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Months Postpartum (month + postpartum)
Selected AbstractsPrebirth Psychosocial Factors as Predictors of Consistency in Contraceptive Use Among Taiwanese Adolescent Mothers at 6 Months PostpartumPUBLIC HEALTH NURSING, Issue 4 2005Ruey-Hsia Wang Abstract,Objective: To assess contraceptive behavior and whether pre-birth psychosocial factors could predict consistency in contraceptive use among adolescent mothers at six-month postpartum. Design: Prospective study. Sample: 104 Taiwanese adolescent mothers. Measurements: Participants completed a contraception questionnaire in their third trimester and a postpartum contraception questionnaire at six-month postpartum. Results: Prior to giving birth, the adolescent mothers most commonly answered that condom use (39.8%) was the contraceptive method they planned to use after delivery. It was also more commonly reported in the postpartum to be the method they actually were using (54.3%). Stepwise logistic regression analysis further showed that a more positive contraceptive attitude (odds ratio = 1.104) and a higher self-efficacy (odds ratio = 1.068) in contraceptive use in the pre-birth period increased the probability that a participant would report that she always used contraceptives in the postpartum period. Nevertheless, a higher score in the pre-birth period in the area of subjective contraceptive norms (odds ratio = 0.978) decreased this probability. The final regression model could correctly classify 81.7% of the participants. Conclusions: Health care professionals should provide adolescent mothers with the information they need to improve their attitude and self-efficacy toward contraception before they enter the postpartum period. [source] Effectiveness of a prenatal education programme on breastfeeding outcomes in TaiwanJOURNAL OF CLINICAL NURSING, Issue 3 2008Shu-Shan Lin RN Aims., The objectives of this study were to design a structured prenatal education programme on breastfeeding and to evaluate the effectiveness of the programme. Indicators of effectiveness were selected based on Kirkpatrick's Training Evaluation Model, including satisfaction with the programme, breastfeeding knowledge, breastfeeding attitude, breastfeeding satisfaction, breastfeeding problems and rate of exclusive breastfeeding. Methods., This study applied a quasi-experimental design. The experimental group included 46 women who received a 90-minute group educational programme on breastfeeding during their 20th,36th week of pregnancy. Each experimental subject was matched by a control subject according to age, educational level, work status and pregnancy gestational age. Control subjects did not receive any intervention. Data were collected through self-administered questionnaires at preintervention, postintervention, three days postpartum and one month postpartum. Results., Satisfaction with the programme was high. The experimental group had higher scores in breastfeeding knowledge and breastfeeding attitude at three days postpartum. The experimental group showed higher breastfeeding satisfaction at three days and one month postpartum. There were no significant differences in experiencing breastfeeding problems. The rate of exclusive breastfeeding was higher for the experimental group at three days and one month postpartum, but the differences were not statistically significant. Conclusion., This study demonstrated the effectiveness of a prenatal education programme on maternal knowledge, attitude and satisfaction toward breastfeeding. Relevance to clinical practice., Other hospitals could apply this model to plan and evaluate their prenatal education programme on breastfeeding. [source] Breastfeeding duration and postpartum psychological adjustment: Role of maternal attachment stylesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2008pek Akman Aim: Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers. Methods: Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life. Results: All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) (P = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) (P < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status. Conclusions: This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery. [source] Social dynamics and individual plasticity of infant care behavior in cooperatively breeding cotton-top tamarinsAMERICAN JOURNAL OF PRIMATOLOGY, Issue 4 2010Sofia Refetoff Zahed Abstract Individual variation in infant caretaking behavior is prevalent among marmoset and tamarin monkeys. Although most group members participate in infant care, the timing and amount provided differs greatly. In this study, we quantified general trends in infant carrying behavior by using a longitudinal database that included 11 years of instantaneous scan observations following 80 births of cotton-top tamarins. Using detailed focal observations on a subset of the same families (10 births) we identified influences that affected expression of infant care at the group and individual levels. Fathers were the primary carriers and paternal carry time gradually decreased with increasing infant age. Paternal carry time also decreased significantly with an increasing number of older sibling helpers. Most fathers began to carry on the first day postpartum. However, we report circumstances in which fathers delayed carrying until almost a month postpartum. Fathers retrieved infants the most, although adult brothers' rates of retrievals peaked and surpassed fathers' rates during week 4 postpartum. Fathers delayed rejection of infants until week 4, whereas mothers rejected infants immediately and throughout the eight weeks. Nonetheless, infants climbed onto their mothers more than onto any other family member. Mothers showed a high initial investment in carrying during the first two weeks, decreasing quickly thereafter. Maternal contributions to infant carrying remained low and relatively consistent regardless of group size. However, mothers dramatically increased their infant carrying behavior in families in which fathers were absent. Older siblings cared for infants more than did younger siblings, and brothers retrieved and carried infants more than did sisters. Individual expression of infant care changed to accommodate infant needs and changed according to varying social dynamics and circumstances across litters. Am. J. Primatol. 72:296,306, 2010. © 2009 Wiley-Liss, Inc. [source] Prepartum Work, Job Characteristics, and Risk of Cesarean DeliveryBIRTH, Issue 1 2002Shirley Hung MPP Background:,Reducing the rate of cesarean deliveries in the United States is a high priority among public health officials and members of the medical community. Many factors known to contribute to an individual woman's risk of having a cesarean rather than a vaginal delivery are not readily altered by public policy intervention. In this study we explored the effects on type of delivery of prepartum work practices, a category of factors that has a potential to affect the likelihood of cesarean delivery and to be amenable to change. Methods:,Data are from U.S. Food and Drug Administration's Infant Feeding Practices Study, using questions on mail surveys administered prenatally and at 1 month postpartum. The sample comprised 1194 women who worked during pregnancy. The outcome measure is type of delivery. Predictor variables are characteristics of prepartum work: how far into their pregnancy the women work, number of hours worked, and occupation. Results:,For most women, maintaining employment through the third trimester, working long hours, and working in certain occupations are not independently associated with the odds of having a cesarean delivery. However, we found marginally significant evidence that those women who worked more than 40 hours a week in a sales job were more likely to have cesarean deliveries than women who worked in other occupations. Conversely, women working part-time in sales jobs were less likely to have a cesarean delivery. Conclusion:,This study provides evidence that prenatal work does not substantially increase the probability of having a cesarean delivery in most occupational categories. (BIRTH 29:1 March 2002) [source] Antioxidant capacity of human milk and its association with vitamins A and E and fatty acid compositionACTA PAEDIATRICA, Issue 11 2009A Tijerina-Sáenz Abstract Aim:, The antioxidant capacity of human milk reflects the presence and activity of multiple components, which prevent oxidative rancidity. The aim of this study was to use the Oxygen Radical Absorbance Capacity assay to assess human milk antioxidant capacity and find correlations with milk components. Methods:, Milk samples collected from 60 breastfeeding women at 1 month postpartum were assayed for antioxidant capacity, vitamins E and A, and fatty acids. Potential statistical relationships of concentrations of vitamins A and E and polyunsaturated fatty acids on the antioxidant capacity of human milk were determined. Results:, Human milk antioxidant capacity was positively attributed to ,-tocopherol concentration (, < 0.05). The vitamin A concentration did not significantly contribute to milk antioxidant capacity, but was correlated to milk ,-tocopherol concentration (r = 0.587; , < 0.001). There was no evidence of an inverse relationship between polyunsaturated fatty acids concentration and the antioxidant capacity value of milk. Conclusion:, This study shows that ,-tocopherol is an important contributor to the oxidative stability of human milk. Moreover, there was no evidence obtained to show that women who have high levels of milk polyunsaturated fatty acids are predisposed to lower milk antioxidant capacity. [source] Breastfeeding duration related to practised contraception in the NetherlandsACTA PAEDIATRICA, Issue 1 2009Jacobus P Van Wouwe Abstract Aim: The aim of this study was to gain insight into contraception practised and related to breastfeeding duration. Methods: Mothers with infants up to 6 months received a questionnaire on infant feeding (breast or formula feeding) and contraception (hormonal or non-hormonal methods). Estimates of the time interval between resuming contraception and cessation of lactation was calculated by Chained Equations Multiple Imputation. Results: Of all women (n = 2710), 30% choose condoms, 22% the combined oral contraceptive pill (OCP) and few other methods. Breastfeeding was started by 80%, and 18% continued up to 6 months. Of the breastfeeding mothers, 5% used hormonal contraception; 7% of women who used hormonal contraception practised breastfeeding. After adjustment for background variables, the use of OCP is strongly associated with formula feeding: after delivery to the third month postpartum, the crude OR being 17.5 (95% CI: 11.3,27.0), the adjusted OR 14.5 (9.3,22.5); between the third and sixth month postpartum, respectively, 13.1 (95% CI: 8.6,19.9) and 11.7 (7.6,17.9). Of all breastfeeding women, 20,27% resumed OCP at 25 weeks postpartum and 80% introduced formula feeding. The time lag between these events is 6 weeks. Hormonal contraception was resumed after formula introduction. Conclusion: Mothers avoid hormonal contraception during lactation; they change to formula feeding 6 weeks before they resume the OCP. To effectively promote longer duration of breastfeeding, the BFHI needs to address contraception as practised. [source] Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2000M. Muzik Objective: The utility of several self-report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD). Method: Fifty women (3 or 6 months postpartum), at heightened risk for MDD, completed several depression and anxiety symptom checklists. Psychiatric diagnoses were obtained via SCID interview. Results: Rates of MDD (n=9) and AD (n=9) were equivalent in this sample, with minimal diagnostic overlap. While all the self-report depression inventories screened accurately for MDD, none discriminated AD sensitively and reliably. Conclusion: The frequent occurrence of AD emphasizes the need to identify appropriate screening instruments for postpartum anxiety disorders. [source] Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problemsADDICTION, Issue 1 2010Colleen M. O'Leary ABSTRACT Background There is a lack of evidence regarding the effect of dose, pattern and timing of prenatal alcohol exposure and behaviour problems in children aged 2 years and older. Methods A 10% random sample of women delivering a live infant in Western Australia (1995,96) were invited to participate in an 8-year longitudinal survey (78% response rate n = 2224); 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years. Alcohol consumption was classified by combining the overall dose, dose per occasion and frequency to reflect realistic drinking patterns. Longitudinal analysis was conducted using generalized estimating equations (GEE) to investigate the association between child behaviour as measured by the Child Behaviour Checklist at 2, 5 and 8 years of age and prenatal alcohol exposure collected 3 months postpartum for each trimester separately, adjusting for a wide range of confounding factors. Results Low levels of prenatal alcohol were not associated with child behaviour problems. There were increased odds of internalizing behaviour problems following heavy alcohol exposure in the first trimester; anxiety/depression [adjusted odds ratio (aOR) 2.82; 95% confidence interval (CI) 1.07,7.43] and somatic complaints (aOR 2.74; 95% CI 1.47,5.12) and moderate levels of alcohol exposure increased the odds of anxiety/depression (aOR 2.24; 95% CI 1.16,4.34). Conclusions Prenatal alcohol exposure at moderate and higher levels increased the odds of child behaviour problems with the dose, pattern and timing of exposure affecting the type of behaviour problems expressed. Larger studies with more power are needed to confirm these findings. [source] Does stage-based smoking cessation advice in pregnancy result in long-term quitters?ADDICTION, Issue 1 200518-month postpartum follow-up of a randomized controlled trial ABSTRACT Aims To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to current standard care. It has been claimed that TTM-based interventions will continue to create quitters after the end of the intervention period. Design Cluster randomized trial. Setting Antenatal clinics in general practices in the West Midlands, UK. Participants A total of 918 pregnant smokers originally enrolled in the trial, of which 393 women were followed-up at 18 months postpartum. Interventions One hundred general practices were randomized into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM-based self-help manuals) and C (TTM-based self-help manuals plus sessions with an interactive computer program giving individualized smoking cessation advice). Measurements Self-reported continuous and point prevalence abstinence since pregnancy. Findings When combined together, there was a slight and not significant benefit for both TTM arms compared to the control, with an odds ratio (OR) 95% confidence interval (CI) of 1.20 (0.29,4.88) for continuous abstinence. For point prevalence abstinence, the OR (95%CI) was 1.15 (0.66,2.03). Seven of the 54 (13%) women who had quit at the end of pregnancy were still quit 18 months later, and there was no evidence that the TTM-based interventions were superior in preventing relapse. Conclusions The TTM-based interventions may have shown some evidence of a short-term benefit for quitting in pregnancy but no benefit relative to standard care when followed-up in the longer-term. [source] Parental representations and subclinical changes in postpartum moodINFANT MENTAL HEALTH JOURNAL, Issue 3 2007Linda C. Mayes Parents commonly experience a depressed mood in the immediate postpartum period, and a smaller proportion experience clinical postpartum depression. Among other factors, mental representations of early parenting experience appear to contribute to the development of major depressive disorder. The present study examines the role of mental representations of early parenting in subclinical fluctuations of parental mood in the peripartum period. Forty-one middle-class mothers and thirty-six fathers were interviewed on three occasions from late in their pregnancy until three months postpartum. Ratings of social support and past history of depression were obtained along with ratings of parents' perceptions of their early parenting experiences. Parents' perception of their own maternal care was significantly predictive of peripartum fluctuations in mood. Parents who perceived their own mothers as less caring showed more dysphoria at 8 months gestation, and at 2 weeks and 3 months postpartum. Perceptions of maternal protectiveness or fathers' caring and protectiveness were not related to prenatal or postpartum mood fluctuations. Both mothers and fathers who perceived their mothers as affectionless and/or controlling were more likely to experience fluctuations in mood in the peripartum period. A past history of one or more episodes of major depression and ratings of perceived social support were also associated with more peripartum mood fluctuation. These findings suggest that early parenting experiences set the threshold for how vulnerable parents are in the peripartum period to the depressive costs of engaging with a new infant. [source] Temporal changes in the affective experience of new fathers and their spousesINFANT MENTAL HEALTH JOURNAL, Issue 6 2004Marsha Kaitz Our aim was to study temporal changes in fathers' affective experience during the first year of parenthood. For comparison, data also were collected from their spouses. Fifty-five Israeli couples comprised the initial sample, and both partners were interviewed during the prepartum period and at 3, 6, and 12 months' postpartum. Measures of emotionality, positive affect, negative affect, and mood regarding self, infant, and spouse/marriage were derived by finely coding parents' answers to interview questions. Analyses show that, for fathers and mothers, time effects were most substantial between the prepartum period and 3 months postpartum, and most of the changes were in a positive direction. Fathers and mothers showed continuity in positive affect and in negative affect, respectively. Overall, the sample experienced heightened positive affect and more positive moods after the birth of their infant than prior to it. [source] Mother,infant behavioral interactions in teenage and adult mothers during the first six months postpartum: Relations with infant developmentINFANT MENTAL HEALTH JOURNAL, Issue 5 2003Andrée Pomerleau The purpose of this study was to compare adolescent mothers' (high-risk group), at-risk adult mothers' (moderate-risk group), and no-risk adult mothers' (low-risk group) behavioral interactions at one and six months postpartum, and to examine the relationships between maternal behaviors and infant developmental scores on the Bayley scales. Results indicated that high-risk teenage mothers and moderate-risk adult mothers vocalized less and had lower contingency rating scores compared to low-risk adult mothers. Also, infants in the high-risk and moderate-risk groups obtained lower mental scores at six months compared to the low-risk group. Moderate stability across time was found for maternal vocalizations and infant scores on the mental scale. Maternal vocalizations and behavioral contingency rating scores at one month were associated with infants' six-month performance on the Bayley scales. Specific intervention strategies were discussed with the aim of targeting and improving early maternal behavioral patterns in at-risk groups. ©2003 Michigan Association for Infant Mental Health. [source] Affect expression in prenatally psychotropic exposed and nonexposed mother,infant dyadsINFANT MENTAL HEALTH JOURNAL, Issue 4 2002Pratibha N. Reebye This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant,mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother,infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal,infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health. [source] Regional anaesthesia for a Caesarean section in women with cardiac disease: a prospective studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010E. LANGESÆTER Background We conducted a prospective observational survey of pregnant women with cardiac disease. The aim was to analyse and present the mode of delivery, outcome, and haemodynamic changes during a caesarean section under regional anaesthesia in women with cardiac disease. Methods All pregnant women with a cardiovascular diagnosis, except hypertension, were included in the registry. Based on the cardiac diagnoses, and on the New York Heart Association classification, a multidisciplinary group made recommendations for each patient and decided on the mode of delivery. The data from continuous, invasive haemodynamic monitoring in intermediate- and high-risk patients under regional anaesthesia for a caesarean section were analysed and presented. Results The hospital had approximately 9000 deliveries in the period from November 2003 to April 2008. A total of 113 pregnancies in 107 women were included. Thirty-two (28.3%) pregnancies were classified into the high-risk category. Of 103 deliveries, caesarean sections were performed in 59 (52.2%) cases, with regional anaesthesia in 51 patients (18 emergencies), general anaesthesia in eight patients (five emergencies), and a planned vaginal delivery in 44 patients. There was no mortality among the mothers or the babies during the hospital stay or 6 months postpartum. Pre-operative cardiovascular stability during the caesarean section was maintained by volume and phenylephrine infusion guided by invasive monitoring of haemodynamic variables. Conclusion Our study suggests that pregnant women with cardiac disease may safely deliver the baby by a caesarean section under regional anaesthesia. According to our findings, haemodynamic stability can be obtained by titrated regional anaesthesia, intravenous (i.v.) volume, phenylephrine infusion, and small repeated doses of i.v. oxytocin guided by invasive monitoring. [source] The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trialJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Linda Mason Aim., This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women. Background., Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings. Design., Randomised controlled trial. Method., Pregnant women recruited from two hospitals in North-west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005,2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8,12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum. Results., The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant. Conclusion., Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence. Relevance to clinical practice., A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum. [source] Indices for studying urinary incontinence and levator ani function in primiparous womenJOURNAL OF CLINICAL NURSING, Issue 4 2003Cathy L. Antonakos PhD Summary ,,Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. ,,The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. ,,A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. ,,Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = ,3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = ,0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = ,0.33, P = 0.029). ,,The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings. [source] Gingival changes during pregnancy: I. Influence of hormonal variations on clinical and immunological parametersJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2010Elena Figuero Figuero E, Carrillo-de-Albornoz A, Herrera D, Bascones-Martínez A. Gingival changes during pregnancy: I. Influence of hormonal variations on clinical and immunological parameters. J Clin Periodontol 2009; 37: 220,229. doi: 10.1111/j.1600-051X.2009.01516.x. Abstract Aim: To test whether exacerbated gingival inflammation in pregnancy is associated with increased salivary hormone levels and changes in gingival crevicular fluid (GCF) interleukin-1, (IL-1,) and prostaglandin-E2 (PGE2) levels. Material and methods: In this cohort study, 48 pregnant women without periodontitis were evaluated in the first, second, and third trimesters and at 3 months postpartum. Twenty-eight non-periodontitis non-pregnant women were evaluated twice, with a 6-month interval. Plaque and gingival indices (PlI, GI), salivary progesterone and estradiol and GCF IL-1, and PGE2 levels were determined. anova for repeated measures or Friedman's test were used for intragroup analyses. Inter-group comparisons were analysed with t -test or Mann,Whitney U -test. Correlations were evaluated with Pearson's and Spearman's test. Results: Pregnant women showed an increase in GI (p<0.05) despite maintaining low PlI values. No changes in IL-1, and PGE2 levels were observed during pregnancy. No significant correlation was found between the GI increase and salivary hormone levels. GI (p<0.05) and IL-1, levels (p<0.001) were lower in non-pregnant than in pregnant women. Conclusions: This study confirms the presence of an exacerbated gingival inflammation during pregnancy, but this phenomenon could not be associated with an increase in progesterone or estradiol or with changes in PGE2 or IL-1,. [source] Women with a recent history of early-onset pre-eclampsia have a worse periodontal conditionJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 3 2007Alina Kunnen Abstract Objective: Pre-eclampsia is a complication of pregnancy characterized by systemic vascular dysfunction and pathological changes in placental arteries. Growing evidence of chronic infection as an aetiological factor in vascular diseases prompted us to study maternal periodontal disease in subjects with early-onset pre-eclampsia (<34 weeks). Methods: A case,control study was carried out on 17 early-onset pre-eclamptic women and 35 controls with uncomplicated pregnancies in a period of 3,28 months postpartum. All were Caucasians. Full-mouth periodontal examinations were performed to determine the periodontal condition. Subgingival-plaque samples were analysed by anaerobic culture techniques for the presence of seven bacterial periodontal pathogens. Potential confounders as age, smoking, educational level and body mass index were determined. Results: Severe periodontal disease was found in 82% of the pre-eclamptic and in 37% of the control group (p=0.009). After adjusting for age, smoking and educational level, the odds ratio was 7.9 (95% CI: 1.9,32.8). The periodontopathic microorganism Micromonas micros was more prevalent in the case group (p=0.040) while Campylobacter rectus was more prevalent in the control group (p=0.047). Conclusion: These results indicate that Caucasian women with a recent history of early-onset pre-eclampsia have a worse periodontal condition, as compared with women with uncomplicated deliveries. [source] The Role of Social Support in Facilitating Postpartum Women's Return to EmploymentJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2005Marcia Gruis Killien Purpose: More than half of mothers with infants under 1 year are employed. This study explored the role of social support in facilitating women's return to employment during the 1st year postpartum. Design: Analysis of existing longitudinal, repeated-measures questionnaire data gathered at 4 and 12 months postpartum. Participants: 94 postpartum women who were married or partnered, employed, and residing in a large urban area in the northwestern United States. Outcome Measures: Satisfaction with decision to return to work, role performance, work-family balance. Results: Relationships between indicators of social support and return-to-work experiences were absent to modest. Satisfaction with child care was related to satisfaction with the decision to return to work. Workplace support was related to work-family balance at 12 months postpartum. Conclusions: Satisfactory child care arrangements and supportive relationships in the workplace are the most significant facilitators of women's return to work postpartum. [source] Postpartum Depression Beyond the Early Postpartum PeriodJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2004IBCLC, Janice H. Goodman MSN Objective: To review the literature concerning maternal postpartum depression beyond the early postpartum period. Data Sources: A literature search was conducted using Cinahl, Medline, and PsychInfo electronic databases. Keywords included postpartum depression, postpartum depressive symptoms, course, prevalence, incidence, and remission. Study Selection: Studies selected included incidence of maternal depression or depressive symptoms, existing in the early postpartum period, and measured again at postpartum points from 6 months through 2 1/2 years after delivery. Only studies published in English were included. Twenty-three articles were located, and a recent relevant study conducted by the current author also was included. Data Extraction: Studies were reviewed and data organized according to year, sample characteristics, time of depression assessment, instrument used, cutoff score, rate of depression, and factors associated with depression at later postpartum time points. Data Synthesis: For a significant percentage of women, postpartum depressive symptoms continue for months or even years after giving birth. Factors associated with postpartum depression at later time points are identified. Conclusions: Continued evaluation of women with elevated depression levels at initial screening, and treatment for women whose depression does not remit spontaneously within the first few weeks or months postpartum is recommended. Further research is needed to understand the phenomenon of persistent postpartum depression. [source] Moyamoya-disease-related ischemic stroke in the postpartum periodJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Kei Miyakoshi Abstract Stroke during pregnancy or the puerperium is an extremely rare yet serious cause of perinatal morbidity and mortality. Moyamoya disease, a cerebrovascular occlusive pathology with a female predominance, may become symptomatic for the first time in association with pregnancy. A 36-year-old woman with postpartum pre-eclampsia suddenly developed hemiparesis in the left arm with dysarthria after the initiation of antihypertensive measures. Cranial magnetic resonance imaging and angiography revealed acute ischemic lesions in the right hemisphere along with the steno-occlusive lesions of bilateral terminal portions of the internal carotid artery, indicating Moyamoya disease. With anti-platelet medication, the patient recovered gradually and was diagnosed as having Moyamoya disease using conventional angiography 3 months postpartum. In this case, the fluctuations in blood pressure in association with pre-eclampsia appear to have exacerbated the clinical symptoms of Moyamoya disease. As such, Moyamoya disease should be considered as an underlying disease of ischemic stroke associated with pregnancy. [source] Non-fatal injuries among Pacific infants in Auckland: Data from the Pacific Islands Families First Two Years of Life studyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2006Philip J Schluter Aims: Child injury is the leading cause of mortality and morbidity in developed countries. While Pacific infant death rates are relatively high in New Zealand, little is known about non-fatal injury rates. We seek to describe maternally reported injury in Pacific infants aged between 0,24 months. Methods: A cohort of Pacific infants born during 2000 in Auckland, New Zealand, was followed. Maternal home interviews were conducted at 6 weeks, 12 months and 24 months postpartum and injury events were recalled. Marginal models using generalized estimating equations (GEEs) were used to analysis the longitudinal data. Results: The inception cohort included 1398 infants at 6 weeks, 1241 infants at 12 months and 1161 infants at 24 months. The age-specific injury incidence per 1000 person-years exposure was estimated at 48 (95% CI: 23, 88) injuries for infants aged 0,6 weeks, 106 (95% CI: 88, 127) injuries for infants aged 7 weeks,12 months and 174 (95% CI: 151, 199) injuries for infants aged 13,24 months. In the multivariable GEE model, older infants (P < 0.001), infants who were male (P = 0.01), born to Pacific Island fathers and non-Pacific Island mothers (P < 0.001), and in higher or unknown income groups (P = 0.01) were significantly more likely to suffer injury events. No significant two-factor interaction with infant age was identified. Conclusions: Among Pacific infants, non-fatal injury is common and injury incidence rates are considerably higher than national levels. Male infants and those born into ethnically mixed families, where the father was of Pacific Island ethnicity and the mother was non-Pacific, were at increased relative risk of injury and might benefit from specific injury prevention targeting. However, given the high injury incidence levels found, we advocate that investigation and targeting of culturally appropriate prevention strategies for all Pacific families with young children is required to reduce injury rates for Pacific infants in New Zealand. [source] Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirthNEUROUROLOGY AND URODYNAMICS, Issue 1 2007Beate M. Wietek Abstract Aims Functional asymmetry of pelvic floor innervation has been shown to exist in healthy subjects, and has been proposed to be a predictor of increased risk for fecal incontinence in case of trauma. However, this remains to be shown for different clinical conditions such as traumatic childbirth. Methods A conventional surface EMG system was used to assess the innervation of the external anal sphincter. A symmetry index was used to define the relative EMG amplitude asymmetry of the external anal sphincter between 0 (symmetric) and 1 (asymmetric). Three cohorts were studied: 40 nulliparous women in the third trimester (Study 1), 15 primiparous women within 6 months following vaginal delivery without clinically apparent anal sphincter trauma (Study 2), and 50 women after childbirth-related third or fourth degree perineal tear 6,12 months postpartum (Study 3). Furthermore, all women underwent conventional anorectal manometry. Results Sixteen or forty nulliparous women reported signs of fecal incontinence; however, relative asymmetry was not correlated to symptom severity (P,=,0.345), and not to manometric measures (Study 1). In Study 2, Women who had suffered clinically apparent anal sphincter trauma (P,=,0.07) tended to have a stronger association between incontinence and asymmetry. In Study 3, 19/50 women reported moderate to severe incontinence. Asymmetry and symptom severity were significantly correlated (P,<,0.001). Patients with incontinence had a significantly higher asymmetry score than their continent counterparts. Conclusion Functional asymmetry of anal sphincter innervation is significantly associated with incontinence symptoms, but only after childbirth-related sphincter injuries and therefore, should be regarded as an additional risk factor. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposityPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2 2010Karen A. Ertel Summary Ertel KA, Koenen KC, Rich-Edwards JW, Gillman MW. Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity. Paediatric and Perinatal Epidemiology 2010; 24: 179,189. Antenatal depression is associated with small-for-gestational age, but few studies have examined associations with weight during childhood. Similarly, few studies address whether antenatal and postpartum depression differentially affect child weight. Among 838 mother,child dyads in Project Viva, a prospective cohort study, we examined relationships of antenatal and postpartum depression with child weight and adiposity. We assessed maternal depression at mid-pregnancy and 6 months postpartum with the Edinburgh Postnatal Depression Scale (score ,13 indicating probable depression). We assessed child outcomes at age 3 years: body mass index (BMI) z-score, weight-for-height z-score, sum of subscapular (SS) and triceps (TR) skinfold thickness (SS + TR) for overall adiposity, and SS : TR ratio for central adiposity. Sixty-nine (8.2%) women experienced antenatal depression and 59 (7.0%) postpartum depression. Mean (SD) outcomes at age 3 were: BMI z-score, 0.45 (1.01); SS + TR, 16.72 (4.03) mm; SS : TR, 0.64 (0.15). In multivariable models, antenatal depression was associated with lower child BMI z-score (,0.24 [95% confidence interval: ,0.49, 0.00]), but higher SS : TR (0.05 [0.01, 0.09]). There was no evidence of a dose,response relationship between antenatal depression and these outcomes. Postpartum depression was associated with higher SS + TR (1.14 [0.11, 2.18]). In conclusion, whereas antenatal depression was associated with smaller size and central adiposity at age 3 years, postpartum depression was associated with higher overall adiposity. [source] A multivitamin supplementation and education intervention as an effective means of increasing multivitamin use among postpartum women of Mexican originPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2007Kathleen M. O'Rourke Summary Postpartum Hispanic women in the USA are at elevated risk for neural tube defects in subsequent pregnancies from the combined effects of ethnicity, folate depletion from the prior pregnancy and lactation, and high parity rates with short inter-birth intervals. This study evaluated an education programme and distribution of a 3-month starter package of multivitamins among Hispanic women attending nutrition clinics for low-income women in El Paso, Texas. At 1,6 weeks postpartum, 329 subjects were selected to receive education only, multivitamins only, education and multivitamins, or no intervention. Multivariable regression obtained odds ratios (OR) and 95% confidence intervals [CI] to measure the association between intervention status and self-reported multivitamin use at least four times per week at 6 and 12 months postpartum, while controlling for potential confounding variables. Multivitamin distribution was related to consumption at both 6 months (OR = 3.5 [95% CI 1.1, 11.2]) and 12 months (OR = 6.5 [95% CI 1.5, 28.3]). Multivitamins plus education was most effective in increasing multivitamin use at both periods: 6 months (OR = 4.0 [95% CI 1.53, 11.7]) and 12 months (OR = 6.4 [95% CI 1.7, 24.2]). At enrolment, 66% of women regularly took vitamins, and approximately 35% took them at both 6 and 12 months postpartum. The education intervention alone was not associated with multivitamin use at either 6 months (OR = 0.79 [95% CI 0.3, 2.4]) or 12 months (OR = 3.1 [95% CI 0.8, 12.1]). Multivitamin use declines precipitously during postpartum at the time Hispanic women may be susceptible to a subsequent pregnancy. This study provides evidence that multivitamin starter packs sustain multivitamin usage up to 1 year postpartum for a specific high-risk group, but the effect of educational intervention alone should be further studied. [source] Predictors of the duration of exclusive breastfeeding among first-time mothers,RESEARCH IN NURSING & HEALTH, Issue 5 2008Sonia Semenic Abstract Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:428,441, 2008 [source] Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensationTHE JOURNAL OF PHYSIOLOGY, Issue 19 2008Dennis Jensen The aim of this study was to identify the physiological mechanisms of exertional respiratory discomfort (breathlessness) in pregnancy by comparing ventilatory (breathing pattern, airway function, operating lung volumes, oesophageal pressure (Poes)-derived indices of respiratory mechanics) and perceptual (breathlessness intensity) responses to incremental cycle exercise in 15 young, healthy women in the third trimester (TM3; between 34 and 38 weeks gestation) and again 4,5 months postpartum (PP). During pregnancy, resting inspiratory capacity (IC) increased (P < 0.01) and end-expiratory lung volume decreased (P < 0.001), with no associated change in total lung capacity (TLC) or static respiratory muscle strength. This permitted greater tidal volume (VT) expansion throughout exercise in TM3, while preserving the relationship between contractile respiratory muscle effort (tidal Poes swing expressed as a percentage of maximum inspiratory pressure (PImax)) and thoracic volume displacement (VT expressed as a percentage of vital capacity) and between breathlessness and ventilation . At the highest equivalent work rate (HEWR = 128 ± 5 W) in TM3 compared with PP: , tidal Poes/PImax and breathlessness intensity ratings increased by 10.2 l min,1 (P < 0.001), 8.8%PImax (P < 0.05) and 0.9 Borg units (P < 0.05), respectively. Pulmonary resistance was not increased at rest or during exercise at the HEWR in TM3, despite marked increases in mean tidal inspiratory and expiratory flow rates, suggesting increased bronchodilatation. Dynamic mechanical constraints on VT expansion (P < 0.05) with associated increased breathlessness intensity ratings (P < 0.05) were observed near peak exercise in TM3 compared with PP. In conclusion: (1) pregnancy-induced increases in exertional breathlessness reflected the normal awareness of increased and contractile respiratory muscle effort; (2) mechanical adaptations of the respiratory system, including recruitment of resting IC and increased bronchodilatation, accommodated the increased VT while preserving effort,displacement and breathlessness, relationships; and (3) dynamic mechanical ventilatory constraints contributed to respiratory discomfort near the limits of tolerance in late gestation. [source] Persistent Genital and Pelvic Pain after ChildbirthTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2009Laurel Q.P. Paterson BA ABSTRACT Introduction., Although genital pain and pelvic pain are common and well-documented problems in the early postpartum period, little is known about their course. The few published studies of such pain beyond 1 year postpartum have focused primarily on the perineum and have not assessed pain onset. Aim., To investigate the prevalence and characteristics of all types of genital and pelvic pain in the second year postpartum, and to explore risk factors for their persistence. Methods., Over a 6-month period, a questionnaire on genital/pelvic pain, sociodemographic and childbirth variables, breastfeeding, and chronic pain history was mailed to patients of the collaborating obstetrician at 12 months postpartum. Main Outcome Measures., The prevalence, characteristics, and correlates of persistent genital/pelvic pain with postpartum onset. Results., Almost half of the 114 participants (82% response rate; M = 14 months postpartum) reported a current (18%) or resolved (26%) episode of genital or pelvic pain lasting 3 or more months. Just under one in 10 (9%) mothers continued to experience pain that had begun after they last gave birth. This pain was described at various locations (e.g., vaginal opening and pelvic area), as moderate in intensity and unpleasantness, and most often as burning, cutting, or radiating. Although it was triggered by both sexual and nonsexual activities, none of the mothers affected were receiving treatment. Univariate analyses revealed that only past diagnosis with a nongenital chronic pain condition (e.g., migraine headache) was significantly correlated with (i) any history of chronic genital/pelvic pain or (ii) the persistence of pregnancy- or postpartum-onset genital or pelvic pain. Conclusions., Postpartum genital and pelvic pain persists for longer than a year for a significant percentage of mothers. Women with a history of other chronic pain appear to be particularly vulnerable to developing persistent genital or pelvic pain. Paterson LQP, Davis SNP, Khalifé S, Amsel R, and Binik YM. Persistent genital and pelvic pain after childbirth. J Sex Med 2009;6:215,221. [source] Development and Maturation of the Pediatric Human Vocal Fold Lamina Propria,THE LARYNGOSCOPE, Issue 1 2005Christopher J. Hartnick MD Abstract Objective: To identify characteristic patterns of maturation of the human vocal fold lamina propria as it develops into a mature structure. Methods: Histologic evaluation of sectioned true vocal folds from 34 archived larynges ages 0 to 18 years using hematoxylin-eosin, trichrome, Alcian blue pH 2.5, Weigert reticular, and Miller's elastin stain. Location: Pathology department at a tertiary care children's hospital. Results: At birth and shortly thereafter, there exists a relative hypercellular monolayer of cells throughout the lamina propria. By 2 months of age, there are the first signs of differentiation into a bilaminar structure of distinct cellular population densities. Between 11 months and 5 years, two distinct patterns are seen: 1) this bilaminar structure and 2) a lamina propria where there exists a third more hypocellular region immediately adjacent to the vocalis muscle (this region is similar to the superficial hypocellular region found just deep to the surface epithelium). By 7 years of age, all of the specimens exhibit this transition between the middle and the deeper layers according to differential density of cell populations. A lamina propria structure defined by differential fiber composition (elastin and collagen fibers) is not present until 13 years of age and then is present throughout adolescence. Conclusions: Using the classic adult model of fiber composition and density to differentiate the layered structure of the lamina propria of the human vocal fold may not adequately allow for a thorough description of the process of maturation and development. Rather, distinct regions of cell density are seen as early as 2 months postpartum, and the model of cellular distribution may serve better to describe the lamina propria as it develops. Cell-signaling processes that shape the formation of the lamina propria appear to produce layered populations of differential cell density that in turn will later produce differential fiber compositions. Early development therefore can be followed by evaluating the maturation of these differing cell populations. Future studies are needed to quantify these cell distribution patterns, to study the cell signaling processes that trigger this maturation, and to correlate these findings with mechanical modeling. 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