly influenced pregnancy outcomes and neonatal risks, with pre-war cohorts showing higher rates of obstetric, gynecologic, and extragenital complications. Perinatal risk factors, intrapartum management, and neonatal characteristics of infants with NS demonstrated significant temporal variations between the pre-war and wartime periods.

Conclusions

Under wartime conditions in Ukraine, parturients delivering neonates with EONS were significantly older, with a 7.9-fold increase in the proportion of women over 26 years of age. Births outside registered partnerships rose from 20% to 28.6%, while pregnancies under adverse socio-economic conditions increased from 1- to 4.1-fold. Compared with the pre-war period, risks of hypertensive disorders (RR = 1.7; OR = 4.0; AR = 30.8%), cesarean delivery (RR = 1.5; OR = 2.3; AR = 20.4%), and meconium-stained amniotic fluid (RR = 1.9; OR = 6.9) were higher. The need for primary neonatal resuscitation increased substantially (RR = 3.6; OR = 12.8), reflecting a more complicated early neonatal course during the full-scale war.