Maternal Postpartum Research Articles

Mother-child bond and its relationship with maternal postpartum depression

ABSTRACT Background The mother-child bond may be related to maternal health, especially postpartum depression (PPD). Existing studies show the need for further in-depth research on the subject. Aim To determine the relationship between bonding and the probability of the development and presence of PPD in women with a biological child between 6 weeks and 18 months of age. Methods A cross-sectional study was conducted. A questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn, a questionnaire measuring the mother-child bond (VAMF-bond), and the Edinburgh Postpartum Depression Scale (EDPS) were administered. Results 1114 women participated. The association between the items of the VAMF-bond subscale and the risk of PPD was statistically significant for all items (p < 0.05), except items 4 and 10. The multivariate analysis showed that the risk of PPD (EPDS scale) was lower in women with higher scores on bond (Adjusted Odds Ratio: aOR = 0.85; 95%CI: 0.81, 0.88), whose birth experience was good or very good (aOR = 0.57; 95%CI: 0.36, 0.89), who received high or very high support from their partner (aOR = 0.34; 95%CI: 0.18, 0.66), and family (aOR = 0.53; 95%CI: 0.32, 0.86). The presence of PPD was less frequent in women who presented higher scores for bond (aOR = 0.90; 95%CI: 0.84, 0.97), who had skin-to-skin contact (aOR = 0.39; 95%CI: 0.17, 0.93) and who received high or very high support from the family (aOR = 0.36; 95%CI: 0.12, 1.04). Conclusions High scores on the subscale VAMF-bond were associated with a lower risk of PPD.

Father Support, Postpartum Depression, and Breastfeeding Weaning Time: A Structural Equation Model

Background: Fathers play a crucial role in family well-being beyond financial support, positively influencing the health of both mothers and infants through involvement in childcare, prenatal care, and emotional support during pregnancy and childbirth. However, research on the long-term effects of father involvement in during prenatal and its postpartum outcome, particularly in Indonesia, is limited.Purpose: This study aimed to measure the direct and indirect effects of father support throughout pregnancy on postpartum depression and breastfeeding weaning time, by considering potential mediating pathways and controlling for relevant sociodemographic variables.Methods: Prospective observational techniques were employed from January to July 2021, involving 648 consecutively selected mothers attending antenatal care in seven health clinics in Makassar. Data collection included meticulous adherence to protocols covering sociodemographic factors, father support, and breastfeeding weaning time. Father support was assessed with the Father Support During Pregnancy questionnaire, administered three times with a 72-hour interval. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale, while breastfeeding weaning time was quantified in weeks. Analysis included Spearman's correlation and SEM using SPSS and SPSS Amos.Result: The study identified negative correlations between maternal breastfeeding weaning time and postpartum depression (r=-0.183, p&lt;0.01), and positive correlations with father support (r=0.148, p&lt;0.01), parity (r=-0.269, p&lt;0.01), and marital age (r=0.187, p&lt;0.01). In the standardized model showed a marginal rise in the overall influence of father support, parity, and marital age on breastfeeding weaning time (0.256, 0.016, and 0.123, respectively). Father support emerged as the primary contributor to postpartum depression, inversely impacting breastfeeding duration. Higher father support correlated with lower maternal depression scores, and longer.Conclusion: This study highlights the role of father support in reducing the impact of postpartum depression on breastfeeding duration. Nurses can contribute by participating in interdisciplinary research and advocating for comprehensive assessment approaches.

Infant neural sensitivity to affective touch is associated with maternal postpartum depression

Classic attachment theory emphasizes the sensitivity of the parent to perceive and appropriately respond to the infant’s cues. However, parent-child attachment is a dyadic interaction that is also dependent upon the sensitivity of the child to the early caregiving environment. Individual differences in infant sensitivity to parental cues is likely shaped by both the early caregiving environment as well as the infant’s neurobiology, such as perceptual sensitivity to social stimuli. Here, we investigated associations between maternal postpartum depression and infant neurological sensitivity to affective touch using brain signal entropy – a metric of the brain’s moment-to-moment variability related to signal processing. We recruited two independent samples of infants aged 0–5 months. In Sample 1 (n = 79), we found increased levels of maternal postpartum depression were associated with diminished perceptual sensitivity – i.e. lower entropy – to affective tactile stimulation specifically within the primary somatosensory cortex. In Sample 2 (n = 36), we replicated this finding and showed that this effect was not related to characteristics of the touch administered during the experiment. These results suggest that decreased affective touch early in life – a common consequence of postpartum depression – likely impacts the infant’s perceptual sensitivity to affective touch and ultimately the formation of experience-dependent neural networks that support the successful formation of attachment relationships.

Effect of health education combined with biofeedback electrical stimulation on early pelvic floor function and psychology: A retrospective study.

To investigate the effects of health education combined with biofeedback electrical stimulation on maternal postpartum pelvic floor function and psychology. The clinical data of 80 patients with postpartum pelvic floor dysfunction (PFD) from May 2020 to May 2022 were selected as retrospective study subjects, and 40 cases were divided into the comparison group and the observation group according to the different intervention methods. Among them, the comparison group implemented biofeedback electrical stimulation and guidance, and the observation group implemented Greene health education and Kegel pelvic floor rehabilitation training intervention based on the comparison group. The differences in pelvic floor muscle strength, sexual quality of life, anxiety, and depression in the 2 groups with postpartum PFD were compared. Comparison of pelvic floor muscle strength: before the intervention (P > .05) and after the intervention, the anterior resting mean electromyography (EMG), slow muscle mean EMG, fast muscle maximum EMG, and mixed muscle mean EMG values of patients in the observation group were higher than those in the comparison group, and the posterior resting mean EMG values were lower than those in the comparison group (P < .05). There was no statistically significant difference in the Hospital Anxiety and Depression Scale (HADS) scores and anxiety and depression subscale scores between the 2 groups of patients before intervention (P > .05). After the intervention, the HADS scores and anxiety and depression subscale scores were lower than those before the intervention in both groups, and the differences were statistically significant in the intervention group than in the comparison group (P < .05). There was no statistically significant difference between The Chinese Female Sexual Life Quality Questionnaire scores of both groups before the intervention (P > .05). Sexual desire, vaginal lubrication, sexual arousal, sexual satisfaction, orgasm, and painful intercourse improved in both groups after the intervention, and the scores in the intervention group were higher than those in the comparison group (P < .05). Health education combined with biofeedback electrical stimulation can effectively improve the quality of patients' sexual life, improve the pelvic floor muscle strength of patients with postpartum PFD, enhance patients' confidence, reduce patients' anxiety and depression, and effectively improve patients' psychological status.

Hair cortisol concentrations across pregnancy and maternal postpartum depressive symptoms - The ELFE cohort

Postpartum depression and depressive symptoms have a major impact on maternal and infant health and well-being, yet to date their aetiology remains unclear. One hypothesis suggests a link between these symptoms and variations in prenatal cortisol levels, but existing evidence is limited and inconclusive. This study aims to provide additional evidence to disentangle the relationship between prenatal cortisol concentrations and subsequent occurrence of postpartum depressive symptoms. Cortisol for all three trimesters of pregnancy was extracted from the hair of 775 women participating in the French ELFE cohort. Depressive symptomatology at two months postpartum was assessed through the Edinburgh Postpartum Depression Scale (EPDS). Associations between prenatal cortisol levels and EPDS scores were tested using propensity-score weighted logistic regression models to control for confounders. An increase in mean cortisol concentrations was observed from the first to the third trimester of pregnancy.No significant differences in hair cortisol concentrations were found during the first and second trimesters between women who experienced postpartum depressive symptoms and those who did not. However, an association was observed between third trimester hair cortisol concentrations and depressive symptoms at two months postpartum. Women whose cortisol concentrations fell within the second quartile had a higher risk of subsequent PPDS (aOR = 2.67, 95%CI [1.01, 7.08]).Using a large sample from the general population, we observed an association between hair cortisol levels during the third trimester of pregnancy and postpartum depressive symptoms. Nevertheless, our results suggest that future studies could benefit from investigating other biomarkers of the reactivity of the corticotropic axis.

The Effect of Virtual Patient Visits in the Intensive Care Unit on Postpartum Depression.

Maternal postpartum depression negatively affects the baby's emotional, behavioral, and cognitive development and attachment pattern. We aimed to examine the effect of virtual patient visits in neonatal intensive care unit on postpartum depression in mothers. Research data were obtained from mothers whose preterm infants were hospitalized in the neonatal intensive care unit between April and December 2022. A total of 100 mothers of preterm infants (50 in the virtual patient visit and 50 in the control group) treated in the neonatal intensive care unit of a hospital constituted the sample of the study. Using the Zoom application, virtual patient visits were made for 5 minutes, seven days a week, between mother and the preterm infants, with no nursing intervention implemented for at least 30 minutes. Mothers in the control group saw their babies face to face two days a week. In standard hospital procedure, mothers saw their babies twice a week. Edinburgh postpartum depression scale (EPDS) was administered online to the all mothers before and after the study. The research resulted with statistically significant decreased EPDS scores of the mothers in virtual patient visit group with the pre-study scores. A statistically significant decrease was found compared to the control group (P<0.001). Virtual patient visits between preterm infants in neonatal intensive care unit and their mothers could be effective in preventing or reducing postpartum depression of the mother.

Relationship between maternal postpartum depression, fatigue, sleep quality and infant growth: A cross-sectional study.

Current research separately analyzed the connection between postpartum depression, fatigue, sleep and infant development. However, depression, fatigue and sleep quality often coexisted as adverse symptoms in postpartum women and influenced infant development together. This study explored the maternal postpartum symptoms on infant growth. Our study included 224 pairs of singleton full-term mothers and their infants who underwent routine pediatric outpatient clinics. Latent profile analysis was applied to identify the latent classes based on mothers' postpartum depression, fatigue and sleep profile characteristics. We evaluated the maternal adverse symptoms and infant development using multivariable logistic regressions. Totally, 224 pairs of eligible mothers (28.85 ± 4.43 years) and infants (30.93 ± 3.26 days) participated in this study. Latent profile analysis identified 3 latent groups: mild (58.04%), moderate (34.37%), and severe (7.59%) postpartum adverse symptoms. Postpartum adverse symptoms were associated with delayed development in the baby's motor level (χ2 = 6.572, p = .037) and weight-for-length (χ2 = 9.652, p = .008). After controlling for mother and infant related factors, postpartum adverse symptoms remained a risk factor for infant motor level (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.25-15.08) and weight-for-length (OR: 5.53; 95% CI: 1.55-19.74). Maternal postpartum depression, fatigue and sleep quality are associated with infant development. Clinically, mothers with these symptoms should be intervened timely to avoid the aggravation of maternal symptoms, which affect baby's development.

Infant neural sensitivity to affective touch is associated with maternal postpartum depression.

Classic attachment theory emphasizes the sensitivity of the parent to perceive and appropriately respond to the infant's cues. However, parent-child attachment is a dyadic interaction that is also dependent upon the sensitivity of the child to the early caregiving environment. Individual differences in infant sensitivity to parental cues is likely shaped by both the early caregiving environment as well as the infant's neurobiology, such as perceptual sensitivity to social stimuli. Here, we investigated associations between maternal postpartum depression and infant neurological sensitivity to affective touch using brain signal entropy - a metric of the brain's moment-to-moment variability related to signal processing. We recruited two independent samples of infants aged 0-5 months. In Sample 1 (n=79), we found increased levels of maternal postpartum depression were associated with diminished perceptual sensitivity - i.e. lower entropy - to affective tactile stimulation specifically within the primary somatosensory cortex. In Sample 2 (n=36), we replicated this finding and showed that this effect was not related to characteristics of the touch administered during the experiment. These results suggest that decreased affective touch early in life - a common consequence of postpartum depression - likely impacts the infant's perceptual sensitivity to affective touch and ultimately the formation of experience-dependent neural networks that support the successful formation of attachment relationships.

The impact of antenatal cluster management on maternal delivery and postpartum rehabilitation

ObjectivePregnancy care can improve maternal pregnancy outcomes. Cluster nursing, an evidence-based, patient-centered model, enhances pregnancy care, can provide patients with high-quality nursing services, has been widely used in clinical practice in recent years. However, most previous studies evaluated cluster nursing program only for a single clinical scenario. In this study, we developed and implemented a antenatal cluster care program for various prenatal issues faced by puerpera to analyze its application effect.MethodsThis is a historical before and after control study. 89 expectant mothers who had their prenatal information files registered in the outpatient department of a grade III, level A hospital from June 2020 to September 2021 were finally enrolled in observation group, and received prenatal cluster management. Another set of 89 expectant mothers from January 2019 to December 2019 were included in the control group and received traditional routine prenatal management. The effect of cluster nursing management on maternal delivery and postpartum rehabilitation was evaluated and compared between the two groups.ResultsCompared with the control group, the observation group had a significantly higher natural delivery rate, better neonatal prognosis, higher rates of exclusive breastfeeding, lower incidence of postpartum complications, shorter postpartum hospital stay, better postpartum health status, and higher satisfaction with nursing services. Compared with before intervention, the SAS and SDS scores of the observation group showed significant improvement after intervention.ConclusionAntenatal cluster care is beneficial to improve maternal and neonatal outcomes, and can have positive effects on natural pregnancy and breastfeeding, while improving the multimedia health education ability of medical care and emphasizing the importance of social support.

Hydroxychloroquine and Pre-eclampsia in a Diverse Cohort of Women With Systemic Lupus Erythematosus.

Patients with systemic lupus erythematosus (SLE) are at risk for pregnancy complications such as pre-eclampsia and eclampsia. These clinically important complications are associated with maternal morbidity, mortality, and postpartum cardiovascular disease. Some studies suggest that hydroxychloroquine (HCQ) may reduce pre-eclampsia risk in lupus pregnancy. Using a cohort of pregnant patients with prevalent SLE at Kaiser Permanente Northern California (KPNC), we investigated whether HCQ treatment in early pregnancy reduced the risk of pre-eclampsia or eclampsia. Among pregnant patients with SLE from 2011 to 2020, we assessed HCQ treatment from three months before pregnancy through the first trimester. HCQ exposure was defined multiple ways to account for adherence and duration of treatment. Propensity scores accounted for multiple confounders and modified Poisson models estimated risk ratios (RRs) and 95% confidence intervals of the association between HCQ treatment and pre-eclampsia or eclampsia. Effect modification by pregestational hypertension, history of nephritis, and antiphospholipid antibody (aPL) status was investigated through stratified analysis. There were 399 pregnancies among 324 patients with SLE at KPNC between 2011 and 2020. Considering multiple exposure definitions, we consistently found a null association between HCQ and pre-eclampsia or eclampsia. The RRs were consistently lower among nullipara patients, and RRs were consistently protective but not statistically significant among the high-risk subgroup of patients with a history of nephritis, aPL positivity, or pregestational hypertension (for both nullipara and multipara patients). Although this study found no reduced risk of HCQ on pre-eclampsia or eclampsia, residual confounding may be attenuating the effect despite an integrated health care delivery system setting with detailed clinical data.

Research Trends in Postpartum Post-Taumatic Stress Disorder Among High-Risk Pregnancies: A CiteSpace Bibliometric Analysis

Background: High-risk pregnancies are associated with increased complications that can jeopardize maternal and fetal health, leading to adverse outcomes such as intrauterine growth restriction and preterm labor. Postpartum psychiatric challenges, including postpartum depression and post-traumatic stress disorder (PTSD), often emerge due to hormonal shifts and physical trauma during childbirth. Previous research indicates that postpartum PTSD is more prevalent among high-risk pregnancy populations, yet the field lacks centralization. Methods: This study utilized CiteSpace software to analyze 175 relevant publications on postpartum PTSD in high-risk pregnancies retrieved from the Web of Science Core Collection (2004–2024). A systematic literature review, employing a Boolean search strategy, ensured comprehensive data collection. The analysis included citation patterns, keyword co-occurrence, and clustering to identify key trends and emerging research areas. Results: Findings revealed a marked increase in research output, particularly from 2019 onward, with the United States leading in publication volume and centrality. High-frequency keywords included "posttraumatic stress disorder," "postpartum depression," and "risk factors," indicating primary focus areas in this domain. Cluster analysis identified eight thematic areas, with significant attention on factors influencing PP-PTSD, clinical symptoms, and prevention strategies. Keyword emergence maps highlighted evolving interests, particularly the impact of adverse childhood experiences and traumatic childbirth. Conclusion: The study underscores the urgent need for targeted mental health interventions for women with high-risk pregnancies, as these populations are particularly susceptible to postpartum PTSD. Continued research into risk factors and the development of predictive models is essential for improving maternal mental health care, ensuring that interventions are tailored to the specific needs of this vulnerable group. Enhanced understanding of the interplay between maternal health and postpartum outcomes is critical for optimizing care strategies.

Prevalence and Determinants of Exclusive Breastfeeding Among Mothers of Children Aged 6-24 Months in the Aseer Region.

Background Exclusive breastfeeding (EBF) is crucial for infant and maternal health, providing optimal nutrition and immune protection for infants while reducing maternal postpartum depression and cancer risk. However, global trends show an early cessation of breastfeeding and the introduction of other foods. This study aims to determine the prevalence and factors influencing EBF among mothers in the Aseer region of Saudi Arabia. Methodology A cross-sectional study using a multistage cluster sampling approach was conducted from January to March 2024 in primary healthcare centers across the Aseer region. Participants included mothers of children aged 6-24 months attending primary healthcare centers for immunizations or routine check-ups. A pretested structured questionnaire, developed after an extensive literature review and expert consultation, was used to interview consenting participants. The questionnaire covered sociodemographic data, obstetric and medical history, child data, EBF practices, maternal knowledge and perception of breastfeeding, counseling about breastfeeding, antenatal care, breastfeeding support, and barriers and motivators of EBF. Results A total of 1,008 eligible mothers were included. Only 131 (13%) fulfilled the World Health Organization criteria for EBF. Moreover, 257 (25.5%) mothers initiated breastfeeding within the first hour after delivery, and 387 (38.4%) exclusively breastfed for six months or more. EBF was less frequent among mothers with higher education (8%, n = 2) compared to those with lower education (23%, n = 23, p = 0.017). EBF was also less frequent among mothers who delivered via cesarean section (7.9%, n = 28) compared to those who had a vaginal delivery (15.8%, n = 103, p = 0.001). Conversely, EBF was more common among mothers with more than five pregnancies (15.8%, n = 45) compared to those with one to two pregnancies (9.4%, n = 37, p = 0.023). EBF was also more common among mothers who had breastfed more than four children (16.7%, n = 39) compared to those who had not (12.1%, n = 49, p = 0.048). Finally, EBF was more common among mothers without postpartum complications (13.4%, n = 131) or whose infants had no birth complications (13.4%, n = 128) compared to their respective counterparts (p = 0.029 and p = 0.048, respectively). Conclusions This study found a low prevalence of EBF in the Aseer region, despite high maternal knowledge and positive perceptions. Factors such as low education, medical barriers, unemployment, and high parity were associated with increased EBF rates. Interventions should focus on improving workplace support and increasing maternal awareness of EBF recommendations.

Stability and change in maternal wellbeing and illbeing from pregnancy to three years postpartum

PurposeMotherhood affects women’s mental health, encompassing aspects of both wellbeing and illbeing. This study investigated stability and change in wellbeing (i.e., relationship satisfaction and positive affect) and illbeing (i.e., depressive and anxiety symptoms) from pregnancy to three years postpartum. We further investigated the mutual and dynamic relations between these constructs over time and the role of genetic propensities in their time-invariant stability.Data and methodsThis four-wave longitudinal study included 83,124 women from the Norwegian Mother, Father, and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. Data were collected during pregnancy (30 weeks) and at 6, 18 and 36 months postpartum. Wellbeing and illbeing were based on the Relationship Satisfaction Scale, the Differential Emotions Scale and Hopkins Symptoms Checklist-8. Genetics were measured by the wellbeing spectrum polygenic index. Analyses were based on random intercept cross-lagged panel models using R.ResultsAll four outcomes showed high stability and were mutually interconnected over time, with abundant cross-lagged predictions. The period of greatest instability was from pregnancy to 6 months postpartum, followed by increasing stability. Prenatal relationship satisfaction played a crucial role in maternal mental health postpartum. Women’s genetic propensity to wellbeing contributed to time-invariant stability of all four constructs.ConclusionUnderstanding the mutual relationship between different aspects of wellbeing and illbeing allows for identifying potential targets for health promotion interventions. Time-invariant stability was partially explained by genetics. Maternal wellbeing and illbeing develop in an interdependent way from pregnancy to 36 months postpartum.

Effects of improved on-farm crop storage on DNA methylation of mothers and their infants: evidence from a randomized controlled trial in Kenya

BackgroundStress during pregnancy can lead to adverse maternal and infant health outcomes through epigenetic changes in the hypothalamic–pituitary–adrenal axis. Among farmers in low-income countries, one important stressor is food insecurity, which can be reduced using hermetic storage bags. This study aimed to determine, for the first time, whether a hermetic storage bag intervention during pregnancy positively affects maternal and infant DNA methylation of the hypothalamic–pituitary–adrenal axis-related genes FKBP5 and NR3C1. We further analyzed whether anthropometrics, stress, and mental health were associated with DNA methylation.MethodsThis study was part of a larger matched-pair randomized controlled trial focusing on the impact of improved on-farm storage on food security, poverty, and net income of smallholder farming households. A total of N = 149 mothers were recruited by telephone and invited to attend a study appointment at health facilities in Kakamega County, Western Kenya, with their infants in April or May 2021. During the appointment, anthropometric measurements were taken, questionnaires on stress and mental health were administered, and saliva samples were collected. Logistic and multiple linear regression were used to examine the effect of the intervention and related measures on DNA methylation.ResultsMothers in the intervention group showed higher mean NR3C1 methylation levels than those in the control group, corrected for multiple testing. Maternal postpartum body mass index was positively associated with infant NR3C1 CpG3 DNA methylation. The more stressful life events a mother had experienced in the previous 12 months (including during pregnancy), the lower her FKBP5 CpG3 methylation levels.ConclusionsFood insecurity and stressful life events during pregnancy seem to exert significant effects on maternal DNA methylation. While these stressors did not appear to impact infant DNA methylation in the present study, maternal postpartum body mass index was significantly related to infant methylation. These findings suggest that while infants may be protected from excessive maternal glucocorticoids by placental barrier activity, maternal metabolic status is still reflected in their epigenetic make-up.Trial registration This study was part of a larger matched-pair randomized controlled trial on the impact of improved on-farm crop storage on welfare, nutrition, and human health. Registration can be found in the American Economic Association (AEA) RCT Registry, RCT ID: AEARCTR-0005845.

A longitudinal multi-centric cohort study assessing infant neurodevelopment delay among women with persistent postpartum depression in Nepal

BackgroundInfant neurodevelopment in the first years after birth is determined by multiple factors, including parental care and maternal mental wellbeing. In this study, we aim to assess the impact of persistent maternal depressive symptoms during the first 3 months postpartum on infant neurodevelopment at 6 months.MethodsUsing a longitudinal cohort design, 1253 mother-infant pairs were followed up at 7, 45, and 90 days to assess postpartum depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS); infants were followed up at 6 months to assess neuro-developmental status using the WHO’s Infant and Young Child Development (IYCD) tool. A generalized linear regression model was used to assess the association between persistent postpartum depressive symptoms and infant neurodevelopmental delay at 6 months. A generalized linear mixed model (GLMM) with a hospital as a random intercept was used to assess the persistent postpartum depressive symptoms with an IYCD score. Linear regression was used to compare the IYCD scores between exposure groups.ResultsIn the study population, 7.5% of mothers had persistent depressive symptoms, and 7.5% of infants had neurodevelopmental delay. Infants born to mothers with persistent depressive symptoms had a higher proportion of neurodevelopmental delay than infants born to women without persistent symptoms (48.6% vs 5.1%; p < 0.001). In the adjusted regression model, infants whose mothers had persistent depressive symptoms at 7, 45, and 90 days had a 5.21-fold increased risk of neurodevelopmental delay (aRR, 5.21; 95% CI, 3.17, 8.55). Mean scores in the motor domain (12.7 vs 15.2; p < 0.001) and language domain (6.4 vs 8.5; p < 0.001) were significant when a mother had persistent depression vs. no depression. Mean scores in the general behavioral domain (5.9 vs 10.4, p < 0.001) and the socio-emotional domain (15.4 vs 17.7; p < 0.001) were significantly different when a mother had persistent depression vs no persistent depression.ConclusionsOur results suggest that 6-month-old infants are at higher risk for neurodevelopment delays if their mother reports persistent symptoms of depression from 7 to 90 days postpartum. The neurodevelopmental delay can be observed in all functional domains. Preventive intervention to reduce maternal postpartum depression may reduce the impact on infant developmental delay.

Risk factors for postpartum readmission: a prediction model in Iranian pregnant women

BackgroundPostpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran.MethodsThis retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019–2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05.ResultsAmong 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery.ConclusionThe method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Association between maternal HIV status and postpartum depressive symptoms in Botswana

ABSTRACT Few studies have evaluated postpartum depression (PPD) in women living with HIV (WLHIV) in Botswana, a high prevalence HIV setting. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate PPD symptoms in WLHIV (n = 300) and women who are HIV-uninfected (n = 131) in the Tshilo Dikotla study, an observational cohort study with a nested randomized trial. The EPDS was administered at 2, 6, and 12 months postpartum. We assessed the association of (1) HIV infection and (2) antiretroviral therapy (ART) with odds of PPD symptoms (EPDS ≥ 10 or thoughts of self-harm) in the first year postpartum using generalized estimating equations. Of WLHIV, 24 (8.00%) had PPD symptoms at one or more follow-up time points, compared to 9 (6.9%) women who were HIV-seronegative. There was no association between HIV status and PPD symptoms (adjusted odds ratio [aOR]:1.69, 95% confidence interval [CI]: 0.73–3.93, p = 0.225); however, WLHIV on efavirenz-based ART regimens had higher odds of experiencing PPD symptoms compared to dolutegravir-based ART (aOR:3.05, 95% CI:1.16–8.03, p = 0.024).

Associations Between Early-Pregnancy Vitamin D Status and Postpartum Depressive and Anxiety Symptoms.

Maternal postpartum depressive and anxiety symptoms are risk factors for subsequent maternal and child mental health problems. Little is known about the potential role of antepartum vitamin D and C-reactive protein (CRP) in the etiology of maternal postpartum affective symptoms. We investigated associations between antepartum vitamin D status and postpartum depressive and anxiety symptoms and whether antepartum CRP mediated these associations. In 2483 participants of the Amsterdam Born Children and their Development prospective cohort, maternal serum vitamin D and CRP were measured at a median of 13 weeks' gestation. Vitamin D status was defined as deficient (≤29.9 nM), insufficient (30-49.9 nM), sufficient (50-79.9 nM), or normal (≥80 nM). Maternal depressive symptoms (Center for Epidemiologic Studies-Depression) and anxiety (State-Trait Anxiety Inventory) were assessed 3 months postpartum. After adjustments for confounders, vitamin D deficiency was only associated with increased postpartum anxiety symptoms ( B = 0.17, 95% confidence interval [CI] = 0.03-0.30, p = .017) compared to normal vitamin D levels (≥80 nM). In women not taking vitamin D supplementation ( n = 2303), vitamin D deficiency was associated with increased postpartum depressive and anxiety symptoms ( B = 0.14, 95% CI = 0.03-0.28, p = .045; and B = 0.17, 95% CI = 0.03-0.32, p = .015). Antepartum CRP did not mediate these links. We found some evidence that antepartum vitamin D deficiency was associated with increased postpartum affective symptoms, especially in women not taking vitamin D supplementation. Clinical trials should determine whether vitamin D supplementation can reduce the risk for postpartum affective disorders.

Incorporating Maternal Blood Pressure Screening Into Routine Newborn Clinic Visits

Background and ObjectivesIn the immediate postpartum period, mothers often prioritize newborn care over postpartum follow-up. There is an increasing contribution of hypertensive disorders of pregnancy (HDP) to maternal morbidity and mortality. In this feasibility study, we sought to implement maternal postpartum blood pressure (BP) screening in a newborn clinic. MethodsWe conducted a non-randomized, prospective feasibility study to evaluate the application of maternal BP screening at newborn clinic visits. An elevated BP was defined as a systolic pressure (SBP) of ≥140 mmHg or a diastolic pressure (DBP) of ≥90 mmHg. BPs were triaged with a standardized algorithm, utilizing support and expertise of on-call maternal subspecialists. ResultsWe screened 72 postpartum individuals, with a mean SBP of 130±19 mmHg and DBP 86±12 mmHg. Most were publicly insured (78%) and self-identified as Black (69%). Of the 31 (43%) with an elevated BP, 13 (42%) did not have a known HDP. Of those without known HDP, 4 were diagnosed with postpartum preeclampsia and 2 with postpartum hypertension. One individual diagnosed with new-onset postpartum preeclampsia was triaged to the emergency department. Only 56% of women attended a obstetrics appointment within 12 weeks after delivery. ConclusionsThis study demonstrates the feasibility of an innovative maternal postpartum BP assessment in a racially and socioeconomically diverse pediatrics clinic. Through collaborative care, individuals were able to be safely triaged, thus providing an opportunity to identify at-risk individuals who could benefit from earlier identification and management of hypertension. Pediatricians have a unique opportunity to contribute to postpartum maternal health.

Impact Of Preeclampsia On Maternal And Neonatal Health: A Retrospective Cohort Study

Objective — Understanding the relationship between maternal characteristics of patients with preeclampsia (PE) and disease progression, as well as the impact on neonatal and parturient outcomes, is critical to the development of effective interventions to improve maternal and fetal outcomes in preeclamptic patients. Material and Methods — This retrospective study analyzed 94 patients with PE and focused on the relationship between maternal characteristics and laboratory findings, as well as on the impact on neonatal and parturient outcomes. Comprehensive laboratory and ultrasound examinations were performed, with primary outcomes classified into antenatal, perinatal and postpartum periods, and secondary outcomes focusing on neonatal health. Results — Patients with PE requiring maternal intensive care unit (ICU) admission had higher median serum creatinine, AST, and ALT levels vs. non-ICU patients. Patients who required postpartum medications to control blood pressure had elevated median values of urea concentration, systolic blood pressure, and diastolic blood pressure at diagnosis. A notable difference in ALT values was observed when primary cesarean section was indicated (p=0.036). Subgroup analysis revealed higher median birth weight in the Proteinuria 1+ subgroup vs. the Proteinuria 4+ subgroup (p=0.002). Patients with negative proteinuria levels demonstrated less need for neonatal intensive care unit (NICU) compared with higher proteinuria levels. In addition, a higher need for postpartum medical therapy was noted in patients of Proteinuria 4+ subgroup (74.2%). Conclusion — This study emphasizes the important role of laboratory data and blood pressure monitoring, advocating targeted interventions and clinical approaches to improve maternal postpartum outcomes (need for ICU). It also highlights the utility of urine dipstick testing for effective decision-making in the care of mothers and newborns in the postpartum period.