Why do mood disturbances often occur in early postpartum? An integrative neurobiological and evolutionary perspective.

The aim of this study is to examine the association of breastfeeding with metabolic syndrome (MetS) in women with recent gestational diabetes mellitus (GDM) in the very early postpartum (PP) period. We performed a secondary analysis of the Balance After Baby Intervention (BABI) study which enrolled women with recent GDM. Data collected during an early (~8 weeks) PP visit were used in this analysis. At this visit, weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), and lipids were obtained. MetS was classified per National Cholesterol Education Program Adult Treatment Program III (NCEP-ATP III) criteria. We defined breastfeeding as currently breastfeeding or not currently breastfeeding for the main analysis. Of 181 women enrolled in BABI, 178 were included in this analysis (3 excluded for missing lipids). Thirty-four percent were Hispanic. Of non-Hispanics, 31.5% were White, 18.5% Asian, and 12.9% Black/African American. The prevalence of MetS was 42.9% in women not breastfeeding versus 17.1% in women breastfeeding (p < 0.001; adjusted odds ratio [aOR] = 0.16 [95% confidence interval (CI): 0.06-0.41]). Breastfeeding women had significantly lower odds of FPG ≥100 mg/dL (aOR = 0.36 [95% CI: 0.14-0.95], p = 0.039), HDL < 50 mg/dL (aOR = 0.19 [95% CI: 0.08-0.46], p < 0.001), and triglycerides (TG) ≥ 150 mg/dL (aOR = 0.26 [95% CI: 0.10-0.66], p = 0.005). When evaluated as continuous variables, WC, FPG, and TG were significantly lower and HDL significantly higher in women breastfeeding in the very early PP period (vs. not breastfeeding). In a diverse population of women with recent GDM, there was lower prevalence of MetS in women breastfeeding compared with those not breastfeeding in the very early PP period. This study extends the findings of an association of breastfeeding with MetS previously reported at time points more remote from pregnancy to the very early PP period and to an ethnically and racially diverse population. · MetS prevalence in women with recent GDM was lower in breastfeeding than not breastfeeding women.. · FPG, HDL, WC, and TG were improved in the breastfeeding group.. · This study extends prior findings to the very early PP period and to a diverse population..

The aim of this study was to measure changes in biochemical markers in the peripartum period of primiparous Holstein cows diagnosed with subclinical and clinical mastitis. In this study, 37 dairy cows were monitored daily during milking until 60 days postpartum and were categorized according to the occurrence of clinical mastitis (group mastitis (GM), n = 9) or subclinical mastitis (group subclinical mastitis (GSUB), n = 10) or absence of symptoms (control group (CG), n = 18). Blood samples were collected weekly from -30 to 60 days from calving. Samples were grouped for prepartum (-30 to 0 days from calving), early postpartum (0 to 30 days from calving), and late postpartum (30 to 60 days from calving) periods. Prepartum serum non-esterified fatty acid (NEFA) concentration was higher in GM than in CG (P < 0.01). In addition, CG had higher prepartum serum glucose concentration than GM (P = 0.03). In the early postpartum period, aspartate aminotransferase (AST) activity was lower in CG than in GSUB (P < 0.05), and in the late postpartum period, AST activity was lower in CG than GSUB and GM (P = 0.01). Somatic cell count was higher during the early and late postpartum periods for GM and GSUB when compared to CG (P < 0.01). In this study, primiparous cows with low glucose and higher NEFA in the prepartum were more susceptible for mastitis in the early postpartum, probably due to low immune function associated to a more negative energy balance. In sum, increased prepartum serum NEFA concentration and decreased glucose in primiparous cows were associated with clinical mastitis incidence in the postpartum period.

The effect of body condition at calving and supplementation with Saccharomyces cerevisiae on energy status and some reproductive parameters in early lactation dairy cows

Purpose: The purpose of this study was to compare the predictors between the early and late postpartum period in parturient women. Methods: The Subjects were 399 healthy postpartum women who visited the obstetric clinic at 5 hospitals for a routine check up after childbirth. They were divided into two groups: one was in the early postpartum period, the first three weeks after childbirth (n=107), the other was in the late postpartum period, four to six weeks after childbirth (n=292). The data were collected by using a self-report questionnaire from July to September, 2006. The data were analyzed with the SPSS 12.0 Win program. Results: There were significant statistical differences in age and parity between the two groups. Postpartum fatigue was significantly predicted by postpartum depression and age in the early period, and postpartum depression, sleep satisfaction, and childcare stress in the late period. The mean scores of childcare stress and perceived infant difficulty in the late period were significantly higher than those of the early postpartum period. Conclusion: Postpartum depression was the most important predictor of postpartum fatigue regardless of the postpartum period. In addition, especially in the late period, sleep satisfaction and childcare stress were significant predictors of postpartum fatigue. Based on these results, primary nursing interventions for reducing postpartum fatigue should focus on postpartum depression management, and nursing interventions for increasing sleep satisfaction and decreasing childcare stress would be helpful for management of postpartum fatigue in parturient women in the late period.

BackgroundPregnant women may have an increased risk of stroke compared with nonpregnant women of similar age, but the magnitude and the timing of such risk are unclear. We examined the risk of a first stroke event in women of childbearing age and compared the risk during pregnancy and in the early postpartum period with the background risk outside these periods.Methods and ResultsWe conducted an open cohort study of 2 046 048 women aged 15 to 49 years between April 1, 1997, and March 31, 2014, using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care records in England. Risk of first stroke was assessed by calculating the incidence rate of stroke in antepartum, peripartum (2 days before until 1 day after delivery), and early (first 6 weeks) and late (second 6 weeks) postpartum periods compared with nonpregnant time using a Poisson regression model with adjustment for maternal age, socioeconomic group, and calendar time. A total of 2511 women had a first stroke. The incidence rate of stroke was 25.0 per 100 000 person‐years (95% CI 24.0–26.0) in nonpregnant time. The rate was lower antepartum (10.7 per 100 000 person‐years, 95% CI 7.6–15.1) but 9‐fold higher peripartum (161.1 per 100 000 person‐years, 95% CI 80.6–322.1) and 3‐fold higher early postpartum (47.1 per 100 000 person‐years, 95% CI 31.3–70.9). Rates of ischemic and hemorrhagic stroke both increased peripartum and early postpartum.ConclusionsAlthough the absolute risk of first stroke is low in women of childbearing age, healthcare professionals should be aware of a considerable increase in relative risk during the peripartum and early postpartum periods.

Background and Aim:It is known that during the early postpartum and lactation periods in dairy cows, metabolic disorders develop, that is, ketosis, which can lead to secondary damage to internal organs. Therefore, it is important to address the issues of changing the lactating cows’ clinical, laboratory, and physiological parameters regarding the development of hepatocardial syndrome. This study aimed to provide clinical and diagnostic justification for developing hepatocardial syndrome in highly productive dairy cows.Materials and Methods:The study was conducted on 20 black and white cows in the early postpartum period (7–10 days after birth), with a milk production level of >4500 kg of milk during the previous lactation period, a positive result in the formol colloid sedimentary test, the presence of deafness and splitting of heart sounds, changes in the size, or increased pain sensitivity of the percussion field of the liver. Clinically healthy dairy cows in the early postpartum period were used as controls (n = 24). Clinical, electrocardiographic, echocardiographic, and biochemical parameters were also evaluated.Results:Dairy cows with hepatocardial syndrome developed arterial hypertension and sinus tachycardia, which led to a significant decrease in PQ and QT intervals at ECG. A significant increase in the diastolic size of the interventricular septum, systolic size of the free wall of the left ventricle, and diastolic and systolic sizes of the left ventricle and a significant decrease in the shortening fraction of the left ventricular myocardium were observed in the cows due to the development of hepatocardial syndrome. The affected cows demonstrated a significant increase in serum activity of gamma-glutamyl transferase, alanine aminotransferase, lactate dehydrogenase, creatine phosphokinase, alkaline phosphatase, troponin, malondialdehyde, diene conjugates, and ceruloplasmin and a decrease in glucose concentration. In addition, they demonstrated decreased activity of superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase.Conclusion:Hepatocardial syndrome in dairy cows occurs due to ketosis, characterized by arterial hypertension, sinus tachycardia, a moderate decrease in myocardial contractility, oxidative stress, and cytolysis of cardiomyocytes and hepatocytes. Therefore, the control and prevention of the development of hepatocardial syndrome will make it possible to maintain the productive health and longevity of dairy cows.

Background: Bovine mastitis causes major economic losses for milk producers by reducing the quantity and the quality of the milk or even leading to the complete loss of the mammary gland secretory capacity. During the transition period, dairy cows are susceptible to infectious diseases; therefore, markers that allow early identification of cows in higher risk of developing diseases are especially useful at this time. Therefore, the aim of this study was to evaluate serum markers in the pre and postpartum of multiparous dairy cows with clinical mastitis and with health condition in the postpartum period in a semi-extensive management system.Materials, Methods &amp; Results: Thirty-Six Holstein cows were monitored daily during milking until 59 days postpartum and were categorized according to the pre-milking strip cup test into clinical mastitis (mastitis group (MG)) and absence of symptoms (control group (CG)) that were negative to the test, representing the health cows. All cows were reared as one group and maintained in a semi-extensive pasture-based system. Blood samples were collected weekly after morning milking via venipuncture of the coccinea vein into tubes without anticoagulant and grouped for prepartum (-21 to 0 days from calving), early postpartum (0 to 30 days from calving), and late postpartum (30 to 59 days from calving) periods. Milk production was recorded daily. The serum markers albumin, aspartate aminotransferase (AST), phosphorus, gamma-glutamyltransferase (GGT) and non-esterified fatty acids (NEFA) were measured. Statistical analyses were performed using SAS®. The cases of clinical mastitis occurred on average at 37.2 ± 4.9 days postpartum. Health cows (CG) had higher milk production compared to the mastitis group (MG) only in the late postpartum period (P &lt; 0.05). There was no difference among groups for albumin and NEFA concentrations in all periods evaluated (P &gt; 0.05). In the early postpartum period the AST activity was higher in CG than in MG (P = 0.02). The GGT enzyme tended to be more concentrated in the CG than in the MG during the early (P = 0.06) and late (P = 0.08) postpartum periods. Late postpartum phosphorus concentration was lower for MG than CG (P = 0.04). In the prepartum and early postpartum periods, there was no difference among groups for phosphorus concentration (P &gt; 0.05).Discussion: A decrease in milk production in MG compared to CG observed in late postpartum period was due to the inci­dence of mastitis observed around 37 days postpartum. Cows that presented clinical mastitis in the postpartum period did not differ in the blood concentration of NEFA in the prepartum period. In the late postpartum period higher concentration of phosphorus was observed in the CG than in MG, indicating that animals affected by mastitis may be in the weakest energy status. Regarding liver health, the concentration of AST was higher in the recent postpartum period for CG, in disagree­ment with previous studies that related AST to tissue injury caused by mastitis. The GGT enzyme tended to had higher concentrations in CG than MG during the whole postpartum period and may be related to increased hepatic metabolism due to higher production. There were no changes in albumin levels among healthy and mastitis cows, indicating that this marker can not be used to predict clinical mastitis. There were no metabolic alterations in the prepartum period related to the occurrence of postpartum mastitis in multiparous cows in a semi-extensive management system.Keywords: AST, dairy cows, NEFA.

Introduction: Women with gestational diabetes (GD) are at increased risk of future cardiovascular disease. The identification of factors that reduce metabolic syndrome (MetS) is important to improve cardiovascular outcomes. MetS has been shown to be associated with breastfeeding in women remote from pregnancy. We examined the association of breastfeeding with MetS in women with recent GD in the very early postpartum (pp) period. Methods: We performed a secondary analysis of the Balance After Baby (BAB) program which enrolled women with recent GD. GD was defined by Carpenter-Coustan criteria, a 50 gram glucose load test >200 mg/dL or by clinician diagnosis. Data collected during an early (~6 weeks) pp visit was used in this analysis. At this visit, weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG) and lipid panel were obtained. MetS was classified per NCEP III. We defined breastfeeding as currently breastfeeding or not currently breastfeeding. We performed Student’s t-tests and Wilcoxon rank-sum tests as appropriate, and fit logistic and linear regression models. Models were adjusted for age, race/ethnicity, low household income, pre-pregnancy BMI, and weeks since delivery. An exploratory model further adjusted for postpartum weight retention. Results: Of 181 women enrolled in BAB, 178 were included in this analysis (3 excluded for missing lipid panels). The mean (± SD) age of participants was 33 ± 5 years and were 8.0 ± 1.8 weeks since delivery. Thirty-four % were Hispanic. Of non-Hispanics, 31.5% were White, 18.5% Asian and 12.9% Black/African American. The prevalence of MetS was 42.9% in women not breastfeeding versus 17.1% in women breastfeeding (P < 0.001; adjusted odds ratio [aOR] 0.16 [95% CI 0.06–0.41]). Breastfeeding women had significantly lower odds of FPG ≥100 mg/dL (aOR 0.36 [95% CI 0.14–0.95], p=0.039), HDL <50 mg/dL (aOR 0.19 [95% CI 0.08–0.46], p<0.001), and triglycerides (TG) ≥150 mg/dL (aOR 0.26 [95% CI 0.10–0.66], p=0.005). There was no significant difference in WC or BP between groups. All ORs remained significant after adjusting for weight retention. When evaluated as continuous variables, WC, FPG, and TG were significantly lower and HDL significantly higher in women breastfeeding in the early pp period (vs not breastfeeding). Conclusion: In a diverse population of women with recent GD, there was a lower prevalence of MetS in women breastfeeding compared to those not breastfeeding in the early postpartum period. This study extends the findings of an association of breastfeeding with MetS previously reported at times remote from pregnancy. Further studies are needed to determine if there is a protective role of breastfeeding on the risk of MetS.

Background: Bovine mastitis causes major economic losses for milk producers by reducing the quantity and the quality of the milk or even leading to the complete loss of the mammary gland secretory capacity. During the transition period, dairy cows are susceptible to infectious diseases; therefore, markers that allow early identification of cows in higher risk of developing diseases are especially useful at this time. Therefore, the aim of this study was to evaluate serum markers in the pre and postpartum of multiparous dairy cows with clinical mastitis and with health condition in the postpartum period in a semi-extensive management system.Materials, Methods &amp; Results: Thirty-Six Holstein cows were monitored daily during milking until 59 days postpartum and were categorized according to the pre-milking strip cup test into clinical mastitis (mastitis group (MG)) and absence of symptoms (control group (CG)) that were negative to the test, representing the health cows. All cows were reared as one group and maintained in a semi-extensive pasture-based system. Blood samples were collected weekly after morning milking via venipuncture of the coccinea vein into tubes without anticoagulant and grouped for prepartum (-21 to 0 days from calving), early postpartum (0 to 30 days from calving), and late postpartum (30 to 59 days from calving) periods. Milk production was recorded daily. The serum markers albumin, aspartate aminotransferase (AST), phosphorus, gammaglutamyltransferase (GGT) and non-esterified fatty acids (NEFA) were measured. Statistical analyses were performed using SAS®. The cases of clinical mastitis occurred on average at 37.2 ± 4.9 days postpartum. Health cows (CG) had higher milk production compared to the mastitis group (MG) only in the late postpartum period (P &lt; 0.05). There was no difference among groups for albumin and NEFA concentrations in all periods evaluated (P &gt; 0.05). In the early postpartum period the AST activity was higher in CG than in MG (P = 0.02). The GGT enzyme tended to be more concentrated in the CG than in the MG during the early (P = 0.06) and late (P = 0.08) postpartum periods. Late postpartum phosphorus concentration was lower for MG than CG (P = 0.04). In the prepartum and early postpartum periods, there was no difference among groups for phosphorus concentration (P &gt; 0.05).Discussion: A decrease in milk production in MG compared to CG observed in late postpartum period was due to the incidence of mastitis observed around 37 days postpartum. Cows that presented clinical mastitis in the postpartum period did not differ in the blood concentration of NEFA in the prepartum period. In the late postpartum period higher concentration of phosphorus was observed in the CG than in MG, indicating that animals affected by mastitis may be in the weakest energy status. Regarding liver health, the concentration of AST was higher in the recent postpartum period for CG, in disagreement with previous studies that related AST to tissue injury caused by mastitis. The GGT enzyme tended to had higher concentrations in CG than MG during the whole postpartum period and may be related to increased hepatic metabolism due to higher production. There were no changes in albumin levels among healthy and mastitis cows, indicating that this marker can not be used to predict clinical mastitis. There were no metabolic alterations in the prepartum period related to the occurrence of postpartum mastitis in multiparous cows in a semi-extensive management system.

Thyroid function and postpartum mood disturbances in Greek women

PURPOSE: Little is known about physical activity (PA) during the early (≤ 6 weeks) postpartum period. Therefore, the purpose of this study was: 1) to describe the amount and types of PA done during early postpartum, and 2) to compare minutes/day of moderate-vigorous PA (MVPA) at 12-25 days (T1) and 33-46 days (T2) postpartum. METHODS: Participants were primiparous women that delivered vaginally. The amount and types of PA women did was measured using wrist-accelerometry (≥ 4 days) and completing an activity checklist (N (%)) by questionnaire at T1 and T2. Median (IQR) was calculated for minutes/day of light, moderate, and vigorous PA and MVPA at T1 and T2. PA data reflect total minutes and 5- and 10-minute bouts. The Wilcoxon Signed Rank test was used to compare daily minutes of MVPA in women at T1 and T2. RESULTS: 577 of 645 eligible women after delivery (age: 28.3 (SD: 5.1)) with valid accelerometry at either T1 or T2 provided descriptive data and 405 (age: 28.7 (SD: 5)) with valid accelerometry at both T1 and T2 provided comparison data. Median (IQR) daily total minutes for light, moderate, vigorous and MVPA at T1 were 295.6 (256.3-331.8), 54.3 (39.4-72.4), 0.4 (0.2-0.8), and 55.1 (40-74.1), respectively, and at T2, were 327.3 (287.6-368.7), 63.1 (45.4-81.9), 0.6 (0.3-1.3), and 64.4 (45.7-83.7), respectively. Median (IQR) minutes/day of MVPA in 5- and 10-minute bouts were 1.6 (0-5.4) and 0 (0-3.7) at T1 and 2.6 (0-8.6) and 0 (0-5.2) at T2. At T1, 75% (406/541) and at T2, 72.4% (397/548) of women reported doing non-impact activities. Less than 4% of women at T1 and 13% of women at T2 reported doing activities with impact or straining. Amongst women with valid accelerometry data at both T1 and T2, minutes/day of MVPA was greater at T2 than T1 by all methods of reporting (p< 0.001 for all): total: median (IQR) = 64.7 (47-84.6) vs 56.5 (41-75) minutes; 5-minute bouts: median (IQR) 3 (0-9.8) vs 1.7 (0-5.6) minutes; and 10-minute bouts: 1.3 (0-6) vs 0 (0-3.8) minutes. CONCLUSION: Early postpartum women are active based upon total minutes of MVPA, but sustained MVPA in bouts was consistently low. Significant increases in MVPA from T1 to T2 were small and few postpartum women reported doing activities with impact or straining. Women may experience challenges when returning to sustained and/or higher intensity activities during postpartum.

Women in the early postpartum period face substantial unmet needs in contraception to encourage birth intervals and reduce unintended pregnancies. The widespread ownership of mobile devices offers an opportunity to employ mobile health strategies for enhancing communication between healthcare providers and clients. However, little is known about the effectiveness of mobile health interventions to improve early adoption of contraceptive methods after childbirth in Ehiopia. This study aimed to evaluate the effectiveness of a mobile health intervention in enhancing the uptake of modern contraceptive methods in the early postpartum period in Dessie and Kombolcha cities, northeast Ethiopia. The research was conducted in Dessie and Kombolcha cities zones located in the Amhara region of Northeast Ethiopia from 15th January to 15th June, 2023. Pregnant women with a confirmed gestation of 30 weeks were enrolled and followed up to the 45-day postpartum period. The study employed a cluster randomized control trial involving 764 participants (381 controls and 383 in the intervention group). The intervention group received a new mobile health intervention in addition to the existing healthcare practices, while the control group solely adhered to the current healthcare practices. Data were collected using the Open Data Kit (ODK) and exported to STATA 17 for analysis. The marginal model Generalized Estimating Equations (GEE) through the application of an exchangeable working correlation was applied. The effect of the intervention on the outcome was measured using the odds ratio with a 95% confidence interval at a p-value less than 0.05 significant level. The study found that 78.7% of participants in the control group and 77.3% in the intervention group had sexual practice after childbirth. The proportion of early postpartum contraceptive uptake in the intervention group (51.6%) was significantly higher than in the control group (38%). The odds of adopting modern contraceptive methods during the early postpartum period were 1.6 times higher among mothers who received the mHealth intervention compared to those in the control group (AOR: 1.6, 95% CI: 1.249-2.123). The study identified significant predictors for the uptake of contraceptive methods during the early postpartum period, including having a live newborn (AOR: 3.7, 95% CI: 1.034-13.353), parity (AOR: 1.7, 95% CI: 1.069-2.695), and previous experience with contraceptive initiation (AOR: 0.5, 95% CI: 0.358-0.912). This study findings demonstrated that the potential effectiveness of mobile health interventions in promoting timely contraceptive adoption during early postpartum period. The mobile health intervention, combined with factors such as timing of previous contraceptive initiation, newborn status, and maternal parity, significantly enhances the likelihood of early contraceptive adoption. These nuanced insights provide a strong foundation for developing targeted health interventions and policies aimed at improving early postpartum contraception. The trial was registered on December 23, 2022, in the Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ID: ClinicalTrials.gov ID: NCT05666037.

Maternal attachment style and psychiatric history as independent predictors of mood symptoms in the immediate postpartum period

Expulsion rates 12 months after early versus interval postpartum intrauterine device placement: a randomized trial

Maternal sleep and psychological status in the postpartum period are associated with functional protein alterations in breast milk:a mother-infant cohort study.