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Annals of Epidemiology Jun 2024To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was...
PURPOSE
To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI).
METHODS
We used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders.
RESULTS
Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74).
CONCLUSION(S)
Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.
PubMed: 38885800
DOI: 10.1016/j.annepidem.2024.06.001 -
Alcohol, Clinical & Experimental... Jun 2024South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding...
An incentive-based text-messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single-arm pilot study.
BACKGROUND
South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive-based text-messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa.
METHODS
A single-arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three-month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health-related text messaging from an evidence-based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self-reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post-enrollment.
RESULTS
Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1-3 days (p-value range: 0.144-0.010) at follow-up timepoints. There were statistically significant increases in the proportions of participants with alcohol-negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p-value range: 0.255-0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow-ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015).
CONCLUSIONS
This study is among the first to pilot test an incentive-based text-messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well-powered, randomized controlled trial.
PubMed: 38884353
DOI: 10.1111/acer.15392 -
Archives of Women's Mental Health Jun 2024Using social media can have negative consequences. The present study aimed to examine how the partner's problematic social media use (SMU) was related to the pregnant...
PURPOSE
Using social media can have negative consequences. The present study aimed to examine how the partner's problematic social media use (SMU) was related to the pregnant woman's time perspective and prenatal depression.
METHODS
The study included 30 pregnant women and their 30 male partners. Research was conducted twice: in the first and third trimesters of pregnancy. Women completed online measures: the Zimbardo Time Perspective Inventory Fatalism scale (ZTPI-Fat), the Dark Future Scale (DFS), and the Edinburgh Postpartum Depression Scale (EPDS). Men completed the online Social Media Addiction Questionnaire (SMAQ).
RESULTS
The woman's depressive symptoms were positively associated with fatalism (r = .35, p < .01 in the first trimester; r = .49, p < .01 in the third trimester) and future negative perspective (r = .33, p < .05 in the first trimester; r = .77, p < .001 in the third trimester). Moreover, in the third trimester, women's depressive symptoms correlated positively with their partners' problematic SMU (r = .36, p < .05) and negatively with their financial situation (r = - .37, p < .05). The results of the mediation analyses showed that the more intensive the partner's problematic SMU, the stronger the pregnant woman's fatalism and, consequently, the stronger her future negative perspective, resulting in more severe prenatal depressive symptoms in the third trimester (indirect effect: β = .16, SE = .09, 95% CI [.021, .393]).
CONCLUSIONS
Our findings show how important the behavior of the partner is for the mental health of the pregnant woman. The results suggest a possible mechanism explaining the relationship between the partner's problematic SMU and the woman's prenatal depressive symptoms. This mechanism probably consists in increasing the woman's sense of helplessness and loss of control over life, which leads to intensified future anxiety and, consequently, to depressive symptoms. Moreover, we interpreted the results to mean that the partner's time-consuming preoccupation with SMU may make the woman feel emotionally neglected. The lack of support from the partner may give rise to feelings of powerlessness, and may cause depressive symptoms.
PubMed: 38878134
DOI: 10.1007/s00737-024-01482-w -
BMC Pregnancy and Childbirth Jun 2024Postpartum depression is a complex mental health condition that often occurs after childbirth and is characterized by persistent sadness, anxiety, and fatigue. Recent...
BACKGROUND
Postpartum depression is a complex mental health condition that often occurs after childbirth and is characterized by persistent sadness, anxiety, and fatigue. Recent research suggests a metabolic component to the disorder. This study aims to investigate the causal relationship between blood metabolites and postpartum depression using mendelian randomization (MR).
METHODS
This study used a bi-directional MR framework to investigate the causal relationship between 1,400 metabolic biomarkers and postpartum depression. We used two specific genome-wide association studies datasets: one with single nucleotide polymorphisms data from mothers diagnosed with postpartum depression and another with blood metabolite data, both of which focused on people of European ancestry. Genetic variants were chosen as instrumental variables from both datasets using strict criteria to improve the robustness of the MR analysis. The combination of these datasets enabled a thorough examination of genetic influences on metabolic profiles associated with postpartum depression. Statistical analyses were conducted using techniques such as inverse variance weighting, weighted median, and model-based estimation, which enabled rigorous causal inference from the observed associations. postpartum depression was defined using endpoint definitions approved by the FinnGen study's clinical expert groups, which included leading experts in their respective medical fields.
RESULTS
The MR analysis identified seven metabolites that could be linked to postpartum depression. Out of these, one metabolite was found to be protective, while six were associated with an increased risk of developing the condition. The results were consistent across multiple MR methods, indicating a significant correlation.
CONCLUSIONS
This study emphasizes the potential of metabolomics for understanding postpartum depression. The discovery of specific metabolites associated with the condition sheds new insights on its pathophysiology and opens up possibilities for future research into targeted treatment strategies.
Topics: Humans; Depression, Postpartum; Female; Mendelian Randomization Analysis; Genome-Wide Association Study; Polymorphism, Single Nucleotide; Metabolomics; Biomarkers; Adult; White People; Pregnancy
PubMed: 38877415
DOI: 10.1186/s12884-024-06628-3 -
European Journal of Obstetrics,... Jun 2024
Letter to the editor on "Perioperative intravenous infusion of dexmedetomidine for alleviating postpartum depression after cesarean section: A meta-analysis and systematic review".
PubMed: 38876953
DOI: 10.1016/j.ejogrb.2024.06.023 -
Journal of Affective Disorders Jun 2024This prospective cohort study, conducted at the Fenglin Community Health Service Center (FCHC) in Xuhui District, Shanghai, aimed to investigate the impact of maternal...
OBJECTIVE
This prospective cohort study, conducted at the Fenglin Community Health Service Center (FCHC) in Xuhui District, Shanghai, aimed to investigate the impact of maternal psychological status on offspring neurodevelopment.
METHODS
A total of 430 mother-child pairs were included, with pregnant women enrolled between February 18, 2020, and April 19, 2021. Face-to-face interviews and electronic data collection on demographic characteristics, health conditions and medical history were employed at various stages of pregnancy and postpartum. Maternal depression and anxiety were assessed using the PHQ-9 and GAD-7 scales, while offspring neurodevelopment was measured at six months using the Ages and Stages Questionnaire 3rd Edition (ASQ-3). In statistical analyses, group-based trajectory modeling (GBTM) was employed to identify the latent groups for maternal psychological trajectories, including depression and anxiety, and logistic regression was used to explore associations between maternal psychological trajectories and offspring neurodevelopment, adjusting for potential confounders.
RESULTS
Five latent trajectory groups were identified for both depression and anxiety, exhibiting distinct patterns over time. Results indicated that maternal psychological trajectories were associated with various domains of offspring neurodevelopment, including communication, problem-solving, personal-social, and gross motor skills. Specifically, mothers in trajectory groups characterized by the highest level of depression or anxiety showed increased odds of offspring neurodevelopmental delays compared to reference groups.
CONCLUSION
Our findings underscore the importance of maternal mental health during the perinatal period and highlight the potential implications for offspring neurodevelopment. Further research is warranted to elucidate underlying mechanisms and inform targeted interventions to support maternal mental well-being and optimize offspring outcomes.
PubMed: 38876315
DOI: 10.1016/j.jad.2024.06.029 -
Midwifery Jun 2024Most new parents spend the first few days with their newborns in the hospital.
BACKGROUND
Most new parents spend the first few days with their newborns in the hospital.
PROBLEM
Although negative hospital care experiences can have short- and long-term negative consequences (e.g., risk of postnatal depression), only a handful of studies have investigated experiences of maternity care after birth.
AIM OF THE STUDY
The aim was to gather more detailed information on the experiences during the immediate postpartum period at the maternity ward, in order to confirm and complement previous findings with additional data sources.
METHODS
A content analysis was conducted on 524 textual units comprising ratings of maternity care units in Germany provided by mothers or accompanying individuals. These units were sourced from a publicly accessible website.
FINDINGS
The analysis identified three overarching themes that influenced positive or negative experiences: Hospital and Maternity Ward Infrastructure; Midwifery, Medical, and Nursing Care; and Breastfeeding and Establishing a Breastfeeding Relationship.
DISCUSSION
The findings indicate systemic challenges within the medical system, including persistent issues such as staff shortages and overworked personnel. Additionally, critical primary support structures related to early parental mental health care and breastfeeding initiation were found to be lacking in certain hospitals.
CONCLUSION
These results underscore the necessity for structural reforms within hospitals to establish a comprehensive prevention network capable of early problem detection and intervention.
PubMed: 38875973
DOI: 10.1016/j.midw.2024.104049 -
Journal of Clinical Psychopharmacology
Topics: Humans; Pakistan; Female; Depression, Postpartum; Anti-Bacterial Agents; Adult; Prescription Drug Overuse; Young Adult; Pregnancy
PubMed: 38875440
DOI: 10.1097/JCP.0000000000001877 -
Journal of the American Heart... Jun 2024Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m) and...
Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity.
BACKGROUND
Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m.
METHODS AND RESULTS
Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (β = -0.18, <0.01) and perceived stress (β = -0.13, =0.02) scores. However, when including sleep, these relationships were no longer significant (all >0.4).
CONCLUSIONS
Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.
Topics: Humans; Female; Pregnancy; Adult; Longitudinal Studies; Depression, Postpartum; Body Mass Index; Postpartum Period; Obesity; Psychological Distress; Overweight; Young Adult; Maternal Health; Sleep; Risk Factors; Time Factors; Exercise; Pregnancy Complications
PubMed: 38874183
DOI: 10.1161/JAHA.123.034153 -
Heliyon Jun 2024During the postpartum period, understanding women's well-being, specifically their Health-related Quality of Life (HRQoL), is vital for comprehensive healthcare.
BACKGROUND
During the postpartum period, understanding women's well-being, specifically their Health-related Quality of Life (HRQoL), is vital for comprehensive healthcare.
OBJECTIVES
Our study aims to explore the HRQoL and its associated factors in Moroccan women after vaginal birth (VB) and cesarean section (CS).
STUDY DESIGN
In this cross-sectional study we assessed the HRQoL and its associated factors among Moroccan women who gave birth at the provincial hospital center of Settat. We gathered data from 566 women, using the EQ-5D-5L instrument alongside questionnaires about socioeconomic and obstetrical aspects. The assessment was conducted utilizing the improved Relative to an Identified Distribution (RIDIT) approach, and we employed a multiple linear regression model to pinpoint the associated factors.
RESULTS
A total of 566 women were included in our study. Our results revealed that the HRQoL in women who underwent CS was significantly lower than in VB women (EQ-5D index score = 0.30 ± 0.28 vs 0.61 ± 0.31; p < 0.0001). Similarly, the CS reduced the EQ-VAS score (mean difference = -10.73 ± 3.78; p < 0.0001). The CS was associated negatively with problems in mobility (ARI = 55 % [42-67], p < 0.0001), autonomy (ARI = 67 % [57-80], p < 0.0001), and usual activities (ARI = 56 % [42-69], p < 0.0001). Also, CS was associated with pain/discomfort (ARI = 47 % [34-60], p < 0.0001) and anxiety/depression (ARI = 3 % [-5.8-12.6], p = 0.31). The women who had birth complications had the worst HRQoL (EQ-5D index score = 0.32) compared to those who had no complications (EQ-5D index score = 0.56). Likewise, women who had postpartum complications had the worst HRQoL (EQ-5D index score = 0.39 vs EQ-5D index score = 0.54).
CONCLUSION
The results highlighted that mode of birth, childbirth complications, and postpartum complications are strongly associated with women's HRQoL. The EQ-5D-5L dimensions were affected after delivery. Hence, there is a requirement to create specialized initiatives for overseeing postpartum HRQoL, aiming to enhance the quality of maternal healthcare.
PubMed: 38873689
DOI: 10.1016/j.heliyon.2024.e32276