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International Journal of Environmental... May 2024Postpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. This study aimed to develop a... (Comparative Study)
Comparative Study
Postpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. This study aimed to develop a predictive model for PPH using early risk factors and rank their importance in terms of predictive ability. The dataset was obtained from an observational case-control study in northern Rwanda. Various statistical models and machine learning techniques were evaluated, including logistic regression, logistic regression with elastic-net regularisation, Random Forests, Extremely Randomised Trees, and gradient-boosted trees with XGBoost. The Random Forest model, with an average sensitivity of 80.7%, specificity of 71.3%, and a misclassification rate of 12.19%, outperformed the other models, demonstrating its potential as a reliable tool for predicting PPH. The important predictors identified in this study were haemoglobin level during labour and maternal age. However, there were differences in PPH risk factor importance in different data partitions, highlighting the need for further investigation. These findings contribute to understanding PPH risk factors, highlight the importance of considering different data partitions and implementing cross-validation in predictive modelling, and emphasise the value of identifying the appropriate prediction model for the application. Effective PPH prediction models are essential for improving maternal health outcomes on a global scale. This study provides valuable insights for healthcare providers to develop predictive models for PPH to identify high-risk women and implement targeted interventions.
Topics: Humans; Female; Machine Learning; Postpartum Hemorrhage; Risk Factors; Adult; Case-Control Studies; Models, Statistical; Pregnancy; Rwanda; Young Adult; Logistic Models
PubMed: 38791814
DOI: 10.3390/ijerph21050600 -
International Journal of Environmental... Apr 2024Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential... (Review)
Review
INTRODUCTION
Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother's milk.
METHODS
A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved.
RESULTS
Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants' cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders.
CONCLUSIONS
The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.
Topics: Humans; Breast Feeding; Female; Depression, Postpartum; Antidepressive Agents; Anti-Anxiety Agents; Infant, Newborn; Consensus
PubMed: 38791766
DOI: 10.3390/ijerph21050551 -
Archives of Psychiatric Nursing Jun 2024This study aimed to identify the prevalence of postpartum depression (PPD) and the factors associated with PPD in Kampong Chhnang Province, Cambodia.
OBJECTIVE
This study aimed to identify the prevalence of postpartum depression (PPD) and the factors associated with PPD in Kampong Chhnang Province, Cambodia.
STUDY DESIGN
A cross-sectional study.
PARTICIPANTS
This study included 440 Cambodian women at 6-8 weeks postpartum who visited health centers between July and September 2021.
MATERIALS AND METHODS
Data were collected through face-to-face interviews by midwives and nurses using a structured questionnaire. The Edinburgh Postnatal Depression Scale (EPDS) in the Khmer language was used to screen for PPD, and suspected PPD was defined as a total EPDS score ≥ 10. Logistic regression analyses were performed to identify the factors associated with suspected PPD.
FINDINGS
The average age of participants was 28.6 years old. The prevalence of suspected-PPD was 30.2 % (n = 133). Factors associated with suspected PPD were income dissatisfaction (adjusted odds ratio (AOR) = 2.66, 95 % confidence interval (CI) 1.27-5.56, P = 0.010), unintended pregnancy (AOR = 1.99, 95 % CI 1.10-3.61, P = 0.023), and a partner employed as a manual laborer (AOR = 3.85, 95 % CI 1.11-13.33, P = 0.034), farmer (AOR = 3.69, 95 % CI 1.11-12.31, P = 0.034), and factory worker (AOR = 5.43, 95 % CI 1.38-21.41, P = 0.016). In addition, poor relationship with partners (AOR = 2.14, 95 % CI 1.17-3.94, P = 0.014), poor relationship with mother-in-law (AOR = 3.51, 95 % CI 1.70-7.21, P < 0.001), and a history of depression before pregnancy (AOR = 6.34, 95 % CI 1.59-25.34, P = 0.009) were significantly associated with suspected-PPD.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE
This study highlighted the need for mental health services in primary healthcare settings. Mental health training for healthcare workers, particularly primary-level nurses, should be prioritized and strengthened. Further clinical study on EPDS validation should be carried out to justify the appropriate cut-off EPDS score for Cambodian women. The EPDS should be integrated into routine PNC services to identify women with suspected-PPD. Education on PPD should be provided not only to the nurses and midwives, but also to the women and their families to support the mental health of pregnant and postpartum women.
Topics: Humans; Female; Adult; Cambodia; Cross-Sectional Studies; Depression, Postpartum; Prevalence; Surveys and Questionnaires; Pregnancy; Psychiatric Status Rating Scales; Risk Factors
PubMed: 38789235
DOI: 10.1016/j.apnu.2024.03.007 -
Journal of Affective Disorders Sep 2024Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general...
BACKGROUND
Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression.
METHODS
The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale.
RESULTS
Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression.
LIMITATIONS
Intergenerational conflicts and quality of grandparenting were not assessed.
CONCLUSIONS
Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.
Topics: Humans; Female; Social Support; Grandparents; Adult; Pregnancy; Depression, Postpartum; Parenting; Australia; Depressive Disorder, Major; Intergenerational Relations; Risk Factors; Cohort Studies; Mothers; Surveys and Questionnaires; Stress, Psychological
PubMed: 38788855
DOI: 10.1016/j.jad.2024.05.104 -
The Journal of Maternal-fetal &... Dec 2024This retrospective follow-up study analyzes the effect of intrauterine postpartum hemorrhage (PPH) therapy on menstrual, reproductive, and mental health outcomes. (Observational Study)
Observational Study
Short and long-term menstrual, reproductive, and mental health outcomes after the intrauterine use of chitosan tamponade or the Bakri balloon for severe postpartum hemorrhage: an observational study.
OBJECTIVE
This retrospective follow-up study analyzes the effect of intrauterine postpartum hemorrhage (PPH) therapy on menstrual, reproductive, and mental health outcomes.
METHODS
All women who delivered at a university hospital between 2016 and 2021 with PPH and who needed intrauterine therapy were included. A questionnaire on well-being, menses, fertility, and reproductive outcomes was mailed to the patients. Those who did not reply were surveyed by telephone.
RESULTS
A total of 214 women treated with chitosan-covered gauze (group A) and 46 women treated with a balloon tamponade (group B) were recruited, and their short-term courses were analyzed. For long-term follow-up, 71 women of group A (33%) and 21 women of group B (46%) could be reached. A total of 89% of group A and 95% of group B had regular menstrual bleeding in the most recent 12 months; 27% (group A) and 29% (group B) were trying to conceive again, and all of them did so successfully. There were 12 deliveries, 3 ongoing pregnancies, 3 miscarriages, and 2 terminations of pregnancies (TOP) in group A and 4 deliveries, 1 miscarriage, and 2 TOPs in group B. More than half of our study participants was sorted into grade II or III of the Impact of Events Scale, indicating they experienced clinical impacts in the form of psychological sequelae. One-quarter of patients had symptoms of post-traumatic stress disorder.
CONCLUSION
Chitosan gauze as well as balloon tamponade appear to have few adverse effects on subsequent menstrual and reproductive function. Women after PPH are at increased risk of long-term adverse psychological outcomes.
Topics: Humans; Female; Postpartum Hemorrhage; Adult; Retrospective Studies; Uterine Balloon Tamponade; Chitosan; Pregnancy; Menstruation; Follow-Up Studies; Mental Health; Young Adult
PubMed: 38782738
DOI: 10.1080/14767058.2024.2354382 -
International Journal of Medical... Jun 2024Staphylococcus aureus (S. aureus) spreads worldwide and occurrence of mastitis caused by it holds significant implications for public health. We aim to reveal the...
OBJECTIVES
Staphylococcus aureus (S. aureus) spreads worldwide and occurrence of mastitis caused by it holds significant implications for public health. We aim to reveal the molecular typing, antibiotic resistance and virulence gene profile of S. aureus causing mastitis through investigation.
METHODS
A total of 200 isolates of S. aureus were collected from outpatients infected with mastitis in a hospital in Beijing from 2020.7 to 2021.7. The molecular characteristics were analyzed by MLST and spa typing, virulence genes were screened by PCR, antibiotic susceptible test was performed by VITEK® 2 Compact system and phylogenetic analysis was performed by MEGA11 and iTOL.
RESULTS
Nineteen sequence types (STs) belonging to 9 clone complexes (CCs) were identified. ST22 was the most dominant clone (77.0%, 154/200). MRSA accounted for 19.0% (38/200) and 89.5% (34/38) of MRSA isolates belonged to CC22 and CC59. The isolates had relatively low levels of antibiotic resistance, with the exception of β-lactams and macrolides with resistance rates above 50.0%. The carrying rate of pvl in the ST22-MRSA strains were 84.2% and the detection rates of seb and pvl in the MRSA isolates were significantly higher than those in the MSSA isolates, while the hlg, fnbA and sdrD showed opposite results. Whole genome sequenced specimens of MRSA strains X4 and B5 show the same evolutionary origin as ST22 EMRSA-15 (HE681097), which is popular in Europe.
CONCLUSIONS
The method based on molecular epidemiology is an important tool for tracking the spread of S. aureus infections. We need to be alert to the major MRSA clones CC22 and CC59 in the region and be vigilant to the possible pandemic and spread of ST22 EMRSA-15.
Topics: Humans; Staphylococcal Infections; Female; Beijing; Staphylococcus aureus; Prevalence; Virulence Factors; Phylogeny; Multilocus Sequence Typing; Microbial Sensitivity Tests; Mastitis; Anti-Bacterial Agents; Community-Acquired Infections; Methicillin-Resistant Staphylococcus aureus; China
PubMed: 38781847
DOI: 10.1016/j.ijmm.2024.151623 -
Journal of Psychopathology and Clinical... May 2024According to Lewisohn's model of depression, decreases in behavioral activation (BA) occurring after facing a vital stressor may increase the risk of depression....
Bidirectional relationship between intraindividual changes in behavioral activation and intraindividual changes in postpartum depressive symptoms: A random intercept cross-lagged panel model.
According to Lewisohn's model of depression, decreases in behavioral activation (BA) occurring after facing a vital stressor may increase the risk of depression. Transition to parenthood is a potentially stressful life event that increases the risks of postpartum depression. We aimed to (a) describe the changes in BA and depressive symptomatology between the prepartum period, 1 month, 3 months, and 6 months postpartum and (b) evaluate the bidirectionality of the relationship between intraindividual changes in BA and intraindividual changes in depressive symptoms longitudinally. Chilean pregnant women (N = 503) completed a battery of questionnaires when they were between 32 and 37 weeks of gestation and 1, 3, and 6 months after delivery. A repeated measures analysis of variance showed that BA significantly decreased from prepartum to 1 month postpartum. A random intercept cross-lagged panel model supported the bidirectional inverse relationship between intraindividual changes in BA and intraindividual changes in depressive symptoms. The effect sizes of these associations were large (βs ranging from -.141 to -.243) according to Orth et al. (2022)'s recommendations for cross-lagged effect benchmarks. This relationship showed robustness when multigroup random intercept cross-lagged panel models were conducted to adjust for several covariates (i.e., marital status, the type of health insurance, type of delivery, primiparous vs. multiparous participants, and pregnancy or delivery complication or newborn health problem). Nonetheless, reporting a previous history of major depression moderated this relationship so that intraindividual decreases in BA more likely led to intraindividual increases in depressive symptoms in people with a history of depression than in people without such a history. We discuss implications for behavioral models of depression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Humans; Female; Depression, Postpartum; Adult; Pregnancy; Chile; Young Adult; Longitudinal Studies; Depression; Postpartum Period; Surveys and Questionnaires
PubMed: 38780541
DOI: 10.1037/abn0000906 -
Journal of Affective Disorders Aug 2024
Topics: Humans; Ketamine; Female; Depression, Postpartum; Antidepressive Agents
PubMed: 38777267
DOI: 10.1016/j.jad.2024.05.101 -
BMJ Open May 2024To examine longitudinal trends in clinical management of lactational mastitis in women attending general practice.
OBJECTIVE
To examine longitudinal trends in clinical management of lactational mastitis in women attending general practice.
DESIGN
Open cohort study.
SETTING
Australian general practice using data from MedicineInsight.
PARTICIPANTS
Women aged 18 to 44 years with one or more clinical encounters for lactational mastitis between January 2011 and July 2022.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome measure was the proportion of prescribed oral antibiotics based on the antibiotic type. Secondary outcome measures were the proportion of women prescribed other medications (eg, antifungals, lactation suppressants) or ordered selected clinical investigations including breast ultrasound, blood test, breast milk culture, nipple swab culture or breast aspirate. Outcomes were examined based on the calendar year and individual- or clinical practice-level characteristics.
RESULTS
Among 25 002 women who had one or more clinical encounters related to mastitis, 90.9% were prescribed oral antibiotics. While the proportion of women prescribed an oral antibiotic remained consistent from 2011 to 2022 (91.1% vs 92.5%), there were changes in the proportion receiving prescriptions for di/flucloxacillin (46.1% vs 60.4%) and cefalexin (38.6% vs 26.5%). Fewer than 12% of women were clinically investigated for their mastitis encounter, most commonly a breast ultrasound (7.1%), followed by a selected blood test (3.8%). Requests for breast milk cultures, nipple swab cultures or breast aspirates occurred in less than 1.1% of individuals. Significant increases were evident with respect to ordering of all clinical investigations, with rates at least doubling between 2011 and 2022 (6.6% vs 14.7%). Large variability in clinical management was evident according to both individual- (eg, concessional status) and clinical practice-level characteristics (eg, remoteness).
CONCLUSIONS
Australian general practitioners commonly prescribe oral antibiotics to women with mastitis and largely in line with clinical guidelines. Their use of clinical investigations as part of mastitis management has increased over the last decade.
Topics: Humans; Female; Adult; Australia; Longitudinal Studies; Anti-Bacterial Agents; Mastitis; Young Adult; General Practice; Adolescent; Practice Patterns, Physicians'; Lactation; Administration, Oral
PubMed: 38772591
DOI: 10.1136/bmjopen-2023-080128 -
BMC Public Health May 2024Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and...
BACKGROUND
Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and their growing newborns. Low and middle-income countries have a higher prevalence of PPD and limited studies about it. This study assessed the percentage of Palestinian mothers experiencing PPD nationally, identified mothers at a higher risk of PPD, and studied the correlation between PPD and mistreatment during childbirth.
METHODS
The study is based on a secondary data analysis from a cross-sectional study in the occupied Palestinian territory (oPt). A total of 745 telephone-based interviews with mothers were done within 2-4 weeks post-childbirth. The Patient Health Questionnaire (PHQ-9) was used as a screening tool for PPD. The Statistical Package for Social Science (SPSS) was used for analyzing the data.
RESULTS
In the context of descriptive epidemiology, we observed that 12.6% of the selected Palestinian mothers experienced PPD, with a higher occurrence of PPD among mothers living in the Gaza Strip, a politically and economically unstable region in Palestine, compared to mothers living in the West Bank (Adjusted Odd Ratio (AOD: 2.2, Confidence Interval (CI): 1.4-3.44). Older mothers were two times more likely to develop PPD compared to young mothers (AOR: 2.03, CI: 1.070-3.84). Mothers who experienced disrespectful behaviors represented by any abuse, negligence, abandonment, ineffective communication, or poor pain management in childbirth settings were more likely to report PPD than those who were not exposed to the disrespect.
CONCLUSION
A notable percentage of Palestinian mothers were identified as experiencing PPD, especially among mothers who experienced mistreatment in childbirth settings. It is essential to support healthcare providers to improve their practices and attitudes to eliminate mistreatment and abusive behaviors of mothers during childbirth.
Topics: Humans; Female; Depression, Postpartum; Adult; Cross-Sectional Studies; Prevalence; Risk Factors; Middle East; Arabs; Young Adult; Surveys and Questionnaires; Adolescent; Parturition; Pregnancy; Mothers
PubMed: 38769541
DOI: 10.1186/s12889-024-18829-8