Postpartum Year Research Articles

A retrospective study on persistent pain after childbirth in the Netherlands.

Reported prevalence rates of persistent postpartum pain (PPP) range from less than 1% to almost 20%. The aim of this study was to examine the prevalence of PPP in a Dutch cohort and to evaluate a possible causal role for specific risk factors on the development of chronic pain after childbirth. A questionnaire was sent to 960 postpartum women approximately 2 years after delivery. Primary outcome was pain that arose from childbirth at follow-up, and secondary outcomes included quality of life (QoL) and Hospital Anxiety and Depression Scale scores. Tested risk factors included mode of labor analgesia, history of negative effect, history of chronic pain, delivery route, parity, and ethnicity. A total of 495 (51.6%) women participated. At a mean time of 2.3 postpartum years, 7.3% of women reported any pain and 6.1% reported significant pain related to the delivery. Compared to spontaneous delivery, cesarean delivery provided protection against persistent pain (odds ratio, 0.12; 95% CI, 0.01–0.63, P<0.05). None of the other risk factors, including remifentanil use for labor pain, were of influence on the prevalence of persistent pain. Women with PPP experienced greater negative effects and had lower QoL scores compared to women without pain. In this cohort of Dutch patients, PPP is a serious problem with a great impact on the physical and mental health of women.

Do Lactation-Induced Changes in Ghrelin, Glucagon-Like Peptide-1, and Peptide YY Influence Appetite and Body Weight Regulation during the First Postpartum Year?

To determine whether fasting and meal-induced appetite-regulating hormones are altered during lactation and associated with body weight retention after childbearing, we studied 24 exclusively breastfeeding women (BMI = 25.2 ± 3.6 kg/m2) at 4-5 weeks postpartum and 20 never-pregnant controls (BMI = 24.0 ± 3.1 kg/m2). Ghrelin, PYY, GLP-1, and appetite ratings were measured before/and 150 minutes after a standardized breakfast and 60 minutes after an ad libitum lunch. Body weight/composition were measured at 6 and 12 months. Fasting and area under-the-curve responses for appetite-regulating hormones did not differ between lactating and control groups; ghrelinacyl, however, tended to track higher after the standardized breakfast in lactating women and was higher (p < 0.05) after the ad libitum lunch despite a 24% higher energy intake (p < 0.05). By 12 months, lactating women lost 5.3 ± 2.2 kg (n = 18), whereas control women (n = 15) remained weight stable (p = 0.019); fifteen of the lactating women returned to within ±2.0 kg of prepregnancy weight but three retained >6.0 kg. The retainers had greater (p < 0.05) postmeal ghrelin rebound responses following breakfast. Overall these studies do not support the hypothesis that appetite-regulating hormones are altered during lactation and associated with postpartum weight retention. Altered ghrelin responses, however, deserve further exploration.

GLATIRAMER ACETATE AND PREGNANCY IN WOMEN WITH MULTIPLE SCLEROSIS – RESULTS FROM THE GERMAN MULTIPLE SCLEROSIS AND PREGNANCY REGISTRY

ObjectiveTo determine the effect of glatiramer acetate (GLAT) exposure during pregnancy on perinatal outcome in women with multiple sclerosis (MS).BackgroundMS is one of the most common neurological diseases of the central nervous system, which mainly affects young women of reproductive age.Only limited data are available on whether GLAT exposure during pregnancy has an effect on perinatal outcome.MethodsWe compared the outcome of pregnancies of patients with MS exposed to GLAT with pregnancies of unexposed controls. Women with MS were enrolled into the German Multiple Sklerosis and pregnancy registry. Data were assessed with a standardized questionnaire during pregnancy and the postpartum year. Detailed information on course of MS, concomitant medication, pregnancy course and outcome was obtained.ResultsWe collected data on 230 pregnancies: 135 with exposure to GLAT and 95 MS controls unexposed to disease-modifying therapies (DMTs) during pregnancy.While 25 of the exposed pregnancies are still ongoing we did not document any malformation in the first 110 GLAT exposed pregnancies with at least 6 months postpartum follow up. The rate of spontaneous abortions did not differ compared to unexposed controls. 3 (3.15%) infants of the DMT unexposed women were born with malformations of non-genetic origin and 1 (0.95%) newborn was diagnosed with Wolf Hirschhorn syndrome.ConclusionsGLAT exposure does not constitute a major human teratogen or influence outcome of pregnancy negatively compared to untreated women with MS. Final data including the outcome of ongoing pregnancies will be presented at the time of the meeting.

Maternal depression as a risk factor for children's inadequate housing conditions

Depression among mothers with young children is an important public health issue that not only has implications for their own well-being, but can also potentially affect their children's health and developmental trajectories. This study explored the extent to which maternal depression is a risk factor for inadequate housing conditions related to utilities, a noteworthy risk factor for poor child health. Using data on 2965 mothers and children from a national urban cohort of U.S. births in 1998–2000, we estimated multivariate logistic regression models of associations between maternal depression during the postpartum year and a U.S. Department of Housing and Urban Development (HUD) measure of severely inadequate housing due to heating issues, as well as a broader measure of energy insecurity that encompasses various types of utility problems. We also considered outcomes that incorporated housing instability and food insecurity in conjunction with housing inadequacy. Mothers who experienced depression had about 60% higher odds of experiencing severely inadequate housing due to heat (OR: 1.57) and 70% higher odds of experiencing energy insecurity (OR: 1.69) compared to mothers who did not experience depression. Maternal depression was even more strongly associated with multiple hardships in the forms of housing inadequacy plus housing instability and/or food insecurity than it was with housing inadequacy. This study provides robust evidence that maternal depression is a risk factor for inadequate housing and multiple hardships during a critical period of children's development. The findings suggest that policy efforts should not occur in mental health, housing, and food security silos.

Negotiating Peril: The Lived Experience of Rural, Low-Income Women Exposed to IPV During Pregnancy and Postpartum.

This qualitative study of 10 rural women examines their lived experience of intimate partner violence during pregnancy and the first 2 postpartum years. In-depth interviews occurred during pregnancy and 4 times postpartum. A Heideggerian approach revealed "negotiating peril" as the overarching theme; sub-themes were unstable environment, adaptive calibration, primacy of motherhood, and numb acceptance. Some incremental shifts in severity of abusive situations were observed. Results elucidate the ambivalence with which these women view institutions that are designed to help them. Findings highlight factors that may explain why interventions designed to help often do not appear efficacious in facilitating complete termination of an abusive situation.

Health Systems Approaches to Diabetes Screening and Prevention in Women with a History of Gestational Diabetes.

Gestational diabetes (GDM) is associated with a high risk of future type 2 diabetes. Despite multiple clinical guidelines highlighting the importance of screening in this high-risk population, many health systems report that fewer than 50 % of eligible women are screened in the postpartum period, and little is known about screening beyond the first postpartum year. Systems-level approaches to screening for and prevention of type 2 diabetes in women with a history of GDM are therefore an opportunity for quality improvement. This review will discuss the literature on interventions to improve screening at the systems level and highlight successful strategies as well as gaps in the existing literature. Future directions for intervention research are suggested.

Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity

AimsPrevious gestational diabetes (GDM) is a risk factor for type 2 diabetes and increased metabolic risk, but the link with vascular dysfunction is not clear. This study examined vascular function in women 4–10 years after a diagnosis of GDM who had a normal oral glucose tolerance test (OGTT) in the first postpartum year. MethodsWe studied 90 women with a history of GDM and 59 age-matched controls, examining differences in insulin resistance as measured by the Homeostatic Model Assessment (HOMA-IR) and glucose responses during an OGTT, adiposity, lipid profile and C-reactive protein (CRP). Using pulse wave analysis, we also measured cardiac function, vascular compliance, and systemic vascular resistance. ResultsWomen with a history of GDM had higher measures of adiposity (body mass index 28.9±6.5 vs. 26.6±6.9kg/m2, P=0.04, waist–hip ratio 0.85±0.06 vs. 0.79±0.07, P<0.001), dyslipidemia (LDL cholesterol 2.78±0.64 vs. 2.41±0.56mmol/L, P<0.001, total cholesterol: HDL cholesterol 3.93±1.2 vs. 3.21±0.82mmol/L, P<0.001) and abnormal glucose metabolism (50% vs. 12%, P<0.001). However, there was no difference in CRP, HOMA-IR, or measures of cardiovascular function including pulse rate, pulse pressure, mean arterial pressure, cardiac output, systemic vascular resistance, small and large artery elasticity index. After controlling for adiposity, blood pressure, lipids and CRP, glycemic status did not contribute to vascular function. ConclusionDespite a higher incidence of adiposity, dyslipidemia, and impaired glycemia, women with a history of GDM who had a normal postpartum OGTT did not have impaired vascular function 4–10 years postpartum, when compared to healthy controls.

Optimal Carbon Monoxide Criteria to Confirm Smoking Status Among Postpartum Women.

Although expired-air carbon monoxide (CO) is a well characterized biomarker of cigarette smoking, limited research has assessed whether the standard clinical CO cutoffs need to be altered for postpartum women and whether these cutoffs remain constant across the postpartum year. Accordingly, the present study evaluated the effectiveness of using CO as a method to confirm smoking status relative to salivary cotinine among postpartum women and assessed optimal CO criteria to confirm smoking status across the postpartum year. Differences in optimal CO criteria to confirm smoking status also were examined between black and white postpartum women. Women (N = 208) for the present study had quit smoking for their current pregnancy and were enrolled in a larger postpartum relapse prevention intervention. Smoking status was assessed at 12, 24, and 52 weeks postpartum using both expired-air CO and salivary cotinine. Receiver-operating characteristic analyses indicated that CO provided moderately high diagnostic accuracy to distinguish between women who were and were not smoking when using salivary cotinine as the reference criterion to confirm smoking status. CO cutoffs of 2 and 3 parts per million (ppm) had the highest overall efficiency and combined sensitivity and specificity across the postpartum year. Results were consistent for black and white women. These findings indicate that optimal CO criteria to confirm smoking status remains stable throughout the postpartum year and support a need to utilize CO cutoffs much lower than the standard clinical CO criterion of 8 ppm to confirm abstinence among postpartum women. Findings from the present study confirm the value of CO as a biomarker of smoking status among postpartum women. Results indicate that CO cutoffs of 2 and 3 ppm were optimal for confirming smoking status across the entire postpartum year in both black and white women. These findings offer a replication and extension of previous work and indicate that optimal CO criteria to confirm smoking status remain stable throughout the postpartum period and further support a need to utilize CO cutoffs much lower than the standard clinical criterion of 8 ppm to confirm smoking status among postpartum women.

Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain

Objective To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. Methodology A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Results Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Conclusions Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Prevalence and Risk Factors of Relationship Dissatisfaction in Women During the First Year After Childbirth: Implications for Family and Relationship Counseling

The aim of this study was to investigate the rate of relationship dissatisfaction among Australian women during the first year after childbirth and to uncover factors affecting their relationships. Postnatal women who had given birth during the previous 12 months were invited to participate in a cross-sectional online study. A comprehensive, multisection questionnaire, as well as the Relationship Assessment Scale (RAS), Female Sexual Function Index (FSFI), and Patient Health Questionnaire - 8 (PHQ-8), were used to collect data. Responses were analyzed using SPSS for Windows. Results showed that 37.2% of the participants experienced relationship dissatisfaction. Results of the multiple logistic regression revealed that the following were significant risk factors for relationship dissatisfaction during the first postpartum year: annual income of less than AU$50,000, sexual dysfunction, and a clinical diagnosis of depression and having symptoms of depression according to the PHQ-8 scores (p < 0.05). Compared to women in a heterosexual relationship, women who were in a same-sex relationship were less likely to have relationship dissatisfaction. In addition, in the period six to 12 months postpartum, women were less likely to have relationship dissatisfaction compared to the period 5 months or less postpartum (p < 0.05).

Adult separation anxiety and unsettled infant behavior: Associations with adverse parenting during childhood and insecure adult attachment

ObjectiveThis study examined the prevalence and correlates of Adult Separation Anxiety Disorder (ASAD) and Adult Separation Anxiety (ASA) symptoms in a sample of first-time mothers with an unsettled infant during the first postpartum year. MethodsEighty-three primiparous women admitted to a residential parent–infant program participated in a structured clinical interview for DSM-IV diagnosis and questionnaires assessing ASA symptoms, adult attachment and childhood parenting experiences. Nurses recorded infant behavior using 24-hour charts. ResultsThe prevalence of ASAD in this sample was 19.3% and women with ASAD were, on average, more likely to be diagnosed with depression and anxiety disorders, report aversive parenting experiences during childhood and show adult attachment style insecurity. Both ASAD and ASA symptoms were predicted by adult attachment anxiety, and ASAD was associated with unsettled infant behavior. Attachment anxiety and attachment avoidance mediated relations between parental over-control and ASAD diagnosis, and between parental abuse and ASAD diagnosis. Attachment anxiety mediated the relation between parental over-control and ASA symptoms, and attachment avoidance mediated the relations of parental over-control and parental abuse with ASA symptoms. ConclusionsThis study highlights the prevalence of ASAD among first time mothers experiencing early parenting difficulties and the roles of childhood parenting experiences and adult attachment style in the development of the disorder. This points to the importance of introducing universal screening for ASAD in postnatal settings, and for the development of targeted interventions.

Análisis coste-efectividad del cribado universal de la enfermedad tiroidea en mujeres embarazadas en España

ObjectiveTo assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. MethodologyA decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. ResultsUniversal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. ConclusionsUniversal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study

BackgroundChildbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period. ObjectiveWe examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period. DesignA prospective, five-time-point longitudinal study. SettingMaternity unit at a medical center. ParticipantsA total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3–5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4–6 weeks and at 3, 6, and 12 months after delivery. MethodsDifferences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined. ResultsCompared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p=0.03); higher scores for non-localized pain at 3–5 days (p<0.001), 4–6 weeks (p=0.03), and 3 months (p=0.046); higher scores for abdominal pain at 3–5 days (p<0.001), 4–6 weeks (p<0.001), and 6 months (p=0.01); lower perineal pain scores at 3–5 days (p <0.001); and higher sexual desire scores (p=0.04) but lower sexual satisfaction scores (p=0.02) at 4–6 weeks. Differences between the vaginal and cesarean groups were significant (p=0.01, p=0.049, respectively) in terms of the decrease in non-localized pain from 3–5 days to 4–6 weeks postpartum and the increase in sexual desire from 4–6 weeks to 3 months postpartum. ConclusionsCesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.

Repeated depression screening during the first postpartum year.

Postpartum depression (PPD) screening at 4 to 12 weeks' postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear. We report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks' postpartum) and again at 6 and at 12 months' postpartum. The main outcomes of this substudy were the 6- and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation. At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6- and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline. Repeated PPD screening at 6 and 12 months' postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes.

Biological and psychosocial predictors of postpartum depression: systematic review and call for integration.

Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.

Common mental disorders among women, social circumstances and toddler growth in rural Vietnam: a population-based prospective study.

Common mental disorders (CMD) and adverse social circumstances are widespread among mothers of infants and toddlers in resource-constrained settings. These can undermine early childhood development through compromised caregiving and insufficient access to essential resources. The aim was to examine the effect of maternal CMD and social adversity in the post-partum year on toddler's length-for-age index in a rural low-income setting. A population-based prospective cohort study of women in Ha Nam province, Vietnam who completed baseline assessments in either late pregnancy or 4-6 weeks post partum and were followed up, with their toddlers, 15 months later. CMD were assessed at both points by psychiatrist-administered Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Diagnoses. Anthropometric indices were calculated from toddler's age, sex, weight and length using World Health Organization Child Growth Standards. Social adversities were assessed by study-specific questions and locally validated psychometric instruments. The hypothesized model of factors governing toddler's length-for-age Z score (LAZ) was tested using path analysis. In total, 211/234 (90.1%) mother-toddler pairs provided complete data. Baseline prevalence of CMD among women was 33.6% and follow-up was 18.5%. The mean LAZ among toddlers was -1.03 and stunting prevalence (LAZ < -2) was 15.6%. Maternal CMD at baseline were indirectly related to toddler LAZ via maternal CMD at follow-up (regression coefficient = -0.05, 95% CI -0.11 to -0.01). Maternal CMD at follow-up was associated significantly with toddler LAZ (regression coefficient = -0.15, 95% CI -0.28 to -0.05). Poorer quality of marital relationship, mothers' experiences of childhood abuse and <30 days dedicated post-partum care were associated indirectly with lower toddler LAZ via maternal CMD. Maternal post-natal CMD are associated with child growth measured by LAZ in this resource-constrained setting. Social adversities affect child growth indirectly through increasing the risk of maternal CMD. Interventions to reduce stunting in low-income settings may need to address maternal CMD and social adversities in order to improve impact.

Postpartum change in common mental disorders among rural Vietnamese women: Incidence, recovery and risk and protective factors

In low- and middle-income countries little is known about changes in women's mental health status from the perinatal period to 15 months postpartum or the factors associated with different trajectories. To determine the incidence and rates of recovery from common mental disorders (CMD) among rural Vietnamese women and the risk and protective factors associated with these outcomes from the perinatal period to 15 months after giving birth. In a population-based prospective study, a systematically recruited cohort of women completed baseline assessments in either the last trimester of pregnancy or 4-6 weeks after giving birth and were followed up 15 months later. The common mental disorders of major depression, generalised anxiety and panic disorder were assessed by psychiatrist-administered Structured Clinical Interview for DSM-IV Disorders at both baseline and follow-up. A total of 211 women provided complete data in this study. The incidence rate of CMD in the first postpartum year was 13% (95% CI 8-19), and 70% (95% CI 59-80) of women who had perinatal CMD recovered within the first postpartum year. Incidence was associated with having experienced childhood maltreatment, experiencing the intimate partner as providing little care, sensitivity, kindness or affection, and the chronic stress of household poverty. Recovery was associated with higher quality of a woman's relationships with her intimate partner and her own mother, longer period of mandated rest following birth, and sharing of domestic tasks and infant care. Modifiable social factors, in particular the quality of a woman's closest relationships with her partner and her own mother, and participation by family members in domestic work and infant care, are closely related to women's mental health in the first year after giving birth in resource-constrained settings.

Postpartum microalbuminuria after gestational diabetes: the impact of current glucose tolerance status.

It has been reported that women with a history of gestational diabetes mellitus (GDM) have an increased risk of microalbuminuria compared with that of their peers. Because previous GDM predicts an increased risk of prediabetes, which itself is associated with microalbuminuria, we hypothesized that current glucose intolerance may confound any association between GDM and microalbuminuria. The purpose of this study was to evaluate the relative impact of gestational and current dysglycemia on postpartum microalbuminuria in a cohort of women reflecting the full spectrum of gestational glucose tolerance from normal to mildly abnormal to GDM. In this prospective observational cohort study, 320 women underwent a glucose challenge test (GCT) and an oral glucose tolerance test (OGTT) in pregnancy, which identified 100 women with GDM, 58 with gestational impaired glucose tolerance, 90 with an abnormal GCT but a normal OGTT, and 72 with a normal GCT and OGTT. At 3 years postpartum, they underwent measurement of urine microalbumin and a repeat OGTT that identified 63 women with glucose intolerance (prediabetes/diabetes). The postpartum urine microalbumin to creatinine ratio did not differ among the 4 gestational glucose tolerance groups (P = .23). Furthermore, on logistic regression analysis, GDM did not independently predict an elevated urine microalbumin to creatinine ratio of ≥1.5 g/mol of creatinine (odds ratio, 0.43; 95% confidence interval, 0.17-1.11), after adjustment for age, ethnicity, family history of diabetes, body mass index, blood pressure, estimated glomerular filtration rate, and current glucose intolerance. In contrast, current glucose intolerance independently predicted a urine microalbumin to creatinine ratio of ≥1.5 (odds ratio, 3.4; 95% confidence interval, 1.4-8.2, P = .005). Current glucose intolerance, rather than previous GDM, may be associated with an increased risk of microalbuminuria in the early postpartum years.

Post-partum reactivation of chronic hepatitis B virus infection among hepatitis B e-antigen-negative women.

To investigate the frequency and timing of post-partum chronic hepatitis B virus (HBV) reactivation and identify its pre-partum predictors. Forty-one hepatitis B e antigen (HBeAg)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28th and the 32nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction (Cobas TaqMan HBV Test) with a lower detection limit of 8 IU/mL. Post-partum reactivation (PPR) was defined as abnormal alanine aminotransaminase (ALT) levels and HBV DNA above 2000 IU/mL. Fourteen out of 41 women (34.1%) had pre-partum HBV DNA levels>2000 IU/mL, 18 (43.9%) had levels<2000 IU/mL and 9 (21.9%) had undetectable levels. Fourteen women were lost to follow-up (failure to return). PPR occurred in 8 of the 27 (29.6%) women evaluated, all within the first 6 mo after delivery (5 at month 3; 3 at month 6). Five of the 6 (83.3%) women with pre-partum HBV DNA>10000 IU/mL exhibited PPR compared with 3 of the 21 (14.3%) women with HBV DNA<10000 IU/mL (two with HBV DNA>2000 and the third with HBV DNA of 1850 IU/mL), P=0.004. An HBV DNA level≥10000 IU/mL independently predicted post-partum HBV infection reactivation (OR=57.02, P=0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases (47.3 IU/L vs 22.2 IU/L, respectively, P=0.094). In the present study, PPR occurred in approximately 30% of HBeAg-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level>10000 IU/mL predicted PPR.

What Happens after the Puerperium? Analysis of “Late” Postpartum Readmissions in California

Objective: Admissions to acute care hospitals represent a significant portion of healthcare utilization. Little is known regarding hospitalization in the first postpartum year beyond the traditional 6 weeks of the puerperium. We sought to investigate whether there are identifiable risk factors for hospital readmission during this time period. Study Design: We conducted a retrospective population-based study using all California birth records between 1999 and 2003. These records were linked with hospital discharge data for all admissions to California hospitals in the first 365 days after delivery. For women with a first birth during the study period, we assessed the likelihood of readmission to an acute care hospital between 42 and 365 days post-delivery. Univariate and multivariable logistic regression were used to determine risk factors for these “late postpartum” admissions. Results: Of 951,570 maternal birth admissions during the time period, 15,727 (1.7%) women were admitted in the late postpartum period. Women with an early postpartum readmission, antepartum admission, extremes of maternal age, black race, diabetes, hypertension, early preterm delivery and cesarean delivery had higher rates of late postpartum readmission. Of women with an antepartum admission for gestational diabetes or pre-existing diabetes, 6.6% and 18.5% of these women experienced a late postpartum admission for a diabetes-related diagnosis. Conclusion: Hospital readmission rates in the first year postpartum, remote from delivery, are significant. Women are at a higher risk of requiring hospital admission in the first year postpartum with select demographics and pregnancy-related diagnoses.