Postnatal Interventions Research Articles

Strategies to prevent Type 2 Diabetes in the postnatal period in women with history of Gestational Diabetes

This literature review emphasizes the critical need for focused interventions to prevent Type 2 Diabetes (T2D) in the postnatal period, particularly for women with a history of Gestational Diabetes Mellitus (GDM). GDM poses a substantial risk, increasing the likelihood of T2D development by 11-fold later in life. With 14% of pregnancies worldwide affected by GDM, the escalating global T2D rates underscore the urgency for targeted postnatal strategies. Current interventions, such as those modelled after the Diabetes Prevention Program (DPP) and the Mediterranean Diet, show promise in reducing T2D risk by over 50%, yet challenges like low engagement persist. To address these complexities, future research should prioritize developing acceptable postnatal interventions, incorporating peer support, addressing barriers, and employing randomized controlled trials with larger participant cohorts. The multidimensional approach involves lifestyle modifications, dietary changes, behaviour change strategies, and exploration of pharmacological options, collectively contributing to a substantial reduction in the long-term T2D risk for women with a history of GDM.

2- to 20-year myelomeningocele follow-up outcomes from a referral center in Southern Iran: the Shiraz experience

BackgroundThe current convention for treatment of children with myelomeningocele (MMC) is timely surgical intervention combined with long-term follow-up by a multidisciplinary specialized team. This study aims to investigate the outcomes of MMC patients treated at Namazi Hospital.MethodsAll children presenting to Namazi Hospital with myelomeningocele between May 2001 and August 2020 were eligible for this study. For those with a documented telephone number, follow-up phone surveys with the patient’s caregivers, on top of the review of the medical documents were carried out to assess mortality, morbidities, and the functional outcome of the care provided to them.ResultsA total of 125 patients were studied (62 females). All of the patients were followed up for a mean duration of 6.28 years (range 1–23 years). The majority were located in the lumbosacral area. All of the patients underwent postnatal surgical intervention for MMC in Namazi Hospital. Mean age at surgery was 9.51 days. There were statistically significant differences between urinary and bowel incontinence and presence of scoliosis, MMT grading of the lower limbs, school attendance, number of readmissions, and requirement of laminectomy at the initial surgical intervention.ConclusionsThis study is the first to characterize the long-term outcomes of MMC patients in Iran. This study illustrates that there is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term stages to improve morbidity and mortality.

Clinical Trials That Have Changed Clinical Practice and Care of Pregnant People With HIV.

Over the last 4 decades, significant advances in the care of HIV during pregnancy have successfully reduced, and nearly eliminated, the risk of perinatal HIV transmission. The baseline risk of transmission without intervention (25% to 30%) is now <1% to 2% in the United States with contemporary antepartum, intrapartum, and postnatal interventions. In this review, we discuss 3 landmark clinical trials that substantially altered obstetric practice for pregnant individuals with HIV and contributed to this extraordinary achievement: 1) the Pediatric AIDS Clinical Trials Group 076 Trial determined that antepartum and intrapartum administration of antiretroviral drug zidovudine to the pregnant individual, and postnatally to the newborn, could reduce the risk of perinatal transmission by approximately two-thirds; 2) the European Mode of Delivery Collaboration Trial demonstrated performance of a prelabor cesarean birth before rupture of membranes among pregnant people with viremia reduced the risk of perinatal transmission compared with vaginal birth; and 3) the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 Trial identified that dolutegravir-containing, compared with efavirenz-containing, antiretroviral regimens during pregnancy achieved a significantly higher rate of viral suppression at delivery with shorter time to viral suppression, with fewer adverse pregnancy outcomes. Collectively, these trials not only advanced obstetric practice but also advanced scientific understanding of the timing, mechanisms, and determinants of perinatal HIV transmission. For each trial, we will describe key aspects of the study protocol and outcomes, insights gleaned about the dynamics of perinatal transmission, how each study changed clinical practice, and relevant updates to current practice since the trial's publication.

Effect of post-discharge postnatal educational intervention on maternal self-efficacy among low-income primiparas living in informal settlements in Nairobi County, Kenya

Background: Maternal knowledge and maternal self-efficacy (MSE) are crucial for the adoption of health-promoting evidence-based postnatal practices. Short hospital stay after normal deliveries curtails delivery of pre-discharge postnatal education thus inadequate knowledge and poor MSE. This is accentuated among low-income primiparas thus a need for post-discharge follow-up. Aim was to determine the effect of self-efficacy theory-based post-discharge postnatal education on low-income primiparas’ MSE. Methods: A Quasi-experimental study on low-income primiparas residing in selected slums in Nairobi, Kenya. The control and experimental sites had 118 primiparas each conveniently recruited on early discharge after normal delivery from health facilities serving the slums. An interviewer-administered entry questionnaire was applied to collect facility and demographic data. The intervention group received post-discharge PNE intervention and routine PNC while the control group received routine PNC only. Perceived maternal parental self-efficacy scale was used to measure MSE at 6 weeks. Focus group discussions were conducted for qualitative data. IBM SPSS was used to analyze data. Independent sample t-tests and multiple linear regression were derived. Results: There was a significant (t=12.322, p=0.000) difference in MSE between experimental and control groups. The intervention was a significant predictor of MSE (β=0.59, p=0.00). Respondents appreciated the multi-pronged learning methods, especially the community health volunteers. COVID-19 pandemic challenges such as loss of livelihood and disruption of social connectedness were highlighted. Conclusions: Self-efficacy theory-based follow-up PNE intervention improves MSE among low-income primiparas thus a valuable complement to routine care.

Congenital Anomalies of the Kidneys and Urinary Tract.

Congenital anomalies of the kidneys and urinary tract encompass the spectrum of disorders that include the kidneys, ureters, bladder, and urethra. These abnormalities often lead to altered renal size and location, dysplastic changes in the kidney parenchyma, and anomalies in the collecting system. Though the etiology of each of these conditions can be variable, it is known that the collection of these defects represent 40% to 50% of all pediatric end-stage renal disease worldwide. The multifaceted management of these conditions is aimed at preserving kidney function and ultimately delaying the need for transplantation. With the advancement of prenatal ultrasonographic techniques, these conditions are more likely to be diagnosed before birth, which often leads to rapid postnatal intervention and better outcomes.

Ultrasound microvascular flow imaging: evaluating fetal mesenteric blood flow and predicting postnatal surgery in meconium peritonitis

Objective This study explored the characteristics of fetal mesenteric blood flow perfusion across various gestational weeks and evaluated the efficacy of Microvascular Flow (MV-Flow) imaging technology in assessing intestinal wall blood flow in fetuses with meconium peritonitis (MP). Method In this retrospective study, we analyzed 35 fetuses with MP and 160 healthy fetuses. We examined the correlation between the Vascular Index (VI) of mesenteric perfusion and gestational age, conducted an analysis comparing MP operative and non-operative groups, and developed a predictive model for surgical intervention. Results The VI value demonstrated no significant change with increasing gestational age (correlation coefficient = 0.005, p = 0.946). For healthy fetuses, VI ranged approximately from 34.66% to 67.26% using the automatic ellipse method. The MP operative group exhibited significantly more cesarean deliveries (100% vs. 52.9%, p = 0.003), shorter gestational periods (34.76 ± 2.16 weeks vs. 37.48 ± 1.55 weeks, p < 0.001), lower birth weights (2762.14 ± 452.76 g vs. 3225.88 ± 339.98 g, p = 0.003), more persistent ascites (92.9% vs. 52.9%, p = 0.021), more frequent intestinal wall echo reductions (57.1% vs. 5.9%, p = 0.004), and lower VI (18.57 ± 5.51% vs. 39.41 ± 7.02%, p < 0.001). A predictive model was established: Logit (P)=8.86 - (0.37* VI) + (1.49* ascites), yielding an area under the curve of 0.857, with 78.6% sensitivity and 88.2% specificity. The VI value was significantly associated with the need for postnatal surgery (OR = 0.689, 95% confidence interval: 0.511 − 0.929, p = 0.015). A Receiver Operating Characteristic curve analysis for VI in predicting postnatal surgery showed an area under the curve of 0.971, with an optimal cutoff value of 35%, achieving 91% sensitivity and 94.4% specificity. Conclusion MV-Flow imaging effectively quantified fetal bowel wall blood flow perfusion. There was no significant change in VI across different gestational weeks. Significantly lower VI values in MP fetuses indicated an increased risk of intestinal wall necrosis and the potential need for postnatal surgical intervention.

Effect of post-discharge postnatal educational intervention on postnatal practices among low-income primiparas in Nairobi informal settlements, Kenya: a post-test quasi-experiment.

informal settlements exhibit disproportionately worse maternal and newborn outcomes. Postnatal care (PNC) is a high-impact intervention for populations contributing to higher mortalities. Postnatal education is crucial to adopting evidence-based postnatal practices (PNPs) thus its post-discharge reinforcement is vital for low-income primiparas. This study aimed to determine the effect of post-discharge follow-up postnatal education intervention (PNE) on the adoption of recommended PNPs among low-income primiparas. quasi-experimental study in Nairobi informal settlements with 118 primiparas discharged early after normal delivery on each arm. Facility and demographic data collected using an interviewer-administered questionnaire. Study arm received the intervention for 6 weeks in addition to routine PNC while control received routine PNC only. An interviewer-administered exit questionnaire was applied after 6 weeks. Focus group discussions were conducted for qualitative data then analyzed thematically. SPSS used to analyze quantitative data then descriptive statistics, t-tests, Chi-square, Mann-Whitney, and multiple linear or logistic regressions derived. PNPs composed of health-seeking for maternal and newborn danger signs, self and baby care practices, and utilization of PNC contacts. the intervention was a positive predictor of adoption of composite PNPs (β=0.26, p=0.00), self-care practices (β=0.39, p=0.00) and mothers' two weeks PNC contact (OR=4.64, p=0.00, 95% CI=1.9-11.2). Neither a significant predictor of health-seeking for maternal (β=-0.11, p=0.31) nor newborns danger signs (β=-0.04, p=0.73) though inversely related. No influence on baby care practices, two weeks of newborn contact and six weeks contact for the dyad. Multi-pronged approaches are appreciated. follow-up post-discharge PNE intervention enhances adoption of PNPs among low-income primiparas thus a worthwhile supplement to routine PNC.

Targeting FGFR3 signaling and drug repurposing for the treatment of SLC26A2-related chondrodysplasia in mouse model

BackgroundMutations in Slc26a2 cause a spectrum of autosomal-recessive chondrodysplasia with a significant and negligible influence on the quality of life. It has been reported that Slc26a2 deficiency triggers the ATF6 branch of the UPR, which may, in turn, activate the negative regulator of the FGFR3 signaling pathway. However, the correlation between the deletion of Slc26a2 and the augmentation of downstream phosphorylation of FGFR3 has not been investigated in vivo. MethodsFirst, we constructed Slc26a2 and Fgfr3 double knockout mouse lines and observed gross views of the born mice and histological staining of the tibial growth plates. The second approach was to construct tamoxifen-inducible Cre-ERT2 mouse models to replicate SLC26A2-related non-lethal dysplastic conditions. Pharmacological intervention was performed by administering the FGFR3 inhibitor NVP-BGJ398. The effect of NVP-BGJ398 on chondrocytes was assessed by Alcian blue staining, proliferation, apoptosis, and chondrocyte-specific markers and then verified by western blotting for variations in the downstream markers of FGFR3. The growth process was detected using X-rays, micro-CT examination, histomorphometry staining of growth plates, and immunofluorescence. ResultsGenetic ablation of Fgfr3 in embryonic Slc26a2-deficient chondrocytes slightly attenuated chondrodysplasia. Subsequently, in the constructed mild dysplasia model, we found that postnatal intervention with Fgfr3 gene in Slc26a2-deficient chondrocytes partially alleviated chondrodysplasia. In chondrocyte assays, NVP-BGJ398 suppressed the defective phenotype of Slc26a2-deficient chondrocytes and restored the phosphorylation downstream of FGFR3 in a concentration-dependent manner. In addition, in vivo experiments showed significant alleviation of impaired chondrocyte differentiation, and micro-CT analysis showed a clear improvement in trabecular bone microarchitectural parameters. ConclusionOur results suggested that inhibition of FGFR3 signaling pathway overactivation and NVP-BGJ398 has promising therapeutic implications for the development of SLC26A2-related skeletal diseases in humans. The translational potential of this articleOur data provide genetic and pharmacological evidence that targeting FGFR3 signaling via NVP-BGJ398 could be a route for the treatment of SLC26A2-associated skeletal disorders, which promisingly advances translational applications and therapeutic development.

Early Life Interventions: Impact on Aging and Longevity.

Across mammals, lifespans vary remarkably, spanning over a hundredfold difference. Comparative studies consistently reveal a strong inverse relationship between developmental pace and lifespan, hinting at the potential for early-life interventions (ELIs) to influence aging and lifespan trajectories. Focusing on postnatal interventions in mice, this review explores how ELIs influence development, lifespan, and the underlying mechanisms. Previous ELI studies have employed a diverse array of approaches, including dietary modifications, manipulations of the somatotropic axis, and various chemical treatments. Notably, these interventions have demonstrated significant impacts on aging and lifespan in mice. The underlying mechanisms likely involve pathways related to mitochondrial function, mTOR and AMPK signaling, cellular senescence, and epigenetic alterations. Interestingly, ELI studies may serve as valuable models for investigating the complex regulatory mechanisms of development and aging, particularly regarding the interplay among somatic growth, sexual maturation, and lifespan. In addition, prior research has highlighted the intricacies of experimental design and data interpretation. Factors such as timing, sex-specific effects, administration methods, and animal husbandry practices must be carefully considered to ensure the reliability and reproducibility of results, as well as rigorous interpretation. Addressing these factors is essential for advancing our understanding of how development, aging, and lifespan are regulated, potentially opening avenues for interventions that promote healthy aging.

The impact of New Families home visiting program on first-time mothers’ quality of life and its association with social support: a non-randomized controlled study

BackgroundThe transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers’ QoL and to investigate the association between their QoL, social support, and selected possible predictive factors.MethodsA prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations.ResultsOur data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain.ConclusionsFurther research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers’ QoL and could be provided and facilitated by public health nurses.Trial registrationclinicaltrial.gov NCT04162626.

Co-designing a nature-based intervention to promote postnatal mental health for mothers and their infants: a complex intervention development study in England

ObjectivesThere is burgeoning evidence for the potential of nature-based interventions to improve wellbeing. However, the role of nature in enhancing maternal mental health, child development and early relationships remains relatively...

Trustworthiness assessment as an inclusion criterion for systematic reviews—What is the impact on results?

AbstractBackgroundThere is increasing concern that a significant proportion of randomized controlled trials (RCTs) included in Cochrane reviews may not be trustworthy. Applying the Cochrane Pregnancy and Childbirth Trustworthiness Screening Tool (CPC‐TST) has already had a clinically important effect on several reviews published by the Cochrane Pregnancy and Childbirth Group.ObjectivesWe wanted to assess the impact of removing untrustworthy RCTs from already‐published Cochrane reviews on a defined clinical area (antenatal and postnatal nutritional interventions).MethodsWe applied the tool to 18 Cochrane reviews (374 RCTs). The tool had four domains: (i) is the research governance trustworthy; (ii) are the baseline characteristics trustworthy; (iii) is the study feasible; (iv) are the results plausible? When additional information was needed, authors were contacted using a standard template. At least two attempts were made to contact the authors. At the end of the evaluation process each study was classified as: (i) included (YES to all questions); (ii) excluded (retracted study); or (iii) awaiting classification (any NO to the questions).ResultsNinety‐three out of 374 included studies (25%) were reclassified as “excluded” or “awaiting classification.” The number of included RCTs was reduced in 14 out of 18 reviews. Six reviews (33%) were judged to require updating because of important differences in the Summary of Findings tables (direction and size of effects and/or GRADE ratings), conclusions, implication for practice, and/or implication for research.ConclusionsFormal assessment of trustworthiness, and inclusion only of studies that satisfy prespecified criteria for trustworthiness, affect conclusions in a relatively large number of Cochrane reviews, with potentially important clinical implications for practice and research.

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions.

Severe left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging. To compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis. Prospective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022. A total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA. Fetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow.

Prognostic algorithms for post-discharge readmission and mortality among mother-infant dyads: an observational study protocol.

In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine follow-up after delivery and facility discharge, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and informing a patient-centered approach to postnatal care interventions. This study aims to derive post-discharge risk prediction algorithms that identify mother-newborn dyads who are at risk of re-admission or death in the first six weeks after delivery at a health facility. This prospective observational study will enroll 7,000 mother-newborn dyads from two regional referral hospitals in southwestern and eastern Uganda. Women and adolescent girls aged 12 and above delivering singletons and twins at the study hospitals will be eligible to participate. Candidate predictor variables will be collected prospectively by research nurses. Outcomes will be captured six weeks following delivery through a follow-up phone call, or an in-person visit if not reachable by phone. Two separate sets of prediction models will be built, one set of models for newborn outcomes and one set for maternal outcomes. Derivation of models will be based on optimization of the area under the receiver operator curve (AUROC) and specificity using an elastic net regression modelling approach. Internal validation will be conducted using 10-fold cross-validation. Our focus will be on the development of parsimonious models (5-10 predictor variables) with high sensitivity (>80%). AUROC, sensitivity, and specificity will be reported for each model, along with positive and negative predictive values. The current recommendations for routine postnatal care are largely absent of benefit to most mothers and newborns due to poor adherence. Data-driven improvements to postnatal care can facilitate a more patient-centered approach to such care. Increasing digitization of facility care across low-income settings can further facilitate the integration of prediction algorithms as decision support tools for routine care, leading to improved quality and efficiency. Such strategies are urgently required to improve newborn and maternal postnatal outcomes. https://clinicaltrials.gov/, identifier (NCT05730387).

Imaging and outcomes of fetal adrenal hemorrhage: A systematic review.

To describe prenatal and postnatal imaging findings of fetal adrenal hemorrhage (FAH) and its associated perinatal outcomes, including frequency of postnatal surgical intervention. A systematic literature review of seven electronic databases was conducted from inception until January 2022, with 2008 articles identified reporting prenatally identified fetal adrenal masses. Studies with confirmed FAH diagnosis were included. Quality and risk assessment were evaluated. Thirty-five studies, including 102 FAH cases, were analyzed. FAH was commonly described as cystic (28/90, 31%), anechoic (25/90, 28%), or mixed echogenic (14/90, 16%) on ultrasound. Outcome data were available for 65 cases (64%) of FAH: 9% (6/65) resolved prenatally, 35% (23/65) resolved postnatally, 34% (22/65) regressed in size after birth, and 22% (14/65) persisted postnatally. Overall, 25% (16/65) of cases underwent postnatal surgical intervention. Neuroblastoma was suspected in all 16 surgical cases. Only one case (1/16, 6%) confirmed a cystic hematoma with microscopic islets of neuroblastoma in situ on pathology. Prenatal diagnosis of FAH is challenging due to the significant heterogeneity of ultrasound findings. Final pathology did not support the need for surgical intervention. Persistent postnatal FAH warrants shared decision making for further management based on the clinical presentation.

Perinatal Outcomes in Hypoplastic Left Heart Syndrome

Aim: To review our experience in fetuses with prenatally diagnosed hypoplastic left heart syndrome (HLHS).&#x0D; Materials and Method: Retrospective study of fetuses prenatally diagnosed with HLHS between 2020 and 2022 in a tertiary referral center.&#x0D; Results: 29 fetuses with HLHS were identified. 13 of all 29 cases (44.8%) had associated cardiac abnormalities and 8 cases (27.5%) had coexisting extracardiac abnormalities. Only a small minority of cases underwent invasive diagnostic testing (20%), and all of which had a normal karyotype. Most cases were delivered at term (58.6%), median gestational week at delivery was 37 (range, 34-39), and the mean standard deviation (SD) birthweight was 3099±455 grams. In addition, HLHS was more common in male than in female fetuses (69% vs 31%). Termination of pregnancy (TOP) was selected in 4 (13.7%) of the diagnosed 29 cases and performed before at ≤ 26 weeks of pregnancy. There were 3 intrauterine fetal demise (IUFD) at 23,29, and 34 weeks of gestation. Among the 29 cases of HLHS, 22 (75.8%) were live born. 3 of 22 live born infants were managed by medical procedures as they were not appropriate surgical candidates and later died at 22nd, 23rd and 25th of postnatal day. Surgery was performed in 15 cases and only one of them is are still alive. Mortality rate in the first three months of neonatal period was 96.5%. &#x0D; &#x0D; Conclusion: Fetal echocardiography allows an accurate diagnosis of HLHS, which is made even&#x0D; in the late first trimester. Despite early prenatal detection and postnatal surgical interventions, the results from our center in last two years reflect poor outcomes for HLHS.

Community-based perinatal mental health peer support: a realist review

BackgroundPeer support has been suggested as an alternative or complement to professional support for mothers with perinatal mental health difficulties. The aim of this realist review was to synthesise the evidence on perinatal mental health peer support programmes outside mental health services, to understand what is it about community-based perinatal mental health peer support that works, for whom, in what circumstances, in what respects, and why.MethodsApplying realist methodology, an initial theoretical model was tested against evidence from empirical studies. 29 empirical studies were included, covering 22 antenatal and postnatal mental health interventions that offered one-to-one or group peer support, in person or by telephone. Data extraction identified the configurations of contexts (C), mechanisms (M) and outcomes (O) relevant to mothers’ use of peer support and to the positive and negative effects of using peer support.Results13 C-M-O configurations explained take-up of peer support. These were based on mothers’ perceptions that peer support would offer empathetic understanding and non-judgemental acceptance outside their social circle; their relationships with primary health professionals; their cultural background and perspectives on mental health; their desire for professional support; overcoming practical barriers; the format of the support; and the use of volunteers. A further 13 C-M-O configurations explained positive impact on mothers. These were based on receiving empathetic listening, acceptance, affirmation and normalisation; peers sharing ideas about self-care, coping, and services; peers using therapeutic techniques; the opportunity to give support to others; meaningful social relationships with volunteers and other mothers; and other benefits of attending a group. There were 8 C-M-O configurations explaining negative impact. These were based on lack of validation; self-criticism from downward and upward social comparison; a culture of negativity; peers being judgemental or directive; not feeling heard; peer support as a stressful social relationship; and distress at endings.ConclusionsPeer support works in complex ways that are affected by personal and social contexts. Providers, commissioners and evaluators can use this review to understand and maximise the valuable benefits of peer support, to minimise potential risks, and to devise ways of reaching mothers who do not currently engage with it.

Estimation of Risk Factors for Intellectual Disability in North Karnataka Region: A Retrospective Analysis

Introduction: Intellectual disability (ID) is a neurodevelopmental disorder characterized by three main clinical conditions, i.e., cognitive deficiencies, impairments of adaptive function, and onset during the developmental period. The causes of ID include genetic abnormalities, as well as prenatal, perinatal, and postnatal environmental factors such as exposure to toxic agents, nutritional deficiencies, childhood brain infections, and maternal infections such as rubella and cytomegalovirus may lead to ID. The present study attempted to perform a detailed analysis of case histories of children with ID among North Karnataka region to examine the frequency of occurrence of risk factors which can cause onset of ID. Methods: Retrospective analysis of records of 1400 individuals who visited our Institute, for speech and language evaluation was analyzed. Among 1400 cases, there were 300 cases were selected for the study. Results: The risk factors identified in this study primely constitute of perinatal and postnatal factors and lower socioeconomic status. Conclusion: It may be implied from the results of the study that appropriate peri and postnatal health care interventions can help to reduce risks leading to ID. Utilizing this knowledge will help with both primary and secondary level prevention by raising public awareness of the probable causes of ID. It is also possible to identify these risk factors, detect ID early, and then intervene at the earliest. Furthermore, extensive researches focusing on a thorough evaluation of risk factors with respect to severity of ID need to be carried out. This will help in understanding the causative factors better, and hence, enhance the development of preventive strategies and planning of a better rehabilitation program.

Factors relating to sustainability and scalability of the 'Food, Move, Sleep (FOMOS) for Postnatal Mental Health' program: Qualitative perspectives from key stakeholders across Australia.

Supporting healthy behaviours (quality diet, physical activity, sleep) through home-based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale-up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research-practice translation. Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi-structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale-up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale-up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. Individual-level: Targeting multiple systems (primary, tertiary, community-based care) and entry points (early, mid-postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at-risk women, was suggested. Provider-level: Stakeholders identified strategies to enhance future roll-out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems-level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. For sustainable implementation and potential scalability of a home-based multi-behaviour postnatal intervention, multi-level implementation and scale-up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. SO WHAT?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future.

Maternal Satisfaction with Home Versus Health Facility Postnatal Nursing Intervention: A quasi Experimental Study

Introduction: The postnatal stage is the most important but also the most ignored stage in the mother and newborn's lives. Early and immediate postnatal care that is satisfactory has been defined as meeting the postnatal health care needs of mothers to the level of their expectations and enhancing their quality of life. Aim: The aim of the present study was to compare how satisfied mothers were with postnatal nursing interventions at home compared to in a hospital. Methods and Materials: This was a quasi-experimental approach and a quantitative design. The study was conducted in Rania City, Kurdistan Region of Iraq, between December 30, 2020, and December 15, 2021. The mothers were divided into three groups at random: one control group (n=50), two groups of intervention (the first group receiving postpartum care at home (n=50), and the other in a medical center (n=50). The mothers were examined within 24 hours of birth and conducted necessary interventions for the two intervention groups during three follow-up visits over a six-week period. The data was analyzed using SPSS version 25 and presented as percentage, frequency, and the chi-square test was used accordingly. Results: A total of 150 postpartum mothers participated in our study, with a mean age of 35 years. Most of them had a high school diploma or equivalent. The majority of mothers had nuclear families. Six weeks after giving birth, the postpartum assessment of mothers' satisfaction with postpartum care overall among the home, facility, and control groups was 17.411, d.f. = 2, P-Value = 0.000. Compared to the two experimental groups, the mothers in the control groups often followed more plans for treatment after giving birth. Conclusion: The study found that home visits were the most effective form of postnatal care. Therefore, home nursing care is an effective method for enhancing postpartum wellness in mothers.