Peripartum Period Research Articles

Maternity care professionals’ preparedness for and experiences of screening and responding to disclosures of domestic violence in the peripartum period: A protocol for a qualitative evidence synthesis

Background Maternity care professionals, such as midwives, public health nurses, doctors, and social workers, are in the unique position of having regular contact with women in the peripartum period. They are well-placed to recognise and respond to disclosures of domestic violence, however many lack confidence and feel unprepared for this in practice. While there are screening tools used for enquiry about domestic violence in pregnancy, there are variations in the tools used, the frequency and timing of enquiry, and the response/referral pathways across professions. Research exists on the role of health care professionals such as midwives, doctors, and nurses with regards to domestic violence, however little is understood about the collective and shared experience of maternity care professionals who screen for and respond to domestic violence in the peripartum period. Methods A qualitative evidence synthesis of maternity care professionals’ preparedness for and experiences of screening and responding to disclosures of domestic violence in the peripartum period will be conducted. Qualitative studies of any design, and mixed method and other design studies where qualitative data can be extracted will be considered for inclusion. A systematic search of the following electronic bibliographic databases will be conducted: ASSIA, CINAHL, EMBASE, Maternity and Infant Care, MEDLINE, APA PsycINFO and SocINDEX. The Critical Skills Appraisal Programme (CASP) qualitative studies tool will be used to assess methodological quality of included studies. Data synthesis will involve three sequential stages, coding, development of descriptive themes and generation of analytical themes. Confidence in findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) tool. Discussion This QES will provide a deeper understanding of maternity care professionals’ preparedness for and experiences of screening and responding to domestic violence disclosures in the peripartum period. The findings will, potentially, identify what aspects of education and preparedness work well and what might be improved.

COVID-19 experiences and persistent maternal mental health symptoms: Examining the role of long COVID, self-efficacy, andpartner support.

Perinatal women were particularly impacted during the pandemic, with documented consequences for both mothers' and infants' well-being. This study investigated the longitudinal relationships between COVID-19-related experiences during the peripartum and women's depression and anxiety symptoms at long-term follow-up. We explored the moderating role of long COVID for the first time, along with perceived partner support and maternal self-efficacy. A sample of 190 US perinatal women completed a survey from May 21, 2020, to September 15, 2021 (T1), and again between December 14, 2022, and February 14, 2024 (T2). The survey assessed COVID-19-related experiences, mental health, long COVID, maternal self-efficacy, partner support, and life events. Anxiety was associated with both long COVID and decreased partner support, and both depression and anxiety were linked to lower self-efficacy. A larger number of COVID-19-related experiences during the peripartum period was associated with higher levels of later depression and anxiety symptoms. Long COVID exacerbated these links, while partner support buffered them. Maternal self-efficacy dampened the association between COVID-19-related experiences and subsequent depression, but not anxiety. Findings suggest that COVID-19 has lasting effects on perinatal women's mental health, with partner support and maternal self-efficacy acting as resilience factors, highlighting the potential benefit of targeted interventions to enhance these modifiable factors.

Comparative Analysis of Venous Thromboembolism Prophylaxis Guidelines Following Cesarean Section.

Comparative Analysis of Venous Thromboembolism Prophylaxis Guidelines Following Cesarean Section.

Peripartum Outcomes and Safe Disease-Specific Medication Use Remain Suboptimal in Women with Immune-Mediated Inflammatory Diseases

ObjectivesObservational and population levels studies confirm that immune-mediated inflammatory diseases (IMIDs) including rheumatoid (RA) and psoriatic (PsA) arthritis, spondyloarthritis (SpA) and systemic lupus erythematous (SLE) can negatively affect maternal and neonatal outcomes by way of disease activity and peripartum treatment choices. We hypothesize that despite increased availability of safe peripartum disease treatments for IMID, outcomes are still worse, and treatments underutilized compared to those without IMID in a contemporary Albertan pregnancy cohort.MethodsA contemporary pregnancy cohort of 446,017 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 5 groups: (1) no IMID (n=728,102), (2) RA (n=2,170), (3) PsA (n=103), (4) SpA (n=312) and (5) SLE (n=393). We compared maternal and neonatal outcomes, comorbid conditions and medication use at any point in the pregnancies among the 5 groups.ResultsPregnant women with SLE were more likely to have preterm delivery (13.7%), “small for gestational age” babies (19.3%), and NICU admissions (18.6%), compared to the other IMIDs (Table 1). Cesarean section deliveries were highest in women with SLE (35.9%) and RA (34.7%) while women with SpA had more induction (37.8%) compared to the other groups. The PsA group had the highest corticosteroid (17.5%) and biologic use (16.5%) in the peripartum period while it was lower in RA (8.7%) patients. Antimalarial use was highest in women with SLE (25.4%) and did not decrease when broken down when assessed per trimester.Table 1.Maternal Characteristics, Peripartum Outcomes and Medication UseConclusionWorse peripartum outcomes are higher among women with SLE and RA compared to women with PsA, AS or no IMID although specific findings including more inductions in SpA patients is notable. Medications are safe in pregnancy (eg, antimalarials and certain biologics) have low uptake which may influence these outcomes. Further peripartum studies evaluating drug safety and outcomes are needed with assessment of the contributions of disease activity.Supported by a CIORA grant

Lifetime history of hypertensive disorders of pregnancy is associated with shorter sleep duration and more sleep disturbance in midlife: results from the Project Viva women’s health cohort

BackgroundHypertensive disorders of pregnancy (HDP) are associated with worse prenatal and perinatal sleep health and higher cardiovascular disease risk beyond the peripartum period. The relationship of HDP with sleep health in midlife, when sleep problems are common, remains unclear.MethodsWe studied women enrolled in Project Viva during early pregnancy (1999–2002) with sleep outcomes assessed in midlife (2017–2024). We determined lifetime HDP via medical records from the index pregnancy and self-report both at enrollment and during midlife. Outcomes were (i) self-reported sleep duration and sleep quality, using the patient-reported outcomes measurement information system sleep disturbance and sleep-related impairment instruments at mean 52.3yrs; and (ii) objectively measured 5-day sleep duration and efficiency by wrist actigraphy at mean 55.8yrs in a subset. We performed linear and logistic regression models adjusted for enrollment age, education, parity, household income, pre-pregnancy BMI, race, and ethnicity and considered modification by social determinants of health.ResultsOf 767 participants, 23% had a lifetime history of HDP, 4% had ≥ 2 episodes, and 7% had HDP during their last pregnancy. Mean (SD) daily sleep duration was 7.1 (1.0) hours by self-report and 6.7 (1.0) hours by actigraphy. Any (vs. no) lifetime HDP was associated with shorter self-reported (-8 min, 95% CI: -19, 2) and actigraphy-measured (-16 min, 95% CI: -31, -1) sleep duration. Estimates were stronger but with wider CIs for those with ≥ 2 (vs. no) HDP episodes (e.g., -23 min, 95% CI: -53, 6 for actigraphy-measured sleep duration). Mean (SD) sleep disturbance T-score was 48.6 (7.4) and sleep-related impairment was 45.8 (8.5). Any lifetime HDP (vs. none) was associated with higher (worse) sleep disturbance T-score (1.85 points, 95% CI: 0.28, 3.42) with stronger associations for ≥ 2 HDP episodes (3.41 points, 95% CI: 0.17, 6.65) and for HDP in the last pregnancy (3.63 points, 95% CI: 0.70, 6.57). HDP was not associated with self-reported sleep-related impairment or sleep efficiency.ConclusionsHistory of HDP was associated with shorter sleep duration and higher sleep disturbance in midlife. Future work should investigate the contribution of sleep health to associations of HDP exposure with cardiovascular disease risk in later life.

Prevalence of Peripartum Cardiomyopathy in Pre-Eclampsia Patients Presenting To a Tertiary Care Health Facility

Objective: To determine the frequency of Peripartum cardiomyopathy (PPCM) in Pre-eclamptic women presenting to a tertiary care facility.Methodology: This descriptive cross-sectional study was conducted over a period of six months, from December 9, 2021, to June 10, 2022,in the Gynecology and Obstetrics Unit I of Liaquat University Hospital, Hyderabad. The study population comprised preeclampsia womenaged 18 to 45 years, with a gestational age of more than 20 weeks as confirmed by early ultrasound, regardless of parity, and carrying asingle alive fetus. PPCM was diagnosed based on echocardiographic findings, with the key diagnostic criterion being a left ventricularejection fraction (LVEF) of less than 45%.Results: Of 102 patients, the mean age of the patients was 25.57 ±3.73 years. The mean height, weight, and BMI of the patients were160.11 ±8.89 cm, 75.09 ±14.82 kg, and 29.08 ±5.19 kg/m2 respectively. The mean 24 hours proteinuria level of the patients was 344.62±16.35 mg/24 hours. The mean ejection fraction was found to be 55.01 ±9.69%. Frequency of PPCM was observed in 9 (9%) patients,which was statistically insignificant according to age, residential status, BMI and mode of delivery (>0.05).Conclusion: PPCM was concluded to be 9% among pre-eclamptic women, highlighting a notable association between pre-eclampsia and thedevelopment of cardiac dysfunction during the peripartum period, which underscoring the need for enhanced clinical observation and routinecardiovascular assessment in this population.Keywords: Peripartum cardiomyopathy, pre-eclamptic women, ejection fraction

Influence of genotype-environment interaction on stress parameters during spontaneous farrowing in modern and traditional pig breeds housed in crates and pens.

Influence of genotype-environment interaction on stress parameters during spontaneous farrowing in modern and traditional pig breeds housed in crates and pens.

Prevalence, Concordance, and Risk Factors of Antibiotic Resistance Genes in Breast Milk and Neonatal Oral Cavity of Preterm Mother-Infant Pairs.

Background: Mothers delivering preterm are very often exposed to antibiotics in the peripartum period. We hypothesize this may select bacteria bearing antibiotic resistance genes (ARGs) in the breast milk and be transmitted to the neonate's mouth while feeding. This study aimed to determine the prevalence of ARGs coding for extended-spectrum beta-lactamases (ESBLs) (including AmpC beta-lactamases [ACBLs]) and carbapenemases in breast milk and neonatal oral swab samples of preterm mother-infant pairs, the concordance of ARGs between paired samples, and risk factors of ARGs coding for ESBLs and carbapenemases. Methods: Breast milk and oral swab samples were obtained aseptically from 100 preterm mother-infant pairs (gestation 28-34 weeks) by postpartum day 10. Multiplex PCR was used to detect 15 common ARGs in these samples. Potential risk factors of the presence of any ARG coding for ESBLs or carbapenemases in breast milk and oral swab samples were studied. Results: The commonest ARGs for ESBLs, ACBLs, and carbapenemases in breast milk were blaSHV (28%), blaCIT (33%), and blaIMP (49%), respectively; and oral swabs blaCTX-M1 (30%), blaCIT (58%), and blaIMP (24%), respectively. ARGs common to breast milk and oral swabs included blaCIT (13%), blaIMP (10%), blaCTX-M-1 (9%), and blaSHV (6%). Formula milk intake was associated with less oral carbapenemase ARGs. Conclusion: ARGs for ESBLs and carbapenemases are highly prevalent in preterm breast milk and oral swabs.

Perioperative and Peripartum Management of Patients with Neuromuscular Disease.

Patients with neuromuscular disease are living longer with advancements in respiratory assistive devices for airway clearance and ventilatory support. This technology has been successfully applied to the perioperative and peripartum periods, making these previously prohibitively high-risk procedures now a risk-controlled intervention. This review will cover preoperative planning and assessment, key intraoperative management interventions, postoperative management, and peripartum management for patients with neuromuscular disorders.

Evidence-based clinical practice guidelines for prevention, screening and treatment of peripartum depression.

Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations. This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD. A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included. One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive-behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts. Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk-benefit for mother and foetus/infant and women's values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.

Selenium-Biofortified Alfalfa Hay Supplemented to Jersey and Holstein Dairy Heifers During the Peripartum Period: Effects on Dams and Their Offspring

The objective of the study was to assess whether supplementing dairy heifers with Se-biofortified hay during the last 40 days of pregnancy and early lactation improves performance, metabolism, oxidative status, and immune response in the dams and their calves. Ten Jersey and eight Holstein pregnant dairy heifers were divided into two groups and supplemented with Se-biofortified or a control alfalfa hay from 40 days before to 2 weeks postpartum. The calves born to the heifers were also monitored during the first month of life. Supplementation of Se-biofortified hay improved milk yield in Holstein heifers only, but had minor effects on blood parameters measured and the liver transcriptome. Similarly, we did not detect any impact of feeding Se-biofortified hay to heifers on their offspring. The data indicated a better immune system and oxidative status in Holstein compared to Jersey heifers. Overall, our data did not support the hypothesis that supplementing Se-biofortified hay to pregnant heifers improves their performance and the health of dams and offspring, at least at the dose we provided.

Management of Opioid Use Disorder Among Peripartum Individuals During Hospitalization.

Peripartum opioid use disorder (OUD) is a significant public health concern. Although hospital admission for labor and delivery is common, little is known about hospitalized peripartum individuals with OUD or their inpatient management. The purpose of this study was to characterize hospitalized peripartum individuals with OUD who were seen by an OUD consult service and to examine their inpatient OUD treatment. This was a retrospective cohort study of peripartum individuals who received an OUD consult from May 2020 to April 2022. All individuals were pregnant or up to 3 months postpartum at admission. Substance use and psychosocial history were collected, along with timing and acceptance of medication for opioid use disorder (MOUD) and details of discharge transitions. Of the 23 peripartum individuals with OUD who received a consult during admission, 61% were white, 30% were black, and all were non-Hispanic. Most individuals (78%) had Medicaid. Only 30% were using MOUD at hospital admission. Two-thirds (63%) of those not using MOUD were started on treatment during hospitalization, most commonly with buprenorphine-naloxone. At discharge, most (74%) individuals were connected to outpatient OUD treatment. Of the total, 35% self-directed their discharge, and there was a higher proportion of self-directed discharges among those who did not receive inpatient MOUD compared with those who did (P < 0.01). Hospitalization during the peripartum period is an important opportunity for initiation of MOUD and linkage to longitudinal, community OUD services. Further understanding of factors contributing to high rates of self-directed discharge in the peripartum period is needed.

Comparison of Fibrinolysis in Peripartum and Non-Pregnant Mares Using Modified Thromboelastography.

During pregnancy and the peripartum period in women, hypofibrinolysis and hypercoagulation minimize excessive hemorrhage risk during parturition. While hypercoagulation is documented in peripartum mares, hypofibrinolysis is not. This study aimed to characterize and compare the fibrinolytic potential of healthy, non-pregnant mares and peripartum mares using tissue-factor (TF)-activated, tissue-plasminogen-activator (tPA)-modified thromboelastography (TEG). TF-activated TEG modified with tPA (500 and 650 U/mL) was performed on plasma samples from 9 pregnant mares at 3, 2, and 1 month pre-partum and 1, 7, and 30 days post-partum, as well as on time-matched samples from 6 non-pregnant mares. At both tPA concentrations, there were relative increases in clot strength [MA] and changes in lysis parameters consistent with hypofibrinolysis (increased CL30 and decreased Ly30) in the pregnant mares compared to the non-pregnant mares. The differences were most frequently detected 1 month pre-partum and at 1 and 7 days post-partum, providing preliminary evidence suggesting pregnant mares are hypofibrinolytic during late gestation and the early post-partum period. However, our small sample size, the unexpected changes in fibrinolysis in the non-pregnant mares over time, and the inconsistent performance of the assay indicate a need for a larger study after further assay optimization to confirm the results. Further investigations of the tPA-modified TEG assay and fibrinolysis in clinical cases are warranted.

Infant Distress from the Still-Face and its Association With Increased Problem Solving: Implications for Early Resilience.

This study aimed to investigate the relationship between infants' negative affect and problem-solving skills, along with the moderating role of mothers' perceived social support. The sample consisted of 110 infants (49% females) and their mothers, who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study at 2 time points: T1 (peripartum period, from late second trimester to 6 months postpartum) and T2 (when the infants were 8-10 months old). We used the Face-to-Face Still-Face (FFSF) procedure as an observational task to assess infant negative affect (T2) and maternal reports of their perceived social support (T1 and T2) and infants' problem-solving skills (T2). Spearman correlations and moderation analysis with PROCESS macro were performed in SPSS, controlling for maternal education, maternal age, maternal mental health (depression and anxiety at T1 and T2), and child sex. We found that infant negative affect was positively (b = 1.88, p = 0.045) associated with problem-solving after controlling for other variables, whereas there was no evidence for a relationship with mothers' perceived social support (b = 0.73, p = ns). Notably, in testing the interaction between negative affect during FFSF and social support (b = 1.13, p = 0.001), the findings reveal more optimal problem-solving skills in infants whose mothers reported at T1 moderate (b = 2.98, p = 0.003) or high (b = 4.11, p = 0.001) social support. There was no evidence of a moderating role of mothers' perceived social support at T2 (b = 0.32, p = ns). Results show that infant negative affect may reflect their capacity for problem-solving and that bolstering social support for perinatal women may enhance their infants' problem-solving abilities. Findings highlight that children's negative affect in stressful situations, such as the FFSF context, may serve as a coping mechanism and offer new insights into the intergenerational transmission of resilience.

Impact of substance use and trauma on postpartum readmission rates and hospitalization costs: An observational study.

Impact of substance use and trauma on postpartum readmission rates and hospitalization costs: An observational study.

Magnesium deficiency and dilated cardiomyopathy diagnosed peripartum.

Dilated cardiomyopathy in pregnancy, whether diagnosed pre-conception, or occurring de novo during pregnancy, may be associated with significant maternal morbidity and mortality. Hypomagnesaemia is associated with ventricular arrhythmias and may be a risk factor for heart failure, coronary artery disease and atrial fibrillation in the general population. Pregnancy is associated with a progressive physiological fall in serum magnesium concentration. Intracellular magnesium deficiency may exist despite normal serum magnesium concentration. Three cases of dilated cardiomyopathy developing in the peripartum period with hypomagnesaemia are presented. The literature regarding associations between magnesium deficiency and dilated cardiomyopathy is reviewed. Potential future research examining magnesium deficiency as a potential contributor to dilated cardiomyopathy in pregnancy is proposed, and possible implications for management are discussed.

Postpartum Depression: Interacting Biological Pathways and the Promising Validation of Blood-Based Biomarkers.

Background/Objectives: Postpartum depression (PPD), the most common and prevalent psychiatric disorder after birth, is a prevalent yet underdiagnosed psychiatric condition that remains insufficiently understood, particularly in terms of its biological basis. While epidemiological data are extensive, few studies have systematically investigated their underlying biological mechanisms. The purpose of this study was to explore the potential links between blood biomarker levels and postpartum depressive symptoms, contributing to the development of a unified biological model of PPD. Methods: We conducted a cross-sectional study between 2023 and 2025 at a tertiary academic hospital in Timisoara, Romania, involving 860 postpartum women recruited at hospital discharge (1-2 weeks after childbirth). The participants completed the Edinburgh Postnatal Depression Scale (EPDS) and provided peripheral blood samples, which were analyzed using standardized protocols. The blood levels of pregnancy-related hormones (estrogen and progesterone), vitamin D, biochemical markers of inflammatory response (white blood cell count, C-reactive protein, fibrinogen, neutrophil count, lymphocyte count, and ferritin), anemia indicators (hemoglobin, red blood cell count, hematocrit, and ferritin), thyroid hormones (TSH, FT3, and FT4) and markers of coagulation abnormalities (D-dimer, platelets, fibrinogen, APTT, and INR) were evaluated. The data were analyzed with JASP v0.19.3. The statistical methods included multivariate linear regression, the Kruskal-Wallis and Mann-Whitney U tests, and Spearman correlation, with significance set at p < 0.05. Results: The analysis revealed that postpartum depression (PPD) is associated with distinct biological profiles, reflecting the unique hormonal and physiological changes in the peripartum period. Significant associations were identified between EPDS scores and the levels of estrogen, progesterone, thyroid hormones (TSH, FT3, and FT4), inflammatory markers (CRP and ferritin), vitamin D, and coagulation parameters (APTT and INR). These findings support the notion that PPD has a multifactorial biological basis and highlight the potential of these biomarkers as early predictors of risk. Conclusions: Integrating biochemical assessments into postpartum care may enhance early identification and inform targeted preventive interventions, such as hormone monitoring, vitamin D and iron supplementation, or thyroid function correction.

The new S2k guidelines on hypertensive diseases during pregnancy (HES): diagnosis and treatment-What do anesthetists need to know?

Hypertensive diseases of pregnancy (HES) affect approximately 6-8% of all pregnancies and contribute to 20-25% of perinatal mortality globally. Among these, preeclampsia represents the most severe manifestation, contributing to over 70,000 maternal and 500,000 perinatal deaths anually worldwide [1]. In July 2024, the updated S2k guidelines on hypertensive diseases during pregnancy (HES) were published, presenting updated recommendations for improved diagnosis and therapeutic strategies. Notable advancements in the revised guidelines include an emphasis on the early identification of patients at risk, implementation of individualized monitoring protocols, establishment of optimized target blood pressure thresholds, and the critical importance of long-term cardiovascular follow-up for the affected mother-ideally extending throughout the patient`s lifespan [2]. As in the previous version, the current guidelines retain a dedicated section addressing anesthesiological considerations in the peripartum period. Furthermore, they expand on the anaesthetic implications relevant to both preclinical and clinical care settings for pregnant individuals with HES. This article provides a concise synthesis of the most clinically pertinent innovations introduced in the 2024 guideline update.

Spontaneous Splenic Rupture Revealed by Hemorrhagic Shock in the Peripartum Period: A Case Report

Background: Spontaneous splenic rupture during pregnancy is an extremely rare and life-threatening condition, often diagnosed late due to nonspecific symptoms and absence of trauma. Case Presentation: We report the case of a 36-year-old woman, gravida 5 para 4, admitted at 36 weeks of gestation for acute fetal distress. An emergency cesarean section revealed massive hemoperitoneum. Surgical exploration identified a spontaneous grade 4 splenic rupture. A hemostatic splenectomy was performed with favorable maternal and neonatal outcomes. Conclusion: Although rare, spontaneous splenic rupture should be considered in pregnant women presenting with unexplained hemorrhagic shock. Prompt diagnosis and surgical intervention are critical to improve prognosis.

Managing pre and postpartum mental health issues of refugee women from fragile and conflict-affected countries: A systematic review.

Managing pre and postpartum mental health issues of refugee women from fragile and conflict-affected countries: A systematic review.