Postpartum Adaptation Research Articles

Temporal dissociation between local and global functional adaptations of the maternal brain to childbirth: a longitudinal assessment.

The maternal brain undergoes significant reorganization during birth and the postpartum period. However, the temporal dynamics of these changes remain unclear. Using resting-state functional magnetic resonance imaging, we report on local and global brain function alterations in 75 mothers in their first postpartum week, compared to 23 nulliparous women. In a subsample followed longitudinally for the next six months, we observed a temporal and spatial dissociation between changes observed at baseline (cluster mass permutation: pFWE < 0.05). Local activity and connectivity changes in widespread neocortical regions persisted throughout the studied time period (ANCOVAs vs. controls: pFDR < 0.05), with preliminary evidence linking these alterations to behavioral and psychological adaptations (interaction effect with postpartum time: uncorrected p < 0.05). In contrast, the initially reduced whole-brain connectivity of putamen-centered subcortical areas returned to control levels within six to nine weeks postpartum (linear and quadratic mixed linear models: pFDR < 0.05). The whole-brain spatial colocalization with hormone receptor distributions (Spearman correlations: pFDR < 0.05) and preliminary blood hormone associations (interaction effect with postpartum time: uncorrected p < 0.05) suggested that the postpartum restoration of progesterone levels may underlie this rapid normalization. These observations enhance our understanding of healthy maternal brain function, contributing to the identification of potential markers for pathological postpartum adaptation processes, which in turn could underlie postpartum psychiatric disorders.

Use of antipsychotics during pregnancy and their impact on congenital malformations and early neonatal adaptation.

Review of recent literature dealing with the effect of antipsychotic use during pregnancy on early postpartum adaptation of exposed infants and the development of congenital malformations. The use of antipsychotics during pregnancy does not appear to lead to significantly higher risk of congenital malformations but may pose a greater risk for the early adaptation of the newborn (especially the risk of preterm birth and intensive care unit admission). The study to date face methodological limitations - lack of information on exact doses of antipsychotics, lack of control groups of women with psychiatric problems but not taking antipsychotics and failure to control for confounding factors. The available data suggest the relative safety of antipsychotics during pregnancy, provided that potential risks are known, and the woman and her baby are carefully monitored.

Changes in left hippocampal volume in first-time fathers: Associations with oxytocin, testosterone, and adaptation to parenthood.

The parenting brain may undergo remodeling that supports the adjustment to new parenthood. Prior work on human mothers has found gray matter volume decreases from preconception to early postpartum in multiple structures, including the left hippocampus, which was the only structure to show gray matter volume recovery at 2 years postpartum. This is consistent with evidence from animal models that the hippocampus is unusually plastic across reproductive transitions. However, no studies have focused specifically on hippocampal volume changes in human fathers. Among 38 men who were scanned by magnetic resonance imaging (MRI) before and after having their first child, individual differences in left hippocampal volume changes were associated with men's prenatal oxytocin, postpartum testosterone, and postpartum adaptation to parenthood. Across the whole sample, hippocampal volumes did not change significantly from prenatal to postpartum. However, men who showed larger increases in left hippocampal volume from prenatal to postpartum reported stronger parent-child bonding and affectionate attachment and lower parenting stress. Fathers with higher levels of prenatal oxytocin showed larger left hippocampal volume increases across the transition to parenthood. In turn, greater increases in left hippocampal volume predicted lower postpartum testosterone after adjusting for prenatal testosterone. These findings did not extend to the right hippocampus. In conclusion, remodeling of the left hippocampus across the transition to new fatherhood may reflect adaptation to parenthood in human males.

Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum – a systematic review with implications for the function of the oxytocinergic system

BackgroundThe reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding.AimTo systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems.MethodsSystematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables.ResultsInfusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2–3 times physiological levels.Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher.Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.ConclusionsSynthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2–3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.

Tpeak-Tend Interval during Pregnancy and Postpartum.

Background: Pregnancy is a condition in which new cardiac arrhythmias can occur or prior undiagnosed arrhythmias may provide symptoms. The occurrence of severe ventricular arrhythmias and polymorphic ventricular tachycardia that may lead to fainting or sudden cardiac death is promoted by the prolongation of the QTc interval. The post-partum adaptation period is the most arrhythmogenic. TpTe (Tpeak-Tend interval) is a novel marker of arrhythmogenesis by many considered a more sensitive marker than QTc. Objective: The aim of our work was to determine the TpTe interval (Tpeak-Tend) in women in the first, second and third trimester of pregnancy and the post-partum period. Materials and Methods: The study group consisted of 128 women in pregnancy or postpartum and a control group of 32 non-pregnant women. A standard 12-lead ECG (electrocardiograph) recording with evaluation of the duration of TpTe and QTc was performed in all patients. Results: In comparison to the non-pregnant women, higher values of QTc and TpTe were observed starting in the first trimester with highest values observed in the postpartum period. Mean duration of TpTe interval during pregnancy (81.59 ± 5.92 ms) and in the whole study group (pregnancy + postpartum) (85.46 ± 6.45 ms) was significantly longer (p < 0.001) compared to the TpTe interval in the control group (74.06 ± 6.14 ms). During pregnancy and postpartum, the increase in the TpTe interval in comparison to the increase in the QTc parameter (31.10% vs. 4.18%) was significantly higher (p < 0.001). Conclusions: The study showed an increase in the duration of the TpTe interval and QTc parameter during pregnancy and postpartum with the highest values in the postpartum period. TpTe interval increase was significantly higher compared to QTc increase during pregnancy and postpartum. Changes of TpTe interval were not associated with any clinical outcome or measure of arrythmia burden. Further studies are needed in order to see the clinical significance of these ECG findings, in particular for larger groups of patients with automatic measurement in correlation with echocardiography

The Genomic Architecture of Pregnancy-Associated Plasticity in the Maternal Mouse Hippocampus.

Pregnancy is associated with extraordinary plasticity in the maternal brain. Studies in humans and other mammals suggest extensive structural and functional remodeling of the female brain during and after pregnancy. However, we understand remarkably little about the molecular underpinnings of this natural phenomenon. To gain insight into pregnancy-associated hippocampal plasticity, we performed single nucleus RNA sequencing (snRNA-seq) and snATAC-seq from the mouse hippocampus before, during, and after pregnancy. We identified cell type-specific transcriptional and epigenetic signatures associated with pregnancy and postpartum adaptation. In addition, we analyzed receptor-ligand interactions and transcription factor (TF) motifs that inform hippocampal cell type identity and provide evidence of pregnancy-associated adaption. In total, these data provide a unique resource of coupled transcriptional and epigenetic data across a dynamic time period in the mouse hippocampus and suggest opportunities for functional interrogation of hormone-mediated plasticity.

Design of Autonomous Controlled Integrated System for Increasing Comfort in Newborns

Background: The adaptations of “term” and “preterm” newborns to the world are quite different, but one of the important problems for both groups during these periods is to provide temperature control of the newborn, to reduce its exposure to light, and to provide ambient sound control. One of the important criteria in the postpartum adaptation of newborn babies is the attempts to increase environmental comfort. In providing comfort; ambient factors such as noise, light, heat, are tried to be controlled. Aim and Objectives: It is aimed to increase comfort by optimizing the environmental conditions of the baby in the Autonomous Controlled Integrated System for Increasing Comfort in Newborn Babies, which will be designed within the scope of this study. Materials and Method: To summarize the integrated system, the autonomously controlled integrated system to be designed and produced within the scope of the project generally consists of three main modules. These modules can be summarized as analyzing the environmental conditions, making decisions based on artificial intelligence depending on the analyzed environmental conditions, and reporting the operations performed to the users using different communication channels. In this structure, first of all; The integrated system designed will measure the cradle environment and baby body temperature in real-time to increase baby comfort. The system will evaluate the measurement values obtained in the second module on the artificial intelligence map and generate commands for the environment to reach optimum conditions. To summarize this module, noise measurement in the integrated system will be measured in decibels with sound level measurement devices. In cases where babies are exposed to excessive noise, system stimulation will be activated and the ambient noise will be reduced, thus protecting the baby from the harmful effects of excessive noise. The light intensity of the lighting environment where the baby's environment is located will be kept in the range of a minimum of 10 lux and a maximum of 600 lux mentioned in the literature. By performing system simulation below or above this range, the user will be informed and the environment will be brought to optimum conditions. In addition to monitoring the environment, the recorded sound data will also make predictions based on artificial intelligence about the baby's needs or problems, according to the baby's crying pattern. In the third module, the system will ensure that the real-time transaction process is reported to the user and the family health center. Results: As a result, with the integrated system that will be designed and produced, it will be possible to intervene in real-time based on artificial intelligence technology to the changes in the environment where the baby is located, and this situation will be reported with real-time data. Conclusion: Thus, baby comfort will be increased, family anxiety level will be reduced, and changes in the baby's environment will be reported in real-time.

Efficacy of an Early Self-care-Based Education Program on the Self-evaluation of Primiparous Postpartum Mothers: A Randomized Controlled Clinical Trial

Background: During the postpartum period, due to the lack of knowledge about postpartum complications and care, women, especially primiparous women, lack the adequate skills to adapt to new conditions and have no confidence to care for themselves and their infants. The early mothers' assessment, education, counseling, and nursing interventions can increase their adaptation and reduce their incompatible responses to their infant and partner. Objectives: This study aimed to examine the effect of early self-care based education program on primiparous women’s self-evaluation. Methods: A randomized controlled clinical trial was conducted from May to October 2018 on 58 primiparous women referred to the Neonatal Screening Center in Karaj (IRAN). A random allocation method was applied to select intervention and control groups. The data were collected using a three-part questionnaire consisting of general, developmental, and health deviation postpartum evaluation made by researchers. The intervention group received three education sessions throughout the 3 - 5, 10 - 15, and 17 - 22 days after childbirth. The control group received routine postpartum care. Data were analyzed by descriptive statistics (such as mean, standard deviation, and absolute frequency) and statistical tests (including t-test, paired t-test, and chi-square) or non-parametric statistical tests (e.g., the Wilcoxon and Mann-Whitney test) using SPSS version 19. Results: Before the intervention, there was no statistically significant difference in the mean total self-evaluation scores between the intervention (131.269 ± 12.742) and control (137 ± 9.600) groups (P-value = 0.073), but six weeks after delivery, a significant difference was observed in the mean self-evaluation scores between the intervention (149.692 ± 7.625) and control (122.923 ± 11.495) groups (P-value &lt; 0.001). Conclusions: The results of this study showed that early self-care education program was effective for primiparous women's self-evaluation and increased the postpartum adaptation of the women.

The impact of having children on domain-specific life satisfaction: A quasi-experimental longitudinal investigation using the Socio-Economic Panel (SOEP) data.

Longitudinal studies have documented improvements in parents' life satisfaction due to childbearing, followed by postpartum adaptation back to baseline. However, the details underlying this process remain largely unexplored. Based on past literature, set-point theory, and results from an exploratory sample, we investigated empirically how first childbirth affected satisfaction with specific domains of life. In a preregistered study, we compared parents with matched childless respondents in their trajectories of life satisfaction, and also satisfaction with family life, health, sleep, work, housework, leisure, dwelling, household income, and personal income. First-time parents and childless respondents were matched in a procedure combining exact and propensity score matching. Using the population-representative German SOEP data (N = 3,370), longitudinal multilevel models revealed heterogeneous effects of childbirth on different domains of satisfaction: Both mothers' and fathers' satisfaction with family life increased temporarily in a similar fashion to life satisfaction before going back to baseline within five years after childbirth. However, only mothers experienced drastic losses to satisfaction with sleep and satisfaction with personal income. For the remaining domains, parents' satisfaction largely resembled that of the matched childless respondents. These divergent domain trajectories underscore the need for multivariate analyses in life satisfaction research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PROGNOSTIC VALUE OF SERUM MAGNESIUM LEVEL AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN PREMATURE BIRTH NEONATES

Optimal magnesium supply during pregnancy and overcoming magnesium deficiency is essential due to its physiological role in many metabolic processes. Metabolic transformations with magnesium are necessary for the vitamin D activation, energy supply for homocysteine restoration, and regulation of nitric oxide synthesis. Magnesium deficiency increases the risk of premature birth, and the diffusion of magnesium to the fetus increases precisely from the second trimester of pregnancy, therefore, its deficiency can adversely affect neonatal adaptation. The aim of this work was to investigate the relationship between the serum magnesium level and markers of endothelial dysfunction and the clinical features of the early neonatal period course. Results. The average level of serum magnesium in 58 premature birth neonates was 1.21 ± 1.09 mg/dl on the first day. A borderline low level of serum magnesium (less than 1.2 mg/dl) was found in 72.41% of the examined children. Statistical analysis did not reveal a relationship between the serum magnesium level on the first day after birth and the studied markers of endothelial dysfunction (eNOS gene variants, nitric oxide level). A positive correlation was found between serum magnesium level and Apgar scores in newborns. For nitric oxide, a negative correlation with the Apgar 2 score and a positive correlation with the degree of respiratory failure were found. Serum magnesium and nitric oxide levels in premature birth neonates measured on the first day after birth enable to assess the course of the antenatal period and to predict postpartum adaptation.

Effect of Aromatherapy Using Bergamot and Lavender Oils on Postpartum Blues

Postpartum adaptation failure can cause a mild psychological disorder in the type of postpartum blues. Various aromatherapy has been tested to treat postpartum blues. This study aimed to compare the effectiveness of aromatherapy using bergamot with lavender oils in postpartum blues. This non-randomized quasi-experimental controlled trial study with a pretest and posttest design was performed on 40 women after cesarean section (C-section) using consecutive sampling. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was used for the diagnosis of postpartum blues. The participants were given seven drops of aromatherapy oils via a handkerchief inhaled with ten deep breaths for 14 days and then placed next to a pillow. The EPDS scores were measured twice (at the baseline and after 7 days). The data were analyzed using SPSS software (version 21) and the Mann-Whitney U and Wilcoxon tests. The mean EPDS scores before the intervention were 11.4±0.9 and 11.1±1.2 in the bergamot and lavender groups, respectively. The mean EPDS scores on the 7th day of the intervention were 8.8±3.1 and 5.3±2.2 in the bergamot and lavender groups, respectively (P=0.003). Aromatherapy is recommended within the 3rd to 5th day following C-section.

Association between long interpregnancy intervals and cesarean delivery due to arrest disorders

It is hypothesized that pregnancy causes time-limited physiologic adaptations of the reproductive system, such as increased blood flow to the uterus. With long interpregnancy intervals, those adaptations may regress, and maternal physiologic characteristics may revert to those of primigravid women. Therefore, it is plausible that long interpregnancy interval is associated with cesarean delivery, especially due to arrest disorders (failed induction of labor, arrest of dilation, or arrest of descent). To examine the association between interpregnancy interval and cesarean delivery due to arrest disorders in multiparous women without a history of cesarean delivery. This was a retrospective cohort study of all women who had more than 1 singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We defined the interpregnancy interval as the duration from the birth of the preceding offspring to the date of conception of the index offspring. We a priori decided to categorize women based on the interpregnancy interval (less than 18 months, 18-59 months, and 60 months or greater). Our primary outcome was cesarean delivery due to arrest disorders. We also examined overall cesarean delivery and cesarean delivery due to nonreassuring fetal heart tracing. Multivariable logistic regression was performed to calculate adjusted odds ratios and 95% confidence intervals, controlling for predefined covariates. Of 2741 women, 1143 (41.7%), 1369 (49.9%), and 229 (8.4%) had an interpregnancy interval of less than 18 months, 18-59 months, and 60 months or more, respectively. After adjusting for confounders, an interpregnancy interval of 60 months or more compared to an interpregnancy interval of 18-59 months was associated with increased odds of cesarean delivery due to arrest disorders (4.8% vs 1.3%; adjusted odds ratio, 3.06; 95% confidence interval, 1.34-6.97) and cesarean delivery due to arrest of dilation (3.1% vs 0.7%; adjusted odds ratio, 3.24; 95% confidence interval, 1.10-9.59). An interpregnancy interval of less than 18 months compared to an interpregnancy interval of 18-59 months was associated with decreased odds of cesarean delivery due to nonreassuring fetal heart tracing (2.4% vs 4.1%; adjusted odds ratio, 0.55; 95% confidence interval, 0.32-0.92). An interpregnancy interval of 60 months or greater compared to an interpregnancy interval of 18-59 months was associated with increased odds of cesarean delivery due to arrest disorders. Beneficial effects on postpartum adaptations in the reproductive system may regress as interpregnancy interval increases.

Postpartum Persistence of Maternal Uterine Vascular Gestational Adaptation in Rodents.

Although pregnancy has long-lasting consequences for maternal vascular health, little is known about vascular changes postpartum (PP). Focusing on the uterine circulation, which undergoes unique structural and functional adaptation during gestation, we hypothesized that most pregnancy-induced changes would return to baseline PP, with minimal hysteresis. Large (main; MUA) and small (segmental; SUA) uterine arteries from adult Sprague Dawley rats (n = 42) were evaluated 1 and 4weeks PP (1PP, 4PP) and compared with those of late-pregnant (LP, day 21) and age-matched non-pregnant (NP) animals. Some comparisons were extended to mesenteric arteries to evaluate differences between reproductive and systemic vessels. Pregnancy-induced axial elongation regressed > 80% 1PP in MUAs and SUAs, although some minimal hysteresis remained 4PP. Circumferential growth was slower to regress, with no reductions in lumen diameter or media thickness 1PP; values returned to (MUA) or approached (SUA) NP values by 4PP. Changes in vascular smooth muscle cell cross-sectional area-a measure of hypertrophy-paralleled those in lumen diameter. Mesenteric and uterine artery compliance diverged during gestation, and continued to do so PP. Decreased MUA compliance 4PP was supported by an increased collagen:elastin ratio. Adrenergic sensitivity increased in uterine, and decreased in mesenteric arteries during pregnancy, and returned to NP values 4PP in both types of vessels. MUA α-1 adrenoceptor expression tracked along with sensitivity. Thus, postpartum adaptation varies by both parameter and vessel type. While many parameters regressed postpartum, alterations in compliance did not, suggesting that matrix changes may have long-term consequences for maternal vascular function and health.

ASSESSMENT OF KNOWLEDGE REGARDING POSTNATAL MINOR DISCOMFORTS AND SELF CARE ACTIVITIES AMONG NULLIPAROUS WOMEN: SUGGESTED GUIDELINES

Postpartum minor discomforts may occur resulting from all systems adaptation. Immediate and effective care for these discomforts can make the differences in postpartum adaptation. The aims of the study were to assess knowledge regarding postnatal minor discomforts and self care activities among nulliparous women and set guidelines for nulliparous women about postnatal minor discomforts and self care activities. Study design: cross sectional descriptive design. Setting: the antenatal clinic of two hospitals (Zagazig university hospital and al Ahrar hospital. Study subjects: A convenient sample included 520 nulliparous women. Tools of data collection: A structured interview questionnaire was used. Results: The mean age of the studied women was 22.67 ± 2.15 years. A higher percentage of the studied women were secondary and university educated than essentially educated 52.7% & 31.5% vs. 15.8% respectively. In addition a higher percentage was rural residents and housewives 55.8% & 84.6% respectively. 68.1% of women were recruited in late pregnancy beyond 20 weeks and mothers were the main source of the studied women knowledge. Conclusion: almost three fourth of nulliparae had poor knowledge regarding the postnatal minor discomforts and self care activities for relieving them. Moreover the socio-demographic characteristics mainly affected the mean knowledge score; as young nulliparae below the age of 25, low level of education, rural residents and housewives their mean knowledge score was low. Recommendations: Health teaching supported by prints and drawings should be given to pregnant women in their antenatal visits that involve information about the postpartum period, minor discomforts that may arise during this period, their relief measures and how to differentiate them from danger signs that may arise during this critical period that require seeking advice of health care giver.

ASSESSMENT OF KNOWLEDGE REGARDING POSTNATAL MINOR DISCOMFORTS AND SELF CARE ACTIVITIES AMONG NULLIPAROUS WOMEN: SUGGESTED GUIDELINES

Postpartum minor discomforts may occur resulting from all systems adaptation. Immediate and effective care for these discomforts can make the differences in postpartum adaptation. The aims of the study were to assess knowledge regarding postnatal minor discomforts and self care activities among nulliparous women and set guidelines for nulliparous women about postnatal minor discomforts and self care activities. Study design: cross sectional descriptive design. Setting: the antenatal clinic of two hospitals (Zagazig university hospital and al Ahrar hospital. Study subjects: A convenient sample included 520 nulliparous women. Tools of data collection: A structured interview questionnaire was used. Results: The mean age of the studied women was 22.67 ± 2.15 years. A higher percentage of the studied women were secondary and university educated than essentially educated 52.7% & 31.5% vs. 15.8% respectively. In addition a higher percentage was rural residents and housewives 55.8% & 84.6% respectively. 68.1% of women were recruited in late pregnancy beyond 20 weeks and mothers were the main source of the studied women knowledge. Conclusion: almost three fourth of nulliparae had poor knowledge regarding the postnatal minor discomforts and self care activities for relieving them. Moreover the socio-demographic characteristics mainly affected the mean knowledge score; as young nulliparae below the age of 25, low level of education, rural residents and housewives their mean knowledge score was low. Recommendations: Health teaching supported by prints and drawings should be given to pregnant women in their antenatal visits that involve information about the postpartum period, minor discomforts that may arise during this period, their relief measures and how to differentiate them from danger signs that may arise during this critical period that require seeking advice of health care giver.

Transitional fetal hemodynamics and gas exchange in premature postpartum adaptation: immediate vs. delayed cord clamping

BackgroundRecent studies suggest that delayed cord clamping (DCC) is advantageous for achieving hemodynamic stability and improving oxygenation compared to the immediate cord clamping (ICC) during fetal-to-neonatal transition yet there is no quantitative information on hemodynamics and respiration, particularly for pre-term babies and fetal disease states. Therefore, the objective of this study is to investigate the effects of ICC and DCC on hemodynamics and respiration of the newborn preterm infants in the presence of common vascular pathologies.MethodsA computational lumped parameter model (LPM) of the placental and respiratory system of a fetus is developed to predict blood pressure, flow rates and oxygen saturation. Cardiovascular system at different gestational ages (GA) are modeled using scaling relations governing fetal growth with the LPM. Intrauterine growth restriction (GR), patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS) were modeled for a newborn at 30 weeks GA. We also formulated a “severity index (SI)” which is a weighted measure of ICC vs. DCC based on the functional parameters derived from our model and existing neonatal disease scoring systems.ResultsOur results show that transitional hemodynamics is smoother in DCC compared to ICC for all GAs. Blood volume of the neonate increases by 10% for moderately preterm and term infants (32–40 wks) and by 15% for very and extremely preterm infants (22–30 wks) with DCC compared to ICC. DCC also improves the cardiac output and the arterial blood pressure by 17% in term (36–40 wks), by 18% in moderately preterm (32–36 wks), by 21% in very preterm (28–32 wks) and by 24% in extremely preterm (20–28 wks) births compared to the ICC. A decline in oxygen saturation is observed in ICC received infants by 20% compared to the DCC received ones. At 30 weeks GA, SI were calculated for healthy newborns (1.18), and newborns with GR (1.38), PDA (1.22) and RDS (1.2) templates.ConclusionOur results suggest that DCC provides superior hemodynamics and respiration at birth compared to ICC. This information will help preventing the complications associated with poor oxygenation arising in premature births and pre-screening the more critical babies in terms of their cardiovascular severity.

Early and late effects of maternal experience on hippocampal neurogenesis, microglia, and the circulating cytokine milieu

The maternal brain displays considerable plasticity, and motherhood is associated with changes in affective and cognitive function. Motherhood can alter the trajectory of brain aging, including modifications to neuroplasticity and cognition. Here, we investigated the short- and long-term effects of motherhood on hippocampal neurogenesis, microglial density and morphology, and circulating cytokines, domains known to be altered with age and implicated in cognition and mood. Female rats were bred then euthanized during gestation or at various postpartum time points, culminating in middle age, and nulliparous rats served as age-matched controls. Hippocampal neurogenesis was significantly suppressed during gestation and the postpartum period. Interestingly, neurogenesis declined significantly in middle-aged nulliparous rats but increased in primiparous rats across the same period. Transient postpartum adaptations to the neuroimmune environment of the hippocampus were evidenced, as Iba-1-immunoreactive microglia assumed a deramified morphology followed by increased density. Intriguingly, aging-related changes in circulating cytokines were dependent on parity. These adaptations in neurogenic and immune processes may have ramifications for maternal mood and cognition across the peripartum period and beyond.

Comparison of Needs for Pregnancy and Postpartum Adaptation of Chinese Immigrant Women and Vietnamese Immigrant Women in South Korea.

To identify needs for pregnancy and postpartum adaptation of Chinese immigrant women and Vietnamese immigrant women in South Korea. A descriptive research design was employed. Data were collected from 244 Chinese immigrant women and Vietnamese immigrant women from 3 provinces, 20 health care centers, and multi-cultural family support centers. Data were analyzed with descriptive statistics, t-test and ANOVA. An average score for needs perceived by Chinese immigrant women was significantly higher than that perceived by Vietnamese immigrant women. There were significantly differences in physical and emotional adaptation after childbirth, nutrition during pregnancy, cross cultural understanding and personal respect, and adaptation daily activity during pregnancy between the 2 groups. The highest score of needs in Chinese immigrant women was for nutrition during pregnancy and that in Vietnamese immigrant women was for baby rearing and family support. Based on needs of pregnancy and postpartum adaption, nursing intervention program in consideration of cultural characteristics of Chinese immigrant women and Vietnam immigrant women need to be developed for their pregnancy and postpartum health care.

ПРОФІЛАКТИКА НЕВИНОШУВАННЯ БАГАТОПЛІДНОЇ ВАГІТНОСТІ З ВИКОРИСТАННЯМ РОЗВАНТАЖУВАЛЬНОГО АКУШЕРСЬКОГО ПЕСАРІЯ

Мета дослідження – оцінити ефективність застосування розвантажувальних акушерських песаріїв у жінок з багатоплідною вагітністю з високим ризиком невиношування.Матеріали та методи. Проаналізовано 40 випадків застосування розвантажувальних акушерських песаріїв у вагітних з двійнятами з ознаками невиношування у термінах 18–28 тижнів вагітності, котрі склали першу групу обстежуваних. Друга група – 12 вагітних з двійнятами, котрим був накладений шов на шийку матки з приводу істміко-цервікальної недостатності. Контрольна група – 18 вагітних з двійнею, яким призначалась консервативна терапія. Проведений аналіз перебігу вагітності, пологів, післяпологового періоду та стану неонатальної адаптації в обстежуваних групах.Результати дослідження та їх обговорення. Динаміка вкорочення шийки матки була значно повільнішою у пацієнток І групи, яким було встановлено розвантажувальний акушерський песарій, це є ефективним методом профілактики та лікування невиношування у жінок з багатоплідною вагітністю, зниження частоти пізнього аборту та передчасних пологів, перинатальних втрат. Пацієнтки І групи мали меншу кількість випадків передчасного розриву плодових оболонок у 7 (17,5 %) пацієнток І групи порівняно з 3 (25,0 %) жінками ІІ групи та у 5 (27,7 %) вагітних контрольної групи. В І групі обстежуваних термінові пологи відбулися у 34 (85 %) випадках, у ІІ групі – у 9 (75,0 %) випадках, у контрольній – 12 (66,6 %) випадках. В контрольній групі перинатальні втрати склали 2,7 %. В І групі перинатальних втрат не було. При оцінці стану неонатальної адаптації новонароджених обстежуваних груп прослідковується зниження росто-вагових показників у дітей ІІ та контрольної груп, також спостерігається зниження показників оцінки стану новонароджених за шкалою Апгар у ІІ та контрольній групах.Висновки. Методика застосування розвантажувального акушерського пессарія є патогенетично обґрунтованою у вагітних з багатопліддям і дозволяє пролонгувати вагітність до доношеного терміну у 85 % жінок досліджуваної групи, знизити медикаментозне навантаження на вагітну та плід.

Antenatal Education on Pregnant Adolescents in Turkey: Prenatal Adaptation, Postpartum Adaptation, and Newborn Perceptions

This clinical trial study was planned in order to evaluate the effect of antenatal education on antenatal and postpartum adaptation and newborn perceptions among adolescent pregnant women. A research assistant met with pregnant adolesencents in a Family Health Center and at the participants' homes. The sample included 70 pregnant adolescents (35 in experimental group, 35 in control group) chosen through simple random sampling. The experimental group received antenatal eduation, whereas the control group merely had routine surveillance. As for data collection tools, the Prenatal Self Evaluation Questionnaire (PSEQ), the Postpartum Self Evaluation Questionnaire (PPSEQ) and the Newborn Perception Scale (NPI) was used. It was found that the experiment group who received antenatal education had a lower mean total PSEQ score (133.94 ± 15.62) compared to the control group (159.86 ± 17.83). In the comparison of two groups, it was determined that the experiment group had lower mean total PPSEQ scores on the 1st day, 1st week and 2nd week compared to the control group, indicating higher levels of postpartum adaptation (p=.017, p=.009, p=.029). It was determined that the level of prenatal adaptation was higher in the experiment group, which received antenatal education, than in the control group and that levels of postpartum adaptation was significantly higher in the experiment group on the 1st postpartum day and the 1st and 2nd postpartum weeks but not on the 4th postpartum week. There were no significant differences between the experiment and control groups in terms of NPI results.