Postpartum Women Research Articles

Ultrasound-guided suction using negative pressure, curettage, and percutaneous drainage to treat rectus sheath hematoma

BackgroundThis study aimed to introduce and evaluate a new treatment method for rectus sheath hematoma: ultrasound-guided suction using negative pressure, curettage, and percutaneous drainage. MethodsThis retrospective study involved five patients with rectus sheath hematoma rectus sheath hematoma who had cesarean sections. For all patients, ultrasound revealed that the maximum diameter of their hematoma exceeded 70 mm. We summarized and analyzed the therapeutic effects of five patients and introduced the procedure, technical points, precautions, advantages, and indications of the procedure. ResultsIn all five patients, hematoma area was significantly reduced as confirmed by ultrasound at follow-up, and all patients’ abdominal pain were significantly relieved. No complications, including bleeding or infection, were detected at both the 2-h postoperative and 3-day follow-up assessments. The hematoma volume reduction rates were 90 %, 67 %, 81 %, 68 %, and 70 % at three days re-examinations, and 99 %, 96 %, 98 %, 98 %, and 90 % at the 30-day follow-up. ConclusionThe removal of rectus sheath hematoma by suction using negative pressure can prevent patients from undergoing abdominal wall exploration, offering a less invasive alternative while potentially achieving comparable therapeutic effect to surgical hematoma removal in certain cases. This treatment method shows potential for clinical application, particularly in relatively young and healthy postpartum women, and is expected to be popularized and applied in clinical practice.

280 - Pelvic floor muscle training in sexual function of postpartum women: a systematic review with meta-analysis

280 - Pelvic floor muscle training in sexual function of postpartum women: a systematic review with meta-analysis

Healthcare Needs of Incarcerated Pregnant and Postpartum Women: Implications for Just Nursing Practice

Women remain the primary caregivers for children, making the imprisonment of women and mothers potentially more complicated for families. Women in the prison system often have significant health problems and lack access to care even before incarceration. While women constitute a minority in the prison system, they have gender-specific needs, often related to pregnancy, birth, and the postpartum period. Often, prisons are not equipped to provide appropriate care, and many state policies vary concerning the healthcare needs of incarcerated pregnant and postpartum women. This article offers an overview of current issues in reproductive healthcare for this vulnerable population by providing a brief background on the topic and exploring how nurses can become their advocates. A review of selected literature describes current relevant research, followed by viewpoints from various healthcare organizations. Recommendations include prison programs and services targeted to pregnant and postpartum women, such as birth doulas and prison nurseries, which are known to benefit this population. Nurses can advocate for this unique population by using a trauma-informed framework of care and participating in legislative efforts to support pregnant and postpartum women who are incarcerated.

The impact of birth preparedness and complication readiness (BPCR) on maternal outcomes among postpartum mothers

<pre><strong><em>Background: </em></strong><em>Birth preparedness and complications readiness (BPCR) is a strategy to prevent three late causes of maternal death. Previous study results focused on BPCR intermediate outcomes, such as utilizing healthcare facilities during pregnancy and delivery,</em><em> rather than maternal outcomes like maternal near miss, morbidity, and mortality.</em><em></em></pre><pre><strong><em>Objectives:</em></strong><em> This study examined the correlation between BPCR practices and maternal outcomes among postpartum mothers</em><em></em></pre><pre><strong><em>Methods: </em></strong><em>This cross-sectional research was conducted on postpartum mothers in the working area of the Sumberbaru Primary Health Service, Jember Regency, which was carried out from April to June 2023. A total of 78 postpartum mothers were selected using simple random sampling. The interview instrument was adopted from the BPCR JHPIEGO questionnaire, and maternal outcome observations were made using the MCH book. Data were analyzed using the chi-square test to examine the relationship between BPCR and maternal outcome. The level of statistical significance was set to p-value < 0.05</em><em></em></pre><p><strong><em>Results: </em></strong><em>The results of this study indicated that 69.2% of postpartum mothers had less prepared BPCR practices, and for most postpartum women, 55.1% recovered. There was a relationship between BPCR practices and maternal outcomes among postpartum mothers (p-value<0.05). Postpartum mothers with well-prepared BPCR practices had a 3.48 times higher chance of experiencing a complete recovery in maternal outcomes than those with less prepared BPCR practices.</em></p><pre><strong><em>Conclusions: </em></strong><em>The practice of BPCR in postpartum mothers is in the poor category; most mothers' maternal outcomes are in the fully recovered category. BPCR is an essential factor influencing maternal outcomes, so increasing counseling for mothers and families regarding BPCR is necessary to ensure more optimal maternal outcomes.</em><em></em></pre><p><em> </em></p>

The Influence of Prenatal Yoga Exercise on Mother Anxiety Pregnant

Anxiety during pregnancy not only affects the health of pregnant women but can also have an impact on the delivery process such as premature labor, prolonged labour, cesarean delivery, low birth weight. Based on WHO data, there are around 10% of pregnant women with psychological disorders and about 13% of postpartum women worldwide. This incidence is higher in developing countries in pregnant women, namely 15.6% and 19.8% in postpartum women. The purpose of this study is The Effect of Prenatal Yoga Exercise on the Anxiety of Pregnant Women at TPMB Mamah Suhaeriah in 2022. Research method This type of research uses the Pre-Experimental method with a one group pretest-posttest design approach. Sampling using total sampling with a total sample of 20 respondents. The research instrument used was an observation sheet. The data analysis used is the Wilcoxon Sign Rank Test statistical test. Research results based on the results of statistical tests using the Wilcoxon Sign Rank test, the p-value (0.000

How does Yoga Exercise affect Anxiety in Pregnant Women? : Pre-Experimental Study

Anxious during pregnancy not only impacts pregnant women's health, but it may also interfere with the delivery process, resulting in early labor, extended labor, cesarean delivery, and low birth weight. According to WHO estimates, psychiatric illnesses affect around 10% of pregnant women and 13% of postpartum women globally. This frequency is greater in underdeveloped nations among pregnant women (15.6%) and postpartum women (19.8%). The goal of this study is to determine the effect of prenatal yoga exercise on the anxiety of pregnant women at TPMB Mamah Suhaeriah in 2022. Method for doing research This sort of study employs the Pre-Experimental technique, using a one-group pretest-posttest design. Total sampling was used, and there were 20 responders in total. An observation sheet was employed as the study instrument. The Wilcoxon Sign Rank Test was performed to analyze the data. The Wilcoxon Sign Rank test yielded a p-value of 0.000, which is less than the threshold of 0.05. This indicates that Ha is accepted. Conclusion: Prenatal yoga practice has an influence on pregnant women's anxiety levels at TPMB Mamah Suhaeriah in 2022. Pregnant women are advised to manage their psychological condition effectively and to exercise often, since exercise has good benefits for survival during pregnancy

Hydrotherapy During Labor and Birth in Water: A Review of Current Researches

Hydrotherapy is one of the most nonpharmacological methods for pain management in labor, where water at different temperatures is used to treat diseases and reduce pain. The American College of Obstetricians and Gynecologists states that hydrotherapy can be used in the first stage of labor, but there is insufficient evidence on the outcomes of water birth. When the effects of hydrotherapy were examined according to the stages of labor, it was determined that it had an effect on pain, anxiety, comfort level, sympathovagal balance, parenting behavior and active phase duration in the first stage of labor. In the second stage of labor; epidural and opioid use, maternal pain, episiotomy use, intact perineum, shoulder dystocia and duration of labor. In the postpartum period, it has been reported to have an effect on the incidence of postpartum hemorrhage, birth satisfaction and women's sense of autonomy, shorten the duration of hospitalization and increase the rate of breastfeeding. When the effects of water birth on the newborn are examined, it is determined that it has an effect on body temperature, arterial and venous pH, while it has no effect on Apgar. Although there are various studies on water birth in the literature, more studies are needed to obtain evidence-based results. The aim of this review is to examine the current research results of hydrotherapy applied in the first stage of labor and the second stage of labor in water (water birth) in the last 5 years.

Prevalence and Associated Factors of Mental Health Problems Among Peripartum Women During the COVID-19 Pandemic

Objective: This study aimed to determine the prevalence and associated factors of probable depression and probable anxiety in early postpartum women during the COVID-19 pandemic. Methods: This cross-sectional study was conducted with early postpartum women who applied to a maternity hospital to give birth in Turkey between March-June 2021. Women aged 19-45 years, with 23–42 weeks of gestation, with a singleton pregnancy, and negative for the SARSCoV-2 polymerase chain reaction test were included in the study. The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence of probable depression (HADS depression score >7) and probable anxiety (HADS anxiety score >10). The associations between women’s sociodemographic and obstetric characteristics and depression and anxiety were evaluated using univariate and multivariate analyses. Results: A total of 450 women were included in the study. Of these, 50.2% (n=226) had probable depression, and 28% (n=126) had probable anxiety. Multivariate analysis revealed that while perceived poor income level increased the odds for the presence of probable depression, unintended pregnancy, anemia, and SARS-CoV2 infection during pregnancy were associated with probable anxiety. Conclusion: The presence of probable depression and probable anxiety were considerably high among women who had given birth during the pandemic. This study identified the most vulnerable groups in terms of mental health problems among women who were in the early postpartum period during the pandemic. It is essential to develop strategies to prevent and control the mental health problems of these risk groups for future emergency health crises.

KAJIAN PROFIL RUJUKAN PADA KASUS PRE EKLAMSIA DI RSUD DATU SANGGUL RANTAU

One of the complications of pregnancy/delivery is pre-eclampsia/eclampsia. Objective is knowing the description of the referral profile in the case of pre-eclampsia at Datu Sanggul Rantau Hospital. Quantitative research was conducted in February 2023. The population was all pregnant, postpartum and postpartum women with pre-eclampsia cases from January 2021 - November 2022 totaling 122 cases. The total sampling technique was analyzed using univariate. The results of the study showed that the highest number of each characteristic was the origin of referrals, namely 84 people (69%), the highest number of referrals complete with officers and referral letters, namely 89 people (73%), the age of most respondents was in the risk category > 35 years 53 people (43%), the most gestational age was term term 83 people (68%), parity was primipara 53 people (43%), the stages of delivery in the mother during intrapartum were 76 people (62%), the classification of the diagnosis of pre eclampsia in cases of pre severe eclampsia, namely 86 people (70%) and the most pre-referral action was given pre-referral action, namely 82 people (67%). The conclusion is referral profile description consists of origin, of referral completeness of referral, age, gestational age, parity, diagnosis, and pre-referral measures.

The relationship between spousal violence, maternal functioning, depression, and anxiety among Iranian postpartum mothers: a prospective study

BackgroundViolence against women is a critical public health issue that adversely affects physical and mental health, contributing to injuries, chronic conditions, and mental health disorders. This study addresses the gap in understanding the relationship between spousal violence with maternal functioning and mental health in postpartum mothers.MethodsThis Prospective study was conducted on 316 postpartum women who gave birth in Al-Zahra and Taleghani Educational Treatment Centers in Tabriz, Iran, from June 2023 to October 2023. Participants were selected using convenience sampling and followed up for 6–8 weeks. The data were collected using the Revised Conflict Tactics Scale (CTS2), the Edinburgh Postnatal Depression Scale (EPDS), the Postpartum Specific Anxiety Scale (PSAS), and the Barkin Index of Maternal Functioning (BIMF). A general linear model, adjusted for individual, social, and obstetric variables, was used to determine the relationship between domestic violence, maternal functioning, depression and anxiety.ResultsMost women (84%) experienced one or more types of intimate partner violence (IPV), including psychological, physical, or sexual abuse. About one-third (32.9%) reported psychological abuse, 21.2% physical violence, 49.4% sexual coercion, and 6.3% reported injuries. The adjusted general linear model showed that the mean depression score was lower in individuals without any experience of violence compared to those who had experienced any violence (β: -1.75; 95% CI: -3.40 to -0.10; p = 0.038). The mean depression score was significantly higher in homemakers compared to employed individuals (β = 3.53; 95% CI = 1.22 to 5.84, p = 0.003). The mean maternal functioning score was significantly higher in those who had not experienced mild physical violence compared to those who had (β = 2.94; 95% CI = 0.34 to 5.55, p = 0.027). The mean anxiety score was lower in individuals with high income (β: -3.38; 95% CI: -5.73 to -1.04; p = 0.005) and moderate income (β: -2.21; 95% CI: -4.35 to -0.07; p = 0.043) compared to those with low income.ConclusionThe findings reveal a high prevalence of violence, particularly sexual coercion, significantly affecting maternal functioning and mental health. Socioeconomic factors also play a crucial role in postpartum mental health. These results highlight the urgent need for enhanced prevention efforts and targeted interventions that consider the socio-economic context and specific forms of violence.

Evaluation of the efficiency of physical exercises for the elimination of diastasis of the rectus abdominal muscles in postpartum women

Evaluation of the efficiency of physical exercises for the elimination of diastasis of the rectus abdominal muscles in postpartum women

Hubungan Perdarahan dan Partus Lama pada Ibu Post Partum dengan Kejadian Infeksi pada Masa Nifas

Postpartum infection is an infection occurring after childbirth up to 42 days postpartum, characterized by fever, pelvic pain, foul-smelling lochia, and subinvolution of the uterus (delayed return of the uterus to its pre-pregnancy state). The leading causes of maternal mortality in Indonesia include hemorrhage, hypertensive disorders during pregnancy, infections, and metabolic disorders, with 25-50% of maternal deaths related to pregnancy, childbirth, and the postpartum period. This study aims to determine the relationship between hemorrhage and prolonged labor in postpartum mothers with the incidence of postpartum infections. The research used an analytical method with a retrospective approach. The population consisted of all postpartum women with infections, totaling 30 respondents in 2022. The sampling technique used total sampling with 30 respondents. Data analysis was performed using the chi-square test. The results showed a significant relationship between hemorrhage (p=0.03) and prolonged labor (p=0.04) with the incidence of postpartum infections at H. Abdul Manap Hospital, Jambi City, in 2023. The conclusion of this study is that there is a relationship between hemorrhage and prolonged labor with the incidence of postpartum infections at H. Abdul Manap Hospital, Jambi City.

Development and external validation of clinical predictive model for stress urinary incontinence in Chinese women : a multicenter retrospective study

BackgroundStress urinary incontinence (SUI), the prevalent form of urinary incontinence, significantly impairs women’s quality of life. This study aims to create a visual nomogram to estimate the risk of SUI within one year postpartum for early intervention in high-risk Chinese women.MethodsWe recruited 1,531 postpartum women who gave birth at two hospitals in Kunshan City from 2021 to 2022. Delivery details were meticulously extracted from the hospitals’ medical records system, while one-year postpartum follow-ups were conducted via phone surveys specifically designed to ascertain SUI status. Utilizing data from one hospital as the training set, logistic regression analysis was performed to pinpoint significant factors and subsequently construct the nomogram. To ensure robustness, an independent dataset sourced from the second hospital served as the external validation cohort. The model’s performance was rigorously evaluated using calibration plots, ROC curves, AUC values, and DCA curves.ResultsThe study population was 1,125 women. The SUI incidence within one year postpartum was 26% (293/1125). According to the regression analysis, height, pre-pregnancy BMI, method of induction, mode of delivery, perineal condition, neonatal weight, SUI during pregnancy, and SUI during the first pregnancy were incorporated into the nomogram. The AUC of the nomogram was 0.829 (95% CI 0.790–0.867), and the external validation set was 0.746 (95% CI 0.689–0.804). Subgroup analysis based on parity showed good discrimination. The calibration curve indicated concordance. The DCA curve showed a significant net benefit.ConclusionDrawing from real-world data, we have successfully developed an SUI predictive model tailored for postpartum Chinese women. Upon successful external validation, this model holds immense potential as an effective screening tool for SUI, enabling timely interventions and ultimately may improve women’s quality of life.

Ideal Time to Conduct a Pharmacokinetic Investigation After Delivery to Fully Capture the Effect of Pregnancy on Drug Exposure.

The World Health Organization is pushing to accelerate the study of new human immunodeficiency virus drugs in pregnant women. However, regulatory guidelines do not specify when to conduct pharmacokinetic studies in postpartum women. This knowledge gap carries the potential to jeopardize the outcomes and conclusions of clinical trials aiming to study the effect of pregnancy on drug exposure. We used physiologically based pharmacokinetic (PBPK) modeling along with clinical data to determine the time needed after delivery for drug exposure to return to prepregnancy levels. A literature review was conducted to collect physiological parameters of pregnant and postpartum women. Regression analyses were performed to derive equations describing the parameters trajectory throughout pregnancy and post partum to inform our PBPK model. Published pharmacokinetic data in pregnant and postpartum women were used for the model verification. The PBPK model was subsequently applied to investigate pharmacokinetic changes throughout pregnancy and post partum. In agreement with the clinical data the PBPK model was able to describe the different effects of pregnancy on drug exposure, with bictegravir showing the largest reduction in exposure (approximately 50%) during the third trimester while ritonavir and raltegravir showing the lowest (approximately 30%). The successfully verified PBPK model predicted that all evaluated antiretrovirals mostly return to prepregnancy exposure 4 weeks after delivery. Pharmacokinetic investigations on hepatically cleared drugs should not be conducted before the fifth week after delivery to fully characterize the effect of pregnancy on drug exposure. Because physiological changes remain after delivery, early measurements can underestimate the pregnancy effect on pharmacokinetics, leading to suboptimal dosing recommendations during pregnancy.

The multiple mediation model of social support and postpartum anxiety symptomatology: the role of resilience, postpartum stress, and sleep problems

ObjectiveThis study aimed to assess the prevalence of postpartum anxiety and the factors influencing it, while also exploring the multiple mediating roles of related factors between social support and postpartum anxiety symptomatology among postpartum women in China.MethodsBetween April and August 2023, we recruited a total of 824 postpartum women through a convenience sampling method. These participants completed a series of general survey questionnaires and were evaluated using the depression anxiety stress scale, perceived social support scale, 10-item Connor–Davidson resilience scale, maternal postpartum stress scale, and Pittsburgh sleep quality index. Additionally, we employed a hierarchical multiple regression model to investigate the relevant factors and mediators of postpartum anxiety symptomatology. A structural equation model was used to examine the mediating role of resilience, postpartum stress, and sleep problems in the relationship between social support and postpartum anxiety symptomatology.ResultsOur study found a postpartum anxiety symptomatology prevalence rate of 18.40%. The factors influencing postpartum anxiety symptomatology included age, education of their husband, mastitis, social support, resilience, postpartum stress, and sleep problems. Through a multiple mediation analysis, we found that resilience, postpartum stress, and sleep problems completely mediated the effects of social support on postpartum anxiety symptomatology, with the mediating effect accounting for 83.57% of the total effect.ConclusionThe multiple mediation analysis revealed that among postpartum women, the impact of social support on postpartum anxiety symptomatology is channeled through resilience, postpartum stress, and sleep problems. Therefore, enhancing social support, resilience, postpartum stress, and sleep problems might alleviate postpartum anxiety symptomatology.

Advanced Hybrid Closed-Loop Therapy Compared With Standard Insulin Therapy Intrapartum and Early Postpartum in Women With Type 1 Diabetes: A Secondary Observational Analysis From the CRISTAL Randomized Controlled Trial.

To determine efficacy and safety of intrapartum and early postpartum advanced hybrid closed-loop (AHCL) therapy compared with standard insulin therapy in pregnant women with type 1 diabetes (T1D). CRISTAL was a double-arm, open-label, randomized controlled trial performed in Belgium and the Netherlands that assigned 95 pregnant participants with T1D 1:1 to a MiniMed 780G AHCL system (n = 46) or standard insulin therapy (n = 49). This prespecified, secondary observational analysis focused on differences in glycemic control and safety outcomes between participants from the original AHCL group who continued AHCL intrapartum (n = 27) and/or early postpartum (n = 37, until hospital discharge) and those from the original standard insulin therapy group using standard insulin therapy intrapartum (n = 45) and/or early postpartum (n = 34). Of the 43 and 46 participants in the AHCL and standard insulin therapy groups, respectively, completing the trial, 27 (62.8%) in the AHCL group continued AHCL and 45 in the standard insulin therapy group (97.8%) continued standard insulin therapy intrapartum. Compared with standard insulin therapy, intrapartum AHCL was associated with more time in range 3.5-7.8 mmol/L (71.5 ± 17.7% vs. 63.1 ± 17.0%, P = 0.030) and numerically lower time above range >7.8 mmol/L (27.3 ± 17.4% vs. 35.3 ± 17.5%, P = 0.054), without increases in time below range <3.5 mmol/L (1.1 ± 2.4% vs. 1.5 ± 2.3%, P = 0.146). Early postpartum, 37 (86.0%) participants randomized to AHCL continued AHCL, with a median increase in insulin-to-carbohydrate ratios of 67% (interquartile range -14 to 126). Similar tight glycemic control (3.9-10.0 mmol/L: 86.8 ± 6.7% vs. 83.8 ± 8.1%, P = 0.124) was observed with AHCL versus standard insulin therapy. No severe hypoglycemia or diabetic ketoacidosis was reported in either group. AHCL is effective in maintaining tight glycemic control intrapartum and early postpartum and can be safely continued during periods of rapidly changing insulin requirements.

Relationship among Childbirth, Onset of Lower Back Pain, and Health-Related Quality of Life in Female Patients with Lower Back Pain: A Retrospective Study.

This study aimed to investigate the relationship between childbirth and lower back pain and determine the health-related quality of life of female patients with lower back pain. A total of 111 patients were divided into three groups: those who had given birth and developed lower back pain due to pregnancy, childbirth, or child-rearing movements (childbirth group, n=41), those who had given birth and developed lower back pain due to other causes (childbirth and other cause group, n=29), and those who were nulliparous (nulliparous group, n=41). A total of 22 physical therapists evaluated the patients during initial rehabilitation. Basic information and health-related quality of life were compared among the three groups using a one-way analysis of variance for the visual analog scale scores for lower back pain, summary scores (physical health [physical component summary] and mental health [mental component summary]), and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) of the Short Form-8 Health Survey. These values were also compared with the national standard values for health-related quality of life. The chi-square test of independence was used to compare distributions, and Fisher's exact probability test was used for cells with an expected value of <5. Most participants had physical component summary scores below the national standard values. The visual analog scale scores for lower back pain were significantly higher in the birth group than in the nonbirth group. The physical component summary, physical functioning, and general health scores were significantly lower in the birth group than in the nonbirth group. Moreover, bodily pain scores were significantly lower in the birth group than in the other groups. For female patients with lower back pain due to pregnancy, childbirth, or childcare activities, physical conditions unique to postpartum women should be considered, and if necessary, instructions for activities of daily living should be provided.

Progress of Traditional Chinese Medicine Nursing Technology in Rectus Abdominis Diastasis

Rectus abdominis diastasis is a common condition in postpartum women, causing back pain, and in severe cases, it can result in abdominal wall hernias and downward migration of abdominal organs. At present, there is no clearly established optimal non-surgical treatment for rectus abdominis diastasis, but traditional Chinese medicine (TCM) nursing techniques have proven to be an effective intervention for postpartum rectus abdominis separation. This paper comprehensively analyzes the TCM nursing technology as an intervention for postpartum rectus abdominis separation, discusses the shortcomings and prospects of TCM nursing technology, and provides references for further exploring and optimizing the intervention program for postpartum rectus abdominis separation.

Evaluation of pharmacokinetics of Tenofovir Alafenamide (TAF) and Tenofovir Disoproxil (TDF) in pregnant and postpartum women in South Africa: PrEP-PP PK study

BackgroundThere are few data on tenofovir-diphosphate (TFV-DP) concentrations in pregnant and postpartum women on Tenofovir Disoproxil Fumarate-Emtricitabine (TDF-FTC) or Tenofovir Alafenamide-Emtricitabine (TAF-FTC). MethodsEligible pregnant women were randomized to TDF-FTC or TAF-FTC and followed for 16 weeks (8-weeks pregnant, 8-weeks postpartum) with weekly collection of dried blood spot (DBS) and 4-weekly peripheral blood mononuclear cells (PBMC). PrEP dosing was observed daily via asynchronous videos sent via cell phone. We report geometric means (GM) and their ratios (GMR) with 95% confidence intervals (CIs) for TFV-DP in PBMC and DBS from pregnancy and postpartum. ResultsWe enrolled N = 39 participants (n = 19 TDF-FTC, n = 20 TAF-FTC): median age was 28 years (IQR:25–34); median gestational age was 24-weeks (IQR:21–28). For TDF-FTC, TFV-DP DBS concentrations at 8-weeks did not differ significantly between pregnancy (GM: 675; 95%CI:537–849) and postpartum (GM: 583; 95%CI:471–722; GMR-TDF = 1.16; 95%CI:0.74–1.80). For TAF-FTC, TFV-DP DBS concentrations at 8-weeks were 44% higher in postpartum (GM: 1199; 95%CI:929–1549) versus pregnancy (GM: 832; 95%CI:751–922; GMR-TAF = 1.44; 95% CI: 1.01–2.06). In PBMC analysis of TDF-FTC, 8-week median TFV-DP (pmol/10^6 cell) was 71 (IQR 44–112) in pregnancy and 73 (IQR 50–102) in postpartum (GMR = 1.04; 95%CI:0.44–2.44). In TAF-FTC, median PBMC at 8-weeks was 580 (IQR:341–985) in pregnancy and 666 (IQR:396–1123) in postpartum (GMR = 1.15; 95%CI:0.30–2.49). ConclusionTFV-DP concentrations were overall lower during pregnancy than postpartum for TAF-FTC. We found high concentrations of TFV-DP in PBMC in pregnancy and postpartum on TAF-FTC, suggesting PrEP efficacy is maintained. Efficacy and safety studies are warranted to evaluate TAF-FTC for PrEP in pregnant and postpartum women.

The screening accuracy of the Edinburgh Postnatal Depression Scale (EPDS) to detect perinatal depression with and without the self-harm item in pregnant and postpartum women

Background This study aims to examine whether the Edinburgh Postnatal Depression Scale (EPDS), excluding the self-harm item (EPDS-9), performs as effectively as the full EPDS in identifying depression among perinatal women. Methods A total of 3571 pregnant women and 3850 postpartum women participated in this observational study. Participants who scored ≥ 9 on the EPDS underwent further diagnostic evaluations by a clinical psychologist and/or psychiatrist. Results The EPDS-9 and full EPDS demonstrated a near-perfect correlation in both the antepartum (r = 0.996) and postpartum (r = 0.998) cohorts. EPDS-9 showed exceptional precision in identifying depression as screened by the full EPDS at cutoff points ranging 9–14, with areas under the curve ≥0.998. The sensitivity of EPDS-9 and full EPDS to detect depression that requires psychotropic medications was poor. The highest accuracy for both versions was at a cutoff score of 9: sensitivity of 0.579 for the full EPDS and 0.526 for the EPDS-9. At the cutoff point of 9, EPDS-9 performed adequately in predicting the response of the participants to the self-harm item. Conclusion The EPDS-9 represents a solid and effective replacement for the full EPDS in clinical settings. If the presence of suicidal thoughts needs to be assessed, specialized scales should be used.