Postpartum Symptoms Research Articles

Postpartum Symptoms of Depression are Related to Infant Feeding Practices in a National WIC Sample

ObjectiveTo examine the association between elevated maternal postpartum depression symptoms and select targets of nutrition education within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), including infant feeding beliefs, feeding practices, and dietary intake choices. DesignLongitudinal analysis of secondary data from the WIC Infant and Toddler Feeding Practices Study-2. SettingEighty WIC sites. ParticipantsThe WIC Infant and Toddler Feeding Practices Study-2 participants interviewed through 13 months postpartum (n = 1,851). Main Outcome MeasuresLatent factor variables for infant feeding beliefs, feeding practices, and dietary intake choices. AnalysisConfirmatory factor analysis using structural equation modeling; multivariable linear regression models. ResultsBiological mothers with elevated postpartum depression symptoms engaged in significantly less optimal feeding practices than biological mothers with fewer symptoms of depression, in multivariable analyses controlling for sociodemographic variables (β = −0.26; P = 0.02). Maternal depression symptoms were not significantly associated with infant feeding beliefs or dietary intake choices. Conclusions and ImplicationsMaternal depression symptoms are specifically associated with infant feeding practices. The Special Supplemental Nutrition Program for Women, Infants, and Children could consider screening for depressive symptoms and referring mothers for treatment. For mothers with elevated depression symptoms, nutrition education may need greater emphasis on healthy and safe feeding practices.

Short-term oestrogen as a strategy to prevent postpartum depression in high-risk women: protocol for the double-blind, randomised, placebo-controlled MAMA clinical trial

IntroductionPostpartum depression affects 10%–15% of women and has a recurrence rate of 40% in subsequent pregnancies. Women who develop postpartum depression are suspected to be more sensitive to the rapid...

Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period.

The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.

Regional Differences in Various Risk Factors for Postpartum Depression: Applying Mixed Models to the PRAMS Dataset.

Purpose: The purpose of this study was to assess the association between various risk factors with postpartum depression severity using a large dataset that included variables such as previous mental health status, social factors, societal factors, health care access, and other state-wide or region-specific variables.Methods: We obtained the most recently available (2016–2017) dataset from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a dataset compiled by the Centers for Disease Control (CDC) that collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy from over 73,000 women in 39 states. We utilized a hierarchical linear model to analyze the data across various levels, with a symptom severity scale (0–8) as the dependent variable.Results: Of the 21 variables included in the final model, nine variables were statistically significant predictors of symptom severity. Statistically significant predictors of increased postpartum depression symptom severity included previous depression diagnosis and depression symptoms during pregnancy, baby not residing with mother, unintentional pregnancy, women with less than a high school degree and more than a college degree, Women Infants Children (WIC) enrollment, and married women. In contrast to these other factors, attendance at a postpartum follow up appointment was associated with significantly increased symptom severity. Age revealed an inverted curve in predicting postpartum symptom severity.Conclusions: There was no significant difference in symptom severity scores across the 39 participating states. Most notably, postpartum depression symptom severity was associated with previous depression diagnosis and previous symptom severity, but our results also reveal novel social and education factors that contribute to the support and well-being of the mother and child.

PSX-B-29 Using ozonized flaxseed oil for treatment of postpartum endometritis

Abstract Postpartum endometritis is one of the leading causes of infertility in cattle. The study aims to investigate the possibility of using ozonized flaxseed oil (OFO) for treating postpartum purulent-catarrhal endometritis in cows. Ozone was synthesized by using medical ozone generator and chemically pure oxygen. Linseed oil (400.0 ml) was bubbled with an ozone-oxygen mixture for 4 hours through a ceramic sprayer. An ozone concentration at the outlet was 30 mg/l. The therapeutic efficacy of OFO was studied on cattle of the Kholmogory breed with a productivity of 4800 - 5800 kg of milk per year. Thirty animals with symptoms of postpartum purulent-catarrhal endometritis were divided into two groups (n = 15). All of the subjects were in the second and third lactation periods. Animals from both groups were injected with 2% sinestrol solution on days 1 and 3 of treatment. OFO was used in the experimental group (EG). The cattle of the control group (CG) received a 7.5% solution of benzethonium chloride. Drugs were administered intrauterine at a dose of 50–150 ml (depending on the uterus’s size) using a polystyrene pipette, with an interval of 48–72 hours. Cows were inseminated artificially by the cervical method. The pregnancy was determined on the 30-35th day after insemination by ultrasonography. After 5 months of observation, all animals of the CG were pregnant. The pregnancy rate in the EG was 93,3%. In the groups efficiency of the first insemination was 20% and 47%, respectively. In the EG, one impregnation required 1.8±0.2 inseminations, which is 0.5 less than in the CG (2.3±0.3). The duration from calving to impregnation in cows in the EG was 104.4±6.9, 21.2 days less (P < 0.05) than the control, where the period was 125.6±7.6. Thus, OFO can be effectively used for the treatment of endometritis in cattle.

NEONATAL OUTCOMES IN POSTPARUM PSYCHOSIS

We aimed to examine neonatal behaviour and cortisol reactivity in neonates born to women at risk of postpartum psychosis (AR) who had a psychiatric relapse within 4 weeks post-delivery (AR-unwell), compared with neonates of women at risk who stayed well (AR-well) and those born to healthy women (HC). We assessed neonatal behaviour using the Neonatal Behavioral Assessment Scale (NBAS), performed on 105 neonates (AR-unwell=17; AR-well=27; HC=61). Neonatal cortisol was measured pre-, immediately post- and 30-minutes post-NBAS. Neonates born to AR women did not differ from those born to HCs in behaviour or cortisol reactivity. There was also no difference in behaviour between neonates born to AR-unwell women and those born to AR-well women. However, neonates born to AR-unwell women had significantly lower pre-NBAS cortisol compared with neonates of AR-well women (t(38)=2.3, p=.02). Neonates of AR-unwell women also had a greater increase in cortisol from pre- to post-NBAS, though the difference did not reach statistical significance (p=.12), and a greater increase from pre- to 30 minutes post-NBAS (t(32)=2.7, p=.01). Maternal postpartum symptoms appear to disrupt the stress response of neonates whose mothers are at risk of postpartum psychosis.

Depressive symptoms postpartum is associated with physical activity level the year prior to giving birth – A retrospective observational study

ObjectivesTo examine physical activity level prior to pregnancy, during pregnancy and postpartum and investigate the association with depressive symptoms postpartum among women in Sweden.Study design: Retrospective observational study including 532 women on self-assessment of physical activity level before pregnancy, during pregnancy and postpartum, depressive symptoms postpartum as well as stressful life events in the past two years.Main outcome measures: Level and change of physical activity before pregnancy, during pregnancy and postpartum and depressive symptoms postpartum. ResultsAlmost two-thirds of the women in the study reported that they were inactive or performed light physical activity (62.9%; n = 331) in the year prior to giving birth. Women with a sedentary lifestyle or performing light physical activity level reported depressive symptoms postpartum to a greater extent than active women. ConclusionsA higher level of physical activity during pregnancy was associated with a lower level of depressive symptoms postpartum. Physical activity is a contributing factor to promote a healthier lifestyle and can contribute to improve mental health for pregnant women, newly become mothers and their children.

Trajectories of pain during pregnancy predict symptoms of postpartum depression.

Postpartum depression imparts a significant and long-lasting burden on maternal and child health. Successful prevention or early detection of postpartum depression will rely on the identification of early risk factors. Pain during pregnancy (before childbirth) is a key potential predictor of postpartum depression risk. However, longitudinal studies characterizing pregnancy pain, its normal trajectory over time, and its prospective relations with symptoms of postpartum depression are lacking. We used data from a longitudinal study of maternal emotion that included assessments of pain and depressive symptoms at 3 time points-during the second and third trimester of pregnancy and at 4 months postpartum. Structural equation modelling was used to estimate longitudinal patterns of change in maternal pain over time. Latent growth curve parameters were tested as predictors of symptoms of postpartum depression. Ninety-three healthy pregnant women enrolled in this study. Although the sample comprised women with relatively low-risk pregnancies, more than 90% of participants experienced pregnancy pain. Greater linear increases and less negative quadratic change in maternal pain over time were associated with greater levels of postpartum depression, even when controlling for prenatal depressive symptoms. Interpreting both parameters together, pain that increased in late pregnancy, when normative patterns had either levelled off or begun to decline, was associated with greater levels of postpartum depression. A developmental trajectory of pain experience that did not subside after childbirth was associated with greater postpartum depressive symptoms, suggesting that atypical trajectories of pain may be a risk factor for postpartum depression.

The moderating role of resilience resources in the association between stressful life events and symptoms of postpartum depression

BackgroundOne in seven women experience postpartum depression, posing a serious public health concern. One of the most robust predictors of elevated postpartum depressive symptoms is major stressful life events that occur during pregnancy. Having greater resilience resources that promote successful adaptation to stressful demands may be protective in the face of stress during pregnancy. The current study tested whether three resilience resources— mastery, dispositional optimism, and spirituality— each predicted early symptoms of postpartum depression and moderated the hypothesized association between experiencing stressful life events during pregnancy and symptoms of postpartum depression. MethodsThe sample included 233 women who participated in a prospective longitudinal study from pregnancy through postpartum. Depressive symptoms were assessed at approximately 4 to 8 weeks after birth, whereas resilience resources and stressful life events were measured in pregnancy. Multiple linear regressions were used to test hypotheses. ResultsStressful life events predicted greater symptoms of depression postpartum. Mastery and optimism predicted fewer symptoms of depression postpartum. Mastery moderated the association between stressful life events and symptoms of depression when controlling for previous psychiatric history, t(231) = -1.97, p=.0497. LimitationsThere was some attrition among study participants across timepoints, which was accounted for in analyses with multiple imputation. ConclusionsThese findings point to the protective nature of a mother's sense of mastery in the face of major life stressors during pregnancy and suggest this is an important construct to target in interventions addressing postpartum depression.

Bilateral Sacral Stress Fracture in Pregnancy without Osteoporosis - A Case Report and Literature Review

Purpose: Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. Methods: A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included “stress fracture”, “postpartum”, “pregnancy”, “atraumatic” and the wildcard “sacr*”. 34 cases were found and summarised in Table 2. Results: 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. 70% of reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bedrest, analgesia and modified weight bearing exercises. Most patients have favourable outcome with complete symptom resolution. Conclusion: Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.

Mothers' neural response to valenced infant interactions predicts postpartum depression and anxiety.

It is currently unknown whether differences in neural responsiveness to infant cues observed in postpartum affective disturbance are specific to depression/anxiety or are better attributed to a common component of internalizing distress. It is also unknown whether differences in mothers’ brain response can be accounted for by effects of past episodes, or if current neural processing of her child may serve as a risk factor for development of future symptoms. Twenty-four mothers from a community-based sample participated in an fMRI session viewing their 3-month- old infant during tasks evoking positive or negative emotion. They were tracked across the ensuing 15 months to monitor changes in affective symptoms. Past and current episodes of depression and anxiety, as well as future symptoms, were used to predict differences in mothers’ hemodynamic response to their infant in positive compared to negative emotion contexts. Lower relative activation in largely overlapping brain regions involving frontal lobe structures to own infant positive vs. negative emotion was associated with concurrent (3-month) depression diagnosis and prospective (3–18 month) depression and anxiety symptoms. There was little evidence for impacts of past psychopathology (more limited effect of past anxiety and nonsignificant effect of past depression). Results suggest biased maternal processing of infant emotions during postpartum depression and anxiety is largely accounted for by a shared source of variance (internalizing distress). Furthermore, differential maternal responsiveness to her infant’s emotional cues is specifically associated with the perpetuation of postpartum symptoms, as opposed to more general phenotypic or scarring effects of past psychopathology.

The impact of postpartum depressive symptoms on self-reported infant health and analgesic consumption at the age of 12 months: A prospective cohort study

The infants of mothers with elevated depressive symptoms (EDS) postpartum appear to be at increased risk of somatic health problems during their first 12 months of life in low- and lower-middle-income countries. However, in higher-income countries, knowledge of this association is scarce. We sought to examine whether maternal reports of infant health problems, adherence to vaccination schedules and analgesic supply to the infant during the first 12 months of life differ between mothers with and without postpartum EDS. Altogether, 969 women who were enrolled in the Kuopio Birth Cohort study (www.kubico.fi) during 2012–2017 were included in this investigation. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale during pregnancy (1st and/or 3rd trimester) and at eight weeks postpartum. Infant health data were collected as a part of a 12-month online follow-up questionnaire for mothers and were based on self-reports of either maternal observations or physician-determined diagnoses. Postpartum EDS were associated with a 2- to 5-fold increased likelihood of abnormal crying and paroxysmal wheezing (based on parental observations), as well as gastroesophageal reflux and food allergy (based on physician-determined diagnoses). Mothers with postpartum EDS also supplied their infants with analgesic medication for longer periods. Adherence to vaccination schedules was similar between the examined groups. In conclusion, infants of mothers with postpartum EDS may be more likely to experience health problems or to be perceived by their mother as having health problems, and thus receive more medications.

Recovery of Abdominal Muscle Thickness and Contractile Function in Women after Childbirth.

Abdominal muscles may be both morphologically and functionally affected by pregnancy. Dysfunction of the muscles can lead to persistent postpartum low back pain. The recovery process of the abdominal muscles following childbirth is not well understood. This study aimed to demonstrate the changes in the thickness and contractile function of abdominal muscles during the first six months postpartum. Nine perinatal and 15 nulliparous females participated. The thicknesses and contraction/relaxation thickness ratios of the rectus abdominis (RA), external abdominal oblique (EO), internal abdominal oblique (IO), and transverse abdominis (TrA) were measured using ultrasound images from 36–39 weeks’ gestation until six months postpartum. The RA, IO, and TrA muscles were thinner in perinatal females than controls at 36–39 weeks of gestation (4.8 vs. 9.47 mm (RA), 5.45 vs. 7.73 mm (IO), 2.56 vs. 3.38 mm (TrA), respectively). The thinner IO muscle persisted for six months after delivery. The decreased TrA thickness ratio persisted until four months post-delivery. Abdominal muscle thickness and contractile function decreased in the postpartum period. Therefore, abdominal muscle exercises might help prevent postpartum symptoms; however, because deterioration of muscle function is significant in the first four months, careful attention should be paid to exercise intensity. The study limitation was a relatively small sample size, thus future studies should involve more participants.

Management of Labor and Psychiatricpostpartum Diseases Using Potential Anti-obesity and Antidiabetic Plants in Cameroon

Globally more than 550 women die per year from childbirth-related causes. Around 9% of women suffer from postpartum post-traumatic stress disorder after childbirth. Postpartum bipolar disorder is humor episodes such as mania, hypomania or depression, which start throughout pregnancy or in few weeks after child bearing. Fifty percent (50%) worldwide estimation of motherly deaths arise in sub-Saharan Africa region alone. Depression is a devastating temperament and mental sickness touching around 13% of postpartum mothers worldwide. The occurrence of 25%-60% of depression is typical of low- and middle-income countries. A combined prevalence of 14.4% of teenage deliveries was revealed in Cameroon where there is unsatisfactory information on the risk factors of motherly mortality and mother care after childbirth. In hinterland local therapists especially in Bororo and Pygmies communities, have developed indigenous strategies in the treatment of certain cases of abnormal labor and psychiatric postpartum sicknesses. Accordingly this study aimed to identify principally amongst anti-obesity and antidiabetic plants used in Cameroon, those with efficient effect on labor and psychiatric mother care after delivery. To achieve this objective the search strategy was performed to identification these plants using the following research engines in Google, Google Scholar and PubMed: 1) Properties oxytocic of a given diabetic or anti-obesity plant name 2) A given diabetic or anti-obesity plant name with capacity to control labor 3) Anti-psychiatric postpartum disease properties of a given diabetic or anti-obesity plant name. Twenty plants used in the treatment of difficult labor and psychiatric postpartum treatment in Cameroon were recorded. Only Daturastramonium and Amblygonocarpusandongensis were respectively poisonous and slightly toxic. Mucunapruriens, Peperomiapellucida, Momordicacharantia and Xylopiaaethiopica are more effective. Nevertheless, preventive measures such as selection of safe herbal medications, avoid psychiatric postpartum diseases symptoms, adequate dosages and their stabilization, duration of treatment, good sanitary herbal medicines preparation, and conservation, must be determined and rigorously respected.

Lived Experience of Participants of a Korean Medicine-Based Postpartum Program: A Protocol for a Qualitative Research Study

Background: The postpartum period is the most critical period in the mother’s and child’s lives, and integrative medical approaches, including Korean medicine, are preferred for promoting postpartum recovery and managing postpartum symptoms. The socially disadvantaged class is known to be more vulnerable to postpartum depression, obesity, and bleeding, and the National Medical Center is undertaking Korean medicine-based postpartum health management projects for the socially disadvantaged mothers. However, clinical evidence and research data on integrative medicine-based postpartum care to expand the scope of these postpartum programs to help these women are lacking. Aim: To investigate the barriers, benefits, and limitations of integrative medical postpartum health management programs for the socially disadvantaged mothers and investigate the experiences of this population. Methods: A qualitative research methodology is used, and a semi-structured, open-ended interview will be conducted. The interview will be conducted among 10 or fewer participants, with each interview session lasting for 60–120 min. Data will be analyzed using grounded theory framework proposed by Strauss and Corbin. Significance: This study will shed light on the users’ experiences and benefits, unmet needs, and limitations of Korean medicine-based postpartum management programs for the socially disadvantaged mothers. The findings will be useful for the improvement of postpartum care programs and used as foundational data for the protocols of quantitative studies in the future.

Underutilization of physical therapy for symptomatic women with MS during and following pregnancy

BackgroundMany patients with MS continue to have symptoms of their disease even when inflammatory activity is reduced by DMTs. Although disease activity tends to be reduced during pregnancy – especially in the third trimester – women with MS can experience ongoing symptoms during pregnancy, or new ones in the immediate postpartum period, that degrade quality of life. While many MS-related and postpartum symptoms can be improved with physical therapy (PT), there are currently no guidelines on pregnancy-related rehabilitation in MS. In this analysis, we evaluated the prevalence of PT-amenable symptoms and patterns of PT referrals in a cohort of UCSF MS Clinic patients who became pregnant. MethodsWe extracted electronic medical records (EMR) data for the year before conception, during pregnancy, and year postpartum for women with MS cared for at UCSF between 09-2005 and 08-2019. This included clinical visits, MS therapies and symptoms (as defined by the National MS Society). PT and pelvic floor PT orders and notes were also extracted. ResultsWe included 142 live birth pregnancies from 118 women. During the course of their pregnancy and within the year postpartum, 107 women (75.4%) reported at least one PT-amenable symptom. A total of 30 (28.0%) referrals were made to PT, with attendance confirmed for 10 (33.3% of referrals). Symptoms most commonly triggering a referral for PT evaluation were numbness and urinary incontinence. Falls were reported after 10 of the pregnancies; 4 resulted in a referral to PT. Forty-one women reported urinary incontinence: 11 (26.8%) were referred to PT, and 2 to pelvic floor PT. Nineteen women experienced a documented relapse during pregnancy and/or postpartum: 11 received a PT referral, and 4 attended PT. ConclusionsWhile women with MS recorded at least 1 PT-amenable symptom during or following 75.4% of their pregnancies, only 28% of these were referred to PT – and only a third attended PT. Of significance was the 4.9% referral rate for pelvic floor PT in postpartum women with a record of urinary incontinence. Pelvic floor PT is a mainstay of general postpartum care in many European countries. These data illustrate critical gaps in rehabilitation referral, access and use at the intersection of neurological conditions and pregnancy in a large US-based MS clinic. They lend support for quality improvement efforts to improve care pathways and for telerehabilitation innovations to reduce barriers to access and improve synergistic care between PT, MD and urologic care.

A comparison of two measures to screen for mental health symptoms in pregnancy and early postpartum: the Matthey Generic Mood Questionnaire and the Depression, Anxiety, Stress Scales short-form

The Matthey Generic Mood Questionnaire (MGMQ) provides a rapid screen of clinically significant emotional difficulties in adults. This study aimed to investigate associations between the MGMQ and Depression Anxiety Stress Scales short-form (DASS-21) and how well the MGMQ detects women scoring high on the DASS-21 in pregnancy and 1 and 2 years postpartum. Pregnant Australian, English-speaking women were recruited from 10 maternity hospitals across two states (for the "right@home" trial, N=729). Prioritized for their experience of social adversity (2 or more of 10 risk factors), they completed the 2-item MGMQ and 21-item DASS-21 in pregnancy and at 1 and 2 years postpartum. DASS-21 Total and subscale scores were classified "high" based on (a) normed percentiles for top 15% and (b) clinical cut-points. The MGMQ and DASS-21 were completed within 7 days of each other by 296 (41%) women in pregnancy, 625 (86%) at 1 year and 573 (79%) at 2 years. Associations between the measures were weak-to-moderate in pregnancy and moderate-to-strong in the postpartum years. Most women scoring "high" on the DASS-21 could be identified with various thresholds of the MGMQ. Pregnant women with 0 or 1 risk factor were excluded; the DASS-21 is not a perinatal specific measure nor a gold standard diagnostic tool. The MGMQ and DASS-21 appeared to assess overlapping but distinct constructs of mental health. These findings can help clinicians and researchers decide whether to use the MGMQ, and which balance of sensitivity, specificity and correct classification will suit their needs.

Faktor- Faktor yang Menyebabkan Kejadian Postpartum Blues

About 70-80% of postpartum mothers experience mood or feeling disorders. In general, this condition is still considered normal, felt from 2-3 days after delivery and normally disappears after 2 weeks post partum. The purpose of this study was to determine the factors that cause the symptoms of postpartum blues to appear. This research method used qualitative through a phenomenological approach by taking the population by means of purposive sampling. The results showed that age and parity did not always trigger the symptoms of postpartum blues, the causes of postpartum blues were worrying about the baby, maternal fatigue, comments from people around the mother, husband's support and presence, adaptation to the baby's presence.

Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety.

BackgroundMaternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period.MethodsDepressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring’s developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed.ResultsThough the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy.ConclusionsThe differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.

Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial

Background“Doing the month” is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health. ObjectivesTo examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health. MethodsA randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups. ResultsWe recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05). ConclusionsEvidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.