Postpartum Assessments Research Articles

Glucose tolerance two years after gestational diabetes classified by old Swedish or new WHO diagnostic criteria

AimTo explore how introduction of the lower WHO gestational diabetes (GDM) glucose criteria in Sweden affected prediabetes/type-2-diabetes (T2D) incidence two years postpartum. MethodsWomen included in the PREvention of PostPartum (PREPP) diabetes study were diagnosed with GDM according to EASD 1991 criteria (GDMOLD; n = 93) or only WHO 2013 criteria (GDMWHO; n = 174). Both groups were further stratified by BMI, and BMI-matched normoglycemic pregnancy controls were included (n = 88). Postpartum assessments included oral glucose tolerance tests (OGTT) and anthropometric measurements. ResultsThere was a higher postpartum incidence of T2D in GDMOLD versus GDMWHO (P < 0.001). Despite similar BMI, GDMOLD exhibited higher fasting and OGTT glucose levels, lower fat-free-mass, and hip circumference compared to GDMWHO. In normal-weight women, both GDM groups displayed higher HOMA-IR and lower fat-free-mass compared to controls, with GDMOLD additionally showing lower HOMA-β, slower insulin release during OGTT, and worse glucose tolerance than GDMWHO. Among obese women, the main differences were lower fat-free-mass and hip circumference in GDMOLD. ConclusionThe lower glucose cut-offs during pregnancy resulted in lower postpartum incidence of T2D, irrespective of BMI. Fat-free-mass emerged as a key determinant in glucose levels across BMI categories, while lower beta-cell function played a significant role in normal-weight women.

Postpartum Excessive Social Support Scale: A Scale Development and Psychometric Testing Study.

In Turkey and other collectivist cultures, child-rearing is a communal effort provided by multiple family members, especially female relatives such as mothers-in-law, aunts, and sisters. Environments with excessively controlling social factors can adversely affect their maternal roles. This study was conducted to develop a measurement tool for determining postpartum excessive social support. This is a scale development and psychometric evaluation study. In the study, a draft of the Postpartum Excessive Social Support Scale (PESSS) was created, subsequently submitted to expert opinion, and administered to mothers in the postpartum period of 1 to 6 weeks online between March and December 2023 (n = 440). A factor analysis (including explanatory factor analysis [EFA] and confirmatory factor analysis) was conducted to determine the construct validity of the scale, while Cronbach's alpha was examined to establish its reliability. Response bias (Hotelling T2) and additivity (Tukey's test of additivity) of the scale were also determined in the study. For the content validity of the scale, 10 experts from the field of midwifery were consulted (content validity index [CVI] = 0.80). As a result of the EFA, Kaiser-Meyer-Olkin value was found as 0.916. Through factor analysis using the direct oblimin rotation technique, a four-factor structure was identified for the scale, explaining 64.197% of the total variance (social pressure, effect of environmental factors on paternal role, effect of environmental factors on maternal role, and barriers in mother-infant interaction). The internal reliability coefficient of the scale was highly reliable (Cronbach's alpha = 0.936). There was no response bias in the scale (Hotelling's T2 = 433.558, p < .001) and it was additive (Tukey's Non-additivity = 0.000, p < .001). The PESSS is a 20-item scale measuring excessive social support between 1 and 6 weeks postpartum. The PESSS serves as a guiding tool for health care professionals to identify excessive environmental pressure hindering mothers' maternal role and to provide care accordingly. In this context, health care professionals can readily utilize the PESSS in routine postpartum assessments for mothers.

Evaluating the effects of prenatal intervention on parenting in women exposed to intimate partner violence.

The Pregnant Moms' Empowerment Program (PMEP) is a brief, group intervention for pregnant women who have experienced intimate partner violence (IPV). This study was a quasirandomized trial of the effects of PMEP on parenting. Participants were 137 pregnant women exposed to IPV in the past year; 82 received PMEP and 55 were in a no-treatment control condition. Participants completed four assessments (pretest [T1], posttest [T2], 3-month postpartum[T3], and 12-month postpartum [T4]). At T1-T4, women self-reported on their parenting attitudes (i.e., expectations of children, parental empathy, corporal punishment, parent-child family roles) and parenting confidence. At the postpartum assessments, mother-infant dyads participated in a videorecorded free play session that was coded for warm-sensitive parenting. Results showed that women who received PMEP had more appropriate expectations of children (β = 0.51, 95% CI [0.03, 0.99], dr = 0.53, 95% CI [0.31, 1.02]) and higher empathy toward children (β = 0.64, 95% CI [0.05, 1.23], dr = 0.53, 95% CI [0.04, 1.02]) at T2, as compared to women in the control group. Women who received PMEP also showed more warm-sensitive parenting at T4 (Wald χ² = 4.01, p = .045; R² = 5.58%, d = 0.41, 95% CI [0.07, 0.88]) as compared to women in the control group. No differences emerged on corporal punishment, parent-child family roles, postpartum empathy and expectations of children, parenting confidence, or 3-month postpartum parenting behaviors. Thus, results were mixed, with some short-term positive effects and other benefits emerging only at 1-year postpartum. Findings highlight the potential clinical utility of brief interventions for pregnant, IPV-exposed women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maternal personality change from pregnancy until 12 months postpartum: Associations with parenting.

Although many studies have shown that personality-as a relatively stable characteristic-is a predictor of parenting behavior, personality changes occur during adulthood. Therefore, we do not know whether previous findings based on personality assessed (long) after the birth of the child indicate that personality as assessed before the child is born predicts behaviors parents eventually display. Possibly, personality changes are additionally predictive for parenting behavior. With this three-wave longitudinal study, we aimed to examine whether mothers' personality change from pregnancy to postpartum predicts maternal parenting behavior above and beyond personality traits as assessed during pregnancy. A sample of 239 pregnant women participated in the study (Mage = 29.95 years, SD = 4.08, range 20-43; 53% primiparous; 95% of Dutch descent). Women reported their big five personality traits during pregnancy (T1), at six- (T2), and 12 months postpartum (T3). At the postpartum assessments, mothers also reported on their affectionate and hostile parenting behavior. Latent Difference Score models indicated that personality at T1 predicted hostile but not affectionate parenting behavior at T2. Changes in personality from T1 to T2 were associated with maternal hostile and affectionate parenting at T2, whereas changes from T2 to T3 were unrelated to parenting. Personality as assessed during pregnancy may thus be helpful in identifying mothers at risk of early hostile parenting behavior. Identifying predictors of personality change may inform preventive efforts aimed at reducing this risk, as personality changes from pregnancy to 6 months postpartum were more predictive of maternal parenting than initial levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi-site pilot trial.

Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). This study was a pilot single-blinded multi-site randomized trial. Two academic medical centers in Pennsylvania (n= 57) and Utah (n= 45), United States participated. One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n= 53) or UC (n= 49). PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2- and 6-month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. Feasibility assessments included consent, session delivery and assessment rates. Mixed-effect models for intent-to-treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non-prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6months postpartum. We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non-prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2months postpartum [PN = 28.0 versus UC = -10.9, 95% confidence interval (CI) =9.7, 62.1] and some evidence for baseline to 6months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = -0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN =7.4 versus UC = -21.3, 95%CI =3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2months (PN = 11.9%/UC = 16.1%) and at 6months postpartum (PN =3.8%/UC =6.2%). Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large-scale trial.

Improving the Quality of Postpartum Care in Ghana: Protocol for a Parallel Randomized Controlled Trial.

Although the postpartum period poses substantial risks and can result in significant maternal morbidity and mortality, postpartum care of the mother receives much less attention in transitional countries. We describe the protocol for a randomized controlled trial to implement and evaluate a postpartum care delivery model titled Focused-PPC (Focused Postpartum Care). Focused-PPC is an integrated group postpartum care model that meets the clinical care, education, and support needs of mothers up to 1 year after birth. The Focused-PPC intervention is a parallel randomized controlled trial with a total of 192 postpartum women at 4 health centers in Tamale, Ghana. Participants will be randomized into 1 of 2 trial arms at a 1:1 allocation ratio: (1) the control arm, which receives the standard postnatal care currently delivered in health facilities, or (2) the intervention arm, which receives the Focused-PPC model of care. Women enrolled in the intervention arm will receive postpartum clinical assessments and education for the first 6 weeks and will continue to receive education, measures of vital signs, and peer support for 12 months post partum during child welfare visits. Led by trained midwives, each postpartum group in the intervention arm will meet at 1-2 weeks, 6 weeks, and monthly thereafter for up to 1 year post partum, following the Ghana Health Service postnatal care schedule. The Focused-PPC guide, data collection tools, and audiovisual education materials were successfully developed and translated into the local language. We have enrolled and conducted baseline surveys for 192 women (sample size met) in the Focused-PPC trial who have been randomized into intervention and control arms. We have established a total of 12 Focused-PPC groups in the intervention arm, 3 groups from each site, all of which have sessions underway. Focused-PPC has the potential to change the postpartum care delivery model in Ghana and other countries in sub-Saharan Africa and beyond. ClinicalTrials.gov NCT05280951; https://clinicaltrials.gov/study/NCT05280951. DERR1-10.2196/47519.

Postpartum glycemia and pregnancy outcomes among women in Arusha Region, Tanzania

Background: Gestational diabetes mellitus is a medical condition that disappears after delivery if early diagnosis and management are done. This study aimed to determine the prevalence of hyperglycemia six weeks postpartum and pregnancy outcomes among women in Arusha City. &#x0D; Methods: A longitudinal study was conducted between March and December 2018 as part of a large study which involved 468 randomly selected pregnant women and excluded those who were diagnosed with diabetes before pregnancy. Women were screened for hyperglycemia six weeks postpartum where fasting and oral glucose tolerant tests were done by Gluco-Plus™ using World Health Organization criteria. Body fat percentage, mid-upper arm circumference, height and weight were measured using standard procedures. Postpartum information was collected using a structured questionnaire and data was analyzed using the Statistical Package for Social Science version 20 to obtain descriptive and inferential statistics.&#x0D; Results: Among 468 women who participated in the study at baseline, 392 (83.7%) returned for postpartum assessments. Postpartum hyperglycemia among women was 2.1% (n=8) and majority had normal delivery (92.6%, n=363) while 7.4% (n=29) delivered through caesarean section. About 8.2% (n=32) of the newborn were macrosomia and 4.1% (n=16) low birth weight. Miscarriages or abortions were not identified while stillbirth was observed in 0.5% (n=2) and neonatal death (1.3%, n=5). Postpartum hyperglycemia was significantly associated with body fat percentage (AOR 1.59, 95% CI: 1.14-1.91), mid-upper arm circumference (AOR 1.62, 95% CI: 1.023-1.99), macrosomia (AOR 2.43, 95% CI: 2.2-10.31) and family history of type 2 diabetes (AOR 6.4, 95% CI: 1.93-13.3).&#x0D; Conclusion: Prevalence of postpartum hyperglycemia was generally low however; it was significantly associated with macrosomia, increased body fat percentage, mid-upper circumference and family history of type 2 diabetes. Also, a low prevalence of poor pregnancy outcomes was reported which may be attributed to actions taken after being referred for further treatments and management which need further exploration.

Maternal early warning criteria predict postpartum severe maternal morbidity and mortality after delivery hospitalization discharge: a case–control study

The predictors of postpartum severe maternal morbidity and mortality have not been well-described using patient-level data. This study aimed to evaluate the application of maternal early warning criteria in the postpartum period and generate a preliminary predictive model for severe maternal morbidity and mortality occurring after delivery hospitalization discharge until 42 days postpartum. A retrospective case-control study was conducted from January 2013 to September 2020. Cases were identified from electronic medical records using the International Classification of Diseases, Tenth Revision codes for Centers for Disease Control and Prevention-defined severe maternal morbidity. Patients meeting the criteria for severe maternal morbidity and mortality from delivery hospitalization discharge until 42 days postpartum were matched for delivery hospital and year with the controls in an approximate 1:2 fashion. The objective was to identify the demographic and clinical risk factors during the antepartum through postpartum periods for postpartum severe maternal morbidity and mortality. Multivariable logistic regression was performed to estimate the risks, and a receiver operating characteristic curve was derived to evaluate the model. Ninety cases of postpartum severe maternal morbidity and mortality that occurred following delivery hospitalization discharge were identified. These were matched with 175 controls. Women with postpartum severe maternal morbidity and mortality had more postpartum assessments (mean: 1.7 vs 1.4, P=.005) and a higher frequency of maternal early warning criteria (58% [52/90] vs 2% [3/175]; P<.001) preceding the diagnosis of severe maternal morbidity and mortality than controls. Black women had higher odds of postpartum severe maternal morbidity and mortality than White women (odds ratio, 1.93; 95% confidence interval, 1.14-3.27). Women with maternal early warning criteria during postpartum assessments were more likely to experience subsequent postpartum severe maternal morbidity and mortality (odds ratio, 67.2; 95% confidence interval, 21.3-211.6) than women with no maternal early warning criteria. Although the point estimate was different in Black women (odds ratio, 161.8; 95% confidence interval, 8.9 to >999) than White women (odds ratio, 47.9; 95% confidence interval, 13.8-167.1), the effect modification between the maternal early warning criteria and race was not statistically significant (P=.93). In a multivariable model, race, body mass index, cesarean delivery, and maternal early warning criteria at postpartum assessments were associated with subsequent severe maternal morbidity and mortality, with an area under the curve of 0.905 (95% confidence interval, 0.864-0.946). Maternal early warning criteria are associated with increased odds of postpartum severe maternal morbidity and mortality. A straightforward model that includes race, body mass index, cesarean delivery, and presence of maternal early warning criteria appears to be a promising tool to identify those at risk for postpartum severe maternal morbidity and mortality following delivery hospitalization discharge. This is an important first step in improving the ability to recognize and respond to conditions preceding postpartum severe maternal morbidity. These findings should be validated in a prospective cohort.

A scoping review of nutritional interventions and policy guidelines in the interconception period for prevention of noncommunicable diseases

AbstractIntroductionThe interconception period is considered a time when parents are likely to engage with health messages and are in frequent contact with healthcare professionals. Through this scoping review and policy analysis, we synthesized articles and guidelines on interconception care to provide recommendations to improve health outcomes for parents, infants and future generations.MethodsFour databases were searched systematically, using Medical Subject Headings and free‐text terms based on ‘interconception’ and ‘postpartum.’ Selected articles included systematic reviews, pilot studies and guidelines on interconception and postpartum interventions published globally and in English by UK public health organizations and government agencies between 1 January 2010 and 12 January 2021. Thirty percent of titles, abstracts and full‐text papers were double‐screened. The description table of identified guidelines was used as a template to qualitatively generate key categories, which later developed into a framework of six domains. Findings are described using a narrative synthesis approach.ResultsWe found 47 documents with guidelines, 29 systematic reviews and 6 pilot studies on interconception and postpartum care. Six domains were generated as follows: interconception care, nutrition‐specific, nutrition‐sensitive, personal‐centred care, health professional, and multistakeholder approach. Interconception care opportunities include the postpartum period, family planning, routine practice and risk assessments. Health and nonhealthcare professionals with roles to play in the interconception period include general pratitioners, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities and charities such as Tommy's and First Step Nutrition.ConclusionsThe interconception and postpartum periods offer crucial opportunities to intervene, to reduce possible long‐term effects of suboptimal nutrition. Although the policy analysis for this scoping review focused on the United Kingdom, the literature review had a global focus and the recommendations can have wider implications for other countries.

Sleep, Anxiety, and Vitamin D Status and Risk for Peripartum Depression.

Peripartum depression is common and carries significant morbidity and mortality. This study aimed to identify modifiable psychological and biological factors that increase the risk for peripartum depression. In a prospective cohort study, pregnant women (n = 105) completed self-report assessments of mood (Edinburgh Postnatal Depression Scale-EPDS), anxiety (Generalized Anxiety Disorder Scale-GAD), and sleep disturbances (Pittsburgh Sleep Quality Index-PSQI) and provided a blood sample at 8-to-12 and 24-to-28weeks of gestation and 6-to-8 and 10-to-12weeks postpartum. During the study, 33.3% (35/105) of participants met criteria for depression (EPDS ≥ 10). Women with elevated PSQI (OR: 1.17; 95% CI 1.04-1.33) or GAD (OR: 1.33; 95% CI 1.18-1.48) scores at 8-12weeks of gestation were significantly more likely to experience elevated depressive symptoms at subsequent assessments. Women with deficient vitamin D levels (≤ 20ng/L) were more likely to report elevated depressive symptoms at follow-up assessments, although these findings were not statistically significant (OR: 2.40; 95% CI 0.92-6.27). Participation rates for postpartum assessments were low. Depressive and anxiety symptoms, and sleep disturbances were assessed through self-report measures. Sleep, anxiety, and potentially vitamin D disturbances in early pregnancy are associated with an increase in peripartum depression. Interventions aimed at reducing sleep and anxiety disturbances and ensuring adequate levels of vitamin D in pregnancy are potential therapeutic targets to reduce risk of peripartum depression.

Total Hemoglobin Trajectories from Pregnancy to Postpartum in Rural Northeast Brazil: Differences between Adolescent and Adult Women.

This study examines total hemoglobin (THB) trajectories during pregnancy and postpartum and associated factors among adolescents and adults from a low-income community. This is an observational, longitudinal study, part of the Adolescence and Motherhood Research (AMOR) project, performed between 2017 and 2019 in the Trairi region of Rio Grande do Norte state, Brazil. The THB levels of 100 primigravida adolescents and adults were monitored up to 16 weeks of gestation, in the third trimester, and 4–6 weeks postpartum, along with socioeconomic characteristics, anthropometrics, and health-related variables. Mixed-effect linear models evaluated the trajectories of THB and the associated factors. THB levels decreased between first and second assessments and increased between the second and postpartum assessments. For the adolescent cohort, the rebound in THB concentration between the third trimester and postpartum was not enough to make up for the initial losses, as occurred in the adult cohort. For the adult group, higher THB levels were associated with pregnancy planning and good self-rated health. Race was marginally associated to THB levels, with black/brown women presenting higher concentrations in the adolescent and lower concentration in the adult group. Special attention to prenatal care among pregnant adolescents should consider their higher risk of anemia and its negative effects.

Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review.

ABSTRACTObjective:The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period.Introduction:Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally.Inclusion criteria:This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2–7, and days 8–42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women).Methods:MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively.Results:A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2–7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%).Conclusion:Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide.Systematic review registration number:PROSPERO CRD42020187341

Race and other characteristics can predict postpartum severe maternal morbidity and mortality

Predictors of postpartum severe maternal morbidity and mortality (SMMM) have been previously reported on a population-based level. On an individual patient-based level, we sought to identify risk factors for postpartum SMMM utilizing demographic and clinical characteristics during the antepartum and intrapartum periods and maternal early warning criteria (MEWC) collected at postpartum assessments.

Maternal early warning criteria and number of postpartum assessments predict postpartum severe maternal morbidity/mortality

Maternal early warning criteria (MEWC) are a trigger tool in the antepartum and intrapartum periods to identify patients at risk for severe maternal morbidity and mortality (SMMM). Data on MEWC during the postpartum period are lacking. We sought to determine whether postpartum SMMM is associated with frequency of postpartum assessments or abnormal MEWC that precedes diagnosis of SMMM.

Maternal emotional distress and infant sleep: A longitudinal study from pregnancy through 18 months.

This longitudinal study examined whether changes in maternal emotional distress (depressive, anxiety, and parenting-stress symptoms) predict changes over time in subjective and objective infant sleep. We recruited 226 Israeli expectant mothers (M age 28.8 ± 3.3), most representing the middle-upper socioeconomic class. Maternal depressive and anxiety symptoms were assessed in the third trimester of pregnancy. After delivery (3, 6, 12, and 18 months), infant sleep quality and duration were assessed for 5 nights using actigraphy and the Brief Infant Sleep Questionnaire. Maternal depressive and anxiety symptoms were reassessed, and maternal parenting-stress was measured at all postpartum assessments. The findings demonstrated significant correlations between maternal emotional distress and mothers' subjective ratings of infant sleep problems (rs >.16 and < .46). Latent trajectory analyses indicated no significant effects of changes in maternal emotional distress variables on changes in infant subjective or objective sleep. Post hoc power analyses demonstrated that we had enough statistical power to reject the null hypothesis. The results suggest that mothers with higher emotional distress symptoms-and especially those with parenting-stress symptoms-are more likely to experience their infant's sleep as problematic. However, our results challenge the assumption that maternal emotional distress symptoms contribute to infant sleep disturbances over time. The findings are relevant to mothers with mild to moderate emotional distress symptoms and must not be generalized to mothers who experience major clinical depression. Future studies should evaluate whether maternal emotional distress interacts with other risk factors, such as infant temperament, to predict infant sleep disturbances. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Chronic Vitamin E Deficiency in Rural Bangladeshi Women

ObjectivesVitamin E deficiency (VED) appears to be common in rural areas of South Asia, with prevalence of ≥ 50% reported among women of reproductive age. Long term deficiency may impart neurological damage, but little information exists about persistence of VED. We provide initial estimates of chronic VED (CVED) in women of reproductive age living in Gaibandha District, a typical rural setting in NW Bangladesh. MethodsWe assessed α-tocopherol concentrations by HPLC in early pregnancy and 3-month postpartum (PP) plasma samples of women participating in biochemical sub-studies of JiVitA-1 (n = 2,319), a cluster-randomized, placebo-controlled, weekly vitamin A or β-carotene supplementation trial from 2001–7, and JiVitA-3 (N = 2,073), a cluster-randomized, daily multiple micronutrient (MMS) versus iron-folic acid (IFA) supplementation trial from 2008–12. VED was conventionally defined by an α-tocopherol concentration < 12 μmol/L and CVED as α-tocopherol < 12 μmol/L at both early pregnancy and postpartum assessments, an interval spanning a median (IQR) of 9.4 (2.8) months. ResultsAcross both trials combined (N = 4,392), the mean ± SD plasma α-tocopherol concentration and prevalence of VED in early pregnancy and at 3 months post-partum was 11.28 ± 4.07 and 10.86 ± 4.41 μmol/L, and 53.5% and 42.2%, respectively. In JiVitA-3, the post-partum prevalence of VED among women not previously receiving MMS (containing 15 mg of vitamin E as all-rac-α-tocopheryl acetate) was 57.5% (vs 42.5% among MMS recipients, p < 0.001). The prevalence of CVED among women in both trials combined was 32.0% (34.45% in JiVitA-1 and 26.65% in JiVitA-3, IFA group only). Across a maternal age range of 11–43 [median: 20 (IQR: 8) years, risk of CVED decreased comparably per year of age in the JiVitA-1 [OR = 0.94 (95% CI: 0.93–0.95)] and JiVitA-3 [OR = 0.93 (95% CI:0.92–0.95)] trials. ConclusionsIn rural NW Bangladesh, where over half of women enter pregnancy vitamin E-deficient, about one-third are also deficient postpartum, ∼10 months later, providing a provisional estimate of chronic maternal vitamin E deficiency in a South Asian setting. Funding SourcesBill & Melinda Gates Foundation (Grant GH614, OPP1141435) and US Agency for International Development (AID (HRN-A-00–97-00015–00).

0534 Cognitive Behavioral Therapy for Perinatal Insomnia: Effects on Postpartum Depressive Symptoms

Abstract Introduction Poor sleep during pregnancy is a risk for postpartum depression. Using data from an RCT of CBT-I for insomnia disorder during pregnancy, we examined whether improvement in insomnia reduced postpartum depression symptom severity. We hypothesized that better response to treatment during pregnancy would result in lower depressive symptom severity during the postpartum. Methods Pregnant women (N=179; gestation age 18-30 weeks) with insomnia disorder were randomized to CBT-I or an active control (CTRL) therapy (5 sessions during pregnancy, one at 6 weeks postpartum). Women with depressive disorders and those using prescription medications that impact sleep were excluded. The Insomnia Severity Index (ISI) and the Edinburgh Postpartum Depression Scale (EPDS) were administered at baseline, during pregnancy, and at 8, 18, and 30 weeks postpartum. The Perinatal Risk Questionnaire (PRQ) was administered at baseline. Included in the analyses were women who provided data for at least one of three postpartum assessments (62 in CBT-I; 55 in CTRL). Results Mixed effects models revealed that lower ISI following the pregnancy treatment phase (p &amp;lt; .001) and greater reduction in ISI during pregnancy (p = .053) predicted overall lower EPDS scores during postpartum; but these effects did not differ significantly between treatment arms. Average postpartum EPDS scores, which were low overall, were higher in women with ISI score at or above the median of 9 (6.6±3.9), compared to those below the median (3.5±3.3). Compared to CTRL, participants in the CBT-I condition were nearly twice likely to have ISI scores below the median following the pregnancy treatment phase (29.1% versus 56.5%). Although higher PRQ scores were associated with overall higher postpartum EPDS (p=.0026), PRQ did not moderate postpartum EPDS trajectories. Conclusion We have previously shown that CBT-I is effective for antenatal insomnia, which is a risk for postpartum depression. Our current findings suggest that improving insomnia in pregnancy may reduce the risk for postpartum depression. Limitations include a small sample and missing data during the postpartum follow-up. A larger study among women specifically at risk for postpartum depression could help identify patient related factors that predict therapeutic benefits of CBT-I on postpartum depression. Support NR013662

Stigma interdependence among pregnant HIV-infected couples in a cluster randomized controlled trial from rural South Africa.

Stigma can exacerbate negative health outcomes in people living with HIV (PLWH). This longitudinal, cluster randomized controlled trial in rural Mpumalanga, South Africa, examined the interdependence of HIV-related stigma among pregnant couples living with HIV, and the potential impact of a lay health worker delivered intervention, Protect Your Family, on changes in stigma over time across couples, controlling for physical intimate partner violence (IPV), verbal IPV, gender, HIV knowledge, and months since HIV diagnosis. Using a form of the Actor-Partner Interdependence model, changes in stigma over time were also examined within each dyad of seroconcordant participants with HIV. Antenatal clinics were randomized to experimental or control conditions, and participants completed baseline antenatal and 12-month postpartum assessments. Both women and male partners participated in intervention sessions in gender concordant groups and couple or individual sessions. Multilevel models (N=1475) revealed stigma was related to condition and verbal intimate partner violence, but not time. Using an Actor-Partner Interdependence cross-lagged path model to examine within dyad changes in stigma for seroconcordant couples (n=201), intervention condition participants' stigma levels were not interdependent over time. Women's 12-month stigma was related to their partners' stigma at baseline in the control condition, but not in the intervention condition. Compared to women in the control condition, postpartum stigma among women in the intervention condition was not related to their male partners' stigma, suggesting that women's perception of stigma became uncoupled from that of their partners. The intervention may have promoted female empowerment to shape their own beliefs and attitudes towards what it means to be infected with HIV, and express their own agency in responding to how others treat them and they treat themselves.

Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial

BackgroundObesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group. MethodsAfrican American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain. ResultsAmong participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms. ConclusionsParticipants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.

Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial.

BackgroundPostpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists.ObjectiveThis study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention.MethodsA cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering.ResultsWe have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018.ConclusionsThere is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs.Trial RegistrationClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php)International Registered Report Identifier (IRRID)PRR1-10.2196/11624