Maternal and neonatal outcomes in Gaza amid armed hostilities in 2025

This study documents facility-based maternal, obstetric, and neonatal outcomes and associated conflict-related exposures and living conditions among pregnancy-related encounters at Al-Helou Maternity Hospital in Gaza from late April to early September 2025, with a small number of additional encounters recorded at Al-Shifa Medical Complex.

We conducted an observational, facility-based study using a combined retrospective-prospective approach. All recorded obstetric encounters were eligible. Outpatient antenatal clinic visits were excluded. Data were abstracted from routine clinical records and contemporaneous intake forms/clinician notes. Analyses were primarily descriptive (medians [interquartile range, IQR] and counts/percentages with variable-specific denominators). Exploratory correlation analyses examined birthweight in relation to selected maternal exposures.

Among 686 women (median age 28 years [IQR 23-33]), 92.9% reported ≤2 meals/day and 71.7% had anemia (Hb <11 g/dL); 78.7% were currently displaced (54.8% living in tents), 57.0% reported nearby bombing within 24 h, 98.0% had smoke exposure, and 74.6% reported heavy lifting. Only 32.1% reported access to prenatal care, 52.6% pregnancies were unplanned, and 11.9% of unplanned pregnancies reported successfully accessing contraception. Gestational age was ≥37 weeks in 80.8%. Delivery management included 57.4% normal vaginal deliveries and 37.6% caesarean sections (53.4% due to prior caesarean). Postpartum intensive care unit admission occurred in 1.0% with 28.6% mortality among those admitted. Neonatal outcomes (n = 665) included median birthweight 3000 g (IQR 2600-3300), neonatal intensive care unit (NICU) admission 12.9%, discharge alive 98.6%, and last documented Apgar score of 10 in 43.0% (0 in 9.5%).

Pregnancy-related encounters in Gaza occurred amid pervasive food scarcity, displacement, smoke exposure, and recent bombardment, alongside high anemia prevalence and limited prenatal care. Maternal care featured substantial caesarean use and severe maternal complications, while neonatal outcomes included frequent NICU admission, underscoring a high-risk environment for mothers and newborns.