Postpartum Week Research Articles

Mental health during and after pregnancy in medically assisted reproduction: a danish cohort study.

Infertility is common and an increasing number of women go through medically assisted reproduction (fertility treatment) to achieve pregnancy. This may affect mental health. We examined if fertility treatment and the specific fertility treatment method used (in vivo or in vitro) were associated with impaired mental health during or after pregnancy. Using self-reported data from the Odense Child Cohort, we assessed prenatal stress by the 10-item Cohen Perceived Stress Scale (PSS-10) during pregnancy at median gestational week 27 and postnatal depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS) at median postpartum week 15. We compared fertility-treated women overall and by fertility treatment method to women who conceived spontaneously. We conducted linear regression analyses to evaluate the PSS-10 score dimensionally and logistic regression to evaluate EPDS scores above cut-off (≥ 11). A total of 108 of 820 women (13%) gave birth after fertility treatment. Their prenatal mean stress (PSS-10) score was 11.38 compared to 11.78 for women who conceived spontaneously, leading to an adjusted mean difference of -0.09 points (95% confidence interval (CI): -1.88 to 1.69). In the fertility-treated group, 9.7% had EPDS scores ≥ 11 compared to 10.7% in the spontaneous conception group (adjusted odds ratio of 0.71 (95% CI: 0.26 to 1.91)). The MAR method (in vivo/vitro) did not influence these results. Women who gave birth after fertility treatment did not report higher levels of prenatal stress or postpartum depressive symptoms than women who conceived spontaneously.

Association Between Cesarean Scar and Pelvic Floor Muscle Tone at 6-8 Weeks Postpartum.

The relationship between cesarean section scars and active pelvic floor muscle tone lacks sufficient evidence. This study is aimed at investigating the relationship between the severity of cesarean section scars and active pelvic floor muscle tone in postpartum women. We conducted a prospective cross-sectional study of 604 women at 6-8weeks postpartum. Active pelvic floor muscle tone was assessed using the Glazer protocol, and scar severity was categorized as no scar, normal scar, and hypertrophic scar. We collected data on demographic and clinical variables, including age, body mass index (BMI), and comorbidities. Linear regression analysis was employed to assess the association between scar severity and active pelvic floor muscle tone, adjusting for potential confounders. Compared with the no scar group, the normal scar group exhibited higher levels of active pelvic floor muscle tone (β = 1.68 and 1.47), and the hypertrophic scar group had the highest levels of active pelvic floor muscle tone (β = 5.09 and 5.03). Active pelvic floor muscle tone was significantly higher in women with scars than in those without scars. The association remained significant after adjusting for age, BMI, and comorbidities. Moreover, women with hypertrophic scars exhibited higher active pelvic floor muscle tone than those with normal scars. Cesarean section scar severity is positively associated with increased active pelvic floor muscle tone in postpartum women. This finding highlights the importance of scar management and targeted pelvic floor rehabilitation to optimize postpartum recovery.

Exhaled Breath Volatile Organic Compounds in Pregnancy: A Pilot Study.

This study aimed to assess the volatile organic compounds (VOC)s in breath samples collected noninvasively from pregnant women during pregnancy and postpartum and compare it with nonpregnant controls. This pilot study included 50 subjects: 10 pregnant patients in their first trimester, 10 in second trimester, 10 in third trimester, 10 in the first postpartum week, and 10 nonpregnant subjects as a control. We collected exhaled breath from subjects who reported to be healthy and free of any respiratory symptoms. Clinical and demographic data were collected. The samples were analyzed for VOCs using a selected-ion flow-tube mass spectrometer. The VOCs monitored were 22 compounds selected for their common presence in exhaled breath. During pregnancy and postpartum period, there were differences in five compounds mainly: 2-propanol, acrylonitrile, 1-nonene, 2-nonene, and hydrogen sulfide. Significant differences in VOCs were identified during each trimester compared with controls. VOCs could be measured safely and noninvasively in pregnant women. VOCs differed significantly among nonpregnant, pregnant women, and postpartum period. The utilization of this novel assay to identify fetal conditions or identifying women at risk of premature delivery, which should be further investigated in future studies. · This study demonstrated that VOCs could be measured noninvasively in exhaled breath of pregnant women.. · VOCs differed significantly among women who were nonpregnant, pregnant, and in postpartum period.. · These findings might serve as a base to look for potential markers for maternal or fetal conditions..

Association of Inpatient Postpartum Quality of Recovery With Postpartum Depression: A Prospective Observational Study

(J Clin Anesth. 2023;91:111263 I, https://doi.org/10.1016/j.jclinane.2023.111263 I) Nearly 7% to 9% of postpartum women have postpartum depression (PPD), which is a significant mood disorder. PPD can adversely influence postpartum recovery areas such as maternal-infant bonding, sleep, pain, cognitive function, and overall functionality. Suicide is a leading cause of death up to 1 year postpartum, highlighting the importance of identifying women at risk for PPD to facilitate early interventions and reduce depressive symptoms. The American College of Obstetricians and Gynecologists (ACOG) recommends routine screening, generally conducted at 6 weeks postpartum in the United States and Israel. However, about one-third of women do not attend the 6-week postpartum visit, presenting a challenge in timely identification and intervention.

Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis

Objective Postpartum depression (PPD) is a major mental health issue affecting 10%–15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine’s efficacy in preventing PPD. Methods Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4–6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability. Results A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3–0.57) and 4–6-week (RR, 0.47; 95%CI, 0.35–0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], −0.94; 95%CI, −1.26 to −0.62) and 4–6-week (SMD, −0.89; 95%CI, −1.25 to −0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence’s reliability. Subgroup analysis showed that ketamine/esketamine’s preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (<0.5 vs. ≥0.5 mg/kg). For the 4–6-week period, PPD risk was favorably reduced only with postoperative administration or the use of esketamine, with the total dosage having no observed influence. Participants on ketamine/esketamine experienced more frequency of hallucinations (RR, 4.77; 95%CI, 1.39–16.44) and dizziness (RR, 1.36; 95%CI, 1.02–1.81). Conclusion Our findings advocate for the postoperative administration of low-dose ketamine/esketamine to avert PPD, which needed additional research for confirmation.

Abstract 4147618: Modality of Research Engagement Among Postpartum Women with Hypertension and High Health-Related Social Needs

Introduction: People of color and non-English speakers are underrepresented in research and disproportionately affected by health-related social needs (HRSNs). Research engagement can be particularly challenging after pregnancy as postpartum care attendance is low. We describe our experience with remote recruitment modalities in a such a population. Methods: The study population included all patients affected by hypertension during a pregnancy who delivered at a large safety-net hospital 1/2022-6/2023. These patients also engaged in 6 weeks of remote blood pressure monitoring postpartum. Patients were contacted between 6 weeks and 12 months post-delivery to complete an online survey regarding HRSNs and provide consent to link survey data to clinical data. The recruitment protocol included initial outreach via the electronic medical record (EMR) patient portal, if available, or else a hard copy letter via mail, followed by a series of text messages then phone calls. All communication was conducted in the patient’s primary language (English, Spanish, or Haitian Creole). Results: We recruited 148 (9.4%) of 1571 patients contacted. Respondents were 51% Black, 39% Latina, 26% White. Table illustrates the comparable rate of recruitment across languages, dominance of EMR as mode of engagement and an illustration of the high rate of complex HRSN among our participants. The most effective recruitment method was EMR communication (57% of total recruitment) followed by text messages (28%). Our Haitian Creole-speaking respondents had the highest rates of HRSN - possibly representing the Haitian migrant crisis affecting Boston in this time period - as well as the highest rate of engaging via EMR messaging. Other domains of HRSN were high among all language groups including trouble affording medication (11-23%) and heating/electric access (21-34%). Conclusions: A diverse postpartum population with a high prevalence of HRSNs is hard to engage in research. Despite presumed digital barriers, EMR and secure text were effective and secure methods of online survey recruitment. Future studies seeking to understand the intersection of health outcomes and HRSNs should consider adding recruitment with EMR to common texting strategies.

How is the posterior ocular segment affected in cesarean section and normal vaginal delivery?

To evaluate the effects of normal vaginal delivery (NVD) and cesarean section (CS) on the retina, optic disc, and choroid in healthy pregnant women by using optical coherence tomography (OCT). This prospectively designed study included 60 healthy pregnant women, of whom 30 underwent NVD and 30 underwent CS. Ophthalmological examinations and OCT scans were performed on all pregnant women during the third trimester and the first postpartum week. The measurements were compared between the two visits within each group. Central retinal thickness, ganglion cell layer and inner plexiform layer (GCL + IPL) thickness, peripapillary retinal nerve fiber layer thickness, and optic disc morphology were determined using OCT scans. Central, nasal, and temporal choroidal thicknesses were manually measured using HD-line OCT. Choroidal vascular parameters were calculated from HD-line OCT scans by using a special image processing module. The ratio of the luminal choroidal area to the total choroidal area was determined as the choroidal vascular index (CVI). In the NVD group, the thinning in the mean and inferior pRNLF, the decrease in the rim area, and the increase in the mean cup/disc and cup volume at the first postpartum week were found to be statistically significant (P < 0.05). In the same group, the CVI was calculated as 0.69 ± 0.02 in the third trimester and 0.66 ± 0.03 in the first postpartum week (P = 0.001). In the CS group, except for the increase in the GCL + IPL thickness, no significant difference was detected in the measurements of the retina, optic disc, and choroid (P < 0.001 and P > 0.05). This is the first study to evaluate the effect of the delivery method on the retina, choroid, and optic disc. In NVD, changes in the choroidal vascular structure and optic disc morphology can be observed in the early postpartum period, which may be attributed to hormonal effects.

Gestational diabetes mellitus – Can we do better with postpartum diabetes screening?

ObjectiveThis study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24–48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6–12-week postpartum oral glucose tolerance test (OGTT). Study designA retrospective cohort study (2012–2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24–28 h postpartum and underwent a 6–12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results. ResultsAmong 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24–48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6–12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance. DiscussionImmediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.

Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study.

This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach. In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6weeks postpartum for 3 to 6months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6weeks, 6months and 12months postpartum and were divided, by their own choice, into users and non-users of the pessary. Initially 857 women were enrolled. After 6weeks 137 pessary users and 133 non-users, after 12months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6weeks postpartum. At 12months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6weeks to 12months postpartum, among pessary users compared to non-users. Pessary users had a significantly greater improvement in pelvic floor function from 6weeks to 12months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group. The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.

"I managed to stand on my own. I saved my baby's life.": qualitative analysis of birth experiences from women living with HIV in Cape Town, South Africa.

There is growing recognition of obstetric violence in health facilities across the globe. With nearly one in three pregnant women living with HIV in South Africa, it is important to consider the influence of HIV status on birth experiences, including potential experience of obstetric violence as defined by the Respectful Maternity Care Charter. This qualitative analysis aims to understand the factors that shape birth experiences of women living with HIV, including experiences at the nexus of HIV status and obstetric violence, and how women react to these factors. Data were collected in a Midwife Obstetric Unit in Gugulethu, Cape Town, South Africa, through 26 in-depth interviews with women living with HIV at 6-8weeks postpartum. Interviews included questions about labor and early motherhood, ART adherence, and social contexts. We combined template style thematic analysis and matrix analysis to refine themes and subthemes. Participants described a range of social and structural factors they felt influenced their birth experiences, including lack of resources and institutional policies. While some participants described positive interactions with healthcare providers, several described instances of obstetric violence, including being ignored and denied care. Nearly all participants, even those who described instances of obstetric violence, described themselves as strong and independent during their birth experiences. Participants reacted to birth experiences by shifting their family planning intentions, forming attitudes toward the health facility, and taking responsibility for their own and their babies' safety during birth. Narratives of negative birth experiences among some women living with HIV reveal a constellation of factors that produce obstetric violence, reflective of social hierarchies and networks of power relations. Participant accounts indicate the need for future research explicitly examining how structural vulnerability shapes birth experiences for women living with HIV in South Africa. These birth stories should also guide future intervention and advocacy work, sparking initiatives to advance compassionate maternity care across health facilities in South Africa, with relevance for other comparable settings.

Peripartum depression symptom trajectories, telomere length and genotype, and adverse childhood experiences

BackgroundAs a biological marker for cellular senescence, telomere length (TL) has been linked to a variety of psychiatric disorders and adverse childhood experiences (ACE), though only preliminarily to peripartum depression (PPD). The present study sought to examine the association between TL and PPD, assessing the moderating role of ACE and genetic polymorphic variations related with the telomere machinery.MethodsAdversity was self-reported, likewise were depressive symptoms evaluated at pregnancy week 17 and 32, as well as six-weeks and six-months postpartum. TL was assessed by use of qPCR in blood samples collected during delivery from females with antenatal depression resolving postpartum, females with depression persisting to postpartum, and healthy controls. Twenty haplotype-tagging Single Nucleotide Polymorphisms in the Telomerase Reverse Transcriptase (TERT) and three in the Telomerase RNA Component (TERC) genes were genotyped.ResultsTL was negatively correlated with severity of PPD symptoms at pregnancy week 32 and postpartum week 6. PPD was associated with shorter TL. Lastly, ACE, but not the TERT/TERC genotype, moderated the TL-trajectory association; with increasing ACE, individuals with persistent PPD symptoms had shorter TL, whereas the opposite pattern (longer TL) was observed in the controls.ConclusionsThe findings contribute to further understanding of PPD underpinnings, suggesting a negative relationship with TL.

Application of time series analysis in predicting postpartum depression: integrating data from the hospitalization period and early postpartum weeks.

This study aimed to explore the dynamic changes in postpartum depressive symptoms from the hospitalization period to 4-8 weeks postpartum using time series analysis techniques. By integrating depressive scores from the hospital stay and the early postpartum weeks, we sought to develop a predictive model to enhance early identification and intervention strategies for Postpartum Depression (PPD). A longitudinal design was employed, analyzing Edinburgh Postnatal Depression Scale (EPDS) scores from 1,287 postpartum women during hospitalization and at 4, 6, and 8 weeks postpartum. Descriptive statistics summarized demographic characteristics. Time Series Analysis using the Auto-Regressive Integrated Moving Average (ARIMA) model explored temporal trends and seasonal variations in EPDS scores. Correlation analysis examined the relationships between EPDS scores and demographic characteristics. Model validation was conducted using a separate dataset. EPDS scores significantly increased from the hospitalization period to 4-8 weeks postpartum (p < .001). The ARIMA model revealed seasonal and trend variations, with higher depressive scores in the winter months. The model's fit indices (AIC = 765.47; BIC = 774.58) indicated a good fit. The Moving Average (MA) coefficient was - 0.69 (p < .001), suggesting significant negative impacts from previous periods' errors. Monitoring postpartum depressive symptoms dynamically was crucial, particularly during the 4-8 weeks postpartum. The seasonal trend of higher depressive scores in winter underscored the need for tailored interventions. Further research using longitudinal and multi-center designs was warranted to validate and extend these findings. Our predictive model aimed to enhance early identification and intervention strategies, contributing to better maternal and infant health outcomes.

Accessing Trauma- and Violence-Informed Breastfeeding Support from Primary Care Providers among Women with Histories of Intimate Partner Violence: An Exploratory Interpretive Description Study.

Intimate partner violence (IPV) is a wicked social problem affecting women of all social strata and geographical location, globally. Pregnancy may be a time of heightened risk of IPV and more deleterious outcomes. Breastfeeding - a protective factor for maternal and child well-being - may be jeopardized or more challenging for women experiencing IPV. This study explored the experiences of postpartum women with histories of IPV who sought trauma- and violence-informed breastfeeding support from primary care providers. Using interpretive description and philosophically underpinned by intersectionality, in-depth semi-structured interviews were completed at 12-weeks postpartum with five breastfeeding mothers with a history of IPV who sought breastfeeding support from a family physician clinic employing a trauma- and violence-informed (TVIC) model of care. Four themes and two sub-themes shed light onto the experience of accessing breastfeeding support for women with a history of IPV and the perceived barriers that they faced when attempting to accesses this support, including: 1) The (demoralizing) navigation of the perinatal system; 2) Fostering trust: i) "It's support, but it's also knowledge"; and ii) TVIC: feeling safe and feeling "I mattered"; 3) Informal support: partners, family, and friends; and 4) Baby in focus: overcoming challenges and building confidence. TVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeeding education and care among women is required.

Markers of Maternal Bone and Renal Toxicity Through 50 Weeks Postpartum: IMPAACT 2010 (VESTED) Trial.

Safety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). A subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared. Six hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up. Markers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/TDF in pregnancy.

Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control.

To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy. This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher). Study outcomes were BP control below 140/90 mm Hg (primary) and medication nonadherence based on a composite score threshold (secondary) at the 6-week postpartum follow-up visit. Participants without follow-up BP measurements were excluded from analysis of the BP control outcome. Participants without health care professional-prescribed antihypertensives at delivery were excluded from the analysis of the adherence outcome. Multivariable logistic regression was used to adjust for potential confounders. Of 2,408 participants, 1,684 (864 active, 820 control) were included in the analysis. A greater percentage of participants in the active group achieved BP control (56.7% vs 51.5%; adjusted odds ratio [aOR] 1.22, 95% CI, 1.00-1.48) than in the control group. Postpartum antihypertensive prescription was higher in the active group (81.7% vs 58.4%, P <.001), and nonadherence did not differ significantly between groups (aOR 0.81, 95% CI, 0.64-1.03). Antihypertensive treatment of mild chronic hypertension during pregnancy was associated with better BP control below 140/90 mm Hg in the immediate postpartum period.

Postpartum Emergency Care Visits Among North Carolina Medicaid Beneficiaries, 2013-2019.

Objective: To describe the rate, timing, and primary diagnosis codes for emergency care visits up to 8 weeks (56 days) after live birth among Medicaid beneficiaries in North Carolina (NC). Materials and Methods: Using a linked dataset of Medicaid hospital claims and certificates of live birth, which included Medicaid beneficiaries who had a live-born infant in NC between January 1, 2013, and November 4, 2019, and met inclusion criteria (n = 321,879), we estimated week-specific visit rates for emergency care visits that did not result in hospital admission (outpatient) and those that did (inpatient). We assessed the 10 leading diagnosis code categories for emergency care visits and described the characteristics of people with 0, 1, or ≥2 outpatient emergency care visits. Results: One in eight (12.4%) Medicaid beneficiaries had an emergency care visit that did not result in inpatient hospital admission during the first 8 weeks postpartum. Visit rates peaked in postpartum week 2. Diagnosis codes for nonspecific symptoms and substance use were the two leading diagnosis code categories for outpatient emergency care visits. Respiratory concerns and gastrointestinal concerns were the two leading diagnosis code categories for inpatient emergency care visits. Compared with those with zero outpatient emergency care visits, a greater proportion of people with ≥2 visits had less than a high school education, used tobacco during pregnancy, had Medicaid insurance outside of pregnancy, had mental health as a medical comorbidity, and/or had ≥2 medical comorbidities. Conclusions: These findings support scheduling health care visits early in the postpartum period, when emergency care visits are most frequent, and point to unmet needs for substance use support.

Evaluation of pharmacokinetics of Tenofovir Alafenamide (TAF) and Tenofovir Disoproxil (TDF) in pregnant and postpartum women in South Africa: PrEP-PP PK study

BackgroundThere are few data on tenofovir-diphosphate (TFV-DP) concentrations in pregnant and postpartum women on Tenofovir Disoproxil Fumarate-Emtricitabine (TDF-FTC) or Tenofovir Alafenamide-Emtricitabine (TAF-FTC). MethodsEligible pregnant women were randomized to TDF-FTC or TAF-FTC and followed for 16 weeks (8-weeks pregnant, 8-weeks postpartum) with weekly collection of dried blood spot (DBS) and 4-weekly peripheral blood mononuclear cells (PBMC). PrEP dosing was observed daily via asynchronous videos sent via cell phone. We report geometric means (GM) and their ratios (GMR) with 95% confidence intervals (CIs) for TFV-DP in PBMC and DBS from pregnancy and postpartum. ResultsWe enrolled N = 39 participants (n = 19 TDF-FTC, n = 20 TAF-FTC): median age was 28 years (IQR:25–34); median gestational age was 24-weeks (IQR:21–28). For TDF-FTC, TFV-DP DBS concentrations at 8-weeks did not differ significantly between pregnancy (GM: 675; 95%CI:537–849) and postpartum (GM: 583; 95%CI:471–722; GMR-TDF = 1.16; 95%CI:0.74–1.80). For TAF-FTC, TFV-DP DBS concentrations at 8-weeks were 44% higher in postpartum (GM: 1199; 95%CI:929–1549) versus pregnancy (GM: 832; 95%CI:751–922; GMR-TAF = 1.44; 95% CI: 1.01–2.06). In PBMC analysis of TDF-FTC, 8-week median TFV-DP (pmol/10^6 cell) was 71 (IQR 44–112) in pregnancy and 73 (IQR 50–102) in postpartum (GMR = 1.04; 95%CI:0.44–2.44). In TAF-FTC, median PBMC at 8-weeks was 580 (IQR:341–985) in pregnancy and 666 (IQR:396–1123) in postpartum (GMR = 1.15; 95%CI:0.30–2.49). ConclusionTFV-DP concentrations were overall lower during pregnancy than postpartum for TAF-FTC. We found high concentrations of TFV-DP in PBMC in pregnancy and postpartum on TAF-FTC, suggesting PrEP efficacy is maintained. Efficacy and safety studies are warranted to evaluate TAF-FTC for PrEP in pregnant and postpartum women.

Effects of a single oral dose of azithromycin in laboring women on antimicrobial resistance (AMR) and the microbiome: a protocol for the Antimicrobial Resistance Sub-Study of the A-PLUS trial

Background The Azithromycin Prevention in Labor Use Study (A-PLUS), a large, multi-national randomized trial, was performed to evaluate the improvement of maternal and newborn outcomes following a single dose of azithromycin (AZ) given during labor. However, the immediate and long-term impact of this single dose on the microbiome and the development or prevalence of antimicrobial resistance are unknown. We designed a sub-study to assess AZ resistance of bacterial isolates from clinical infections and of three target bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli) from the serial surveillance of the nasopharynx and rectum. Additionally, the serially surveilled samples will be evaluated for changes to the microbiome and the resistome of the nasopharynx and rectum. Methods and Analysis As part of the large, randomized APLUS trial, maternal and neonatal clinical infections were monitored for up to 42 days postpartum, and samples collected for culture using site-specific routine methods. For this sub-study, cultured bacterial isolates will be assessed for AZ resistance using an antibiotic susceptibility method. Additionally, a random subset of maternal-neonatal dyads from the main trial will be selected for serial surveillance with aseptic swab collections of the nasopharynx and the rectum at baseline, and subsequently at 1-week, 6-weeks, 3-months, 6-months, and 12-months postpartum. The serial samples will undergo selective culturing of sentinel bacterial species and screened for AZ resistance. An additional set of serial samples will be stored for future microbiome and resistome analyses. Ethics and Dissemination The study protocol was reviewed, and ethics approval obtained from all the relevant ethical review boards at each research site. All participants will provide informed written consent prior to their enrollment. Results of the trial will be disseminated through peer-reviewed publications, presentations at relevant conferences, and at dissemination meetings with the ministries of health and local stakeholders at each research site. Trial Registration NCT03871491.

The effect of an educational video on the immediate insertion of postpartum contraceptive implants: A randomized controlled trial.

To assess the impact of an educational video on immediate postpartum contraceptive implant utilization. This was a randomized controlled study conducted in a university hospital. Postpartum women aged over 18 years were recruited and divided into two groups: the intervention group, which viewed a 7-min educational video about contraceptive implants; and the control group, which did not. We evaluated the uptake of contraceptive implants immediately and during a 12-week period postpartum, in addition to the reasons for not selecting this method. A total of 202 participants were included in the study, 101 in each group. Viewing the educational video was associated with higher immediate postpartum contraceptive implant usage (22.77% vs 10.89%; relative risk [RR] 2.09, 95% confidence interval [CI] 1.08-4.06). However, no significant difference was observed at the postpartum follow-up visit (29.9% vs 25.74%; RR 1.61, 95% CI 0.74-1.82). The primary reasons for not selecting contraceptive implants were concerns about potential side effects and discomfort associated with the insertion procedure. The inclusion of an animated educational video significantly improved immediate postpartum contraceptive implant uptake, making it a potentially viable strategy in settings with high rates of loss to follow-up. However, further research into how to address patients' fears regarding the implant is required.

Investigation of the Postpartum Depression Levels at the 6th Postpartum Week of Mothers Who Gave Birth in One of the Eastern Provinces of Türkiye

Aim: The aim of this study is to investigate postpartum depression (PPD) levels in postpartum women living in rural areas. Material and Method: The study was carried out between 10.11.2022 and 10.11.2023 at a Training and Research Hospital in Ağrı province. The study was designed as a cross-sectional study and was conducted with 337 participants. In the study, the Data Collection Form and the Edinburgh Postpartum Depression Scale (EPDS) were used. Results: In the study, the mean Edinburgh Postpartum Depression Scale (EPDS) score was found to be 11.51 ± 4.77 (min-max: 1-25). Age groups, place of residence, income and expense status, educational status, spouse's education status and mother's employment status, planned pregnancy status, number of pregnancies, number of stillbirths/miscarriages, postpartum weight, violence during pregnancy and presence of social support, starting work after birth. It was determined that there was a relationship between the time of birth, the time of holding the baby after birth, complications developing in the baby and the mother, and the scale score averages (p