Postnatal Research Articles

Study of the biochemical status of calves in the early postnatal period in connection with dyspepsia

Purpose: to study changes in the most important metabolic parameters in case of dyspepsia in calves.Materials and methods. Two groups of calves of 8 heads each, aged from 6 to 14 days, were formed. The first group included calves with signs of dyspepsia, who, in addition to diarrhea syndrome, had decreased appetite, weakness, and signs of abdominal pain. At the time of the study, the duration of the illness was 2-4 days. The second (control) group included clinically healthy animals of the same age. Blood was taken from the calves from the jugular vein in the morning before feeding. Blood serum was examined in a clinical biochemical laboratory using standard test systems to determine biochemical parameters.Results. In calves with dyspepsia, a significant decrease in the concentration of triglycerides by 1,8 times, cholesterol by 1,57 times, total protein by 5,5 % and albumin by 12,3 % was revealed. They also revealed a significant increase in the activity of transamination enzymes — ALT (2,6 times) and AST (1,6 times), which may indicate both damage to hepatocytes and the induction of enzymes to accelerate transamination reactions in order to meet energy needs calf body. The studies did not reveal significant changes in the concentrations of urea, creatinine and bilirubin.Conclusion. Studies have revealed metabolic changes that occur due to decreased absorption of nutrients in the intestines. Damage to the intestinal mucosa leads not only to a deterioration in the absorption of nutrients, but also to the penetration of proteins, primarily albumins, into the intestinal lumen and their removal from the body into the external environment. Redistribution of metabolic pathways to ensure homeostasis plays an adaptive role, but subsequently can have a negative role in the processes of growth and development of the calf’s body.

Expression and distribution of rAAV9 intrathecally administered in juvenile to adolescent mice.

Intrathecal (IT) lumbar puncture delivery of recombinant adeno-associated virus serotype 9 (rAAV9) is a gene therapy approach being explored in preclinical studies and ongoing gene therapy clinical trials for neurological diseases. Few studies address IT rAAV9 vector distribution, tropism, and expression with respect to age of administration. Therefore, we IT delivered a rAAV9/GFP vector in mice at ages ranging from early postnatal development through adulthood (P10-P90). Tissues were assessed for transgene expression, cell tropism, and vector distribution. In the CNS, transduction was highest when delivered at post-natal day 10 (P10) and there was an age-dependent decline in transduction. We found higher transduction of astrocytes relative to neurons when rAAV9 was administered at younger ages and a switch to higher neuronal transduction with delivery at older timepoints. Biodistribution analysis of peripheral tissues showed that when delivered at P10, rAAV9 has the greatest distribution to the heart. Conversely, at P90 rAAV9 liver distribution was highest. As rAAV9 IT-delivered gene therapies continue to emerge for neurological diseases, careful consideration of the age of delivery should be taken in relation to the expected distribution and cell expression in animal models, and how this may translate to human studies.

Effectiveness of Telemedicine and Remote Monitoring in Reducing Postpartum Hemorrhage Rates: A Meta-Analysis

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited access to healthcare. Telemedicine and remote monitoring technologies offer potential solutions for early detection and management of PPH. This meta-analysis aimed to evaluate the effectiveness of these technologies in reducing PPH rates. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published between 2013 and 2024 investigating the impact of telemedicine and remote monitoring interventions on PPH rates. Randomized controlled trials (RCTs) and observational studies with a control group were included. The primary outcome was the incidence of PPH (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after cesarean delivery). Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Publication bias was assessed using funnel plot asymmetry and Egger's test. Six studies involving 4200 women met the inclusion criteria. The pooled analysis demonstrated a statistically significant reduction in PPH rates in the intervention groups compared to the control groups (RR 0.56; 95% CI 0.47-0.67; p<0.00001). The funnel plot was symmetrical, and Egger's test was not statistically significant (p=0.45), suggesting no evidence of publication bias. Telemedicine and remote monitoring interventions are associated with a significant reduction in PPH rates. These findings support the integration of these technologies into postpartum care to improve maternal outcomes, particularly in resource-constrained settings.

Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines

BackgroundGestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.MethodsWe searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.ResultsTwenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.ConclusionsMost of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.Protocol RegistrationThis review was registered in PROSEPRO (CRD42023454900).

Pregnant Woman in Outcomes with Prosthetic Heart Valves

We here sought to assess thrombotic and hemorrhagic complications and associated risk factors during pregnancy, delivery, and postpartum in women with prosthetic heart valves (PHV). Methods: The retrospective cohort study covered January 2011 to December 2022. The objective of the study was to assess the risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery, and the postpartum period in women with PHV based on the experience of one perinatal center. We included 88 pregnancies with 77 prosthetic heart valves (PHV), which were divided into two groups, mechanical valve prostheses (MVP) (n = 64) and biological valve prosthesis (BVP) (n = 24). In the study we analyzed pregnancy outcomes, as well as thrombotic and hemorrhagic complication frequencies. Results: Of 88 pregnancies, 79 resulted in live births. In the MVP group, there were six miscarriages (9.4%) and two medical abortions (3.1%), including one due to Warfarin’s teratogenic effects. No miscarriages were reported in the BVP group, but one fetal mortality case (4.2%) occurred. During pregnancy, 11 MVP cases (17.2%) experienced thrombotic complications. In the BVP group, one patient (4.2%) had transient ischemic attack (TIA). Two MVP cases required surgical valve repair during pregnancy, and one in the post-delivery stage was caused by thrombotic complications. Postpartum, two MVP cases had strokes, and in one MVP patient, pulmonary embolism was registered, while no thrombotic complications occurred in the BVP group. Hemorrhagic complications affected 15 MVP cases (17.9%) in the postpartum period. There were no registered cases of maternal mortality. Conclusions: The effective control of anti-factor Xa activity reduced thrombotic events. However, the persistently high incidence of postpartum hemorrhagic complications suggests a need to reassess anticoagulant therapy regimens, lower target levels of anti-Xa, and reduce INR levels for discontinuing heparin bridge therapy. Despite the heightened mortality risk in MVP patients, our study cohort did not have any mortality cases, which contrasts with findings from other registries.

Behavioral, Physiological and Hormonal Changes in Primiparous and Multiparous Goats and Their Kids During Peripartum

The objective of this study was to evaluate the effect of maternal experience on behavior, progesterone and estradiol concentrations, weight and body condition in goats in the peripartum period, as well as the behavior and weight of the kids in the first hours after birth. Twenty multiparous and 10 primiparous dairy goats were enrolled. Behaviors such as walking, isolation, aggression, eating, inactivity and rumination were recorded in females during the last three days prior to the day of delivery, as well as the behaviors of the dam and her progeny in the first 2 h postpartum and the ability of the mother to discriminate between own kid and the alien one (selectivity test) at 2 h postpartum. Gestational and postpartum plasma progesterone and estradiol concentrations were determined. In the prepartum period there was a higher percentage of primiparous goats that were eating and remained less inactive compared to multiparous goats (p < 0.05). During the postpartum period, the lick latency to the kid was shorter in multiparous than in primiparous goats (p = 0.015). There was a greater proportion of kids born from multiparous (67%) than from primiparous (27%) that stood up in the first 30 min postpartum (p < 0.0001). Therefore, the proportion of multiparous kids (33%) than primiparous kids (9%) that were nursed within the first hour after birth was also higher (p < 0.0001). Progesterone and estradiol concentrations were not affected by maternal experience, neither in the prepartum nor the postpartum. In conclusion, maternal experience affected some behaviors at peripartum of the dam and vitality in the kid; however, the differences in behavior were not accompanied by differences in the variations in circulating estradiol and progesterone levels in the dam.

Editorial: Postnatal brain development in moderate and late preterm infants: challenges and context-relevant interventions

Editorial: Postnatal brain development in moderate and late preterm infants: challenges and context-relevant interventions

Evaluation of depression at 6 and 12 months postpartum by examining depressive symptoms and self-harm ideation during the early postpartum period: Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

The aim of this study was to evaluate depression at 6 and 12 months postpartum, using the Edinburgh Postpartum Depression Scale (EPDS) total score and its subitem regarding self-harm ideation (SHI) at 1 month postpartum. A sample of 12,358 postpartum women answered the EPDS and questionaries at 1, 6, and 12 months postpartum longitudinally. For participants with postpartum depression (PPD; EPDS total score ≥9) and SHI (SHI sub-score ≥1) at 1 month postpartum, the risk of depression at 6 and 12 months postpartum (odds ratio [95% confidence interval] at 6 and 12 months postpartum: 20.03 [16.8-23.8] and 14.55 [12.3-17.2], respectively) was higher than for those with PPD but without SHI at 1 month postpartum (OR: 8.57 [7.36-10.0], and 6.24 [5.38-7.24], respectively). Additionally, SHI even without depressive symptoms at 1 month postpartum is also a risk for depression at 6 and 12 months postpartum. To support our longitudinal evaluation of depression at 6 and 12 months postpartum, these related factors were examined: traumatic events or relocations after the Great East Japan Earthquake, employment status, household income, personality traits, sleep status, psychological distress, and social networks. The result showed employment status, low household income and poor social networks were significantly associated with depression at 12 months postpartum but not at 6 months postpartum. This study showed a high risk of depression at 6 and 12 months postpartum for those who had depressive symptoms with SHI at 1 month postpartum. Our findings may contribute to the precise evaluation of depression at 6 and 12 months postpartum while considering sleep status, psychological distress and social network during pregnancy.

The Incidence of Postpartum Post-Traumatic Stress Disorder in Women Exposed to Adverse Childhood Experiences: A Systematic Review and Meta-Analysis.

Adverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post-traumatic stress disorder (PTSD) in women with ACEs is lacking. A systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random-effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software. Seven studies were included in the system review. One study was identified as an outlier and excluded from the meta-analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%-29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta-regression to identify factors influencing study heterogeneity was not conducted. The incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women.

Dr Associate Professor

Background: Most women do not desire pregnancy immediately after delivery and are highly motivated to accept family planning methods. The post partum intrauterine device is one of the family planning methods that can address this need. According to prior reports intrauterine device use has been very low from the contraceptive method mix. Objective: To assess barriers to postpartum intra uterine device uptake among mothers who delivered at two public hospitals in Addis Ababa, Ethiopia. Method: It is an institution based cross-sectional study. Simple random sampling method was used to select study participants. Descriptive statistics and regression analysis were used to determine the presence and strength of association between uptake of post partum intrauterine device and independent variables. Result: In this study the uptake of postpartum intrauterine contraceptive device was 11% (95%CI=8.0, 14). The stated barriers for the none uptake of post partum intrauterine device were fear and concern (61.6%), religions value for family planning (16.9%), husband and relative opinion (7%), culture norm (5%) and health provider related factor (5% (17/367)). Parity and mode of delivery were significantly associated post partum intrauterine device uptake. The odds of intrauterine contraceptive device utilization for mothers with previous number of deliveries of ?3 and 1-2 were 35 (AOR=34.8, 95%CI=7.33, 165.4) and 4 (AOR=4.2, 95%CI=1.47, 12.07) times higher than those with no previous delivery. In addition, assisted vaginal delivery had 11 (AOR=11.06, 95%CI=3.26, 37.5) times increased odds of intrauterine contraceptive device uptake than SVD. Conclusion and recommendations: The uptake of post partum intrauterine device was low (11%). The main barriers identified for the low uptake were fear and concern to myth and misconceptions, religions value for family planning, husband and relative opinion, culture norm and health provider related factors. To identify and address reasons for gaps in knowledge and to clear public misconceptions and fears further large scale studies are recommended. Key-words: PPIUD, Contraception, post partum, Ethiopia.

Spousal Postpartum Social Support and Association with Sexual Function and Sexual Quality of Life among Breastfeeding Women

Background: The present study investigated the relationship between spousal support during postpartum period and the sexual function and sexual quality of life among lactating women. Methods: A cross-sectional study was carried out from October to March 2021 comprising 301 breastfeeding women referred to comprehensive health centers in Qazvin, Iran. The sampling method was performed in two stages. First, via cluster sampling, ten comprehensive health centers were randomly selected. Then based on the list of lactating mothers, 31 mothers in each center were randomly selected and invited to complete the survey. The survey included three psychometric instruments (i.e., Postpartum Partner Support Scale [PPSS], Female Sexual Function Index [FSFI] and Sexual Quality of Life-Female version [SQOL-F]) as well as a reproductive and demographic information questionnaire. The findings were analyzed using univariable and multivariable regression models at a significance level of p&lt;0.05. Results: The participants had a mean age of 30.33 years and a mean length of marriage of 7.99 years. A total of 219 women were exclusively breastfeeding (72.8%), and 82 used a combination of breastfeeding and formula milk to feed their infants (27.2%). The mean (standard deviation) scores in the postpartum period were 61.34 out of 80 (SD=11.41) on the PPSS, 86.52 out of 108 (SD=19.68) on the SQOL-F, and 22.78 out of 36 (SD=6.20) on the FSFI. Based on adjusted multivariable regression models, spousal support in the postpartum period was a significant predictor of sexual quality of life (β=0.39, p&lt;0.001) but not a significant predictor of sexual function. Sexual quality of life was a significant predictor of sexual function (β=0.44, p&lt;0.001). Conclusion: Given the importance of spousal support during the postpartum period in relation to sexual quality of life and sexual function, designing and implementing counseling programs based on the role of spousal support during postpartum sexual life would be helpful.

Perinatal running training reversed postnatal anxiety and depressive-like behavior and cognitive impairment in mice following prenatal subchronic variable stress.

Pregnancy is a very complex and highly stressful time in women. Despite the high prevalence of postpartum depression, more than 50 % of mothers are undiagnosed or untreated, showing an urgent need to explore an effective preventive strategy. Regular physical activity has been suggested to be associated with an increased quality of life in pregnant and postpartum women. The purpose of this study was to determine whether perinatal running training can affect maternal care stress-related anxiety, depressive-like behavior, and cognitive changes in postpartum dams and to explore the possible underlying mechanism. 40 female C57BL/6J mice were divided into four groups: prenatal control (NC) and running training (EX) group (NC+EX), prenatal control and nonrunning training (RE) group (NC+RE), prenatal subchronic variable stress (SCVS) and running training group (SCVS+EX) and prenatal SCVS and non-running training group (SCVS+RE). Mice in prenatal stress groups were subjected to SCVS after pregnancy confirmed. Mice in running training groups subjected to running training throughout pregnancy and lactation. Then after the delivery, maternal behavior, cognitive changes, anxiety and depressive-like behaviors were tested. Then we measured the serum prolactin (PRL), hypothalamic-pituitary adrenal (HPA) axis activity, and adult hippocampus neurogenesis (AHN) in dams. Compared to NC+RE, prenatal SCVS caused cognitive impairments, the decrease in maternal behavior, and anxiety and depressive-like behavior in SCVS+RE dams, accompanying increase in HPA axis activity and decreased the PRL levels and AHN in postpartum period. Then compared to SCVS+RE, perinatal running training mitigates cognitive impairments, increased maternal behavior, and alleviates anxiety and depressive-like behavior in SCVS+EX dams, accompanying the decreased HPA axis activity, and the increased PRL levels and AHN in postpartum period. Overall, this study suggests that perinatal running training might improve maternal care and reverse prenatal stress-related cognitive impairment and anxiety and depressive-like behavior in postpartum dams.

Evaluation of thiol/disulphide and oxidant-antioxidant status of dairy cows in periparturient and post-partum period.

Thiol/disulphide homeostasis (TDH) has a critical role in many cellular activities such as antioxidant protection. Alterations of oxidative stress in the transition period play an important role in development of some diseases and disorders in dairy cows. The purpose of this study is to assess the total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), total thiol, native thiol, disulphide and lipid profile in Simmental and Montofon dairy cows (aged 2-3) before and after calving. Blood samples were collected 233-280 days of pregnancy and the 30 days of post-partum. Serum total thiol, native thiol and disulphide levels were determined as well as TAS, TOS and paraoxonase-1 (PON-1) levels were measured using colorimetric assays. Triglycerides (TG), total cholesterol, HDL cholesterol and LDL cholesterol levels were measured with an automatic analyser. Total thiol (p=0.038) and disulphide (p=0.015) levels were higher after calving compare to pregnancy in Montofon. TAS was found lower (p<0.001), and OSI was higher in both breeds (Montofon p=0.012, Simmental p=0.028) after calving than in pregnancy. When compared between pregnancy and after calving levels in the same breed, HDL was found to be higher after calving (p<0.001) and TG was lower after calving (p=0.020) in Montofon. PON (p=0.090), HDL (p<0.001) and cholesterol levels were found higher (p<0.001) and TG level was lower (p<0.001) after calving in Simmental. According to our results, we observed different responses between two breeds before and after calving. There are few studies about TDH in animal research, and this is the first study in the literature that evaluates the TDH along with oxidative stress and lipid profiles in dairy cows in the periparturient and post-partum period.

Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies.

Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods. We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods. A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse. Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family. This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.

Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.

Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women. 51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase. Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement. Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.

Perceptions, attitudes and beliefs on antenatal exercises among primiparous pregnant women: a qualitative study in Sri Lanka

BackgroundEven if promoting antenatal exercises is an evolving concept worldwide, there is a scarcity of qualitative exploratory studies which directly focus on pregnant mothers’ views about exercises. So, this study...

Prognostic Value of Clinicopathological Parameters Assessed During Admission of Foals with Neonatal Encephalopathy and Comorbidities Developed During Hospitalization

Neonatal encephalopathy represents a broad neurological syndrome which encompasses newborn foals presenting a variety of non-infectious neurologic signs and/or abnormal behaviors in the immediate postpartum period. It is recognized as the most predominant neurological disorder in neonatal foals. Prognostic factors can guide clinicians in medical decision-making, aiding in the establishment of survival probabilities. The aim of this work was to scrutinize the prognostic value of clinical and laboratorial findings upon admission and posterior comorbidities developed during hospitalization, assessing their influence on the outcome of foals with NE. For this purpose, the medical records of 61 neonatal foals with a primary diagnosis of NE were retrospectively analyzed. The overall survival rate was 57.4%. Most foals presented recumbency at admission, which was associated with higher mortality rates (p = 0.002). Hypothermic foals at admission were 4.85 times more likely to succumb (p = 0.015). The presence of hypoglycemia at admission was associated with higher mortality rates (p = 0.002). Foals with hypercreatinemia at admission had 6.67 times greater odds of dying. The development of seizures contributed to 4.14 greater odds of dying. Foals that developed comorbidities during hospitalization had 40.1 times greater odds of dying, with pneumonia and sepsis being the most relevant comorbidities. In foals with NE, rectal temperature, hematocrit, blood glucose, and creatinine concentrations are simple, quick-to-measure parameters that may have prognostic value during admission.

Effectiveness of Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM) -intervention on self-efficacy in weight management in pregnant women: a quasi-experimental trial

BackgroundHalf of women with overweight gain excessive weight during pregnancy. Perceived self-efficacy plays a significant role in adherence to healthy behaviours, especially in turning points of life, such as a pregnancy. ObjectivesTo assess the effectiveness of the Supporting lifestyle change in pregnant mothers with obesity through the wearable internet-of-things (SLIM)-intervention in terms of improving self-efficacy in eating and physical activity and preventing excessive weight gain of pregnant women with overweight. The second aim was to evaluate the fidelity of the intervention implementation. MethodsPregnant women with overweight (N=54) attending maternity clinics in Southwest Finland between 2021 and 2023, were recruited using convenience sampling. The SLIM-intervention included: health technology, motivational interviewing, feedback, and goal setting. The intervention was implemented in prenatal visits in maternity clinics continuing to 12 weeks postpartum. The change in self-efficacy was measured with Weight Efficacy Life-Style Questionnaire (score 0–180) and Self-Efficacy for Physical Activity Scale (score 5–25) with repeated measures in three timepoints. Data on weight were collected from patient records. ResultsThe levels of self-efficacy were high throughout the study period and there were no significant changes in self-efficacy in eating (p=0.650) or physical activity (p=0.936). Most of the women (N=9/10), whose gestational weight gain was within recommendations or less, managed to lose weight during the postpartum period (p<0.001). ConclusionsAlthough the intervention was not effective in improving self-efficacy, the importance of recommended gestational weight gain on better postpartum weight management was highlighted. A long follow-up time was valuable for examination of changes over time and understanding trends, patterns, and outcomes of the study. RegistrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on March 17th, 2021.

Blended CBT Intervention vs. a Guided Web-Based Intervention for Postpartum Depression: Results From a Pilot Randomized Controlled Trial.

This pilot randomized controlled trial evaluated the acceptability and preliminary effectiveness of a blended cognitive behavioural intervention-combination of a web-based program and sessions with a psychologist (intervention group)-compared to a guided web-based intervention (active control group) for the treatment of postpartum depression. Adult Portuguese women in the postpartum period (up to 12 months) presenting clinically relevant depressive symptoms were considered eligible. Participants were randomly assigned to the intervention group (n = 17) or the control group (n = 17) and completed self-report questionnaires at baseline, post-intervention and at 3-month follow-up. In both arms, dropout rates were low, and participants considered the treatment acceptable and useful. Mixed ANOVAs revealed a significant reduction in depressive symptoms and improvements in secondary outcomes (anxiety, negative thoughts, emotion regulation, self-compassion and psychological flexibility) from baseline to post-intervention in both groups. No time × group interactions were found. A significant clinical change in depressive symptoms was observed in more than 80% of the participants in both groups. Significant associations were observed among therapeutic alliance and depressive symptoms. The results of our study support the acceptability, usability and preliminary effects on postpartum depression of both interventions and highlight the important role of therapist support in blended and guided web-based interventions. ClinicalTrials.gov identifier: NCT04441879.

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760