Weeks Postpartum (week + postpartum)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Arousal, but not nursing, is necessary to elicit a decreased fear reaction toward humans in rabbit (Oryctolagus cuniculus) pups

Péter Pongrácz
Abstract Rabbits that are handled at the time of feeding during the first week postpartum show reduced fear of humans later in their lives as compared to unhandled controls. Effective handling has been shown to be confined to a sensitive period. Our study aimed to investigate if feeding itself (provided by a second doe, 6 hr after the standard nursing time) affects the levels of fear of humans later in life. Our results showed that (a) the prenursing state of excitement is only characteristic of the standard nursing and is not elicited by a second feeding 6 hr past the usual nursing time, repeated daily across the first week postpartum; and (b) handling linked to a second feeding 6 hr after the standard nursing does not reduce fear responses toward humans at weaning. We conclude that the aroused state, per se, is essential for the reduction of a rabbit's fear response toward humans provoked by early handling. © 2003 Wiley Periodicals, Inc. Dev Psychobiol 43: 192,199, 2003. [source]

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period,

Cindy-Lee E. Dennis
Abstract Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29: 256,268, 2006 [source]

ORIGINAL ARTICLE: Suppression of Natural Killer Cell Cytotoxicity in Postpartum Women

Maureen Groer
Citation Groer M, El-Badri N, Djeu J, Harrington M, Van Eepoel J. Suppression of natural killer cell cytotoxicity in postpartum women. Am J Reprod Immunol 2010; 63: 209,213 Problem, Natural Killer (NK) cell numbers and cytotoxicity are suppressed during pregnancy. Little is known about postpartum NK number and function. Method of study, Postpartum women (n = 39) were studied at one week and then monthly over the first six postpartum months. The standard natural killer cell cytotoxicity assay (NKCA) was performed. This is a Cr51 release assay from K562 cells cultured with peripheral blood mononuclear cells (PBMCs). Results, Data indicate suppression of NK cytotoxicity in postpartum women. Cytotoxicity at each effector:target (E:T) ratio showed a drop from 1 week postpartum, reaching a nadir at around 2 months, and a trend towards recovery of cytotoxicity from 3 to 6 months. Lytic units (LUs) from pre-incubated cells from postpartum women were lower than age-matched, non-pregnant, non-postpartum controls through the fifth postpartum month. Conclusion, These data suggest that the postpartum period, like pregnancy, is characterized by decreased NK cytotoxicity activity. This suppressed NK cytotoxic effect may result as a response to interaction with tolerized fetal microchimeric cells accumulated during pregnancy in maternal blood and tissues. [source]

Maternal care affects the development of maternal behavior in inbred mice

Hirotaka Shoji
Abstract The present study investigated the effects of variations in maternal behavior on the development of maternal behavior of female offspring in BALB/c and CBA/Ca inbred mice. In Experiment 1, we conducted fostering within or between the two strains and observed the maternal behaviors of mothers and female offspring for 2 weeks postpartum. Although fostering changed the maternal behavior of mothers in both strains, CBA mothers generally showed greater frequency of nursing posture and pup licking than BALB mothers. BALB female offspring reared by CBA mothers showed more body licking than those reared by BALB mothers, whereas fostering did not affect the maternal behavior of CBA female offspring. In Experiment 2, we examined the maternal behavior of females of F1 hybrids derived from reciprocal crosses between the two strains to confirm the maternal effect demonstrated in Experiment 1. Female F1 hybrids from CBA mothers showed more arched-back nursing, body licking, and nest building than those from BALB mothers. These results suggested that maternal care affect the development of maternal behavior in inbred mice, though the contributions of genetic and prenatal factors cannot be ignored. © 2009 Wiley Periodicals, Inc. Dev. Psychobiol 51: 345,357, 2009. [source]

Genetic damage detected in CD-1 mouse pups exposed perinatally to 3,-azido-3,-deoxythymidine and dideoxyinosine via maternal dosing, nursing, and direct gavage

Jack B. Bishop
Abstract Human immunodeficiency virus (HIV)-infected pregnant women are administered nucleoside-analogue antiretrovirals to reduce maternal-infant viral transmission. The current protocol recommends treating newborns for 6 additional weeks postpartum. The treatment is effective, but the risk of drug-induced chromosomal damage in neonates remains undefined. We used a mouse model to investigate this concern. In a multigeneration reproductive toxicity study, female CD-1 mice received 3,-azido-3,-deoxythymidine (AZT) and dideoxyinosine (ddI) (50/250, 75/375, 150/750 mg/kg/day AZT/ddI) by gavage twice daily in equal fractions beginning prior to mating and continuing throughout gestation and lactation. Direct pup dosing (same regimen) began on postnatal day (PND) 4. Peripheral blood erythrocytes of male pups were screened for micronuclei, markers of chromosomal damage, on PNDs 1, 4, 8, and 21. Extraordinary increases in micronucleated cells were noted in pups for each treatment group at each sampling time; treated dams exhibited smaller yet significant increases in micronucleated erythrocytes. The frequencies of micronucleated cells in untreated pups were higher than in the untreated dams, and all pups had markedly elevated levels of circulating reticulocytes compared to dams. These observations suggest that fetal and neonatal mouse hematopoietic precursor cells have heightened sensitivity to genotoxic agents, perhaps due to rapid cell proliferation during the perinatal period of development. The amount of genetic damage observed in treated pups raises concern for the potential of similar damage in humans. Investigations of chromosomal integrity in exposed newborns and children are recommended. Environ. Mol. Mutagen. 43:3,9, 2004. © 2004 Wiley-Liss, Inc. [source]

Lamotrigine in Pregnancy: Pharmacokinetics During Delivery, in the Neonate, and During Lactation

EPILEPSIA, Issue 6 2000
Inger Ohman
Summary: Purpose: To investigate the pharmacokinetics of lamotrigine (LTG) during delivery, during the neonatal period, and lactation. Methods: High-performance liquid chromatography was used to determine plasma and milk levels of LTG in nine pregnant women with epilepsy treated with LTG, and plasma levels in their 10 infants. Samples were obtained at delivery, the first 3 days postpartum, and at breast-feeding 2,3 weeks after delivery. Results: At delivery, maternal plasma LTG concentrations were similar to those from the umbilical cord, indicating extensive placental transfer of LTG. There was a slow decline in the LTG plasma concentration in the newborn. At 72 h postpartum, median LTG plasma levels in the infants were 75% of the cord plasma levels (range, 50,100%). The median milk/maternal plasma concentration ratio was 0.61 (range, 0.47,0.77) 2,3 weeks after delivery, and the nursed infants maintained LTG plasma concentrations of ,30% (median, range 23,50%) of the mother's plasma levels. Maternal plasma LTG concentrations increased significantly during the first 2 weeks after parturition, the median increase in plasma concentration/dose ratio being 170%. Conclusions: Our data demonstrate a marked change in maternal LTG kinetics after delivery, possibly reflecting a normalization of an induced metabolism of LTG during pregnancy. LTG is excreted in considerable amounts in breast milk (the dose to the infant can be estimated to 0.2,1 mg/kg/day 2,3 weeks postpartum), which in combination with a slow elimination in the infants, may result in LTG plasma concentrations comparable to what is reported during active LTG therapy. No adverse effects were observed in the infants, however. [source]

Pregnancy-induced sympathetic overactivity: a precursor of preeclampsia,

T. Fischer
Abstract Background, Preeclampsia has been shown to constitute a state of sympathetic overactivity. However, it remains unclear if the sympathetic activity precedes preeclampsia or represents only a secondary phenomenon. To further investigate this issue, we performed a prospective study in pregnant women considered to be at increased risk for preeclampsia owing to preeclampsia during a preceding pregnancy. Materials and methods, Twenty-two women with a history of preeclampsia were longitudinally studied on three occasions: twice during pregnancy (M1: 22 ± 4, M2: 33 ± 5 weeks) and once postpartum (M3: 26 ± 6 weeks postpartum). We measured muscle sympathetic nerve activity (MSNA), forearm blood flow, and blood pressure at rest and during reactive hyperaemia after forearm occlusion. Results, At M1 and M2, none of the subjects was hypertensive, however, muscle sympathetic nerve activity levels were significantly augmented, compared with their postpartum values (M1: 21 ± 9, M2: 29 ± 14, M3: 9 ± 5 bursts min,1; P < 0·05). Forearm vascular resistance did not significantly change from M1 through M3 (M1: 16 ± 9, M2: 15 ± 7, M3: 16 ± 7 U; P = NS). Gestational muscle sympathetic nerve activity values did not differ significantly among the subjects with subsequent preeclampsia compared with those who remained normotensive [with preeclampsia (n = 6): M1: 21 ± 5, M2: 27 ± 6, M3: 7 ± 4 bursts min,1; without preeclampsia (n = 16): M1: 21 ± 11, M2: 30 ± 16, M3: 9 ± 6 bursts min,1; P = NS]. Conclusion, Invariably, all women at risk for preeclampisa showed a pregnancy-induced increase in MSNA (pregnancy-induced sympathetic overactivity, PISO), which normalized after delivery. Most importantly, PISO is not necessarily associated with peripheral vasoconstriction and hypertension. Furthermore, only a subset of patients developed preeclampsia later on. Therefore, we hypothesize that PISO constitutes a precursor of preeclampsia which is physiologically compensated for by vasodilating mechanisms, leading to preeclampsia only when they fail. [source]

Lopinavir protein binding in HIV-1-infected pregnant women

HIV MEDICINE, Issue 4 2010
FT Aweeka
Background Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and ,-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ,1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy. [source]

Maternal Psychosocial Adversity and the Longitudinal Development of Infant Sleep

INFANCY, Issue 5 2008
Alison Cronin
Research has identified associations between indicators of social disadvantage and the presence of child sleep problems. We examined the longitudinal development of infant sleep in families experiencing high (n = 58) or low (n = 64) levels of psychosocial adversity, and the contributions of neonatal self-regulatory capacities and maternal settling strategies to this development. Assessments of infant sleep at 4-, 7-, and 12-weeks postpartum indicated no differences in sleeping difficulties between high- and low-adversity groups. However, more infant sleep difficulties were reported in the high- versus low-adversity groups at 12- and 18-month follow-ups. Neonatal self-regulatory capacities were not related to the presence or absence of adversity, or to subsequent infant sleep quality. However, there were group differences in maternal settling strategies that did predict subsequent infant sleep difficulties. The pattern of sleep disturbance observed in association with maternal psychosocial adversity at 18-months was consistent with risk for broader impairments in child functioning. [source]

The effect of different soothing interventions on infant crying and on parent,infant interaction

M. Ruth Elliott Professor Emeritus
Conducted in the home environment, this study examines the effects of three complementary soothing techniques on the duration of infant crying and on caregiver,infant interaction. In one group, the caregivers apply massage; in another, they provide supplemental carrying to their infants, and in the last, the caregivers both massage and provide supplemental carrying. Measurements, for the one control and three treatment groups took place prenatally (third trimester) and in the first 16 weeks postpartum for parental perception of infant temperament, parental sense of competence, parent,infant interaction, and the duration of infant crying. Whereas analyses indicate no statistically significant differences between groups in reducing infant crying, results approached significance (p , .06) in favor of the combined supplemental carrying/massage group. These results challenge accepted beliefs that tactile stimulation and/or supplemental carrying enhance parental sense of competence, positive parental perceptions, and interactions with infants. Practitioners can apply these conclusions when counselling parents on the advisability of selecting any one complementary soothing technique. ©2002 Michigan Association for Infant Mental Health. [source]

Indices for studying urinary incontinence and levator ani function in primiparous women

Cathy 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]

Perineal Trauma and Postpartum Perineal Morbidity in Asian and Non-Asian Primiparous Women Giving Birth in Australia

Hannah Dahlen
ABSTRACT Objectives: To describe the postpartum perineal morbidity of primiparous women who had a vaginal birth and compare outcomes between Asian and non-Asian women in the first 2 days following the birth and at 6 and 12 weeks postpartum. Design: Data from a randomized clinical trial of a perineal management technique (perineal warm packs) were used to address the study objective. Setting: Two maternity hospitals in Sydney, Australia. Participants: Primiparous women who had a vaginal birth in the trial were included (n=697). One third of the women were identified as "Asian." Results: Compared with non-Asian women, Asian women were significantly more likely to have an episiotomy; require perineal suturing; sustain a third- or fourth-degree perineal tear; and report their perineal pain as being moderate to severe on day 1 following the birth. Asian women were less likely to give birth in an upright position or to resume sexual intercourse by 6 or 12 weeks following the birth. Conclusion: More research is needed into methods that could reduce the high rates of perineal trauma experienced by Asian women, and midwives need to be able to offer appropriate support for Asian women. [source]

Breastfeeding Support and Early Cessation

Lynne Porter Lewallen
Objective:, To examine the types of help women received with breastfeeding both in the hospital and at home and the reasons why women stopped breastfeeding earlier than intended. Design:, A descriptive design with open-ended questions. Setting:, After participant recruitment in the postpartum hospital room, data were collected by phone 8 weeks after delivery. Patients/Participants:, Three hundred seventy-nine women planning to breastfeed for at least 8 weeks after uncomplicated delivery. Main Outcome Measures:, Breastfeeding status at 8 weeks postpartum; report of help with breastfeeding in the hospital and at home. Results:, Sixty-eight percent of women were still breastfeeding at 8 weeks, although 37% of those reported supplementing with formula. Of those who had stopped, the most common reason was insufficient milk supply. Other reasons included painful nipples and latch problems, personal reasons, returning to work or school, and drugs/illness of the mother or baby. Most women received help with breastfeeding in the hospital, but only 55% received help with breastfeeding after hospital discharge. Conclusions:, The primary reasons for early cessation of breastfeeding are amenable to nursing intervention. Every opportunity should be taken to address these issues both in the hospital and through follow-up calls. JOGNN, 35, 166-172; 2006. DOI: 10.1111/J.1552-6909.2006.00031.x. [source]

Retention of Pregnancy-Related Weight in the Early Postpartum Period: Implications for Women's Health Services

Lorraine O. Walker
Objective: To examine the proportion of women who reached their prepregnant weight at 6 weeks postpartum and the average amount of weight retained or lost by this time; to determine predictors of early (6 week) postpartum weight retention; and to propose related implications for women's health care and services. Data Sources: The literature review was based on a search of Medline for the years 1986 to 2004 using the keywords postpartum weight with inclusion of additional articles known to the authors that did not appear in the electronic search. Study Selection: The resulting 83 articles were scrutinized to identify those that reported data on weight retention at 6 weeks postpartum (range, delivery to 3 months) and associated anthropometric, social, obstetric, or behavioral predictors. A total of 12 articles met inclusion criteria for the review. Data Extraction: Data were extracted related to the proportion of women achieving their postpartum weight at 6 weeks postpartum, the amount of weight retained or lost up to 6 weeks postpartum, and predictors of amount of weight retained or lost. Data Synthesis: On average, at 6 weeks postpartum, women retain 3 to 7 kg of the weight gained during pregnancy, with at least two thirds exceeding their prepregnant weights. Gestational weight gain is the most significant predictor of weight retention. Conclusions: Women vulnerable to obesity and weight gain need weight-related health care and improved access to such care to promote weight loss after 6 weeks postpartum. [source]

Urinary Incontinence in Pregnancy and the Puerperium

Charlotte E. Spellacy MS
Objective: To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors. Design: A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics. Setting: A secluded area of a university teaching hospital prenatal clinic. Participants: A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States. Results: First Interview (N= 50). More than half (62%; n= 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n= 2). Among the participants who experienced UI (n= 31), 76% (n= 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n= 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n= 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n= 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n= 4). Among the participants reporting episiotomy (n= 4), 3 (75%) reported having UI 4 to 6 weeks postpartum. Conclusions: Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors. [source]

Social support and symptoms of postpartum depression among new mothers in Eastern Turkey

Emel Ege
Abstract Aim:, The aim of the present study was to examine the relationship between symptoms of postpartum depression and social support in new mothers in a semi-rural province (Malatya) of Eastern Turkey. Methods:, This is a descriptive, cross-sectional study. The study was conducted with a 12-item Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire, a 10-item Edinburgh Postnatal Depression Scale (EPDS) questionnaire, and a 16-item demographic/obstetric questionnaire designed by the authors. 364 women who were between 6 to 48 weeks postpartum were included in the study. Results:, Symptoms of postpartum depression were negatively correlated with social support (,0.39, P = 0.000). The frequency of the prevalence of symptoms of postpartum depression was 33.2%. The study showed that EPDS mean score was related to several factors, including age, woman's education, woman's occupation, socioeconomic status of family, spouse's education, number of years married, parity, planned pregnancy, method of delivery, knowledge of infant care, sharing of problems with a close person, past psychiatric history and family support during the postnatal period in an Eastern province of Turkey. Conclusion:, Symptoms of postpartum depression were negatively correlated among Turkish women living in the Malatya province of Eastern Turkey and were associated with the level of social support. The prevalence of postpartum depression was higher than in the published reports regarding most regions of Turkey, with the exception of Northeastern Turkey. [source]

Clinical applications of anxiety, social support, stressors, and self-esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women

Tippawan Liabsuetrakul
Abstract Aim:, To assess the clinical applications of anxiety, social support, stressors and self-esteem as well as the Postpartum Depression Risk Scale (PDRS), measured during pregnancy and postpartum, for screening postpartum depression. Methods:, A questionnaire regarding anxiety, social support, stressors and self-esteem was administered to 400 women during 36,40 weeks of gestation and 6,8 weeks postpartum prospectively, using factor analysis. The enrolled women were interviewed 6,8 weeks postpartum by psychiatrists using a diagnostic system of the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), for diagnosis of postpartum depression. Multiple logistic regression was used to identify the significant predictors for postpartum depression and then developed to be the PDRS and tested for clinical benefit. Results:, Of 400 enrolled women, 40 (10%) were diagnosed with minor or major postpartum depression. After factor analysis, 10 items of anxiety, 10 items of social support, four items of stressors and five items of self-esteem were identified, with a standardized reliability coefficient of 0.85, 0.82, 0.81 and 0.82 during pregnancy and of 0.84, 0.82, 0.85 and 0.84 during the postpartum period, respectively. During pregnancy, a significant predictor was anxiety about postpartum depression, but postpartum significant predictors were anxiety and social support, which were generated to be PDRS. The clinical benefit of PDRS as a measure was better postpartum than during pregnancy. Conclusions:, Anxiety and social support were identified as the predictors of postpartum depression. The development of the PDRS is clinically beneficial and useful during pregnancy and postpartum for the screening of postpartum depression in Thai women. [source]

Incidence and risk factors for pulmonary embolism in the postpartum period

Summary.,Background: Pregnancy and the postpartum period are times of hypercoagulability, increasing the risk of pulmonary embolism. Better quantification of risk factors can help target women who are most likely to benefit from postpartum thromboprophylaxis with heparin. Objectives: To determine the incidence rate and timing of postpartum pulmonary embolism, and assess perinatal risk factors predictive of the event. Patients/Methods: Antenatal, delivery and postpartum admission records of a cohort of 510 889 pregnancies were analysed. Pulmonary embolism was identified from ICD-10 codes at delivery, transfer or upon readmission at any time in the postpartum period. Results: Pulmonary embolism occurred in 375 women and was most common postpartum. The rate of postpartum pulmonary embolism without an antecedent thrombotic event was 0.45 per 1000 births. By the end of 4 weeks postpartum, the weekly rate approached the background rate of pulmonary embolism in the population. Although the Caesarean section rate rose significantly throughout the study period, and pulmonary embolism was more common following abdominal birth, the rate of pulmonary embolism following Caesarean birth fell. Regression modelling demonstrated that stillbirth (adjusted odds ratio [aOR] =5.97), lupus (aOR = 8.83) and transfusion of a coagulation product (aOR = 8.84) were most strongly associated with pulmonary embolism postpartum. Conclusions: Pulmonary embolism most commonly occurs up to 4 weeks postpartum and following abdominal birth. Despite this the absolute event rate is low and a broadly inclusive risk factor approach to the use of pharmacological thromboprophylaxis will require many women to be exposed to heparin to prevent an embolic event. [source]

A multivitamin supplementation and education intervention as an effective means of increasing multivitamin use among postpartum women of Mexican origin

Kathleen 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]

Validation of the WHOQOL-BREF among women following childbirth

Background:, There is increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instruments has been validated for use postnatally. Aim:, To assess the psychometric properties of the 26-item WHOQOL-BREF (short version of the World Health Organization Quality of Life assessment) among women following childbirth. Methods:, Using a prospective cohort design, we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL-BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL-BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure. Results:, In all, 221 (69.1%) women returned their six-week questionnaire. All domains of the WHOQOL-BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed women and non-depressed women. P , 0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r , 0.45). The domain structure of the WHOQOL-BREF was also valid in this population of new mothers, with moderate-to-high correlation between individual items and the domain structure to which the items were originally assigned. Conclusion:, The WHOQOL-BRF is a well-accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies. [source]

Comparison of cerebral magnetic resonance and electroencephalogram findings in pre-eclamptic and eclamptic women

Mehmet A. OSMANA
Abstract Objective:, To compare the cerebral magnetic resonance (MR) and electroencephalogram (EEG) findings in pre-eclamptic and eclamptic pregnant women. Methods:, A total of 38 pregnant women with mild pre-eclampsia (n = 15), severe pre-eclampsia (n = 11) and eclampsia (n = 12) were included in this study. Cranial MR without contrast and EEG were performed in these women on admission or within 3 days of onset. Follow-up control MR or EEG evaluations were performed 4,6 weeks postpartum in women with MR or EEG abnormalities in the initial examination. To compare differences, X2 test, Fisher exact or Mann,Whitney U -tests were used. Results:, Abnormal cranial MR findings were found in one (6%) pre-eclamptic woman, in four (36%) severe pre-eclamptic women, and in 11 (92%) eclamptic women. Cranial MR findings were consistent with ischaemia in 15 (39%) patients and haemorrhage in one (3%) case. Two (5%) severe pre-eclamptic women showed cerebral infarction during the follow-up period. MR and EEG abnormalities were totally resolved in 88% of cases. The MR findings of 12 (71%) patients were located in the occipital lobes followed by the parietal lobes in six (40%) cases. Three (20%) mild pre-eclamptic women, four (36%) severe pre-eclamptic women and 10 (83%) eclamptic women had abnormal EEGs. The EEG changes were totally resolved in 13 of 14 (93%) patients after the first month. In one patient with cerebral haemorrhage, the EEG changes lasted for a duration of 6 months. Conclusions:, A correlation between EEG abnormalities and MR findings was found in this study. The combined use of MR and EEG may help to determine the prognosis for these patients, but the interictal EEG findings recorded in eclampsia were non-specific. [source]

Changes in the plasma activities of protein C and protein S during pregnancy

Semra Oruç
Summary: The objective of the study was to determine the changes in the plasma activities of protein C and protein S that occur during normal pregnancy. In this prospective cross-sectional study, plasma activities of protein C and protein S were measured in 32 normal pregnant women in the first, second and third trimester and 6 weeks after delivery. There was a significant fall in protein C and protein S activities during normal pregnancy compared with the post-puerperal period. The activities of protein C and protein S also gradually decreased through-out pregnancy (p < 0.01). Increasing plasma volume during normal pregnancy and its dilutional effect might play some role in the low activities of protein S observed. The normal falls in protein S and protein C activities make it difficult to diagnose protein S and C deficiency during pregnancy. Based on our findings, if a woman has a thromboembolic event during pregnancy, testing for a definitive diagnosis of protein C or protein S deficiency or functional failure should be delayed until at least 6 weeks postpartum. [source]

Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees

Jennifer L Payne
Objectives:, We sought to determine if postpartum mood symptoms and depressive episodes exhibit familial aggregation in bipolar I pedigrees. Methods:, A total of 1,130 women were interviewed with the Diagnostic Interview for Genetic Studies as part of the National Institute of Mental Health (NIMH) Genetics Initiative Bipolar Disorder Collaborative Study and were asked whether they had ever experienced mood symptoms within four weeks postpartum. Women were also asked whether either of two major depressive episodes described in detail occurred postpartum. We examined the odds of postpartum mood symptoms in female siblings, who had previously been pregnant and had a diagnosis of bipolar I, bipolar II, or schizoaffective (bipolar type) disorders (n = 303), given one or more relatives with postpartum mood symptoms. Results:, The odds ratio for familial aggregation of postpartum mood symptoms was 2.31 (p = 0.011) in an Any Mood Symptoms analysis (n = 304) and increased to 2.71 (p = 0.005) when manic symptoms were excluded, though this was not significantly different from the Any Mood Symptoms analysis. We also examined familial aggregation of postpartum major depressive episodes; however, the number of subjects was small. Conclusions:, Limitations of the study include the retrospective interview, the fact that the data were collected for other purposes and the inability to control for such factors as medication use. Taken together with previous studies, these data provide support for the hypothesis that there may be a genetic basis for the trait of postpartum mood symptoms generally and postpartum depressive symptoms in particular in women with bipolar disorder. Genetic linkage and association studies incorporating this trait are warranted. [source]

Prevalence and Persistence of Health Problems After Childbirth: Associations with Parity and Method of Birth

BIRTH, Issue 2 2002
Jane F. Thompson MSc
ABSTRACT: Background: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies examining their duration have been published. The aim of this study was to describe changes in the prevalence of maternal health problems in the 6 months after birth and their association with parity and method of birth. Methods: A population-based, cohort study was conducted in the Australian Capital Territory (ACT), Australia. The study population, comprising women who gave birth to a live baby from March to October 1997, completed 4 questionnaires on the fourth postpartum day, and at 8, 16, and 24 weeks postpartum. Outcome measures were self-reported health problems during each of the three 8-week postpartum periods up to 24 weeks. Results: A total of 1295 women participated, and 1193 (92%) completed the study. Health problems showing resolution between 8 and 24 weeks postpartum were exhaustion/extreme tiredness (60,49%), backache (53,45%), bowel problems (37,17%), lack of sleep/baby crying (30,15%), hemorrhoids (30,13%), perineal pain (22,4%), excessive/prolonged bleeding (20,2%), urinary incontinence (19,11%), mastitis (15,3%), and other urinary problems (5,3%). No significant changes occurred in the prevalence of frequent headaches or migraines, sexual problems, or depression over the 6 months. Adjusting for method of birth, primiparas were more likely than multiparas to report perineal pain and sexual problems. Compared with unassisted vaginal births, women who had cesarean sections reported more exhaustion, lack of sleep, and bowel problems; reported less perineal pain and urinary incontinence in the first 8 weeks; and were more likely to be readmitted to hospital within 8 weeks of the birth. Women with forceps or vacuum extraction reported more perineal pain and sexual problems than those with unassisted vaginal births after adjusting for parity, perineal trauma, and length of labor. Conclusions: Health problems commonly occurred after childbirth with some resolution over the 6 months postpartum. Some important differences in prevalence of health problems were evident when parity and method of birth were considered. (BIRTH 29:2 June 2002) [source]

The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border population

Lucina Suarez
Abstract BACKGROUND Hyperthermia produces neural tube defects (NTDs) in a variety of animal species. Elevated maternal body temperatures may also place the developing human embryo at risk. We examined the relation between maternal hyperthermia and the development of NTDs in a high-risk Mexican-American population. METHODS Case-women were Mexican-American women with NTD-affected pregnancies who resided and delivered in any of the 14 Texas counties bordering Mexico, during 1995,2000. Control-women were randomly selected from study area residents delivering normal live births, frequency-matched to cases by hospital and year. Information on maternal fevers, febrile illnesses, exposures to heat generated from external sources, and hyperthermia-inducing activities was gathered through in-person interviews, conducted about six weeks postpartum. RESULTS The risk effect (OR) associated with maternal fever in the first trimester, compared to no fever, was 2.9 (95% CI, 1.5,5.7). Women taking fever-reducing medications showed a lower risk effect (OR, 2.4; 95% CI, 1.0,5.6) than those who did not (OR, 3.8; 95% CI, 1.4,10.9). First-trimester maternal exposures to heat devices such as hot tubs, saunas, or electric blankets were associated with an OR of 3.6 (95% CI, 1.1,15.9). Small insignificant effects were observed for activities such as cooking in a hot kitchen (OR, 1.6; 95% CI, 1.0,2.6) and working or exercising in the sun (OR, 1.4; 95% CI, 0.9,2.2). CONCLUSIONS Maternal hyperthermia increases the risk for NTD-affected offspring. Women intending to become pregnant should avoid intense heat exposures, carefully monitor and manage their febrile illnesses, and routinely consume folic acid supplements. Birth Defects Research (Part A), 2004. © 2004 Wiley-Liss, Inc. [source]

IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depression

Joan Webster
Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. Design A randomized controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for postnatal depression. Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression (Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50,1.28). Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful. [source]

Skin-to-skin contact of fullterm infants: an explorative study of promoting and hindering factors in two Nordic childbirth settings

E Calais
Abstract Aim:, To explore factors that promote or hinder skin-to-skin contact (SSC) during the first days after birth between parents and healthy fullterm infants. Methods:, A total of 117 postnatal mothers and 107 fathers/partners attending two childbirth settings, where Kangaroo mother care (KMC) was implemented as a standard routine of care, one in Sweden and one in Norway, were recruited consecutively and answered questionnaires two weeks postpartum. Results:, Satisfaction with support for SSC in postnatal care and being a mother in the Swedish setting was found to promote SSC during the first day postpartum; previous knowledge about SSC increased the practice also during the 2nd and 3rd days. Receiving visitors apart from partner and siblings emerged as a hindering factor. SSC was known of and practised to a larger extent in the Swedish setting, whereas parents in the Norwegian setting received more visitors and were more satisfied with the received information and support for SSC in postnatal care. Conclusions:, The results highlight the need for caregivers to give parents adequate support for practising SSC with their newborn healthy fullterm infants and indicate the importance of developing information routines during the antenatal period as well as in relation to the birth of the child, to effectively introduce and implement SSC. [source]

Breastfeeding duration related to practised contraception in the Netherlands

Jacobus 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]

Social support and postpartum depressive symptomatology: The mediating role of maternal self-efficacy

Divna M. Haslam
Research shows that social support and maternal self-efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self-efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192). It was hypothesized that higher levels of parental support, partner support, and maternal self-efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self-efficacy. Results indicated that as expected, higher parental support and maternal self-efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self-efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self-efficacy. [source]