1st Postpartum Research Articles

Effect of postpartum depression and role of infant feeding practices on relative weight of child at 1 and 3 years of age

BackgroundChildhood obesity has increased and is considered one of the most serious public health challenges of the 21st century globally, and may be exacerbated by postpartum depression (PPD). The purpose of this study was to examine the association between PPD at 1st and 6th month postpartum, infant feeding practices, and body mass index (BMI) z-score of the child at one and three years of age.MethodsThis study used data from an ongoing prospective maternal-child birth cohort performed at the National Center for Child Health and Development (NCCHD) in suburban Tokyo, Japan with the period of recruitment from May 13, 2010 to November 28, 2013. Out of 2,309 total number of mothers, 1,279 mother–child dyads were assessed in the study. We performed multivariable linear regression analysis to examine the association between PPD and child’s BMI z-score stratified by the child’s age at 1 year and 3 years of age.ResultsThe prevalence of PPD at 1 month postpartum (17%) was found to be higher than at 6 months (12%). In multivariable linear regression analysis we observed that children at 3 years who had mothers with PPD at 6 months had, on average, a BMI z-score 0.25 higher than children of mothers who did not have PPD at 6 months (ß coefficient 0.25, 95% CI [0.04 to 0.46], p value 0.02), holding all other covariates constant. Also, initiation of weaning food when child is at six months of age was associated with higher BMI z-score of the child at 3 years after adjusting for all covariates (ß coefficient = 0.18, 95% CI [0.03 to 0.34], p-value < 0.05).ConclusionThe significant association between PPD at 6 months and child’s BMI z-score at 3 years of age, in conjunction with birth trends and high prevalence of PPD, can add to the body of evidence that there is need for multiple assessment across the first postpartum year to rule out PPD as early screening and early interventions may benefit both maternal health and child development outcomes. These findings can indicate the need for establishing support systems for care-giving activities for mothers with PPD.

Abstract PO5-08-03: Breastfeeding and Breast Cancer Screening Among Carriers of Pathogenic Variants in BRCA 1 and BRCA 2 and Other High Penetrance Genes: Knowledge and Perspectives

Abstract Objectives: Carriers of pathogenic variants in high penetrance mutations, including BRCA 1 or BRCA 2 face higher lifetime risks of developing breast and tubo-ovarian cancers, and possibly endometrial cancers, than non-carriers. In particular, relative risks are higher among carriers than non-carriers at younger ages, suggesting the value of early initiation of breast cancer screening and the use of sensitive imaging methods, such as magnetic resonance imaging (MRI). Further, breastfeeding appears protective for these three cancers in the general population, and potentially among mutation carriers, albeit based on limited evidence. Given that data related to knowledge and perspectives of carriers about these issues are limited, we surveyed mutation carriers regarding breastfeeding, cancer risk, and the deferral of breast cancer screening coinciding with reproductive events. These data may guide future cancer prevention research and developing of targeted communication campaigns. Methods: Researchers at Mayo Clinic, in collaboration with Facing Our Risk of Cancer Empowered (FORCE) – a large, national non-profit organization that addresses the needs of people and families affected by inherited mutations linked to cancer – designed and conducted a survey using the Mayo Clinic’s external RedCap system. The survey covered genetic testing and results, history of live births and breastfeeding history for mothers, history of risk-reducing surgery, personal cancer history, sources of information about cancer screening, breastfeeding knowledge, and breast cancer screening at various times, including during pregnancy, while breastfeeding, and after weaning. The survey was disseminated through FORCE’s electronic newsletter, website, social media pages, and advocacy partners. Survey responses were collected anonymously and analyzed descriptively using standard descriptive statistics, including frequency and percentages for categorical responses and means (SD) or medians (IQR) for continuously scaled responses. The open-ended responses were analyzed qualitatively using standard qualitative methodology. Results: Respondents included 253 women, of whom 88.7% were U.S. residents and 92.9% were white. The mean age + SD was 47(13) years, 61.7% were parous, with a mean age at first birth of 22.58 (13.16) years. Approximately 60% of women were carriers of mutations in BRCA1 or BRCA2 or both genes and all but two of the remaining women reported mutations in other genes linked to increased cancer risk. At the time of the survey, 92% of women had undergone a mammogram, with first screen at a mean age of 35 (6.49) years, and 85.3% had undergone breast MRI, with first screen at a mean age of 43 (12.39) years. Among 34.3% of participants, their 1st postpartum mammogram occurred &amp;gt;3 years after the birth of their last child and 57% had 1st MRI 3 years postpartum. Preliminarily, our analysis shows that nearly 90% of women were unaware of their mutation status prior to pregnancy and approximately 1/3 did not undergo radiologic screening until 3 years postpartum. While 62.6% of respondents believed that breastfeeding lowers breast cancer risk, 74.2% of participants responded that nursing had no effect on tubo-ovarian cancer risk, and 78.2% considered that nursing did not impact endometrial cancer risk. Discussion and Conclusions: Preliminarily, we conclude that most women in the surveyed population were unaware of their mutation status when pregnant years earlier and many had not undergone screening until years after delivery. Many participants did not consider breastfeeding a potentially protective factor for women’s cancers. These data raise issues about the potential value of discussing genetic testing with women when considering family planning and mutation carriers, addressing complex issues about breast cancer screening while pregnant and breastfeeding. Citation Format: Laura Pacheco-Spann, Mark Sherman, Susan Friedman, Diane Rose, Miriam Levi, Alex Hochwald, Jennifer Ridgeway, Sophia Blumenfeld. Breastfeeding and Breast Cancer Screening Among Carriers of Pathogenic Variants in BRCA 1 and BRCA 2 and Other High Penetrance Genes: Knowledge and Perspectives [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-08-03.

Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers

ObjectiveThere is a lack of longitudinal population-based research comparing women’s experiences of intimate partner violence (IPV) prior to and during the COVID-19 pandemic. Using data from the Mothers’ and Young...

Effect of rumen protected methionine and choline supplementation on leukogram profile, oxidative stress, inflammatory and immunomodulatory responses of Surti buffaloes during transition period

Present study was conducted to observe effect of supplementing rumen protected methionine and choline on leukogram profile, oxidative stress, inflammatory and immunomodulatory responses during transition period in Surti buffaloes. Twenty-seven pregnant Surti buffaloes were selected and divided into three groups of nine animals each with following diet regime: Group I (Control)-basal diet, Group II (RPM)-basal diet+rumen protected methionine and Group III (RPM+RPC)-basal diet+rumen protected methionine+rumen protected choline. Supplementation of RPM @ 10 g/buffalo/day and RPC @ 50 g/buffalo/day was done from -15 d prepartum to 30 d postpartum. Blood samples were collected at start of experiment, 1st, 3rd and 6th week postpartum. At 1st and 3rd week postpartum, significantly higher level of GSH, SOD as well as TAS and lower level of LPO were observed in Group II and III as compared to control. Group III had highest SOD as well as TAS and lowest LPO levels. TNF-α and haptaglobin during postpartum period were significantly lower in Group II and III. Group III had lowest levels of TNF-α at 1st and 3rd week and haptoglobin at 1st, 3rd and 6th week postpartum. In vitro neutrophil phagocytic activity and lymphocyte proliferation were significantly higher in Group III followed by Group II and control during entire postpartum period. It was concluded that supplementation of rumen protected methionine and choline during transition phase of Surti buffaloes reduces oxidative stress as well as inflammatory tendencies and increases antioxidant status as well as immune response. Beneficial effects of supplementing both are more than supplementing rumen protected methionine alone.

Effects of prepartum melatonin treatment and suckling on postpartum reproductive performance of Beetal goats under subtropical conditions

The current study determines the effect of prepartum melatonin treatment on postpartum reproductive cyclicity, uterine involution, the onset of estrus, and ovarian activity in restricted or continuous suckled Beetal goats. Forty-six pregnant goats of 110 days gestation were either inserted with melatonin implants (M; n = 24) or left untreated (control, C; n = 22). Each group was subdivided into continuous (CS) and restricted suckling (RS) groups i.e., MCS (n = 11), CCS (n = 11), a ” ”MRS (n = 13), and CRS (n = 11) to monitor estrous response while uterine involution and ovarian activity were monitored in a subset of goats (n = 8 in each group) via transrectal ultrasonography (7.5 MHz transducer) twice a week. Blood BHBA and glucose levels were monitored 40 days before and 28 days after kidding. Data were analyzed using multifactor analysis of variance (ANOVA) designs, Chi-square, and Student’s t-test (SPSS version 20). Estrous response of goats was similar in MRS (30.8 %), CRS (45.4 %), and MCS (18.2 %) groups; however, MRS and CRS goats had better (P < 0.05) estrous response than those of CCS (0 %) goats. Between the groups, the ovulatory response and interval to 1st postpartum estrus were similar (P > 0.05). Melatonin tended to have shortened (P = 0.07) the interval to 1st postpartum ovulation and placental expulsion time (P < 0.05) in melatonin-treated than untreated goats. Melatonin or suckling treatment did not affect Gestation length, kidding time, uterine involution, and regression of caruncles (P > 0.05). BHBA levels were higher (P < 0.05) at 28 days postpartum than 40 days before kidding in all groups; however, glucose levels were similar in all groups except CCS. In conclusion, restricted suckling and prepartum melatonin treatment have more impact on postpartum reproductive performance than prepartum melatonin treatment alone in Beetal goats.

Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study

A key unresolved controversy in severe COVID-19 pneumonitis in pregnancy is the optimum timing of delivery and whether delivery improves or worsens maternal outcomes. We aimed to assess clinical data on every intensive care unit (ICU) day for pregnant and postpartum women admitted to the ICU with COVID-19, with a particular focus on the days preceding and following delivery. In this multicentre, nationwide, prospective and retrospective cohort study, we evaluated all pregnant women who were admitted to an ICU in Israel with severe COVID-19 pneumonitis from the 13th week of gestation to the 1st week postpartum. We excluded pregnant patients in which the ICU admission was unrelated to severe COVID-19 pneumonitis. We assessed maternal and neonatal outcomes and longitudinal clinical and laboratory ICU data. The primary overall outcome was maternal outcome (worst of the following: no invasive positive pressure ventilation [IPPV], use of IPPV, use of extracorporeal membrane oxygenation [ECMO], or death). The primary longitudinal outcome was Sequential Organ Failure Assessment (SOFA) score, and the secondary longitudinal outcome was the novel PORCH (positive end-expiratory pressure [PEEP], oxygenation, respiratory support, chest x-ray, haemodynamic support) score. Patients were classified into four groups: no-delivery (pregnant at admission and no delivery during the ICU stay), postpartum (ICU admission ≥1 day after delivery), delivery-critical (pregnant at admission and receiving or at high risk of requiring IPPV at the time of delivery), or delivery-non-critical (pregnant at admission and not critically ill at the time of delivery). From Feb 1, 2020, to Jan 31, 2022, 84 patients were analysed: 34 patients in the no-delivery group, four in postpartum, 32 in delivery-critical, and 14 in delivery-non-critical. The delivery-critical and postpartum groups had worse outcomes than the other groups: 26 (81%) of 32 patients in the delivery-critical group and four (100%) of four patients in the postpartum group required IPPV; 12 (38%) and three (75%) patients required ECMO, and one (3%) and two (50%) patients died, respectively. The delivery-non-critical and no-delivery groups had far better outcomes than other groups: six (18%) of 34 patients and two (14%) of 14 patients required IPPV, respectively; no patients required ECMO or died. Oxygen saturation (SpO2), SpO2 to fraction of inspired oxygen (FiO2) ratio (S/F ratio), partial pressure of arterial oxygen to FiO2 ratio (P/F ratio), ROX index (S/F ratio divided by respiratory rate), and SOFA and PORCH scores were all highly predictive for adverse maternal outcome (p<0·0001). The delivery-critical group deteriorated on the day of delivery, continued to deteriorate throughout the ICU stay, and took longer to recover (ICU duration, Mantel-Cox p<0·0001), whereas the delivery-non-critical group improved rapidly following delivery. The day of delivery was a significant covariate for PORCH (p<0·0001) but not SOFA (p=0·09) scores. In patients who underwent delivery during their ICU stay, maternal outcome deteriorated following delivery among those defined as critical compared with non-critical patients, who improved following delivery. Interventional delivery should be considered for maternal indications before patients deteriorate and require mechanical ventilation. None.

Community health workers' involvement in mother-child care during the 1st year after birth, in Kaya health district, Burkina Faso: A contribution analysis.

Maternal and infant morbidity and mortality remain high in sub-Saharan Africa. However, actions to strengthen postpartum care are still weak and mainly limited to health facilities (HFs). In Kaya health district, Burkina Faso, community health workers (CHWs) were involved in mother and child care during the 1st year postpartum through home visits, outreach sessions and accompanying mothers to health facilities. The aim of this study was to assess the contribution of CHWs to postpartum women's attendance at the health facilities. We conducted an effect assessment using Mayne and Lemire's contribution analysis framework. Qualitative and quantitative data were collected through project documents review and individual semi-structured interviews with key-informants. All the participants interviewed acknowledged that the number of women, who came to postpartum care, had increased since the implementation of the project activities. Postpartum consultation rates within the 1st week postpartum increased from 29% in 2011 to 80% in 2015 and from 19 to 50% within 6 weeks. Others interventions such as Performance based financing, Save The Children nutritional project and the health services component of Missed Opportunities in Mother and Infant Health (MOMI) were the alternative explanations. CHWs involvement in women care contributed to improve their adherence to postpartum consultations in Kaya health district.

Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study

BackgroundPostpartum depression (PPD) is a serious complication commonly seen in postnatal women. In this paper, an investigation was conducted to see if obstetric anesthesia clinic childbirth course combined with labor epidural analgesia (LEA) was associated with a decreased risk of PPD.MethodsSix hundred fifty-five nulliparous women were enrolled in this prospective cohort study. The parturients were divided into 4 groups, with Group C being the control group, Group AC received the obstetric anesthesia clinic childbirth course only, Group LEA received LEA only, and Group AC + LEA received both the obstetric anesthesia clinic childbirth course and LEA. Maternal and neonatal variables in the perinatal period were recorded. PPD at 6 weeks was assessed using the Chinese version of the Edinburgh Postpartum Depression Scale (EPDS), where a score ≥ 10 is the threshold for PPD. Multivariate logistic regression analysis was performed to assess the association between obstetric anesthesia clinic childbirth course combined with LEA and postpartum depression.ResultsA total of 124 maternities had EPDS ≥10 points, the incidence of PPD was 18.9%。The incidence of PPD and EPDS scores were significantly lower in Group AC + LEA than in Group C (12.1% vs 26.8%, P < 0.05; 6 (5, 7) vs 7 (5, 11), P < 0.05). Received an anesthesia clinic childbirth course combined with LEA was associated with a decreased risk of PPD (OR 0.273, 95% CI, 0.100–0.743, P = 0.013). Multivariate logistic regression analysis identified 5 other independent factors for PPD, including maternal SAS score in the delivery room, W-DEQ score in the delivery room, living in a confinement center, EPDS score at 1st week postpartum and perinatal care satisfaction .ConclusionsReceived an obstetrics anesthesia clinic childbirth course combined with LEA for nulliparous women with a single term cephalic pregnancy was associated with a decreased risk of PPD at 6 weeks.Trial registrationChinese Clinical Trial Registry, ChiCTR2000039163. Registered on 20/10/2020.

Correlation between Uterine Hemodynamics, Sex Steroid Hormone Concentrations, and Enzymatic Antioxidant Levels in Postpartum Buffaloes

The present investigation aimed to evaluate uterine hemodynamics in six multiparous postpartum buffaloes and their relationship with sex steroid hormone concentrations and enzymatic antioxidant levels. The buffaloes were examined by transrectal Doppler ultrasonography to record the vascular perfusion in uterine arteries of both ipsilateral and contralateral ones. All Doppler indices such as peak (PV) endpoints (EV) of velocity, peak systolic velocity (PSV), blood flow volume (BFV), resistance (RI), and pulsatility index (PI) were recorded from 1st to 6th postpartum. The blood samples were collected starting from 1st-week post-calving and every week thereafter following each ultrasound Doppler examination for assay of steroid hormones (progesterone and estradiol) and antioxidant (superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase, CAT) were measured. PV of the ipsilateral previously gravid arteries showed a linear pattern of significant (P=0.001) decline from the 1st week after parturition till the 6th week. This decline was also associated with a linear decrease in EV from the 1st week till the 6th week after birth. While contralateral PV and EV are not significantly changed throughout weeks after parturition. The levels of SOD and CAT are significantly elevated at 1st week postpartum compared to the 6th week after parturition. In contrast, the GPx levels did not reveal any significant differences during the puerperal period. Estradiol and progesterone declined from 1st to 5th week after parturition. PV of the ipsilateral uterine artery had a significant (P≤0.05) positive correlation with BFV (r=0.49), estradiol 17- α(r=0.98) and progesterone (r=0.85). The same parameter showed a statically (P≤ 0.001) positive correlation with SOD (r=0.87) and CAT (r=0.92). While, Ipsilateral uterine RI showed a significant (P≤0.05) negative correlation with PV(r=-0.85), BFR ((r=-0.62), estradiol 17- α(r=-0.52), and progesterone (r=-0.88), in addition, RI also correlated negatively with both SOD (r=-0.57) and CAT (r=-0.63). Progesterone and estrogen levels are strongly correlated with SOD and CAT. The uterine hemodynamics in buffaloes is affected by the day of the postpartum period. SOD and CAT antioxidants recorded herein, except GPx, increase in the 1st weeks of calving and are affected by the day of the postpartum period.

Reproductive Women's Knowledge on Possibility of Pregnancy after Birth but before Resumption of Menstruation and Its Associated Factors in Ethiopia: A Population-Based Study Using the 2016 Ethiopian Demographic Health Survey.

Introduction Worldwide, specifically in developing countries, women believe that a woman cannot become pregnant unless she sees her first postpartum menstruation. Due to this knowledge gap, most women did not use any contraceptives till their 1st postpartum menstruation. Hence, about 44% of women were susceptible to unintended pregnancy in the postpartum period. Assessing women knowledge on possibility of pregnancy after giving birth but before returning of menses and its associated factors will help to increase women's recognition on the issue and for early commencement of appropriate postpartum family planning methods to reduce burden of unintended pregnancy. Objective To assess the level of knowledge on possibility of pregnancy after giving birth but before returning of menses and its associated factors among reproductive women in Ethiopia. Methods A secondary data analysis using the 2016 Ethiopian Demographic Health Survey was employed. Samples were selected using two-stage stratified sampling technique. Descriptive statistics and logistic regressions were used. Adjusted odds ratio (AOR) with 95% confidence interval was used to interpret associations, and a significant association was declared at a p value of <0.05. Result A total of 15,683 reproductive women aged from 15 to 49 years were included. Of them, about 53% did not know that a woman can get pregnant after giving birth but before resumption of her menstruation. Age being 35 years and above (AOR = 1.50; 95%CI = 1.34, 1.67), educational status of secondary and above (AOR = 1.18; 95%CI = 1.06, 1.32), being ever married (AOR = 1.67; 95%CI = 1.47, 1.89), knowledge of any family planning method (AOR = 1.81; 95%CI = 1.52, 2.16), getting counseling on family planning methods (AOR = 1.41; 95%CI = 1.28, 1.55), and being knowledgeable on their ovulatory cycle (AOR = 1.68; 95%CI = 1.55, 1.82) were found to be significantly associated with being knowledgeable on the issue. Conclusion Reproductive women's level of knowledge on the possibility of pregnancy after giving birth but before returning of menses was low. Factors associated with being knowledgeable on the issue were identified. Therefore, strategies should be developed to increase their level of knowledge for reducing unintended pregnancy and its complications by integrating family planning counseling with infant immunization services.

Assessment of Blood Metabolites during Early Postpartum Period as an Indicator of Reproductive Performance in Mehsana Buffaloes

Background: The postpartum period being a crucial on future performance and fertility, it should be monitored critically and evaluated. Therefore, the study was designed to investigate associations between the metabolic indicators during early postpartum period with uterine diseases and the subsequent effect on reproductive performance. Methods: The blood metabolites including non-esterified fatty acid (NEFA), beta hydroxy butyrate (BHBA), cholesterol, total protein, blood glucose and calcium are studied at 1st and 2nd week postpartum (PP) in 50 Mehsana buffaloes. The difference and their association were seen in relation to postpartum diseases and reproductive performance. Result: The glucose concentration significantly (P less than 0.05) decreased in 2nd week compared to 1st week postpartum in Mehsana buffaloes with anoestrous ( greater than 75 days PP), longer service period ( greater than 125 days) and postpartum disorders (Within 125 days). The BHBA and NEFA did not differ significantly between the time points or between the buffaloes suffering from postpartum disorders or not. The early postpartum glucose level can be used as a predictive indicator for buffaloes suffering from anoestrus, longer service period and postpartum disorders.

Associations Between Habitual Dietary Behaviors and Glutamic Acid Levels in Human Milk.

Glutamic acid, an amino acid that exhibits umami taste, is utilized in Japanese food and is abundant in human milk. We examined the influence of maternal habitual eating behavior on glutamic acid concentration in human milk. To determine the association between maternal dietary behaviors at the end of pregnancy and the 1st month postpartum and glutamic acid concentration in colostrum and mature milk. This was a prospective, correlational, one-group longitudinal study. Women aged 20-30 years during the third trimester of pregnancy (N = 30) consented to participate and completed the data collection. Dietary history questionnaires were used to measure food intake. Glutamic acid levels in whey from colostrum and mature milk and in plasma during late pregnancy and the first month postpartum were measured. Data were considered significant at p < .05. Basic statistics, correlation coefficients analysis, unpaired t test, and one-way analysis of variance were performed. Glutamic acid concentrations in human milk and plasma were found to be significantly associated with the consumption of several different foods. There was no association between glutamic acid concentrations in human milk and plasma or between glutamic acid concentrations in colostrum and mature milk. The glutamic acid content of mature milk differed by physical activity level (mild and moderate) during the first month postpartum (t [46] = 2.87, p < .01). There was no clear association between habitual dietary behavior and glutamic acid concentration in human milk. However, maternal factors other than diet may be important and require additional research.

Cow-related factors associated with intramammary infections during the 1st week postpartum in primiparous dairy cows in certified organic herds

The objectives if this exploratory study were to identify variables associated with intramammary infections (IMI) during the 1st week of lactation in primiparous organic dairy cows, and to evaluate the association of those variables with somatic cell count (SCC) linear scores and milk yield in early lactation. Nulliparous cows (n = 240) were evaluated for: udder edema, teat edema, milk leakage (ML) and udder hygiene at weeks 6, 4, 2, and 1 prepartum and 1st week postpartum; body condition score (BCS) at 6 weeks prepartum and 1st week postpartum; age at calving (days), gestation length, dystocia, stillbirth, calf sex were included in the analysis. Milk samples from the 1st week postpartum were cultured using standard laboratory techniques and bacterial growth was considered IMI. Intramammary infection was observed in 58.7% of cows, with Staphylococcus chromogenes and S. aureus being the most prevalent pathogens. Cows with ML at 1st week postpartum were at 3.42 greater odds of IMI (P < 0.01). Cows with prepartum BCS ≥ 3.75 were at 3.12 greater odds of IMI (P < 0.01). Cows with ML in the 1st week of lactation had increased SCC (P < 0.01) and lower milk production in the second month of lactation (P = 0.05). Intervention studies are needed to evaluate if monitoring prepartum BCS and ML at early postpartum can aid in the control of IMIs in heifers in organic dairies.

Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico.

IntroductionIn this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices.Materials and MethodsThis was a formative cross-sectional study that included 143 mothers with infants 4–6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF.ResultsBy the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full.ConclusionMany factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.

What Recovery Means to Postpartum Women in Treatment for Opioid Use Disorder.

Introduction: Opioid overdose has become a leading cause of pregnancy-associated deaths, particularly in the 1st year postpartum, highlighting the need to better understand how to promote recovery for postpartum women. This mixed-methods study aims to investigate how postpartum women receiving medication for opioid use disorder (MOUD) define recovery and factors associated with recovery progression or inhibition.Methods: Women receiving MOUD 2–6 months postpartum were recruited from an outpatient perinatal addiction clinic. Participants completed electronic measures including the Brief Assessment of Recovery Capital (BARC-10, total score range: 6–60) and semistructured individual interviews. Substance Abuse and Mental Health Services Administration (SAMHSA)'s recovery framework served as the conceptual model for interview guide development. Descriptive statistics were generated for survey responses. A qualitative descriptive approach was used to analyze and report the interview data.Results: On average, participants (n = 8) were 28.6 years old and taking 19.5 mg/day buprenorphine (range 8–24). Fifty percent identified as white and 37.5% as black. All participants identified as currently in recovery, with mean BARC-10 score 52.5 (standard deviation 4.8). Recovery goals included no use of drugs or alcohol (62.5%), being a better partner/spouse (87.5%), and improving finances (87.5%). Interviews generated themes including recovery as transformative, building resilience, and transforming one's health, relationships, and environment through recovery.Conclusions: Participants defined recovery as a dynamic transformative process, including nonabstinence-based goals consistent with SAMHSA domains coupled with reduced substance use. Central to recovery for our postpartum participants was the sense of self reinforced throughout their recovery journey. Women highlighted the key role of MOUD in their recovery process. Findings underscore the need for individualized treatment for postpartum women with opioid use disorder based on their personal goals and will inform development of a validated, gender-informed measure of patient-reported recovery outcomes tailored for this population.

Effect of Rumen Protected Methionine and Choline on Blood Biochemical Metabolites, Milk Yield and its Composition during Transition Period in Surti Buffaloes

Background: Methionine and choline supplementation can aid in nutritionally managing transition Surti buffaloes. Present study has evaluated blood biochemical metabolites, milk yield and its changes in composition on supplementation of rumen protected methionine (RPM) and choline (RPC) in transition Surti buffaloes. Methods: Twenty-seven pregnant multiparous Surti buffaloes in three groups (n=9) from -15 d to 30 d postpartum received supplementation as: T1 (Control: basal diet), T2 (basal diet + RPM@10 gm/animal/day) and T3 (basal diet + RPM@10 gm/animal/day + RPC@ 50 gm/animal/day). Sample was collected at beginning, 1st, 3rd and 6th week for blood and at 1st, 3rd, 6th, 9th and 12th week postpartum for milk. Milk yield was recorded upto 100 days postpartum. Result: Postpartum TC, HDL and VLDL differed significantly (P less than 0.05) being highest in T3 and lowest in control (T1) whereas it was reverse for NEFA and BHBA. Supplemented groups had significantly lower TG levels at 1st and 3rd week postpartum. Milk fat upto 9th and SNF, protein, lactose, TAS, Ca, P and Mg upto 6th week were significantly (P less than 0.05) highest in T3, followed by T2 and T1. It was concluded that RPC along with RPM supplementation is more beneficial than only RPM supplementation in terms of enhancing liver health, reducing negative energy balance and improving milk quality.

Initial Evidence for Symptoms of Postpartum Parent-Infant Relationship Obsessive Compulsive Disorder (PI-ROCD) and Associated Risk for Perturbed Maternal Behavior and Infant Social Disengagement From Mother.

Infant socioemotional development and underlying brain maturation occur primarily within the context of early caregiver-infant relationships. Perinatal research demonstrates detrimental impact of postpartum pathology, including postnatal onset of maternal OCD—on the mother-infant relationship. The present study is the first to examine postnatal onset of a particular dimension of OCD symptoms focusing on close interpersonal relationships (relationship-OCD, i.e., ROCD) within a general population sample. Specifically, we assessed whether symptoms of Parent-Child ROCD (PC-ROCD), may onset postnatally, thus yielding symptoms of Parent-Infant ROCD (PI-ROCD). We adapted the previously validated Parent-Child ROCD measure for use during infancy to assess symptoms of PI-ROCD. The adapted measure, Parent-Infant Relationship Obsessive Compulsive Symptoms Inventory (PI-PROCSI), was administered to 143 mothers from the general population at 4-months postpartum. We investigated concurrent associations between postnatal onset of PI-ROCD, maternal depression and bonding, as well as longitudinal predictive associations with observed maternal and infant behaviors in dyadic interactions at 10 months. Due to dropout across the 1st year postpartum, the subsample with longitudinal data was substantially reduced compared to the full sample. PI-PROCSI scores explained unique variance in concurrent maternal depression over and above concurrent anxiety. PI-PROCSI scores also associated with concurrent impairments of maternal bonding. Moreover, unique associations emerged between maternal PI-ROCD scores and perturbations in both maternal and infant observable behaviors at 10-months. Specifically, observable perturbations in maternal behaviors mediated associations between symptoms of PI-ROCD at 4-months and observable infant avoidance of social engagement behaviors at 10-months. Findings suggest that parent-child ROCD symptoms may onset during the postnatal period, and that such symptoms may play a significant role in shaping quality of reciprocal caregiver-infant interactions. Theoretical and clinical implications are discussed.

Subtypes of gestational diabetes and future risk of pre-diabetes or diabetes.

BackgroundRecent studies have suggested that gestational diabetes (GDM) is a heterogeneous condition with distinct subtypes determined by whether the predominant metabolic abnormality is impaired insulin sensitivity or deficient insulin secretion. However, it is not known if the elevated future risk of pre-diabetes/diabetes associated with GDM varies according to these subtypes. Thus, we sought to evaluate maternal metabolic function in the 1st year postpartum in relation to GDM subtypes.MethodsIn this prospective cohort study conducted in Toronto, Canada, 613 women underwent GDM screening by oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT at both 3-months and 12-months postpartum between 09/2003 and 03/2016. The antepartum OGTT identified 3 groups of women: GDM with predominant sensitivity defect (GDM-sensitivity), GDM with predominant secretion defect (GDM-secretion), and non-GDM.FindingsAntepartum findings persisted after pregnancy, with lower insulin sensitivity in GDM-sensitivity (Matsuda index; HOMA-IR) and lower insulin secretion in GDM-secretion (Stumvoll first-phase; insulinogenic index (IGI)) at both 3-months and 12-months (all p<0.005). Beta-cell compensation (Insulin Secretion-Sensitivity Index-2; IGI/HOMA-IR) was lower in both GDM subtypes compared to non-GDM (all p<0.0005) but did not differ between GDM-sensitivity and GDM-secretion. Similarly, both subtypes exhibited higher post-challenge glycemia on OGTT at 3-months and 12-months than non-GDM (all p<0.0005) but did not differ from one another. The prevalence of pre-diabetes/diabetes was higher in both GDM-sensitivity (30.9%; 95%CI: 21.7–41.2) and GDM-secretion (27.6%; 16.7–40.9) than in non-GDM (10.4%; 7.7–13.6) at 12-months (both p<0.005), with no difference between GDM subtypes (p = 0.75).InterpretationBeta-cell dysfunction, glycemia and incident pre-diabetes/diabetes do not vary between GDM subtypes in the 1st year postpartum.FundingCanadian Institutes of Health Research; Diabetes Canada

Associations of Thyroid Hormones Profile During Normal Pregnancy and Postpartum With Anxiety, Depression, and Obsessive/Compulsive Disorder Scores in Euthyroid Women.

ObjectiveThyroid dysfunction (overt and subclinical) has been consistently linked to pregnancy adversity and abnormal fetal growth and development. Mood disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD) are frequently diagnosed during pregnancy and at postpartum, and emerging evidence suggests association with impaired offspring neurodevelopment and growth. This study aimed to examine potential associations between thyroid function and mood symptoms during pregnancy and postpartum.DesignThis is a prospective study measuring thyroid hormones and assessing mood symptoms by employing specific questionnaires in the same cohort of 93 healthy pregnant women at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week.MethodsSerum thyroid hormones, TSH, anti-TPO, and anti-Tg antibodies were measured at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week. Specific validated questionnaires were employed at the same time-points to assess separately symptoms of anxiety [Generalized Anxiety Disorder Inventory (GADI), Penn State Worry Questionnaire (PSWQ), STAI-State Anxiety inventory (STAI-S), STAI-Trait Anxiety Inventory (STAI-T)], depression [Edinburgh Postnatal Depression Scale (EPDS), Stein’s Blues Scale (BLUES), Beck Depression Inventory (BDI)], and obsessive compulsive disorder (OCD) [Yale-Brown Obsessive Compulsive scale (Y-BOCS)].ResultsAt the 2nd trimester, GADI score correlated negatively with FT3 (p < 0.010, r = −0.545) and positively with TSH (p < 0.050, r = 0.837) concentrations; GADI, PSWQ, EPDS and Y-BOCS scores correlated negatively with FT4 concentrations (p < 0.010, r = −0.768; p < 0.010, r = −0.384; p < 0.050, r = −0.364; p < 0.010, r = −0.544, respectively). At the 3rd trimester, BLUES score correlated positively with rT3 concentrations (p = 0.00, r = 0.89); GADI, EPDS, and Y-BOCS scores correlated negatively with FT4 concentrations (p = 0.001, r = − 0.468; p = 0.036, r = −0.39; p = 0.001, r = −0.625, respectively); GADI, STAI-S, and Y-BOCS scores correlated positively with TSH concentrations (p = 0.015, r = 0.435; p = 0.024, r = 0.409 p = 0.041, r = 0.389, respectively). At postpartum, PSWQ, STAI-T, EPDS, and BDI scores correlated positively with rT3 concentrations (p = 0.024, r = 0.478; p = 0.014, r = 0.527; p = 0.046, r = 0.44; p = 0.021, r = 0.556, respectively, Y-BOCS score correlated positively with TSH (p = 0.045, r = 0.43), and BLUES score correlated positively with anti-TPO antibody concentrations (p = 0.070, r = 0.586).ConclusionThe reported findings demonstrate positive associations between low-normal thyroid function at the 2nd and 3rd trimesters of pregnancy and postpartum with anxiety, depression, and OCD scores.

Immediate Pre-Partum SARS-CoV-2 Status and Immune Profiling of Breastmilk: A Case-Control Study.

ObjetiveTo address the prevalence of SARS-CoV-2 and the evolutionary profile of immune compounds in breastmilk of positive mothers according to time and disease state.MethodsForty-five women with term pregnancies with confirmed non-severe SARS-CoV-2 infection (case group), and 96 SARS-CoV-2 negative women in identical conditions (control group) were approached, using consecutive sample. Weekly (1st to 5th week postpartum) reverse transcription polymerase chain reaction (RT-PCR) in nasopharyngeal swabs (cases) and breastmilk (cases and controls) were obtained. Concentration of cytokines, chemokines, and growth factors in breastmilk (cases and controls) were determined at 1st and 5th week post-partum.ResultsThirty-seven (study group) and 45 (control group) women were enrolled. Symptomatic infection occurred in 56.8% of women in the study group (48% fever, 48% anosmia, 43% cough). SARS-CoV-2 RNA was not found in breastmilk samples. Concentrations of cytokines (IFN-γ, IL-1ra, IL-4, IL-6, IL-9, IL-13, and TNF-α) chemokines (eotaxin, IP-10, MIP-1α, and RANTES) and growth factors (FGF, GM-CSF, IL7, and PDGF-BB) were higher in breastmilk of the study compared with the control group at 1st week postpartum. Immune compounds concentrations decreased on time, particularly in the control group milk samples. Time of nasopharyngeal swab to become negative influenced the immune compound concentration pattern. Severity of disease (symptomatic or asymptomatic infection) did not affect the immunological profile in breast milk.ConclusionsThis study confirms no viral RNA and a distinct immunological profile in breastmilk according to mother’s SARS-CoV-2 status. Additional studies should address whether these findings indicate efficient reaction against SARS-CoV-2 infection, which might be suitable to protect the recipient child.