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Cardiovascular Diabetology Oct 2023Women with gestational diabetes mellitus (GDM) have higher insulin resistance and/or reduced secretion, an increased risk of future diabetes and cardiovascular disease,...
BACKGROUND
Women with gestational diabetes mellitus (GDM) have higher insulin resistance and/or reduced secretion, an increased risk of future diabetes and cardiovascular disease, which may be due to a pathological activation of the innate immune system. C-reactive protein (CRP) is induced by inflammatory cytokines and reflects innate immune activity. We investigated the prospective associations between CRP during the perinatal period with adverse metabolic outcomes at 1 year postpartum in women with previous GDM.
METHODS
We analyzed data from the MySweetheart trial that included 211 women with GDM at 28-32 weeks gestational age (GA). CRP was measured during pregnancy at 28-32 weeks GA, at 6-8 weeks and at 1 year postpartum. Metabolic outcomes at 1 year postpartum included weight, total and central body fat, measures of insulin resistance and secretion and presence of the metabolic syndrome (MetS). A 75 g oral glucose tolerance test was performed to measure glucose and insulin values every 30 min over 2 h to calculate indices of insulin resistance (MATSUDA, HOMA-IR) and of absolute (AUC, HOMA-B) and insulin resistance-adjusted insulin secretion (ISSI-2).
RESULTS
CRP during pregnancy and at 6-8 weeks postpartum predicted increased weight, body fat and visceral adipose tissue (VAT), insulin resistance (higher HOMA-IR, lower MATSUDA), absolute insulin secretion (HOMA-B, AUC), a reduced adjusted insulin secretion (ISSI-2) and a higher prevalence of the MetS at 1 year postpartum (all p ≤ 0.036). These relationships particularly those concerning CRP during pregnancy, were independent of weight ( for VAT, insulin resistance and secretion indices, MetS; all p ≤ 0.032) and of body fat ( for VAT, MATSUDA, MetS; all p ≤ 0.038). CONCLUSION: CRP during pregnancy and in the early postpartum predicted an adverse cardio-metabolic profile in women with prior GDM at 1 year postpartum independent of weight. The prospective association of CRP with increased insulin resistance and reduced adjusted insulin secretion hint to the role of inflammation in the development of impaired metabolism after GDM and could be used as an early marker for risk stratification.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; C-Reactive Protein; Insulin Resistance; Blood Glucose; Postpartum Period; Insulin; Metabolic Syndrome; Outcome Assessment, Health Care
PubMed: 37891561
DOI: 10.1186/s12933-023-02034-9 -
Revista Brasileira de Ginecologia E... Sep 2023To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion.
OBJECTIVE
To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion.
METHODS
Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices.
RESULTS
One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively.
CONCLUSION
Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.
Topics: Female; Humans; Male; Pregnancy; Aftercare; Brazil; Cesarean Section; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Intrauterine Devices; Physicians; Postpartum Period
PubMed: 37846185
DOI: 10.1055/s-0043-1772187 -
Journal of Human Hypertension Dec 2023Postpartum hypertension including persistent and recurrent hypertension could significantly affect maternal morbidity in preeclampsia. Data on the postpartum management...
Postpartum hypertension including persistent and recurrent hypertension could significantly affect maternal morbidity in preeclampsia. Data on the postpartum management of women with preeclampsia is limited. The objective of this study was to investigate the details of women experiencing persistent postpartum hypertension (PerPPH) or developing recurrent postpartum hypertension (RecPPH) after birth and whether the treatment with anti-hypertensive drugs could shorten the hospital stay. We also compared the clinical parameters in women who developed RecPPH and who did not. Data on 188 preeclamptic women, including the severity or time of onset, duration of hospital admission postpartum, and blood pressure during the admission were collected and analyzed. Overall, 30% of preeclamptic women developed RecPPH on day 1, 13% on day 3, and 12% on day 5 after birth. Women with severe preeclampsia or early onset preeclampsia are more likely to develop RecPPH, compared to women with mild or late onset preeclampsia. The overall time in days before discharge was not different between women with normal blood pressure and women with abnormal blood pressure 1 h after birth, regardless of the severity or gestation of onset. However, women with severe or early onset preeclampsia stayed longer in the hospital, compared to women with mild or late onset preeclampsia. In addition, women with severe or early onset preeclampsia or early delivery increased risk of developing RecPPH. In conclusion, we demonstrate that RecPPH became apparent on day 1 after delivery, and hence close monitoring of blood pressure even if initially seemingly normal after birth is important.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Hypertension; Postpartum Period; Blood Pressure; Antihypertensive Agents
PubMed: 37481613
DOI: 10.1038/s41371-023-00849-3 -
PloS One 2024Guidelines and other strategic documents were collated to understand the extent of the global use of terms postpartum and postnatal along with the duration and schedule... (Review)
Review
INTRODUCTION
Guidelines and other strategic documents were collated to understand the extent of the global use of terms postpartum and postnatal along with the duration and schedule of maternal care after delivery.
METHODS
Postpartum care guidelines and strategies published in English, by international organisations including the World Health Organization, and countries in either the Organization for Economic Co-operation and Development or Group of 20 were included in this scoping review. All documents available online with unrestricted access and published before May 31, 2023, were included. The evolution of the World Health Organization's definition of the period after delivery for mothers and the changes in the schedule of routine maternal care following delivery over time were displayed pictorially. A summary table was then developed to present the level of similarities and differences in the latest available documents from the international organisations and countries belonging to either the Organisation for Economic Co-operation and Development or the Group of 20.
RESULTS
Ten documents from the World Health Organization, one from the European Board, and 15 country-level guidelines from six countries met the inclusion criteria. The interchangeable use of 'postpartum' and 'postnatal' is common. While the World Health Organization mentions the definitive length (six weeks) of the postpartum/ postnatal period, it is not stated in documents from other organisations and countries. Additionally, the length and schedule of routine maternal care after delivery vary substantially between organisations/countries, spanning from six weeks to one year with two to six healthcare contacts, respectively.
CONCLUSION
Through this review, we make a case for a universal harmonisation of the term postpartum when referring to mothers after delivery; add clarity to the documents on the rationale for and duration of the postpartum period; and extend the routine maternal care schedule after delivery to support women in this vulnerable period.
Topics: Humans; Postpartum Period; Female; World Health Organization; Postnatal Care; Pregnancy; Terminology as Topic; Time Factors; Practice Guidelines as Topic
PubMed: 38669219
DOI: 10.1371/journal.pone.0300118 -
Journal of Psychiatric Research Dec 2023Postpartum anxiety has negative consequences for both mother and infant, so effective identification and measurement is vital to enable intervention. Despite NICE...
Postpartum anxiety has negative consequences for both mother and infant, so effective identification and measurement is vital to enable intervention. Despite NICE recommendations to prioritise the measurement of postpartum anxiety in mothers, current clinical measurement in England remains both fragmented and flawed. The Postpartum Specific Anxiety Scale [PSAS] offers an alternative, as it measures maternal-focused anxieties which can enable specifically targeted interventions. However, it is only currently used as a research tool and may require modification for clinical use. To inform modification of the PSAS, nineteen stakeholders from a variety of organisations participated in a two-round Delphi consensus survey to measure its clinical relevance and potential for effective identification of clinical anxiety. Descriptive analyses revealed all subscales of the PSAS scored highly across all domains, excluding Practical Infant Care Anxieties. Analyses also indicated good consensus between stakeholders across specific items, suggesting that the some items on the PSAS are relevant and effective at identifying clinical postpartum anxiety. Participants also expressed a need for a shorter version of the PSAS for clinical use, and that additional items may need including. Future research must now adapt the existing PSAS based on the results of this study and pilot the adapted measure in a clinical population.
Topics: Infant; Female; Humans; Anxiety; Postpartum Period; Anxiety Disorders; Mothers; England
PubMed: 37976556
DOI: 10.1016/j.jpsychires.2023.10.041 -
Archives of Women's Mental Health Dec 2023Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with...
Postpartum psychosis is a psychiatric emergency that is currently not represented in diagnostic systems, to the detriment of people with lived experience. Engaging with stakeholders offers an important avenue to improve clinical practice and make research more impactful, by providing perspectives based on first-hand, expert experience. There is a paucity of reports on stakeholders' engagement in psychiatry. Activities have thus far been limited to Western countries and there are few reports on postpartum psychosis. We report the results of public involvement activities (in the form of discussion groups) with key stakeholders in India, Malawi and the UK. These discussions centred around the clinical picture of postpartum psychosis and the terminologies used to describe these episodes. Seven major areas were highlighted: how postpartum psychosis is handled within services, common symptoms and characteristics, impact of episode, barriers to care, non-medical approaches, terminology and research areas of interest. According to the discussions, postpartum psychosis presents similarly across countries, although there are differences in access to services, approaches to mental health and terminologies used within and across countries. With this understanding comes the foundation for cross-cultural assessment, service improvement and a stakeholder-informed research agenda.
Topics: Female; Humans; Psychotic Disorders; Mental Health; Puerperal Disorders; Psychiatry; Postpartum Period
PubMed: 37615717
DOI: 10.1007/s00737-023-01347-8 -
Nutrients Oct 2023This multicentric cohort study aimed to describe changes in dietary patterns during pregnancy and postpartum and the association with BMI variation at six and twelve...
This multicentric cohort study aimed to describe changes in dietary patterns during pregnancy and postpartum and the association with BMI variation at six and twelve months postpartum in women with gestational diabetes mellitus (GDM). Between 2014 and 2018, we enrolled women with GDM in prenatal clinics of the Brazilian National Health System and followed them for one year postpartum. The dietary patterns during pregnancy and the postpartum period were obtained by factorial analysis. The relationship between these patterns and variation in postpartum BMI was evaluated by Poisson regression with robust variance adjusted for confounders. We identified three dietary patterns in 584 women, two healthy (generally healthy and Dash type), which were associated with less weight gain (RR 0.77 CI 95% 0.62-0.96 and RR 0.71 CI 95% 0.57-0.88, respectively). The high-risk pattern (based on ultra-processed, high-calorie foods and sweetened drinks) was associated with weight gain (RR 1.31 CI 95% 1.07-1.61 and RR 1.26 CI 95% 1.01-1.59) in six and twelve months postpartum, respectively. Although the participants learned about healthy dieting during pregnancy, dietary habits worsened from pregnancy to postpartum, especially, with lower consumption of fruits and dairy and higher consumption of sweetened beverages, with consequent weight gain postpartum. Postpartum support is needed to prevent weight gain and obesity.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Cohort Studies; Postpartum Period; Obesity; Weight Gain; Body Mass Index
PubMed: 37836542
DOI: 10.3390/nu15194258 -
Bulletin of the World Health... Nov 2023Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although...
Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth.
Topics: Pregnancy; Female; Humans; Cesarean Section; Incidence; Delivery, Obstetric; Labor, Obstetric; Postpartum Period
PubMed: 37961052
DOI: 10.2471/BLT.23.290140 -
BMC Urology Feb 2024Postpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women's health and quality of life. This study aimed to...
PURPOSE
Postpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women's health and quality of life. This study aimed to investigate the risk factors for postpartum SUI and the relative importance of each factor, including pelvic floor ultrasound measurement data and clinical data.
METHOD
Pregnant women who delivered in our hospital from March 2021 to January 2022 were selected as the study population. The clinical and anatomical Data from women with SUI and those without SUI were collected and analyzed. The clinical and anatomical risk factors associated with postpartum SUI were identified using univariate and multivariate analyses.
RESULTS
A total of 255 participants were recruited. Logistic regression analysis indicated that age (OR:1.215, 95% CI:1.097-1.346, P < 0.001), vaginal delivery (OR:3.05, 95% CI:1.328-7.016, P < 0.009), parity (OR:3.059, 95% CI:1.506-6.216, P < 0.002), bladder neck descent (OR:4.159, 95% CI: 2.010-8.605, P < 0.001), the angle of the internal urethral orifice funnel (OR:1.133, 95% CI:1.091-1.176, P < 0.001) were important independent risk factors for postpartum SUI (all P < 0.05). The AUC was 0.883 (95% CI: 0.839-0.926) in the model.
CONCLUSIONS
Age, vaginal delivery, parity, bladder neck descent and the angle of the internal urethral orifice funnel are independent risk factors for postpartum SUI. To prevent the occurrence of postpartum SUI, high-risk factors of postpartum SUI should be identified as early as possible during pregnancy and after delivery, and postpartum pelvic floor rehabilitation training should be promoted.
Topics: Pregnancy; Female; Humans; Urinary Incontinence, Stress; Prospective Studies; Quality of Life; Postpartum Period; Risk Factors
PubMed: 38365685
DOI: 10.1186/s12894-024-01430-x -
Medicine Nov 2023During pregnancy and postpartum, changes in biomechanics can cause dysfunctions in the myofascial system, such as rectus abdominis diastasis, various types of pain, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
During pregnancy and postpartum, changes in biomechanics can cause dysfunctions in the myofascial system, such as rectus abdominis diastasis, various types of pain, and pelvic floor dysfunction. These common postpartum problems seriously threaten women's health. Myofascial therapy, as an effective means of improving biomechanics, has no unified understanding of its therapeutic effects on postpartum functional disorders. This study aims to systematically evaluate the rehabilitative effects of myofascial therapy on postpartum rectus abdominis diastasis, low back and leg pain, and pelvic floor dysfunction through a meta-analysis of published randomized controlled trials.
METHODS
A systematic literature search of databases in Chinese and English was performed through May 2023. The treatment methods were randomized controlled studies using myofascial therapy in the treatment of rectus abdominis separation, lumbo-leg pain, and pelvic floor dysfunction. The main outcome indicators were abdominal circumference, rectus abdominis separation distance, visual analogue pain score, pelvic floor muscle potential, ability to live daily activities, number of events, and treatment effectiveness.
RESULTS
There were 22 studies, including 2235 patients. The result showed that compared with control group, myofascial therapy demonstrated to reduce abdominal circumference and rectus abdominis separation index, improve lumbar function significantly, and decrease urinary incontinence and pelvic organ prolapse. In the myofascial therapy group, pelvic floor muscle strength was significantly enhanced, anterior/posterior resting potential of pelvic floor muscle was significantly decreased, and pelvic floor muscle potential was enhanced. Compared with the control group, the number of patients with various types of pain and pain scores were significantly reduced after myofascial therapy. When myofascial therapy lasted <4 weeks, pain relief was greater. In the myofascial therapy group, the ability to perform daily activities was significantly improved. An analysis of the effectiveness of the treatment showed that after myofascial therapy, the patient's symptoms improved significantly. There also saw low heterogeneity among all outcomes.
CONCLUSION
The results suggested that myofascial therapy could effectively reduce rectus abdominis separation, relieve pelvic floor muscle dysfunction, enhance lumbar function, relieve pain, and improve the ability of daily living activities. All the data demonstrated that myofascial therapy had a good therapeutic effect on postpartum dysfunction.
Topics: Pregnancy; Female; Humans; Rectus Abdominis; Leg; Postpartum Period; Abdominal Muscles; Puerperal Disorders; Pelvic Pain; Randomized Controlled Trials as Topic
PubMed: 37932976
DOI: 10.1097/MD.0000000000035761