Postpartum Check-up Research Articles

Postpartum Depression, Social Support and Quality of Life Between Adolescent and Adult Mothers in Six Months Postpartum in the COVID-19 Pandemic: Longitudinal Comparative Study.

To determine the proportion of postpartum depression (PPD), explore associated risk factors with PPD, and examine changes in PPD, social support and quality of life (QOL) among adolescent and adult mothers in the first 6 months postpartum during the COVID-19 pandemic. A longitudinal comparative study was conducted using an online questionnaire from January to August 2021. The study recruited 65 adolescent and 65 adult mothers who attended postpartum checkups at 6 weeks postpartum in primary hospitals across Ayutthaya, Chachoengsao and Phetchaburi provinces in Thailand. Data were collected by the Edinburgh Postnatal Depression Scale, Postpartum Support Questionnaire, and the World Health Organisation Quality of Life Brief at 6 weeks, 4 months and 6 months postpartum. Finally, 60 adolescent and 60 adult mothers were included for analysis. Adolescent mothers experienced lower social support and QOL compared to adult mothers over the 6-month postpartum period. Notably, both adolescent and adult mothers had significantly increased PPD proportions from 6 weeks to 6 months postpartum (31.7%-48.3% and 23.3%-43.3%, respectively). However, there was no significant difference in the PPD proportions between groups. In adjusted models, significant risk factors for PPD during the first 6 months postpartum included educational level, unintended pregnancy, mode of delivery and social support. Significant changes in PPD, social support and QOL were observed in both adolescent and adult mothers during the first 6 months postpartum. Adolescent mothers consistently demonstrated lower levels of social support and QOL at 6 weeks, 4 months and 6 months postpartum compared to adult mothers. Additionally, mothers with lower educational attainment, unintended pregnancies, caesarean deliveries and low social support were more likely to experience PPD. Midwives/nurses should provide routine PPD screenings throughout the first six months postpartum for all mothers, particularly for at-risk mothers such as adolescent mothers or those with lower education, unintended pregnancies, caesarean deliveries and limited social support. We have followed the STROBE guidelines. No patient or public contribution.

A Quasi-Experiment of Self-Weight Combined with Dietary and Physical Activity to Reduce Postpartum Weight Retention

Abstract Background: The failure to lose postpartum weight retention (PPWR) can impact obesity in later life, making programs aimed at reducing PPWR crucial. The study aimed to assess the effect of a self-weight approach combined with dietary and physical activity interventions to reduce PPWR. Materials and Methods: This quasi-experimental study employed a three-group, pretest–posttest design. The study recruited 178 postpartum mothers who attended a 6-week postpartum check-up at a university hospital in Chiang Mai, Thailand, from 2018 to 2020. Data was collected using a self-administered questionnaire. The intervention groups received dietary counseling combined with self-weighting (D) and diet and physical activity counseling combined with self-weighting (DP), while the control group received standard care. Analysis of covariance was used for data analysis, with pre-pregnancy weight as the covariance. Results: PPWR was 3.39 kg for the D group, 3.20 kg for the DP group, and 4.14 kg for the control group (F (2,174) =1.91, p > 0.05). At 6 months postpartum, on comparing self-weighting and non-self-weighting groups, it was found that PPWR was 2.88 and 3.99 kg for the self-weighting and non-self-weighting groups, respectively (t 176= −2.28, p = 0.024). Conclusions: The study results indicated that dietary or combined dietary and physical activity counseling for postpartum mothers is necessary. For optimal success, postpartum mothers should be encouraged to undertake daily or weekly self-weighing to reduce PPWR.

Voice analysis and deep learning for detecting mental disorders in pregnant women: a cross-sectional study

IntroductionPerinatal mental disorders are prevalent, affecting 10–20% of pregnant women, and can negatively impact both maternal and neonatal outcomes. Traditional screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), present limitations due to subjectivity and time constraints in clinical settings. Recent advances in voice analysis and machine learning have shown potential for providing more objective screening methods. This study aimed to develop a deep learning model that analyzes the voices of pregnant women to screen for mental disorders, thereby offering an alternative to the traditional tools.MethodsA cross-sectional study was conducted among 204 pregnant women, from whom voice samples were collected during their one-month postpartum checkup. The audio data were preprocessed into 5000 ms intervals, converted into mel-spectrograms, and augmented using TrivialAugment and context-rich minority oversampling. The EfficientFormer V2-L model, pretrained on ImageNet, was employed with transfer learning for classification. The hyperparameters were optimized using Optuna, and an ensemble learning approach was used for the final predictions. The model’s performance was compared to that of the EPDS in terms of sensitivity, specificity, and other diagnostic metrics.ResultsOf the 172 participants analyzed (149 without mental disorders and 23 with mental disorders), the voice-based model demonstrated a sensitivity of 1.00 and a recall of 0.82, outperforming the EPDS in these areas. However, the EPDS exhibited higher specificity (0.97) and precision (0.84). No significant difference was observed in the area under the receiver operating characteristic curve between the two methods (p = 0.759).DiscussionThe voice-based model showed higher sensitivity and recall, suggesting that it may be more effective in identifying at-risk individuals than the EPDS. Machine learning and voice analysis are promising objective screening methods for mental disorders during pregnancy, potentially improving early detection.ConclusionWe developed a lightweight machine learning model to analyze pregnant women's voices for screening various mental disorders, achieving high sensitivity and demonstrating the potential of voice analysis as an effective and objective tool in perinatal mental health care.

Effects of US state paid family leave policies on perinatal and postpartum health: A quasi-experimental analysis.

The US is the only high-income country without a national paid family leave (PFL) policy, although several states have implemented policies recently. This study evaluated whether PFL policies in six states improved maternal and infant health. We used difference-in-differences, a quasi-experimental approach, to estimate the impact of state-level policy implementation. We leveraged recently developed methods designed to account for staggered policy implementation and treatment effect heterogeneity. Data were drawn from the Pregnancy Risk Assessment Monitoring System 2004-2021 waves. Primary outcomes included breastfeeding, maternal postpartum depressive symptoms, and attendance at a postpartum check-up; secondary outcomes included birth outcomes. Multivariable regressions were adjusted for possible confounders. PFL policies led to increased breastfeeding duration (0.53 weeks; 95% CI: 0.06 to 0.99) and decreased depressive symptoms (-0.93 percentage points; 95% CI: -1.84 to -0.01). Policies were also associated with worsening of some birth outcomes, possibly reflecting selection in utero, data limitations, or true negative effects. Estimates were largely robust to alternative specifications, with subgroup differences by race/ethnicity and income. This study adds important evidence on the health effects of state-level PFL policies at a critical point when many states are considering or enacting policies, and during ongoing conversations about national PFL policy implementation.

Impact of Racial Bias on Providers' Empathic Communication Behaviors with Women of Color in Postpartum Checkup.

Racial bias in healthcare settings can manifest as biased communication, discriminatory treatment, lower quality of care, and a lack of empathy toward women of color [WoC; Nong et al. in JAMA Netw Open 3:e2029650-e2029650, 1; McLemore et al. in Soc Sci Med 201:127-135, 2; Hagiwara et al. in Patient Educ Couns 102:1738-1743, 3]. Despite a large body of research on racial bias, more research is needed to understand how bias translates into specific communication behaviors to develop interventions that reduce racial mistreatment in communication with WoC (Hagiwara et al. in Patient Educ Couns 102:1738-1743, 3). This study contributes to the existing research by exploring the impact of colorblind racial ideology (i.e., the denial and minimization of racism) and ethnocultural empathy (i.e., the ability to understand and relate to others from different ethnic or cultural groups) on health providers' observed empathic communication behaviors. Providers were recruited through US hospital listservs. Inclusion criteria required that participants work in the field of maternal health. A total of 65 healthcare providers completed a survey, which included measures of colorblindness and ethnocultural empathy, and simulated interaction over HIPAA Zoom with trained actors playing patients. Participants were randomly assigned to administer the Edinburgh Postpartum Depression Scale to a Black, Asian, or White patient in a simulated postpartum 4-week checkup. Path analyses were conducted using Mplus. Findings indicated that colorblind racial ideology and ethnocultural empathy were associated with racially biased reasoning, which in turn was related to a lack of providers' empathic communication behaviors. Study findings suggest racial bias can lead to less empathic patient-provider communication interaction and support changes aimed at both reducing racial bias and increasing empathic interaction.

What Influences Postpartum Depressive Symptoms? The role of Social Determinants of Health, Race-Based Discrimination and Stressful Life Experiences.

Development of postpartum depressive symptoms (PDS) is influenced by many social determinants of health, including income, discrimination, and other stressful life experiences. Early recognition of PDS is essential to reduce its long-term impact on mothers and their children, but postpartum checkups are highly underutilized. This study examined how stressful life experiences and race-based discrimination influence PDS development and whether or not a women has a postpartum checkup. Pregnancy Risk Assessment Monitoring System (2016-2022) was used for secondary data analysis of mothers from 9 sites (n = 8,851). Stressful life experiences prior to birth, race-based discrimination, PDS, and postpartum checkup data were collected using the PRAMS questionnaire. Covariates were collected using primarily birth certificate data. Women of multiple races and ethnicities were significantly more likely to experience PDS if they reported a greater number of stressful life experiences. Women of multiple races and ethnicities were more likely to experience PDS if they reported experiencing race-based discrimination, with Asian women having nearly 8 times greater odds. Black and Hispanic women were less likely to have a postpartum checkup if they reported a greater number of stressors. Black women were less likely to have a postpartum checkup if they had previously experienced race-based discrimination. The influence of race-based discrimination was seen across a diverse group of races and ethnicities. Findings highlight the need to expand questionnaires focused on social determinants of health, specifically discrimination, in PRAMS to all 50 states to better assess their significant consequences for maternal wellbeing.

Physical Intimate Partner Violence Among Women Experiencing Homelessness Before and During Pregnancy.

Intimate partner violence (IPV) and homelessness can have devastating health consequences for pregnant women. Using the Pregnancy Risk Assessment Monitoring System, we assessed differences in the association of physical IPV before and/or during pregnancy with adverse health outcomes between women experiencing homelessness (WEH) and domiciled women. Among 186,891 respondents, representing an estimated 11,489,161 women, 27.1% and 3.4% of WEH and domiciled women, respectively, reported experiencing physical IPV. Physical IPV was associated with higher odds of having postpartum depression and preterm birth and lower odds of having a postpartum checkup among domiciled women (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.62 - 2.08 for postpartum depression, aOR 1.29, 95%CI 1.08 - 1.53 for preterm birth, and aOR 0.56, 95%CI 0.49 -0.64 for postpartum checkup). The differences in these outcomes between women who experienced physical IPV and those who did not were smaller among WEH, as indicated by aORs of interaction terms (aOR 0.74, 95%CI 0.58 - 0.94 for postpartum depression, aOR 0.68, 95%CI 0.49 - 0.93 for preterm birth, and aOR 1.32, 95%CI 1.01 - 1.74 for postpartum checkup). Further research is needed to identify factors that may offer WEH a protective effect against the negative impacts of IPV.

Performance evaluation and comparative analysis of different machine learning algorithms in predicting postnatal care utilization: Evidence from the ethiopian demographic and health survey 2016.

Postnatal care refers to the support provided to mothers and their newborns immediately after childbirth and during the first six weeks of life, a period when most maternal and neonatal deaths occur. In the 30 countries studied, nearly 40 percent of women did not receive a postpartum care check-up. This research aims to evaluate and compare the effectiveness of machine learning algorithms in predicting postnatal care utilization in Ethiopia and to identify the key factors involved. The study employs machine learning techniques to analyse secondary data from the 2016 Ethiopian Demographic and Health Survey. It aims to predict postnatal care utilization and identify key predictors via Python software, applying fifteen machine-learning algorithms to a sample of 7,193 women. Feature importance techniques were used to select the top predictors. The models' effectiveness was evaluated using sensitivity, specificity, F1 score, precision, accuracy, and area under the curve. Among the four experiments, tenfold cross-validation with balancing using Synthetic Minority Over-sampling Technique was outperformed. From fifteen models, the MLP Classifier (f1 score = 0.9548, AUC = 0.99), Random Forest Classifier (f1 score = 0.9543, AUC = 0.98), and Bagging Classifier (f1 score = 0.9498, AUC = 0.98) performed excellently, with a strong ability to differentiate between classes. The Region, residence, maternal education, religion, wealth index, health insurance status, and place of delivery are identified as contributing factors that predict postnatal care utilization. This study assessed machine learning models for forecasting postnatal care usage. Ten-fold cross-validation with Synthetic Minority Oversampling Technique produced the best results, emphasizing the significance of addressing class imbalance in healthcare datasets. This approach enhances the accuracy and dependability of predictive models. Key findings reveal regional and socioeconomic factors influencing PNC utilization, which can guide targeted initiatives to improve postnatal care utilization and ultimately enhance maternal and child health.

Assessment Of A Health System-Integrated Children's Savings Account and Financial Coaching Program Serving Low-Income Moms and Babies in Texas.

Families living in poverty with young children are particularly vulnerable to poor health outcomes. This study used a randomized controlled trial to analyze the impact of Early Bird (EB), a novel health system-integrated program that provided financial incentives to low-income mothers for achieving healthy milestones. Participants randomized to the EB condition received contributions in a tax-advantaged children's savings account (CSA) for attending a maternal six-week postpartum check-up ($25), a pediatric dental visit by age 12 months ($75), six well-check visits by age 15 months ($75), two financial coaching sessions ($30), and enrolling in the EB program and opening a CSA ($250). We found that Early Bird increased the likelihood that mothers attended a financial coaching session. We found no evidence of an increase in the likelihood of completing any of the medical milestones. Future work should examine whether larger contributions to CSAs might incentivize mothers to achieve the medical milestones.

Nonuse of Contraception at Conception Due to Partner Objection and Pregnancy-Related Health Care Utilization, Postpartum Health, and Infant Birth Outcomes.

Objective: Reproductive coercion has been associated with adverse reproductive health experiences. This study examined the relationship between nonuse of contraception due to partner objection, one aspect of reproductive coercion, and selected pregnancy-related outcomes. Methods: We used 2016-2020 data from the Pregnancy Risk Assessment Monitoring System in 22 jurisdictions to assess the prevalence of nonuse of contraception due to a partner objection by select characteristics among individuals with a recent live birth who reported an unintended pregnancy. We calculated adjusted prevalence ratios (aPRs) to understand associations with health care utilization, postpartum behaviors and experiences, postpartum contraceptive use, and infant birth outcomes. Results: Among people with a recent live birth in the study jurisdictions (n = 29,071), approximately 5% reported nonuse of contraception due to a partner objection and unintended pregnancy. This experience was associated with lower prevalence of attending a health care visit before pregnancy (aPR 0.8, 95% confidence interval [CI] 0.7-0.9), first trimester prenatal care, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6-0.9 for both). Higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1-1.6) and partner objecting to using birth control postpartum (aPR 2.8, 95% CI 2.1-3.9). Conclusions: Nonuse of contraception due to a partner objection at conception was associated with poor mental health and lower health care utilization around the time of pregnancy. Prevention efforts may include strategies that ensure provider screening for intimate partner violence, and evidence-based approaches that teach about healthy relationships, enhance self-efficacy, and address underlying drivers of violence.

“They say it may cause cancer:” A Qualitative Exploration of Filipinos' Contraceptive Misconceptions and Primary Healthcare Interventions

Background and Objective. Contraceptives are widely acknowledged for preventing unwanted pregnancies. However, there is a prevalent lack of awareness regarding contraceptives, leading to unaddressed misconceptions. This study aimed to identify common contraceptive misconceptions among men and women of reproductive age and explore how primary health workers address them. Methods. A qualitative study was conducted in two phases within District 5, Manila City. Phase 1 comprised focused group discussions with men and women of reproductive age (n=60), while Phase 2 involved conducting in-depth interviews with primary healthcare providers (n=16). MAXQDA, a qualitative software, to organize and code the data, was utilized. Results. Women of reproductive age reported several misconceptions about contraceptives, including concerns about adverse health effects, emotional and behavioral changes, perceived ineffectiveness, and cosmetic or bodily changes. For instance, they believed that contraceptives could lead to serious health complications, such as cancer, genital injury, and even death. Primary healthcare providers addressed these misconceptions through open dialogue during service delivery, particularly during prenatal and postpartum check-ups and infant immunizations. They utilized patient education strategies, including the teach-back method, and conducted community outreach and workshops on contraceptives and family planning, especially during Women’s Month. Conclusion. Several misconceptions were identified among women of reproductive age regarding the proper use and safety of contraceptive methods, as well as misguided beliefs. In contrast, men did not exhibit any misconceptions about contraceptives, which warrants further investigation. Primary healthcare providers have taken a proactive approach to address this issue by offering comprehensive explanations and ensuring clear understanding between healthcare providers and women. Promoting contraceptive health literacy could help bridge the knowledge gap between men and women of reproductive age.

Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023.

Objectives. To assess the relationship between doula utilization and health outcomes of females enrolled in Medicaid-affiliated plans in the United States. Methods. In this retrospective, observational cohort study, we used Medicaid claims data from a national health insurer to compare health outcomes between females who used and who did not use a doula (2014-2023). We conducted propensity score matching using a 1:1 case‒control match, without replacement, and fit logistic regressions to analyze the relative risks for maternal health outcomes. Results. The study population included 722 matched pairs with and without a doula. Results indicate females with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup (all differences P < .05). Conclusions. Doula care is associated with improved health outcomes among Medicaid enrollees. Public Health Implications. Doulas have garnered increasing interest from policymakers as a strategy to address increasing trends in maternal morbidity and persistent health disparities. This study provides evidence from Medicaid enrollees across the United States that doula care can improve maternal health. (Am J Public Health. 2024;114(11):1275-1285. https://doi.org/10.2105/AJPH.2024.307805).

The prevalence of contraceptive use among postpartum women and its associated factors during the early phase of COVID-19 outbreak: a time series study

BackgroundUnintended pregnancies can adversely affect maternal health, preventable through timely postpartum contraception. During the COVID-19 pandemic, family planning services were constrained by policies that curtailed outpatient visits. We investigated the prevalence of postpartum contraceptive initiation at King Chulalongkorn Memorial Hospital (KCMH) during January to June 2020, comparing with the same period in 2019, and identified factors associated with such initiation.MethodsWe reviewed the medical records of 4506 postpartum women who delivered at KCMH during the study period. Logistic regression was conducted to test the association between early COVID-19 phase deliveries and post-partum long acting reversible contraception (LARC) initiation including copper intrauterine devices, levonorgestrel intrauterine systems, contraceptive implants, and progestogen-only injectable contraceptives.ResultsA total of 3765 women (83.6%), of whom 1821 delivered during the pandemic and 1944 during the historical cohort period, were included in this study. The proportion of women who initiated non-permanent modern contraceptives at six weeks postpartum was comparable between the COVID-19 (73.4%) and historical cohort (75.3%) (p = 0.27) periods. The proportion of women who initiated LARC at six weeks postpartumwas comparable between the historical cohort period (22.5%) and the COVID-19 (19.7%) (p = 0.05) period. Accessing a six-week postpartum check-up was independently associated with LARC initiation, of which the adjusted odds ratio (OR) (95% confidence interval) was 3.01 (2.26 to 4.02).ConclusionsOur findings demonstrated that accessing postpartum care significantly associate with the use of LARC. The data suggest the strong influence of postpartum check-ups in facilitating the adoption of effective contraception, emphasizing the need for accessible postpartum care to sustain maternal health during health crises.

Cigarette Smoking Among Pregnant Women During the Perinatal Period: Prevalence and Health Care Provider Inquiries - Pregnancy Risk Assessment Monitoring System, United States, 2021.

Cigarette smoking during pregnancy increases the risk for pregnancy complications and adverse infant outcomes such as preterm delivery, restricted fetal growth, and infant death. Health care provider counseling can support smoking cessation. Data from the 2021 Pregnancy Risk Assessment Monitoring System were analyzed to estimate the prevalence of smoking before, during, and after pregnancy; quitting smoking during pregnancy; and whether health care providers asked about cigarette smoking before, during, and after pregnancy among women with a recent live birth. In 2021, the prevalence of cigarette smoking was 12.1% before pregnancy, 5.4% during pregnancy, and 7.2% during the postpartum period; 56.1% of women who smoked before pregnancy quit smoking while pregnant. Jurisdiction-specific prevalences of smoking ranged from 3.5% to 20.2% before pregnancy, 0.4% to 11.0% during pregnancy, and 1.0% to 15.1% during the postpartum period. Among women with a health care visit during the associated period, the percentage of women who reported that a health care provider asked about smoking was 73.7% at any health care visit before pregnancy, 93.7% at any prenatal care visit, and 57.3% at a postpartum checkup. Routine assessment of smoking behaviors among pregnant and postpartum women can guide the development and implementation of evidence-based tobacco control measures at the jurisdiction and health care-system level to reduce smoking among pregnant and postpartum women.

Postpartum Depression During the Fourth Wave of the Pandemic and Related Factors

Aims: Many studies have shown the effects of the COVID-19 pandemic on postpartum depression (PPD) as a stressor. In addition, there have been many changes in the pandemic process, such as vaccination and removal of restrictions. However, few studies have been conducted on the psychological effects of changing conditions. In this study, we aimed to examine the frequency of PPD and the associated sociodemographic–obstetric factors in mothers who gave birth or were in the last pregnancy period in the fourth wave of the pandemic.&#x0D; Methods: This cross-sectional study included 211 women who underwent a postpartum checkup between December 2021 and August 2022. All women had given birth or passed the last part of their pregnancy in the fourth wave of the pandemic. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). In addition, the authors assessed sociodemographic and obstetric characteristics with a form.&#x0D; Results: The prevalence of PPD was 22.7% (EPDS cut-off score ≥ 13). EPDS scores were higher in those with inadequate social support, fear of childbirth, or having a past psychiatric illness.&#x0D; Conclusions: In the late pandemic, the negative effect on PPD does not seem to continue. However, PPD remains a significant public health problem in Turkey. In addition, some sociodemographic characteristics associated with PPD continue to pose risks.

The Effect of the Number of Breastfeeding Sessions per Day in the Early Postpartum Period on Postpartum Depression Scores Among Pregnant Women Without Risk Factors for Depression: A Retrospective Cohort Study.

Background: The objective of this study was to investigate the relationship between the Edinburgh Postpartum Depression Scale (EPDS) score on the 10th day postpartum and the number of breastfeeding sessions per day among puerperal women (with no known depression risk factors and a low [<10] EPDS score after delivery). Materials and Methods: A total of 1,451 nulliparous, 37- to 41-week pregnant women who gave birth between August 2020 and August 2022 and who underwent routine postpartum checkups on the 10th day after delivery were included in this study. Pregnant women with risk factors for depression before pregnancy, during pregnancy, and after delivery were not included. Patients with an EPDS score of ≥10 after delivery were excluded from the study. On the 10th day after birth, the mean number of breastfeeding sessions per day of the population in the study was determined. Patients with a number of breastfeeding sessions per day above the mean value were classified as Group A (n = 45), and those with values below the mean were classified as Group B (n = 67). Results: The mean number of breastfeeding sessions per day was 10.15. The EPDS scores of Group A (6 [0-19]) were significantly lower than those of Group B (8 [0-20]) (p < 0.05). A negative linear relationship was found between the number of breastfeeding sessions per day and the EPDS scores on the 10th day postpartum (p < 0.05). No statistically significant difference was found between the EPDS scores and the education status, age, or gestational week of the patients (p > 0.05). There was no statistically significant difference between the number of breastfeeding sessions per day and the education status or age of the patients (p > 0.05). Conclusions: Higher number of breastfeeding sessions per day is associated with less risk of maternal postpartum depression. There is a need for new studies on the consequences of the number and quality of breastfeeding sessions.

Homelessness in the Perinatal Period and Associations With Reproductive Interconception Care: 2016-2019 Pregnancy Risk Assessment Monitoring System.

Women experiencing homelessness have higher rates of unintended pregnancy than stably housed women and may benefit from reproductive interconception care. How reproductive interconception care differs between women who did and did not experience perinatal homelessness is not known. We estimated prevalence ratios of reproductive interconception behaviors among US women experiencing homelessness during the perinatal period. We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System to calculate the prevalence of 5 reproductive interconception care outcomes: attending a maternal postpartum checkup, participating in a conversation with a health care provider about birth intervals, receiving family planning counseling, obtaining a prescription for short-acting contraception, and having a long-acting reversible contraceptive inserted. We used complex survey weights, stratified by perinatal homelessness, and converted adjusted logistic regression odds ratios between housing status and outcome variables to adjusted prevalence ratios (aPRs) and 95% CIs. Among participants, approximately 2.4% (weighted percentage; unweighted 2953 of 100 706) experienced homelessness sometime in the 12 months before their children were born; the majority were non-Hispanic (83.2%) and White (69.4%), were not married (82.2%), and had public health insurance (56.8%). Perinatal homelessness was significantly associated with a lower prevalence of attending a postpartum maternal visit (aPR = 0.90; 95% CI, 0.87-0.94) and a higher prevalence of having a conversation about birth intervals with their health care providers (aPR = 1.13; 95% CI, 1.03-1.21). Findings suggest that improving attendance at postpartum visits and evaluating birth interval conversations may strengthen interconception care practices while contextualizing social determinants such as housing stability. Improving uptake of postpartum visits may reduce unintended pregnancy, short birth intervals, and adverse birth outcomes in future pregnancies among women experiencing homelessness.

Syrian Women Knowledge and Attitudes Towards Hepatitis B Prevention

Abstract Background Globally, mother-to-child transmission during childbirth is the most prevalent transmission method of hepatitis B (HBV). However, early immunization following birth is a safe and effective method of preventing this disease. This study evaluates Syrian mothers’ and pregnant females’ knowledge, attitude, and practice regarding HBV prevention and immunization. Methods This online cross-sectional study was performed in Syria between 2 October and 12 November. The inclusion criteria for this study were Syrian pregnant women who visited obstetrics and gynaecologist clinics for prenatal care, delivery, and postpartum checkups. The survey was adapted from a previous study, which contains 33 items divided into three sections. Data were analyzed using descriptive and multivariate logistic regression. Results This study enrolled 419 participants with a mean age of (28.4±5.9). More than half of the participants agreed that HBV could be transmitted from mother to her child at birth, and about two-thirds of them agreed that HBV vaccination is necessary for their infant (87.4%). Among participants with a university education degree, 35.7% revealed good knowledge, while only 12.3% of respondents with a primary school education level have good knowledge. More than half of housewife participants have shown positive attitudes (52.4%). Females with academic careers have a higher probability of good knowledge and positive attitudes than housewife women (OR = 107.09, P value&amp;lt;0.05) and (OR = 16.31, P value&amp;lt;0.05), respectively. Conclusions Syrian women have a moderate knowledge level about HBV prevention, with gaps in knowledge and attitudes among low-educated women. Performing local awareness campaigns about HBV and its vaccination for women can increase their knowledge and attitudes about this topic. Obstetric care providers should provide more information for pregnant females about HBV prevention for their children which may limit the occurrence of this phenomenon. Key messages • Syrian women have moderate knowledge of HBV prevention for their children, while lower-educated women have gaps in knowledge and attitudes. • Local awareness campaigns about HBV and its vaccination for women can improve their knowledge and attitudes.

Prevalence and correlates of very rapid repeat pregnancy: Pregnancy Risk Assessment Monitoring System, United States, 2009-2020.

Most rapid repeat pregnancies, defined as those occurring within 18 months of a previous birth, are unintended. These pregnancies are associated with later initiation of prenatal care and are more common among people with lower socio-economic status and among racially and ethnically minoritised populations. To assess prevalence and correlate pregnancies occurring in the immediate period after a live birth in the United States, using the Pregnancy Risk Assessment Monitoring System (PRAMS). We assessed data from the 2009-2020 PRAMS, a population-based survey of perinatal maternal characteristics of mothers of liveborn infants in US locations. We assessed pregnancies reported during the immediate postpartum period (approximately 2-6 months post-delivery), and term this 'very rapid repeat pregnancy' (VRRP). We assessed the adjusted prevalence of VRRP from 2009 to 2020. From 2016 to 2020, we calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for maternal characteristics. The adjusted prevalence of VRRP ranged from 0.38% (95% CI: 0.29, 0.48) in 2009 to 0.76% (95% CI: 0.61, 0.91) in 2020. Demographic characteristics associated with VRRP included younger age, lower educational attainment, and being unmarried. Black mothers had a higher prevalence of VRRP compared to white mothers. Mothers who attended a healthcare visit in the 12 months preconception had a lower prevalence of VRRP as did mothers who attended a postpartum check-up, compared to their counterparts without these visits. Among those receiving prenatal care, mothers whose prenatal healthcare provider asked about postpartum contraception birth had a lower prevalence of VRRP, compared to those not asked about postpartum contraception. VRRP appeared to increase over time in 2009-2020. Mothers who are younger, Black, have lower educational attainment, or who did not attend healthcare visits before or after pregnancy had a higher prevalence of VRRP and may comprise a population who would benefit from additional family planning resources.

Effect of 2-week postpartum check-ups on screening positive for postpartum depression: a population-based cohort study using instrumental variable estimation in Japan.

Postpartum depression is experienced by approximately 10% of women and affects the health and development of their children. Although it is recommended that all mothers have the opportunity for early detection and intervention for postpartum depression, it is unclear whether early postpartum check-ups help to reduce postpartum depression. The aim of this study was to assess the effect of 2-week postpartum check-ups on screening positive for postpartum depression in Japan. This was a population-based cohort study that used the administrative database of Tsuyama, Japan. Participants were women who received postpartum home visits from a public health nurse in Tsuyama during the fiscal years 2017-2019. Data were obtained on participant's attendance at a 2-week postpartum check-up and their responses on the Edinburgh Postpartum Depression Scale. Owing to the initiation of a publicly funded postpartum check-up programme, participants were pseudo-randomly assigned to receive/not receive a 2-week postpartum check-up. We conducted instrumental variable estimation to assess the causal effects of the check-up on screening positive for postpartum depression. The characteristics of the 1,382 participants did not differ by fiscal year of childbirth. We found a 6.7% (95% confidence interval 2.2-11.2) reduction in the prevalence of screening positive for postpartum depression as an effect of 2-week postpartum check-ups among women received 1-month postpartum home visits. The results suggest that 2-week postpartum check-ups are effective in reducing the prevalence of screening positive for postpartum depression among 1-month postpartum women. Despite some limitations, early postpartum care could reduce postpartum depression.