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BMC Pregnancy and Childbirth Apr 2024Postpartum anemia, characterized by hematocrit or hemoglobin levels below the defined cutoff point (< 11gm/dl or hematocrit < 33%), is a prevalent global issue. It... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postpartum anemia, characterized by hematocrit or hemoglobin levels below the defined cutoff point (< 11gm/dl or hematocrit < 33%), is a prevalent global issue. It serves as an indirect contributor to maternal mortality and morbidity. Mothers in the postpartum period experience diminished quality of life, impaired cognitive function, emotional instability, and an increased risk of postpartum depression due to anemia. Additionally, infants of affected mothers may face challenges such as insufficient breast milk supply and a lack of proper care. Examining the combined prevalence and factors associated with postpartum anemia is crucial for addressing maternal health risks and complications during the postnatal phase attributed to anemia.
OBJECTIVE
The study aimed to synthesize the existing literature on the prevalence and associated factors of postpartum anemia in public health facilities of Ethiopia, in 2024.
METHODS
The study was conducted by searching through the Google Scholar, PubMed, and Cochrane Library search engines. The search utilized keywords and MeSH terms such as anemia, low hemoglobin, postpartum, postnatal women, and Ethiopia. The collected data underwent analysis and comparison with the WHO criteria to determine if it met the threshold for declaring a public health concern. Heterogeneity was evaluated through the Cochran Q test and I2 statistics. Prevalence and odds ratio estimations were performed using a random-effects model with a 95% confidence interval.
RESULT
Four studies were included in this systematic review and meta-analysis. The overall pooled prevalence of anemia among postpartum women in Ethiopia was 69% (95% CI: 60- 77%).Lack of formal education(OR = 3.5;CI:2.639,4.408),Low Pre-delivery hemoglobin (OR = 4.2;CI: 1.768-6.668), Postpartum women < 4 ANC visit (OR = 2.72; 95% CI:2.14,3.3 ),history of post partum hemorrhage (OR = 2.49; CI: 1.075-3.978),history of Forceps/vacuum delivery(OR = 3.96; CI:2.986-4.947), Poor iron and folic acid adherence (OR = 2.8;95% CI:2.311,3.297), C/S (OR = 4.04; 95% CI: 3.426,4.671),lower dietary diversity (OR = 4.295% CI:1.768,6.668) were significantly associated postpartum anemia.
CONCLUSION
Postpartum women in Ethiopia continue to face a considerable public health challenge in the form of anemia. Consequently, there is a pressing need for the government to formulate comprehensive, multi-sectorial policies and strategies. These initiatives should be designed to address the substantial regional disparities influenced by interconnected factors, with the aim of reducing the prevalence of anemia among postpartum women in Ethiopia.
Topics: Humans; Ethiopia; Female; Prevalence; Anemia; Postpartum Period; Risk Factors; Pregnancy; Mothers; Adult; Health Facilities
PubMed: 38678183
DOI: 10.1186/s12884-024-06525-9 -
Health Psychology and Behavioral... 2024Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer... (Review)
Review
BACKGROUND
Adolescence is the most crucial part of life. The vulnerability of adolescent mothers is even more pronounced and can affect various health aspects. While they suffer from social and emotional stresses shortly after giving birth, the long-term effect after the post-partum period of adolescent pregnancy on the mental outcomes holds prime importance. Thus, this systematic review aims to ascertain the association between adolescent pregnancy on mental health outcomes.
METHODS
The search strategy was run in June 2023 on databases including PubMed, CINAHL, Scopus, Psych Info, and Embase . Quality assessment of the studies was done using the National Institute of Health (NIH)'s National Heart, Lung and Blood Institute (NHLBI) tool for observational studies. For studies that measured similar outcomes, a meta-analysis was conducted.
FINDINGS
The search strategy yielded 21 results from all databases and cross-referencing. Of these, all except for one (case-control) were cross-sectional and cohort studies. The pooled analysis found a significant association between adolescent pregnancy and depression (RR 1.34; 95% CI 1.05, 1.72, 6 studies, heterogeneity: Chi P 0.01; I = 60%); however, no association was found in anxiety (RR 1.05; 95% CI 0.26, 4.14, 2 studies; heterogeneity: Chi² = 0.0003; I = 93%) and suicidal ideation (RR 3.21; 95% CI 0.17, 59.33; 3 studies; heterogeneity: Chi < 0.00001; I = 98%).
IMPLICATION
These findings suggest that the mental health needs of adolescent mothers must be addressed and innovative and effective interventions that support and address the mental health needs of adolescent mothers are needed to improve their mental health.
PubMed: 38313449
DOI: 10.1080/21642850.2024.2305741 -
Psychoneuroendocrinology Aug 2024Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA)...
BACKGROUND
Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, ALLO seems to have antidepressant and anxiolytic effects, and was therefore approved as a specific medication for the treatment of postpartum depression in 2019. Despite the growing number of publications investigating ALLO levels, results on the biological and psychological correlates in the peripartum period remain inconsistent, possibly due to methodological challenges regarding measurement. To date, however, there is no systematic review examining the correlates, concentrations, and challenges in measuring ALLO in peripartum women.
METHOD
A systematic literature search of PubMed and PsycINFO was conducted in August 2023. Original research articles that measured ALLO concentrations in peripartum women were included. Reports were excluded if they were not original research, included non-human subjects, did not include peripartum women, did not include ALLO measurement as an outcome, included (pharmacological) interventions, constituted method validations, or used the same cohort as another study.
RESULTS
The literature search yielded 234 articles, and two articles were identified from other sources. After full-text screening, 19 articles (N = 1401) met the inclusion criteria, of which seven focused on biological correlates of ALLO and 12 on mood correlates. Of the latter, six found no association between ALLO and mood, four found a negative association, and two found a positive association. Overall, the results show an increase in ALLO levels during pregnancy and a decrease after birth, with levels then remaining low until six months postpartum. ALLO was most commonly measured in blood plasma and by gas chromatography-mass spectrometry (GC-MS). A significant matrix effect was found for blood serum and a significant method effect for radioimmunoassays (RIAs). A significant effect of time of measurement was found.
CONCLUSION
ALLO measurement shows method and matrix effects. ALLO levels are higher when measured in serum compared to in plasma, and when measured using RIA compared to other methods. Time of measurement, study design, and standardization of measurement also influence the reliability of measurement and the interpretation of results.
Topics: Humans; Pregnanolone; Female; Peripartum Period; Pregnancy; Depression, Postpartum; Adult
PubMed: 38759520
DOI: 10.1016/j.psyneuen.2024.107081 -
Heliyon Feb 2024The postnatal period is a critical time for maternal mental health, presenting unique challenges and vulnerabilities. Identifying effective and accessible strategies to... (Review)
Review
BACKGROUND
The postnatal period is a critical time for maternal mental health, presenting unique challenges and vulnerabilities. Identifying effective and accessible strategies to improve postnatal mental health and well-being is therefore crucial and could have substantial benefits for both mothers and babies, alongside broader implications for healthcare systems. Yoga is a potential intervention that has demonstrated notable benefits; however, a gap exists in systematically evaluating the existing literature on postnatal yoga-based interventions. This systematic review addresses this, aiming to comprehensively assess the impact of postnatal yoga on maternal mental health and well-being.
METHODS
Six databases were searched using keywords "yoga", "yogic", "postnatal", "postpartum", "perinatal", "maternal", "mother*". Articles were considered if they were quantitative and evaluated a yoga or yoga-based intervention in postnatal samples. Study outcomes were extracted and synthesised descriptively. A quality assessment of studies was also conducted.
FINDINGS
Of the 383 non-duplicated records that were identified, nine met criteria for full-text review. Only 6 met the inclusion criteria and so were included in the review. Across the 6 studies within this review, data from 377 adult women were included and looked at the outcomes of women in the USA, Northern Ireland, Taiwan and Turkey. The findings of the studies suggest that taking part in postnatal yoga is associated with decreased symptoms of depression, an increase in psychological well-being and quality of life.
KEY CONCLUSIONS
Yoga-based interventions may offer a promising and effective intervention for maternal mental health and well-being. However, due to the limited number of studies, and a lack of consistency in study design and measures, more high-quality research is required to establish these effects and explore the potential benefits on other aspects of maternal well-being and infant outcomes.
PubMed: 38322903
DOI: 10.1016/j.heliyon.2024.e25455 -
International Breastfeeding Journal Apr 2024Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions. Teleinterventions are flexible and widely used following the global pandemic and increase maternal autonomy over intervention delivery. They show promise in improving other maternal conditions in LIW, including postpartum depression. Teleinterventions can increase breastfeeding rates in the wider maternal population, however their efficacy for this underserved population has not yet been systematically assessed. This meta-analysis aimed to identify if teleinterventions increase 'exclusive' or 'any' breastfeeding by LIW in HIC at 1-, 3-4, and 6-months postpartum.
METHODS
We searched five online databases for randomised controlled trials assessing breastfeeding teleinterventions for LIW in HIC. Risk ratios (RR) were used to calculate the average effect of teleinterventions on 'any' and 'exclusive' breastfeeding at at 1-, 3-4, and 6-months postpartum using random effects meta-analysis. Study bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), and outcome quality was evaluated against GRADE criteria.
RESULTS
Nine studies met inclusion criteria: six providing telephone calls, two text messages and one an online support group. All the studies were conducted in the United States, with small sample sizes and a high risk of bias. Pooled results indicate teleinterventions modestly increase 'any' and 'exclusive' breastfeeding at all time points, with a statistically significant increase in 'exclusive' breastfeeding after 3-4 months (RR 1.12, 95% CI [1.00,1.25]). At 3-4 months teleinterventions providing peer support were more effective than educational teleinterventions at promoting any and exclusive breastfeeding. Evidence for all outcomes were rated 'low' or 'very low' quality using the GRADE tool, mainly due to high attrition and low power.
CONCLUSIONS
Despite insufficient high-quality research into breastfeeding teleinterventions for LIW, our results suggest teleinterventions may improve exclusive and any breastfeeding. Given breastfeeding is particularly low in LIW population from HIC, our findings are promising and require further exploration by larger, methodologically sound trials in other HIC.
Topics: Female; Humans; Breast Feeding; Developed Countries; Poverty; Income; Mothers
PubMed: 38615079
DOI: 10.1186/s13006-024-00631-2 -
BMC Pregnancy and Childbirth May 2024
PubMed: 38760768
DOI: 10.1186/s12884-024-06576-y -
BMC Pregnancy and Childbirth Apr 2024Over the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth.... (Review)
Review
INTRODUCTION
Over the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities.
METHODS
A PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected.
RESULTS
Ten articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback.
DISCUSSION
These results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour.
CONCLUSION
The specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.
Topics: Female; Humans; Pregnancy; Attitude of Health Personnel; Delivery, Obstetric; Maternal Health Services; Parturition; Professional-Patient Relations; Quality of Health Care; Respect
PubMed: 38671343
DOI: 10.1186/s12884-024-06524-w -
BJGP Open May 2024Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin...
BACKGROUND
Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice.
AIM
To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding.
DESIGN & SETTING
A systematic review of prescribing formularies in England and Wales.
METHOD
A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.
RESULTS
Seventy-four prescribing formularies were reviewed. Of these, 14.9% ( = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% ( = 21/74) provided links to guidance on PPH risk, and 1.4% ( = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% ( = 9/74), 23.0% ( = 17/74), and 21.6% ( = 16/74) of formularies, respectively.
CONCLUSION
Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.
PubMed: 38272494
DOI: 10.3399/BJGPO.2023.0255 -
Frontiers in Psychiatry 2024Maternal mental health problems, such as perinatal depression, are a major public health issue. In the U.S., several states have policies related to mental health during...
INTRODUCTION
Maternal mental health problems, such as perinatal depression, are a major public health issue. In the U.S., several states have policies related to mental health during pregnancy and postpartum. The extent of these laws at the state level needs to be further explored and described.
METHODS
We systematically searched the Illinois General Assembly to determine all existing legislation on the topic of perinatal mental health.
RESULTS
This search uncovered two major Acts that 1) require universal perinatal depression screening and 2) raise awareness of the symptoms and treatment options related to maternal mental health. We also discovered provisions in the law that allow for untreated or undiagnosed postpartum depression or psychosis to be considered as a mitigating factor for women who commit forcible felonies.
DISCUSSION
Through legislation, states can lead change at the systems-level to improve perinatal mental health outcomes.
PubMed: 38699448
DOI: 10.3389/fpsyt.2024.1347382