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BMJ Open May 2024Postnatal depression affects up to one in six new mothers in Australia each year, with significant impacts on the woman and her family. Prevention strategies can be...
Preventing postnatal depression in new mothers using telephone peer support: protocol for the DAISY (Depression and AnxIety peer Support studY) multi-centre randomised controlled trial.
INTRODUCTION
Postnatal depression affects up to one in six new mothers in Australia each year, with significant impacts on the woman and her family. Prevention strategies can be complicated by a woman's reluctance to seek professional help. Peer support is a promising but inadequately tested early intervention. Very few trials have reported on the efficacy of peer support in the perinatal period and no study has been undertaken in Australia. We will explore if proactive telephone-based peer (mother-to-mother) support, provided to women identified as being at high risk of postnatal depression, impacts on clinically significant depressive symptomatology at 6 months postpartum.
METHODS AND ANALYSIS
This is a protocol for a single-blinded, multi-centre, randomised controlled trial conducted in Melbourne, Australia. Eligible women will be recruited from either the postnatal units of two maternity hospitals, or around 4 weeks postpartum at maternal and child health centres within two metropolitan council areas. A total of 1060 (530/group) women will be recruited and randomly allocated (1:1 ratio) to either-usual care, to receive the standard community postpartum services available to them, or the intervention group, to receive proactive telephone-based support from a peer volunteer for 6 months, in addition to standard community services.
PRIMARY OUTCOME
clinically significant depressive symptomatology at 6 months postpartum as measured using the Edinburgh Postnatal Depression Scale.
SECONDARY OUTCOMES
symptoms of anxiety and/or stress, health-related quality of life, loneliness, perception of partner support, self-rated parenting, child health and development, infant feeding and health service use. The cost-effectiveness of the intervention relative to standard care will also be assessed.
ETHICS AND DISSEMINATION
Ethics approval has been obtained from La Trobe University, St. Vincent's Hospital, the Royal Women's Hospital, Northern Health, Victorian Department of Health and Human Services and Victorian Department of Education and Training. Written informed consent will be obtained from all participants before randomisation. Trial results will be disseminated through peer-reviewed publications, conference presentations and a higher degree thesis.
TRIAL REGISTRATION NUMBER
ACTRN12619000684123; Australian New Zealand Clinical Trials Registry.
Topics: Adult; Female; Humans; Anxiety; Australia; Depression, Postpartum; Mothers; Multicenter Studies as Topic; Peer Group; Quality of Life; Randomized Controlled Trials as Topic; Single-Blind Method; Social Support; Telephone
PubMed: 38749691
DOI: 10.1136/bmjopen-2024-087477 -
Hypertension (Dallas, Tex. : 1979) Jun 2024
Review
Topics: Humans; Female; Pregnancy; Diabetes, Gestational; Hypertension; Postpartum Period; Women's Health; Cardiovascular Diseases; Puerperal Disorders
PubMed: 38748767
DOI: 10.1161/HYPERTENSIONAHA.124.22919 -
Revista Latino-americana de Enfermagem 2024to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women.
OBJECTIVE
to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women.
METHOD
this cross-sectional survey included 253 puerperal women who were evaluated using the Edinburgh Postnatal Depression Scale and the Childhood Trauma Questionnaire. Multivariate logistic regression analyses were performed to verify the association of different types of trauma and the co-occurrence of forms of abuse and neglect with postpartum depression.
RESULTS
postpartum depression was identified in 93 women (36.8%; 95% Confidence Interval: 30.8-42.7). All forms of childhood trauma assessed (emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse) were independently associated with postpartum depression after adjusting for confounding variables. Emotional abuse remained associated with postpartum depression when the co-occurrence of all forms of childhood trauma was analyzed.
CONCLUSION
the results suggest an association between the different forms of childhood trauma and postpartum depression. In this sense, childhood trauma is an indicator for Nursing professionals to screen for risk factors of postpartum depression during obstetric_follow-up.
Topics: Humans; Female; Depression, Postpartum; Cross-Sectional Studies; Brazil; Adult; Young Adult; Adolescent
PubMed: 38747754
DOI: 10.1590/1518-8345.6761.4170 -
Journal of Nursing Care QualityPostpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a...
BACKGROUND
Postpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a standardized intervention bundle to mitigate morbidity and mortality associated with PPH.
LOCAL PROBLEM
At a large Philadelphia tertiary hospital, health disparities existed for severe maternal morbidity and mortality, and PPH was a significant factor.
METHODS
A quality improvement design, using Plan-Do-Study-Act cycles and interrupted time series analysis, was undertaken.
INTERVENTIONS
The Code Crimson project implemented a standardized bundle to manage PPH, including blood product administration and massive transfusion protocol activation.
RESULTS
After implementing the Code Crimson bundle, there was a significant decrease in blood product use ( P < .001), with minor reductions in packed red blood cell administration over 4 units and mean blood loss.
CONCLUSIONS
The Code Crimson bundle effectively reduced blood product utilization for PPH treatment.
Topics: Humans; Postpartum Hemorrhage; Quality Improvement; Female; Pregnancy; Blood Transfusion; Philadelphia; Interrupted Time Series Analysis; Patient Care Bundles; Adult
PubMed: 38747711
DOI: 10.1097/NCQ.0000000000000771 -
Schweizer Archiv Fur Tierheilkunde May 2024Feeding raw meat is becoming increasingly common among dog owners. This feeding practice can pose a hygienic risk and can lead to health risks for dogs and their owners....
Feeding raw meat is becoming increasingly common among dog owners. This feeding practice can pose a hygienic risk and can lead to health risks for dogs and their owners. Hygienically sound food rations, that are balanced in terms of all nutrients and energy, must be feed to breeding dogs. The aim of this study was to record the influence of raw feeding on the occurrence of mastitis, metritis and the survival of puppies. An online questionnaire was sent to kennel club registered dog breeders in Germany and Switzerland. A total of 531 litters were recorded and evaluated. Mastitis and/or metritis were present in 9,2 % and 2,8 % (n = 49 and n = 15, respectively) of the breeding bitches. 29 % (n = 154) of the breeders reported loss of puppies in the litter. The most common cause were stillbirths (n = 105 litters with 187 stillborn puppies), and/or early mortality (n = 50 litters with 73 puppies that died in the first 48 hours). The occurrence of puppy losses in the litter and/or a higher proportion of puppy losses in the litter was favored by increased body weight of the bitch in larger dog breeds, existing previous illnesses, previously reported gestation or postpartum problems, increasing length of the parturition phase and/or a cesarean section. A higher total number of surviving puppies was associated with increased weight and anamnestic reported health of the bitch and the use of milk powder instead of other milk substitutes. A relationship between raw feeding and the occurrence of mastitis, metritis, the total number of surviving puppies and/or the occurrence or proportion of pup losses in the litter and was not found in this study. However very few breeders in this cohort fed their bitches raw, which in turn was due to the random selection of breeders. Many years of breeding experience and the increasing parity of the bitch had a clearly positive influence on the health of the bitch.
Topics: Dogs; Animals; Female; Dog Diseases; Mastitis; Surveys and Questionnaires; Endometritis; Switzerland; Germany; Pregnancy; Stillbirth; Animal Feed
PubMed: 38747035
DOI: 10.17236/sat00423 -
BMC Public Health May 2024Postpartum depression (PPD) affects around 10% of women, or 1 in 7 women, after giving birth. Undiagnosed PPD was observed among 50% of mothers. PPD has an unfavorable...
BACKGROUND
Postpartum depression (PPD) affects around 10% of women, or 1 in 7 women, after giving birth. Undiagnosed PPD was observed among 50% of mothers. PPD has an unfavorable relationship with women's functioning, marital and personal relationships, the quality of the mother-infant connection, and the social, behavioral, and cognitive development of children. We aim to determine the frequency of PPD and explore associated determinants or predictors (demographic, obstetric, infant-related, and psychosocial factors) and coping strategies from June to August 2023 in six countries.
METHODS
An analytical cross-sectional study included a total of 674 mothers who visited primary health care centers (PHCs) in Egypt, Yemen, Iraq, India, Ghana, and Syria. They were asked to complete self-administered assessments using the Edinburgh Postnatal Depression Scale (EPDS). The data underwent logistic regression analysis using SPSS-IBM 27 to list potential factors that could predict PPD.
RESULTS
The overall frequency of PPD in the total sample was 92(13.6%). It ranged from 2.3% in Syria to 26% in Ghana. Only 42 (6.2%) were diagnosed. Multiple logistic regression analysis revealed there were significant predictors of PPD. These factors included having unhealthy baby adjusted odds ratio (aOR) of 11.685, 95% CI: 1.405-97.139, p = 0.023), having a precious baby (aOR 7.717, 95% CI: 1.822-32.689, p = 0.006), who don't receive support (aOR 9.784, 95% CI: 5.373-17.816, p = 0.001), and those who are suffering from PPD. However, being married and comfortable discussing mental health with family relatives are significant protective factors (aOR = 0.141 (95% CI: 0.04-0.494; p = 0.002) and (aOR = 0.369, 95% CI: 0.146-0.933, p = 0.035), respectively.
CONCLUSION
The frequency of PPD among the mothers varied significantly across different countries. PPD has many protective and potential factors. We recommend further research and screenings of PPD for all mothers to promote the well-being of the mothers and create a favorable environment for the newborn and all family members.
Topics: Humans; Depression, Postpartum; Female; Adult; Cross-Sectional Studies; Prevalence; Mothers; Young Adult; Risk Factors; Adolescent
PubMed: 38745303
DOI: 10.1186/s12889-024-18502-0 -
BMC Pregnancy and Childbirth May 2024Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management;...
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this study is to understand the perspective of patients readmitted for postpartum hypertension.
METHODS
This was a qualitative study with data generated through semi-structured interviews. Patients readmitted with postpartum HDP at an urban academic medical center from February to December 2022 were approached and consented for an interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n = 9). Two coders coded all interviews using Nvivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus among the two coders. Themes were identified through an initial a priori template of codes which were expanded upon using grounded theory, and researchers were reflexive in their thematic generation.
RESULTS
Six themes were generated: every pregnancy is different, symptoms of preeclampsia are easily dismissed or minimized by both patient and providers, miscommunication regarding medical changes can increase the risk of readmissions, postpartum care coordination and readmission logistics at our hospital could be improved to facilitate caring for a newborn, postpartum care is often considered separately from the rest of pregnancy, and patient well-being improved when conversations acknowledged the struggles of readmission.
CONCLUSIONS
This qualitative research study revealed patient-identified gaps in care that may have led to readmission for hypertensive disorders of pregnancy. The specific recommendations that emerge from these themes include addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.
Topics: Humans; Female; Patient Readmission; Qualitative Research; Pregnancy; Adult; Postpartum Period; Hypertension, Pregnancy-Induced; Puerperal Disorders; Postnatal Care; Interviews as Topic
PubMed: 38745136
DOI: 10.1186/s12884-024-06564-2 -
Translational Psychiatry May 2024Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk...
Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.
Topics: Humans; Female; Depression, Postpartum; Pregnancy; Heart Rate; Adult; Anxiety; Psychiatric Status Rating Scales; Sweden; Anxiety Disorders; Young Adult
PubMed: 38744808
DOI: 10.1038/s41398-024-02909-9 -
PloS One 2024The previous studies have found an association between Big Five personality traits and postpartum depression in women. The present study aimed to find out an association...
The previous studies have found an association between Big Five personality traits and postpartum depression in women. The present study aimed to find out an association between Big Five personality traits and postpartum depression in a sample of Pakistani fathers. A total of 400 Pakistani fathers who had birth of a child in the past 1 month to 1 year period and had been living with their married partners were recruited purposively by using Google Form based survey from the major cities of Pakistan. The Urdu translated versions of Big Five Personality Inventory (BFI) and Edinburgh Postnatal Depression Scale (EPDS) were used as the main outcome measures to assess the relationship between personality traits and postpartum depression. The results found a significant negative and moderate association between Big Five personality traits and paternal postpartum depression except openness which had a weak association and neuroticism which had a positive and moderate association with PPPD (r(398) = .45). The multiple linear regression analysis found that Big Five personality traits significantly predicted paternal postpartum depression (F(5, 394) = 53.33, p = .001) except openness (B = .007, p = .98). The analysis of variance (ANOVA) found significant differences in paternal postpartum depression for age of father (F(2, 397) = 6.65, p = .001, ηp2 = .03), spouse age (F(2, 393) = 5.97, p = .003, ηp2 = .02), employment type (F(2, 395) = 9.69, p = .001, ηp2 = .04) and time spent at home (F(2, 397) = 6.23, p = .002, ηp2 = .03) while there were found no significant differences for education (F(2, 397) = 1.29, p = .27, ηp2 = .006), marital duration (F(2, 397) = 2.17, p = .11, ηp2 = .01), and birth number of recent child (F(2, 397) = 1.48, p = .22, ηp2 = .007). The study concluded that Big Five personality traits are significantly correlated with and predict paternal postpartum depression except openness which did not predict paternal postpartum depression. The occurrence of paternal postpartum depression varied significantly for age of father, age of spouse, type of employment and time spent at home.
Topics: Humans; Depression, Postpartum; Fathers; Pakistan; Male; Adult; Female; Personality; Middle Aged; Young Adult; Personality Inventory
PubMed: 38743742
DOI: 10.1371/journal.pone.0303474 -
European Heart Journal May 2024Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women...
BACKGROUND AND AIMS
Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-risk AMVP who developed malignant VA during the perinatal period and to assess if pregnancy and the postpartum period were associated with a higher risk of malignant VA.
METHODS
This retrospective international multi-centre case series included high-risk women with AMVP who experienced malignant VA and at least one pregnancy. Malignant VA included ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter defibrillator. The authors compared the incidence of malignant VA in non-pregnant periods and perinatal period; the latter defined as occurring during pregnancy and within 6 months after delivery.
RESULTS
The authors included 18 women with AMVP from 11 centres. During 7.5 (interquartile range 5.8-16.6) years of follow-up, 37 malignant VAs occurred, of which 18 were pregnancy related occurring in 13 (72%) unique patients. Pregnancy and 6 months after delivery showed increased incidence rate of malignant VA compared to the non-pregnancy period (univariate incidence rate ratio 2.66, 95% confidence interval 1.23-5.76).
CONCLUSIONS
The perinatal period could impose increased risk of malignant VA in women with high-risk AMVP. The data may provide general guidance for pre-conception counselling and for nuanced shared decision-making between patients and clinicians.
Topics: Humans; Female; Pregnancy; Mitral Valve Prolapse; Retrospective Studies; Adult; Pregnancy Complications, Cardiovascular; Risk Factors; Arrhythmias, Cardiac; Tachycardia, Ventricular; Puerperal Disorders; Defibrillators, Implantable; Incidence; Ventricular Fibrillation; Postpartum Period
PubMed: 38740526
DOI: 10.1093/eurheartj/ehae224