Postpartum Body Mass Research Articles

Body mass index trajectories and time in target range after delivery and long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus.

This study aims to determine whether postpartum body mass index (BMI) trajectories and its time in target range (TTR) are associated with long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM). The present study included 1057 women with a history of GDM who participated in the Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP). Oral glucose tolerance tests or physician-diagnosed information were used to diagnose type 2 diabetes after a median follow-up period of 8.47 years. Latent class modelling was applied to identify trajectories of BMI after delivery. TTR was defined as the proportion of time that BMI was within the standard range (18.5 ≤ BMI < 24.0 kg/m2). The associations of BMI trajectories and TTR with type 2 diabetes risk were analysed using multivariable Cox modelling. Five distinct trajectories of postpartum BMI were identified. Compared with low-stable class, the multivariable-adjusted hazard ratios of type 2 diabetes were 2.02 (95% confidence interval 0.99-4.10) for median-stable class, 3.01 (1.17-7.73) for high-stable class, 2.15 (0.63-7.38) for U-shape class and 7.15 (2.08-24.5) for inverse U-shape class (p for trend = 0.012), respectively. Multivariable-adjusted hazard ratios of type 2 diabetes associated with postpartum BMI TTR of 100%, >43.4%-<100%, >0%-≤43.4% and 0% were 1.00, 1.84 (0.72-4.73), 2.75 (1.23-6.15) and 2.31 (1.05-5.08) (p for trend = 0.039), respectively. Postpartum BMI trajectories of high-stable and inverse U-shape class as well as lower TTR were associated with an increased risk of type 2 diabetes among women with a history of GDM. Reducing BMI to a normal range in the early postpartum period and maintaining stable over time could attenuate the development of long-term type 2 diabetes.

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

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

Species-Specific Seasonal Shifts in Reproductive Allocation in the Southern Grass Lizard, Takydromus sexlineatus (Lacertidae).

We designed a common garden design to collect data on female reproductive traits from three populations of the southern grass lizard Takydromus sexlineatus, testing the hypothesis that a species-specific pattern of seasonal shifts in reproductive allocation should be shared by geographically separated populations. Of the seven examined traits, six differed among populations, with four of the six also differing among successive clutches. Females grew longer during the breeding season and produced more eggs in the first clutch than in the subsequent clutches; egg size was unchanged throughout the breeding season. After removing the influence of female size or postpartum body mass we found the following. First, postpartum body mass, clutch mass, and relative clutch mass were greater in the Wuzhishan population than in the Shaoguan and Zhaoqing populations. Second, egg size was greatest in the Wuzhishan population and smallest in the Zhaoqing population. Third, clutch size was greatest in the Wuzhishan population and smallest in the Shaoguan population. Females did not trade-off egg size against number within each population × clutch combination. Our study validates the hypothesis tested, supports the conventional view that reproductive output is highly linked to maternal body size in lizards, and follows the classic prediction that females with different amounts of resources to invest in reproduction should give priority to adjusting the total number rather than size of their offspring.

Sleep Quality in Individuals with and without Persistent Postpartum Hypertension.

This study aimed to compare sleep quality at 1 year postpartum following a hypertensive disorder of pregnancy (HDP) among individuals with persistent postpartum hypertension (HTN) compared with those with normal blood pressures (BPs). We combined data from the Heart Health 4 New Moms pilot randomized trial (n = 118) and the Pathways prospective cohort study (n = 36). Individuals with a singleton pregnancy complicated by gestational HTN or preeclampsia underwent a research study visit at a mean 48.7 ± 9.5 weeks postpartum with standardized BP measurement and assessment of subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Persistent postpartum HTN was defined as Stage 1 HTN or greater (mean systolic BP ≥ 130 mm Hg or mean diastolic BP ≥ 80 mm Hg over three measurements at rest) or requiring antihypertensive medication. Statistical analysis was performed using univariate and multivariable logistic regression analyses. Of 154 individuals with an HDP included in the analysis, 84 (55%) were normotensive at 1 year postpartum and 70 (45%) had persistent postpartum HTN. Individuals with persistent postpartum HTN were more likely to be older, self-identify as Black race, have higher prepregnancy and 1-year postpartum body mass index (BMI), be multiparous, and deliver at an earlier gestational age. The mean global PSQI score was 8.7 ± 3.7, with 81% reporting poor sleep (PSQI > 5), and scores were higher among individuals who were persistently hypertensive (9.6 ± 3.5) compared with those who were normotensive at 1 year postpartum (7.9 ± 3.6), p < 0.01. Findings were unchanged in a multivariable model adjusting for age, self-reported race, prepregnancy BMI, and parity. Following an HDP, individuals reported poor sleep quality at 1 year postpartum. Individuals with persistent postpartum HTN reported lower sleep quality, suggesting that sleep behavior may be a target for intervention to improve maternal cardiovascular health following an HDP. · After an HDP, poor sleep quality was common at 1 year postpartum.. · Those with persistent postpartum HTN reported worse sleep quality at 1 year postpartum.. · Sleep behavior may be a target for intervention to improve maternal cardiovascular health..

Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum.

We evaluated associations between antepartum weight change and adverse pregnancy outcomes and between antiretroviral therapy (ART) regimens and week 50 postpartum body mass index in IMPAACT 2010. Women with human immunodeficiency virus (HIV)-1 in 9 countries were randomized 1:1:1 at 14-28 weeks' gestational age (GA) to start dolutegravir (DTG) + emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) versus DTG + FTC/tenofovir disoproxil fumarate (TDF) versus efavirenz (EFV)/FTC/TDF. Insufficient antepartum weight gain was defined using Institute of Medicine guidelines. Cox-proportional hazards regression models were used to evaluate the association between antepartum weight change and adverse pregnancy outcomes: stillbirth (≥20 weeks' GA), preterm delivery (<37 weeks' GA), small size for GA (<10th percentile), and a composite of these endpoints. A total of 643 participants were randomized: 217 to the DTG + FTC/TAF, 215 to the DTG + FTC/TDF, and 211 to the EFV/FTC/TDF arm. Baseline medians were as follows: GA, 21.9 weeks; HIV RNA, 903 copies/mL; and CD4 cell count, 466/μL. Insufficient weight gain was least frequent with DTG + FTC/TAF (15.0%) versus DTG + FTC/TDF (23.6%) and EFV/FTC/TDF (30.4%). Women in the DTG + FTC/TAF arm had the lowest rate of composite adverse pregnancy outcome. Low antepartum weight gain was associated with higher hazard of composite adverse pregnancy outcome (hazard ratio, 1.44 [95% confidence interval, 1.04-2.00]) and small size for GA (1.48 [.99-2.22]). More women in the DTG + FTC/TAF arm had a body mass index ≥25 (calculated as weight in kilograms divided by height in meters squared) at 50 weeks postpartum (54.7%) versus the DTG + FTC/TDF (45.2%) and EFV/FTC/TDF (34.2%) arms. Antepartum weight gain on DTG regimens was protective against adverse pregnancy outcomes typically associated with insufficient weight gain, supportive of guidelines recommending DTG-based ART for women starting ART during pregnancy. Interventions to mitigate postpartum weight gain are needed.

Per- and polyfluoroalkyl substances, gestational weight gain, postpartum weight retention and body composition in the UPSIDE cohort

BackgroundPer- and polyfluoroalkyl substances (PFAS) are synthetic chemicals found in drinking water and consumer products, resulting in ubiquitous human exposure. PFAS have been linked to endocrine disruption and altered weight gain across the lifespan. A limited and inconsistent body of research suggests PFAS may impact gestational weight gain (GWG) and postpartum body mass index (BMI), which are important predictors of overall infant and maternal health, respectively.MethodsIn the Understanding Pregnancy Signals and Infant Development (UPSIDE/UPSIDE-MOMs) study (n = 243; Rochester, NY), we examined second trimester serum PFAS (PFOS: perfluorooctanesulfonic acid, PFOA: perfluorooctanoic acid, PFNA: perfluorononanoic acid, PFHxS: perfluorohexanesulfonic acid, PFDA: perfluorodecanoic acid) in relation to GWG (kg, and weekly rate of gain) and in the postpartum, weight retention (PPWR (kg) and total body fat percentage (measured by bioelectrical impedance)). We fit multivariable linear regression models examining these outcomes in relation to log-transformed PFAS in the whole cohort as well as stratified by maternal pre-pregnancy BMI (< 25 vs. = > 25 kg/m2), adjusting for demographics and lifestyle factors. We used weighted quantile sum regression to find the combined influence of the 5 PFAS on GWG, PPWR, and body fat percentage.ResultsPFOA and PFHxS were inversely associated with total GWG (PFOA: ß = -1.54 kg, 95%CI: -2.79, -0.30; rate ß = -0.05 kg/week, 95%CI: -0.09, -0.01; PFHxS: ß = -1.59 kg, 95%CI: -3.39, 0.21; rate ß = -0.05 kg/week, 95%CI: -0.11, 0.01) and PPWR at 6 and 12 months (PFOA 6 months: ß = -2.39 kg, 95%CI: -4.17, -0.61; 12 months: ß = -4.02 kg, 95%CI: -6.58, -1.46; PFHxS 6 months: ß = -2.94 kg, 95%CI: -5.52, -0.35; 12 months: ß = -5.13 kg, 95%CI: -8.34, -1.93). PFOA was additionally associated with lower body fat percentage at 6 and 12 months (ß = -1.75, 95%CI: -3.17, -0.32; ß = -1.64, 95%CI: -3.43, 0.16, respectively) with stronger associations observed in participants with higher pre-pregnancy BMI. The PFAS mixture was inversely associated with weight retention at 12 months (ß = -2.030, 95%CI: -3.486, -0.573) amongst all participants.ConclusionPFAS, in particular PFOA and PFHxS, in pregnancy are associated with altered patterns of GWG and postpartum adiposity with potential implications for fetal development and long-term maternal cardiometabolic health.

Factors influencing functional near-infrared spectroscopy in postpartum depression: A cross-sectional study.

To explore whether functional near-infrared spectroscopy (fNIRS) can aid in the early detection and diagnosis of postpartum depression. The study was a cross-sectional survey that invited all women who sought postpartum health examination 42 days after childbirth between August 2020 and January 2021. Personal information, Edinburgh Postnatal Depression Scale (EPDS), and well as fNIRS results were collected. In all, 109 individuals agreed to participate and completed the examination in its entirety. The variance in integral and centroid values was not statistically significant across different subgroups of depression (P > 0.05). The difference in diagnosis of postpartum major depression between EPDS and fNIRS was statistically significant (P < 0.001). fNIRS results in postpartum depression diagnosis were substantially associated with gestational diabetes mellitus (P=0.027), the number of pregnancies (P=0.001), and postpartum body mass index (P=0.035). fNIRS can provide an objective method for early detection and diagnosis of postpartum depression. Certain clinical conditions can have an effect on brain activity, which may result in postpartum depression. Additional high-quality study is required to establish strong evidence on the subject.

A randomised placebo-controlled trial of the effectiveness of early metformin in addition to usual care in the reduction of gestational diabetes mellitus effects (EMERGE): study protocol

BackgroundPregnancies affected by gestational diabetes mellitus (GDM) are associated with an increased risk of adverse maternal and foetal outcomes. Current treatments for GDM involve initial medical nutritional therapy (MNT) and exercise and pharmacotherapy in those with persistent hyperglycaemia. Insulin is considered first-line pharmacotherapy but is associated with hypoglycaemia, excessive gestational weight gain (GWG) and an increased caesarean delivery rate. Metformin is safe in selected groups of women with GDM but is not first-line therapy in many guidelines due to a lack of long-term data on efficacy. The EMERGE trial will evaluate the effectiveness of early initiation of metformin in GDM.MethodsEMERGE is a phase III, superiority, parallel, 1:1 randomised, double-blind, placebo-controlled trial comparing the effectiveness of metformin versus placebo initiated by 28 weeks (+6 days) plus usual care.Women aged 18–50 years will be recruited. Women with established diabetes, multiple pregnancies, known major congenital malformation or small for gestational age (<10th centile), intolerance or contraindication to the use of metformin, shock or sepsis, current gestational hypertension or pre-eclampsia, significant gastrointestinal problems, congestive heart failure, severe mental illness or galactose intolerance are excluded.InterventionImmediate introduction of metformin or placebo in addition to MNT and usual care. Metformin is initiated at 500mg/day and titrated to a maximum dose of 2500mg over 10 days. Women are followed up at 4 and 12 weeks post-partum to assess maternal and neonatal outcomes.The composite primary outcome measure is initiation of insulin or fasting blood glucose ≥ 5.1 mmol/L at gestational weeks 32 or 38. The secondary outcomes are the time to insulin initiation and insulin dose required; maternal morbidity at delivery; mode and time of delivery; postpartum glucose status; insulin resistance; postpartum body mass index (BMI); gestational weight gain; infant birth weight; neonatal height and head circumference at delivery; neonatal morbidities (neonatal care unit admission, respiratory distress, jaundice, congenital anomalies, Apgar score); neonatal hypoglycaemia; cost-effectiveness; treatment acceptability and quality of life determined by the EQ5D-5L scale.DiscussionThe EMERGE trial will determine the effectiveness and safety of early and routine use of metformin in GDM.Trial registrationEudraCT Number 2016-001644-19l; NCT NCT02980276. Registered on 6 June 2017.

Cesarean Section Delivery Does Not Impact Postpartum Weight Loss And Recovery

Inability to lose weight gained during pregnancy increases a woman’s risk of becoming overweight or obese. Epidemiological studies have suggested that obesity is strongly associated with history of cesarean section (c-section) delivery. This association may be related to postpartum changes in physiological (e.g. physical activity) and behavioral (e.g. sleep) factors associated with weight loss. PURPOSE: To examine differences in postpartum body mass and factors related to weight loss between women who gave birth via c-section vs. vaginally. METHODS: Body mass was measured in 37 women (11 c-section [CD] and 26 vaginal [VD] delivery), at 3, 6, 9, and 12 months postpartum. Additionally, physiological factors (body composition (DXA), resting energy expenditure, and physical activity) and behavioral factors (sleep quality, fatigue, depression, and body image) related to weight loss were assessed at each time point. Self-reported pre-pregnancy weight and pregnancy weight gain were recorded and differences between CD and VD were assessed with student’s t-tests. Differences between CD and VD postpartum factors were assessed using two-way ANOVA with repeated measures. RESULTS: There was no significant difference between CD and VD groups in pre-pregnancy BMI (26.5 ± 5.9 kg/m2 vs. 25.4 ± 5.4 kg/m2, p = 0.59, CD vs VD respectively), pregnancy weight gain (16.2 ± 5.2 kg vs. 14.4 ± 4.8 kg, p = 0.32, CD vs VD respectively), and body mass at delivery (86.3 ± 17.8 kg vs. 83.9 ± 13.8 kg, p = 0.67, CD vs VD respectively). At 12 months postpartum, similar weight loss occurred in both groups (14.3 ± 6.1 kg vs 13.8 ± 5.4 kg, p = 0.77, CD vs VD respectively). ANOVA analysis of the changes in physiological and behavioral factors related to weight loss over the postpartum period revealed no significant difference between CD and VD women. CONCLUSION: Despite potentially longer recovery time associated with c-section delivery, weight loss in the postpartum period was not impacted and therefore c-section delivery does not appear to be a risk factor for obesity.

Measuring Annual Variation in Reproductive Output Reveals a Key Role of Maternal Body Condition in Determining the Size of Eggs in Snakes.

Simple SummaryWe measured female reproductive traits of a colubrid snake (Lycodon rufozonatus) from Zhejiang, East China in four years (1999, 2010, 2011, and 2014). After removing the influence of female size, postpartum body mass was greater in 2010 than in 2014, clutch mass was greater in 2010 than in 2011 and 2014, and egg size was greater in 2010 than in the other three years. Egg size was positively related to postpartum body condition in each year. Females laid larger eggs in 2010 than in other three years after removing the influence of maternal size and body condition. Our study does not follow the prediction that reproductive females with different amounts of resources to invest should give priority to adjusting the number rather than size of offspring.Long-term studies are especially suited for disentangling the effects of extrinsic and intrinsic factors on both total reproductive investment and reproductive allocation in offspring number versus offspring size. Female reproductive traits of the red-banded wolf snake (Lycodon rufozonatus) from Zhejiang, East China were studied in four years between 1999 and 2014. Egg-laying dates overall extended from late June to late July, and varied among years. Postpartum body mass, clutch size, clutch mass, and egg size were positively related to female size (snout vent length, SVL) in each year. Postpartum body mass, clutch mass, and egg size differed among years after accounting for female SVL, whereas clutch size did not. Setting female SVL at the same level, postpartum body mass was greater in 2010 than in 2014, clutch mass was greater in 2010 than in 2011 and 2014, and egg size was greater in 2010 than in the other three years. Females did not trade off egg size against number. Egg size was positively related to postpartum body condition in each year. Females laid larger eggs in 2010 than in other three years after removing the influence of maternal body condition. Our study provides evidence for the traditional view that reproductive output is highly linked to maternal body size in snakes, but not following Smith and Fretwell’s (1974) classic prediction that females with different amounts of resources to invest in reproduction should give priority to adjusting the number rather than size of their offspring. Maternal body size and condition both are important sources of variation in egg size, but factors other than these two variables may also affect the size of eggs produced by female L. rufozonatus.

Maternal serum adiponectin and leptin levels and their gene expression, postpartum body mass index, and breastfeeding duration based on mode of delivery: A prospective study.

Adipokines are involved in inflammatory responses, associated with body mass index whose concentrations may change in response to inflammatory conditions, including surgery and delivery. We examined adiponectin and leptin levels and their gene expression at birth, body mass index, and breastfeeding duration at 24 months postpartum according to mode of delivery. In this study, 90 normal pregnant women were investigated. Blood samples were collected after delivery. Serum levels and gene expression of adiponectin and leptin were evaluated. Body mass index and breastfeeding duration were calculated at 24 months postpartum. Data were analyzed using SPSS-16 and p < 0.05 was considered as significant. Serum leptin level was significantly higher in vaginal delivery than in cesarean section (p=0.033). No significant difference was found between two groups regarding adiponectin level and gene expression, while leptin gene expression was significantly higher in cesarean (p=0.005). Postpartum body mass index did not differ between the two groups (p=0.14). On the other hand, postpartum body mass index was significantly higher than the equivalent prepregnancy index in both groups (p < 0.001) and was associated with serum leptin and adiponectin in vaginal delivery (r= 0.46, p=0.001, and r=-0.3, p=0.04, respectively). The duration of breastfeeding was longer in vaginal delivery (p=0.008). Cesarean section was associated with lower maternal leptin levels and shorter breast-feeding duration compared to vaginal delivery. Leptin gene expression was significantly higher in cesarean section than in vaginal delivery. Postpartum body mass index, adiponectin level, and gene expression did not differ between the two groups.

Early Postpartum Glucose Intolerance, Metabolic Syndrome and Gestational Diabetes Mellitus Determinants after Assisted Conception: A Prospective Cohort Study.

Background:This study aimed to determine the prevalence of postpartum metabolic syndrome (MetS), glucose intolerance, and the determinants, 6-12 weeks postpartum in women with assisted reproduction technology conception gestational diabetes mellitus diagnosis (ART-GDM) compared to women with spontaneous conception and GDM diagnosis (SC-GDM).Materials and Methods:In this prospective cohort study, two groups consisting of 62 ART-GDM and 64 SC-GDM singleton pregnant women were followed 6-12 weeks after delivery for postpartum MetS. Fasting glucose, 75-g 2-h OGTT, and lipid profile were assessed. Waist and hip circumference, and systolic and diastolic blood pressures (BP) were measured at postpartum. Clinical, paraclinical, and obstetric data were recorded from registry offices. The prevalence of MetS and glucose intolerance were determined. Predictors of MetS and glucose intolerance were evaluated by logistic regression.Results:The prevalence of postpartum MetS was 20.8% in ART-GDM women and 10.9% in SC-GDM (P=0.123). Mean postpartum BMI and systolic BP were significantly higher in the ART-GDM group (P=0.016 and P=0.027 respectively). Adverse pregnancy outcomes were significantly higher in the ART-GDM group. Postpartum glucose intolerance prevalence did not vary significantly between the groups. Family history of diabetes was a predictive factor for postpartum MetS and glucose intolerance 6-12 weeks after delivery.Conclusion:Early postpartum MetS and glucose intolerance prevalence after assisted conception did not vary significantly; however, postpartum body mass index (BMI) and systolic BP were significantly higher in the ART-GDM group. Lifestyle modification programs and long-term health care of ART women with GDM diagnosis can be recommended. Further studies with larger sample size and longer follow-up are necessary to verify our findings.

Epidemiological investigation of urinary incontinence in peri- and postpartum women from Nanjing, China.

We aimed to determine the prevalence of urinary incontinence (UI) during the peri- and postpartum period in women from Nanjing, China, and estimate its risk factors. From January to December 2018, a total of 6500 postpartum women were enrolled and asked to complete the questionnaires. Of these, 6370 (98%) women returned the questionnaires with valid responses. Additional data were collected, including age, height, weight, gestation time and parity, and neonatal weight. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form was used. Surface electromyography (sEMG) and a biofeedback training system were used as a testing platform, and PESEMG values were obtained. The prevalence of UI during pregnancy and at 6 weeks postpartum in women was 29.76% and 12.50%, respectively. The prevalence of stress UI (SUI), urge UI (UUI), mixed UI (MUI), and other types of UI that developed during pregnancy was 25.48%, 1.66%, 1.65%, and 0.97%, respectively. The prevalence of SUI, UUI, MUI, and other types of UI at 6 weeks postpartum was 8.49%, 2.07%, 1.16%, and 0.77%, respectively. Multivariate analysis showed that advanced age, greater postpartum body mass index (BMI), macrosomia, multiparity, and vaginal delivery were risk factors of postpartum UI. Women with mild degree of UI in pregnancy, those who had undergone cesarean section, and those without UI before pregnancy were relieved from UI at 6 weeks postpartum. The rate of UI in peri- and postpartum women from Nanjing is consistent across China. The most common type of UI was SUI, with many risk factors affecting its occurrence. Advanced age, greater postpartum BMI, multiparity, macrosomia, and vaginal delivery might be the main risk factors of UI in postpartum women.

Associations between Maternal and Infant Illness and the Risk of Postpartum Depression in Rural China: A Cross-Sectional Observational Study.

This study explored how maternal and infant illness correlated with the risk of postpartum depression in the Chinese Qinba Mountains region. In total, 131 villages comprising 435 families with infants (≤6 months old) were randomly sampled. We collected data on maternal and infant illnesses and maternal health knowledge level. The Depression, Anxiety, and Stress Scale-21 was used to measure the risk of postpartum depression. We used descriptive statistics and multivariate logistic regression for the analysis. Infant overall health status was a risk factor for postpartum depression (odds ratio (OR) = 1.90, 95% Confidence Interval (95% CI) = 1.10~3.28), whereas maternal overall health status was not correlated with postpartum depression (OR = 1.36, 95% CI = 0.55~3.39). For specific illnesses, infants experiencing over two common illnesses in the past two weeks (OR = 1.98, 95% CI = 1.13~3.45) and mothers experiencing over two common pains within two weeks after delivery (OR = 1.77, 95% CI = 1.02~3.08) were risk factors for postpartum depression, whereas infants with mild and severe stunted growth, maternal C-section, and postpartum body mass index (normal or overweight) were not correlated with it (all p > 0.050). Maternal health knowledge was an important moderator of maternal and infant illnesses on the risk of postpartum depression. In conclusion, maternal and infant illness were essential factors for the risk of postpartum depression in a poor rural region in western China, which may be mainly affected by the feeling of uncertainty of illness. Improved maternal and infant health and enhanced maternal health knowledge might alleviate the risk of postpartum depression.

Age-related reproduction of female Mongolian racerunners (Eremias argus; Lacertidae): Evidence of reproductive senescence.

The reproductive maturation hypothesis, the terminal investment hypothesis, and the senescence hypothesis are the most extensively evaluated hypotheses proposed to explain age-related patterns of reproduction in iteroparous organisms. Here, we evaluated these hypotheses for the Mongolian racerunner (Eremias argus), a short-lived lacertid lizard, by comparing reproductive traits between females that completed reproductive cycles under the same laboratory conditions in two consecutive years (2008 and 2009). Reproductive females gained linear size (snout-vent length) not only as they got 1 year older but also during the breeding season. Larger females generally laid eggs earlier and invested more in reproduction than did smaller ones. Females switched from laying smaller eggs in the first clutch to larger eggs in the subsequent clutches but kept clutch size and postpartum body mass constant between successive clutches in a breeding season and between years. Females that laid more clutches or eggs in 2008 did not lay fewer clutches or eggs in 2009. Of the traits examined, only clutch frequency, annual fecundity, and annual reproductive output were susceptible to ageing. Specifically, the clutch frequency was reduced by 1.1 clutches, annual fecundity by 3.1 eggs and annual reproductive output by 1.0 g in 2009 compared with 2008. Our results suggest that the reproductive maturation hypothesis better explains patterns of reproduction in young or prime-aged females of E. argus, whereas the senescence hypothesis better explains reproductive patterns in old females. The terminal investment hypothesis does not apply to any trait examined because no trait value was maximized in old females.

Relation of low birth weight and low-density lipoprotein cholesterol of neonates with postpartum maternal body mass index

Objectives: This study was undertaken to compare the relation of low birth weight (LBW) categories and level of low-density lipoprotein (LDL) of LBW neonates with maternal postpartum body mass index (BMI). Materials and Methods: This was a hospital-based observational cross-sectional study conducted in the Department of Neonatology and in the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results: A total of 81 LBW neonates and mothers pairs were included in the study. There was no difference in LBW categories with maternal postpartum BMI categories (P = 0.15, post hoc). There was an increase in LDL level in the neonates of the obese mother (P = 0.02), but the difference of LDL level was not significant in the neonates of the normal and overweight mother. Conclusion: LBW categories do not differ with maternal BMI categories, but the LDL level is more in the neonates of obese mother than that of overweight mothers and normal weight mother.

Geographical location specific composition of cultured microbiota and Lactobacillus occurrence in human breast milk in China.

Breast milk bacteria play an important role in the early development of the gut microbiota and the immune system. Dominant living bacteria of 89 healthy Chinese women from 11 cities in five regions were analysed by broad-range yeast extract, casitone, and fatty acid and de Man, Rogosa, and Sharpe-based culturing coupled with 16S rRNA sequence and quantitative polymerase chain reaction. Principal coordinate analysis showed that human breast milk samples were classified into three groups, driven by Enterococcus (abundance in group 1, 63.13%), Streptococcus (abundance in group 2, 68.16%) and Staphylococcus (abundance in group 3, 55.17%). The microbiota profile was highly region-specific. Samples from the Northwest and North of China showed higher alpha diversity compared to other regions (p < 0.05). Staphylococcus, Streptococcus, and Enterococcus were the dominant genera in all samples. Lactobacillus had a high occurrence in samples from the Northwest and North, dominated by Lactobacillus reuteri and Lactobacillus gasseri. Samples of mothers with a high postpartum body mass index showed more Staphylococcus and less Lactobacillus and Streptococcus. Staphylococcus was negatively correlated with Lactobacillus and Streptococcus. The mode of delivery also affected the composition of microbiota, even after culture. These findings indicate differences between the North and South, provide effective information for collection of samples in which Lactobacillus is the predominant genus, and lower the detection limit for small amounts of bacteria.

Postpartum assessment of the beta cell function and insulin resistance for Chinese women with previous gestational diabetes mellitus

Gestational diabetes mellitus (GDM) imparts a high risk of developing postpartum diabetes and is considered to be an early stage of type 2 diabetes mellitus (T2DM). In this study, a 75-g oral glucose tolerance test was performed on 472 women with GDM at 6–8 weeks after delivery. The clinical and metabolic characteristics were compared between the patients with normal glucose tolerance (NGT) and abnormal glucose metabolism (AGM). These data were then compared between pre-diabetic and diabetic patients. A total of 37.7% of the women with GDM continued to have abnormal glucose levels after delivery. Compared with the women who reverted to normal, HOMA-IR was significantly higher in AGM. A multiple stepwise regression analysis revealed that age, the postpartum body mass index (BMI), low density lipoprotein-cholesterol (LDL-C), 2 h glucose load plasma glucose (2 h PG), triglycerides (TG), hemoglobin A1c (HbA1c), 1 h glucose load plasma insulin (INS) level, and 2 h INS level were independent risk factors for the development of insulin resistance after delivery. This study has identified a high prevalence of AGM after GDM. Insulin resistance appears to be the major contributor. Any treatment to reduce the postpartum BMI and lipids level may be beneficial to decrease insulin resistance.

Prevalence of Urinary Incontinence, Its Risk Factors and Effect on the Quality of Life in Women after Their First Delivery

Introduction: Although urinary incontinence is commonly associated with increasing parity, there is however a lack of published data on urinary incontinence among primiparous women. This study aims to determine its prevalence among primiparous women at 6-8 weeks postpartum, its risk factors and effects to their quality of life. Methods: This is a crosssectional study involving primiparous women at 6-8 weeks postpartum. Women in their third trimester were recruited using convenience sampling. Data were obtained using a study proforma, and International Consultation on Incontinence Questionnaire – Short Form (ICIQSF) over a face-to-face interview. The same questionnaire with additional enquiries on delivery was completed over a telephone interview at 6-8 week postpartum. Data were analysed using chi-square and simple logistic regression tests contained in the Statistical Package for Social Science version 20.0. Results: Three hundred and six women participated in this study. The prevalence of urinary incontinence in the third trimester of pregnancy was 34.3% (95%CI: 29.0, 39.7) and dropped to 5.2% (95% CI: 2.7, 7.7) at 6-8 weeks postpartum. Childhood enuresis and postpartum body mass index were the two factors that showed significant association with postpartum urinary incontinence. Urinary incontinence in 95 (31%) women had resolved by 6-8 weeks postpartum, whereas 10 (3.3%) women still had persistent symptom. A small proportion of women (2.0%) developed urinary incontinence in the postpartum period. Majority of women with urinary incontinence did not feel it significantly affected their quality of life. The ICIQ- SF mean score was 6.13 (range 2- 12). Conclusions: Postpartum urinary incontinence is rather uncommon among primiparous women and does not seem to affect their quality of life. Childhood enuresis and postpartum BMI were risk factors associated with postpartum urinary incontinence.

Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus.

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.