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Cardiovascular Research Mar 2020Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy characterized by acute or slow progression of left ventricular (LV) systolic dysfunction (LV... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy characterized by acute or slow progression of left ventricular (LV) systolic dysfunction (LV ejection fraction of <45%) late in pregnancy, during delivery, or in the first postpartum months, in women with no other identifiable causes of heart failure. PPCM patients display variable phenotypes and risk factor profiles, pointing to involvement of multiple mechanisms in the pathogenesis of the disease. The higher risk for PPCM in women with African ancestry, the prevalence of gene variants associated with cardiomyopathies, and the high variability in onset and disease progression in PPCM patients also indicate multiple mechanisms at work. Experimental data have shown that different factors can induce and drive PPCM, including inflammation and immunity, pregnancy hormone impairment, catecholamine stress, defective cAMP-PKA, and G-protein-coupled-receptor signalling, and genetic variants. However, several of these mechanisms may merge into a common major pathway, which includes unbalanced oxidative stress and the cleavage of the nursing hormone prolactin (PRL) into an angiostatic, pro-apoptotic, and pro-inflammatory 16 kDa-PRL fragment, resulting in subsequent vascular damage and heart failure. Based on this common pathway, potential disease-specific biomarkers and therapies have emerged. Despite commonalities, the variation in aetiology and mechanisms poses challenges for the diagnosis, treatment, and management of the disease. This review summarizes current knowledge on the clinical presentation of PPCM in the context of recent experimental research. It discusses the challenge to develop disease-specific biomarkers in the context of rapid changing physiology in the peripartum phase, and outlines possible future treatment and management strategies for PPCM patients.
Topics: Animals; Cardiomyopathies; Female; Genetic Predisposition to Disease; Humans; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Puerperal Disorders; Risk Factors; Ventricular Function, Left
PubMed: 31605117
DOI: 10.1093/cvr/cvz252 -
Frontiers in Bioscience (Landmark... Mar 2020Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating... (Review)
Review
Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.
Topics: Adult; Female; Humans; Immunity; Mental Disorders; Obstetric Labor Complications; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 32114440
DOI: 10.2741/4863 -
Emergency Medicine Practice Mar 2022Postpartum patients may present to the emergency department with complaints ranging from minor issues, requiring only patient education and reassurance, to severe,...
Postpartum patients may present to the emergency department with complaints ranging from minor issues, requiring only patient education and reassurance, to severe, life-threatening complications that require prompt diagnosis and multidisciplinary consultation and management. At times, vague presentations or overlapping conditions can make it difficult for the emergency clinician to recognize an emergent condition and initiate proper treatment. This issue reviews the major common emergencies that present in postpartum patients, by chief complaint, including hemorrhage, infection, pre-eclampsia, eclampsia, headache, and cardiopulmonary conditions, and reviews the most recent evidence and guidelines.
Topics: Emergency Service, Hospital; Female; Humans; Postpartum Period; Pre-Eclampsia; Pregnancy; Puerperal Disorders; Referral and Consultation
PubMed: 35195979
DOI: No ID Found -
JACC. Heart Failure Sep 2023The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic...
BACKGROUND
The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic profiling, a powerful tool to gain insights into the pathophysiology of diseases at a systems biology level, has never been used to investigate PPCM relative to nonischemic cardiomyopathy.
OBJECTIVES
The aim of this study was to characterize the pathophysiology of PPCM through serum proteomic analysis.
METHODS
Aptamer-based proteomic analysis (SomaScan 7K) was performed on serum samples from women with PPCM (n = 67), women with nonischemic nonperipartum cardiomyopathy (NPCM) (n = 31), and age-matched healthy peripartum and nonperipartum women (n = 10 each). Serum samples were obtained from the IPAC (Investigation of Pregnancy-Associated Cardiomyopathy) and IMAC2 (Intervention in Myocarditis and Acute Cardiomyopathy) studies.
RESULTS
Principal component analysis revealed unique clustering of each patient group (P for difference <0.001). Biological pathway analyses of differentially measured proteins in PPCM relative to NPCM, before and after normalization to pertinent healthy controls, highlighted specific dysregulation of inflammatory pathways in PPCM, including the upregulation of the cholesterol metabolism-related anti-inflammatory pathway liver-X receptor/retinoid-X receptor (LXR/RXR) (P < 0.01, Z-score 1.9-2.1). Cardiac recovery by 12 months in PPCM was associated with the downregulation of pro-inflammatory pathways and the upregulation of LXR/RXR, and an additional RXR-dependent pathway involved in the regulation of inflammation and metabolism, peroxisome proliferator-activated receptor α/RXRα signaling.
CONCLUSIONS
Serum proteomic profiling of PPCM relative to NPCM and healthy controls indicated that PPCM is a distinct disease entity characterized by the unique dysregulation of inflammation-related pathways and cholesterol metabolism-related anti-inflammatory pathways. These findings provide insight into the pathophysiology of PPCM and point to novel potential therapeutic targets.
Topics: Pregnancy; Humans; Female; Peripartum Period; Proteomics; Heart Failure; Cardiomyopathies; Puerperal Disorders; Pregnancy Complications, Cardiovascular; Inflammation; Cholesterol
PubMed: 37542511
DOI: 10.1016/j.jchf.2023.05.031 -
The American Journal of Emergency... Jan 2021A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not...
A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not complicated by pre-eclampsia. She did not present with signs or symptoms consistent with postdural puncture headache or pre-eclampsia. Her delivery was not complicated by hypotension or post-partum hemorrhage. By chance, she was found to be hyponatremic and admitted to internal medicine for further work-up. She was diagnosed with postpartum lymphocytic adenohypophysitis and treated with steroids. She was discharged with a steroid taper and had complete resolution on follow up. Lymphocytic hypophysitis (LH), or commonly known as autoimmune hypophysitis, is a rare inflammatory condition affecting the pituitary gland. Acute LH can result in sudden death as demonstrated in some case reports. The most common symptom in >50% of cases is headache. First-line pharmacological treatment consists of high-dose corticosteroids and is effective in reducing pituitary size and improving endocrine insufficiency in 75% of cases. LH is a potential cause of postpartum headache that can be easily screened for with history and routine bloodwork and has good outcomes with early intervention. LH should be added to the differential for postpartum headaches presenting to the emergency department and routine blood work should be considered for all postpartum headaches.
Topics: Adult; Autoimmune Hypophysitis; Female; Headache; Humans; Puerperal Disorders
PubMed: 32718737
DOI: 10.1016/j.ajem.2020.07.022 -
Asia-Pacific Psychiatry : Official... Mar 2021Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal... (Review)
Review
BACKGROUND
Lack of recognition in national programs, poor referral system, and non-availability of trained human resources are the important barriers for the delivery of perinatal depression (PND) services in low- and middle-income countries (LAMICs). To address this there is an urgent need to develop an integrative and non-specialist-based stepped care model. As part of its research thrust on target areas of India's National Mental Health Programme (NMHP), the Indian Council of Medical Research funded a research project on the outcome of PND at four sites. In this article, we describe the development of the primary health care worker-based stepped care model and brief psychological intervention for PND.
METHODS
A literature review focused on various aspects of PND was conducted to develop a model of care and intervention under NMHP. A panel of national and international experts and stakeholders reviewed the literature, opinions, perspectives, and proposal for different models and interventions, using a consensus method and WHO implementation toolkit.
RESULTS
A consensus was reached to develop an ANM (Auxillary nurse midwife)-based stepped-care model consisting of the components of care, training, and referral services for PND. Furthermore, a brief psychological intervention (BIND-P) was developed, which includes the components of the low-intensity intervention (eg, exercise, sleep hygiene).
CONCLUSION
The BIND-P model and intervention provide a practical approach that may facilitate effective identification, treatment, and support women with PND. We are currently evaluating this model across four study sites in India, which may help in the early detection and provision of appropriate and integrative care for PND.
Topics: Depressive Disorder; Female; Humans; India; Perinatal Care; Pregnancy; Pregnancy Complications; Psychosocial Intervention; Puerperal Disorders
PubMed: 33098740
DOI: 10.1111/appy.12436 -
International Journal of Obstetric... Nov 2020This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. (Observational Study)
Observational Study
BACKGROUND
This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder.
METHODS
In this prospective, longitudinal, observational study, women were assessed at different time points for depression and post-traumatic stress disorder. The risk of depression or post-traumatic stress disorder based on patient characteristics and specific birth events was assessed within three months postpartum.
RESULTS
We enrolled 600 women; 426 were eligible for postpartum assessment. At six weeks and three months postpartum, 15.9% and 12.7% screened positive for depression respectively. Positive post-traumatic stress disorder screenings at six weeks and three months postpartum were 6.2% and 5.1% respectively. Twenty-seven women (8.3%) with a negative screening at six weeks converted to a positive depression or post-traumatic stress disorder screening at three months. A pre-existing history of anxiety or depression was associated with an increased risk of developing depression (aOR 2.12, 95% CI 1.30 to 3.47) and post-traumatic stress (aOR 3.15, 95% CI 1.42 to 7.02) within three months postpartum. The risk of developing post-traumatic stress disorder within three months postpartum was also increased among patients experiencing their first delivery (aOR 2.55, 95% CI 1.10 to 5.88) or operative management of postpartum hemorrhage (aOR 4.44, 95% CI 1.16 to 17.02).
CONCLUSION
Depression and post-traumatic stress symptoms either persisted or had new onset at three months postpartum. Mental health screening and postpartum follow-up after six weeks should be considered in high-risk patients who have a history of psychopathology, nulliparity, or undergo operative management of postpartum hemorrhage.
Topics: Adolescent; Adult; Depression, Postpartum; Female; Humans; Longitudinal Studies; Parturition; Prospective Studies; Puerperal Disorders; Risk Factors; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Young Adult
PubMed: 32861082
DOI: 10.1016/j.ijoa.2020.07.008 -
Seminars in Perinatology Apr 2020Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological... (Review)
Review
Optimal dose management of psychotropic drugs during the perinatal period reduces the risk for recurrence of mood episodes in women with Bipolar Disorder. Physiological changes during pregnancy are associated with decreases in the plasma concentrations of the majority of mood stabilizing medications. Regular symptom and drug concentration monitoring for lithium and anticonvulsants with reflexive dose adjustment improves the probability of sustained symptom remission across pregnancy. The elimination clearance trajectory across pregnancy for psychotropics dictates the frequency of laboratory monitoring and dose adjustment. The literature on the pharmacokinetics of lithium, lamotrigine, carbamazepine and atypical antipsychotics during pregnancy and postpartum are reviewed, recommendations for symptom and laboratory monitoring are proposed and recommendations for dose adjustments are presented.
Topics: Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Carbamazepine; Drug Elimination Routes; Female; Humans; Lactation; Lamotrigine; Lithium Compounds; Perinatal Care; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Puerperal Disorders
PubMed: 32151481
DOI: 10.1016/j.semperi.2020.151230 -
MCN. the American Journal of Maternal...The purpose of this study was to explore the experiences of spouses whose wives had peripartum cardiomyopathy (PPCM).
PURPOSE
The purpose of this study was to explore the experiences of spouses whose wives had peripartum cardiomyopathy (PPCM).
DESIGN METHODS
Participants were recruited for this phenomenological study through online sites Facebook and SavetheMommies. Fifteen men from four countries participated through semistructured phone interviews conducted between October 2019 and August 2020. Data were analyzed using a modified version of the constant comparison method.
RESULTS
The overarching theme of spouses' experiences was Living with the 'what ifs' of persistent uncertainty. Four main themes were: Feeling the shock, Facing the challenge, Figuring out a new normal, and Finding meaning. Spouses had to deal with the fear of their wives' heart failure relapse or death, changed marital and parental roles, and unclear expectations of the future.
CLINICAL IMPLICATIONS
PPCM is a rare complication of pregnancy with uncertain implications for the future that can have a profound impact on the woman's spouse and family. Our findings should alert nurses and other health care professionals to the need for emotional, spiritual, and informational support of spouses or partners of women who have PPCM. Nurses should include spouses and partners in care and communication to make sure they are as informed as possible, have their questions and concerns addressed as needed, and receive adequate follow-up support.
Topics: Cardiomyopathies; Female; Humans; Male; Peripartum Period; Pregnancy; Puerperal Disorders; Qualitative Research; Spouses; Uncertainty
PubMed: 35749765
DOI: 10.1097/NMC.0000000000000831 -
JACC. Heart Failure Dec 2023
Topics: Female; Humans; Pregnancy; Heart Failure; Peripartum Period; Proteomics; Cardiomyopathies; Puerperal Disorders; Inflammation; Pregnancy Complications, Cardiovascular
PubMed: 38056973
DOI: 10.1016/j.jchf.2023.09.019