Relationship Between Postpartum Depression and Psychological and Biological Variables in the Initial Postpartum Period

Objectives The aims of this study were to evaluate the predictive relationship between psychological symptomatology 24 h postpartum and depression 4 months postpartum, and analyze the relationship between estradiol and postpartum mood. Methods Two hundred women participated in an assessment 24 h postpartum and gave a blood sample for estradiol analysis. One hundred eleven of these women completed the second assessment 4 months postpartum. The Beck Depression Inventory II and the Scale of State-Trait Anxiety were used to assess psychological symptoms. Results At 24 h postpartum, symptoms of depression, trait anxiety, and state anxiety were all significantly correlated with each other. Depression at 24 h postpartum was the only significant independent predictor of depression at 4 months postpartum, explaining 28.7% of the variance. No statistically significant relationship was found between levels of estradiol and mood. Symptoms of depression immediately postpartum thus appear to be a predictor of postpartum depression. Conclusions for Practice These results suggest that early postpartum psychological evaluation of the mother, and intervention as warranted, might prevent or lessen postpartum depression.     

The Association Between Postpartum Insurance Instability and Access to Postpartum Mental Health Services: Evidence From Colorado

IntroductionThe objective of this study was to assess the association between postpartum insurance instability and access to postpartum mental health services.MethodsWe used 2018–2019 Colorado Health eMoms survey data, which sampled mothers from the 2018 birth certificate files at 3–6 months and 12–14 months postpartum. Respondents were classified as stably insured or unstably insured based on postpartum insurance status at each time point. We examined postpartum insurance patterns and used logistic regression to assess the association between postpartum insurance instability and mental health care access.ResultsInsurance changes primarily occurred by 3–6 months postpartum. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage (p < .001). Respondents who were younger, had incomes of less than $50,000, and were of Hispanic ethnicity were more likely to experience unstable postpartum insurance. Respondents who experienced postpartum insurance instability had a lower odds of reporting that they discussed mental health at a postpartum check-up (adjusted odds ratio, 0.4; 95% confidence interval, 0.2–0.7; p < .01) and received postpartum mental health services (adjusted odds ratio, 0.4; 95% confidence interval, 0.2–0.9; p < .05).ConclusionsThe majority of postpartum insurance disruptions occurred among respondents with public coverage at childbirth and by 3–6 months postpartum. Respondents who experienced unstable coverage were more likely to have less access to postpartum mental health care. Policies that increase postpartum insurance stability, such as postpartum Medicaid extensions beyond 60 days, are needed to improve access to postpartum mental health services.     

Postpartum Depression

SUMMARY

Postpartum depression is a common and treatable clinical syndrome which effects up to fifty percent of all women and which can best be considered as a triad of disorders. Postpartum blues, postpartum affective disorders or major depressions, and postpartum psychosis have distinct symptoms with corresponding implications for social work interventions and treatment strategies. The role of prevention can be pivotal in terms of reducing negative impacts of psychological problems after birth and minimizing adverse consequences for the new baby and all family members.     

产后出血的预防与护理

目的探讨产后出血的发生率、原因及预防措施。方法用回顾性分析法对36例产后出血病例的临床资料进行分析。结果产后出血发生率为2．12％,子宫收缩乏力是引起产后出血的主要原因。结论认真做好产前、产时、产后的预防、急救护理,措施得当,就能有效的预防产后出血的发生。     

Predictors of Mothers' Postpartum Body Dissatisfaction

Purpose: To investigate changes in mothers' body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics. Methods: In this prospective longitudinal study, 506 mothers completed surveys at 0–1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum body dissatisfaction were identified by stepwise multiple regression analysis. Results: Mothers' body dissatisfaction increased significantly from 0–1 to 9 months postpartum (mean scores of 15.2 and 18.2, respectively, p < .001). Although women lost an average of 10.1 pounds (sd = 16.3) or 4.6 kg. (sd = 7.4) between 0–1 and 9 months postpartum (p < .001), their weight at 9 months postpartum remained an average of 5.4 pounds (sd = 15.6) or 2.5 kg (sd = 7.1) above their pre-pregnancy weights (p < .001). Body dissatisfaction at 9 months postpartum was associated with overeating or poor appetite, higher current weight, worse mental health (SF-36 Mental Health scale), race other than black, bottle-feeding (vs. breastfeeding), being single (vs. married), and having fewer children. Conclusions: Mothers' body satisfaction worsened from 1 to 9 months postpartum, and 9-month body dissatisfaction was associated with eating/appetite abnormalities, greater weight, worse mental health, non-black race, non-breastfeeding status, and fewer immediate family relationships. Given these relationships, it is important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers' postpartum self-esteem and body satisfaction.     

Understanding Factors Associated with Postpartum Visit Attendance and Contraception Choices: Listening to Low-Income Postpartum Women and Health Care Providers

Background While there is considerable variability with respect to attendance at the postpartum visit, not much is known about women’s preferences with respect to postpartum care. Likewise, there is also limited information on providers’ practices regarding the postpartum visit and care including the delivery of contraception. To understand and address deficits in the delivery and utilization of postpartum care, we examined the perceptions of low-income postpartum women with respect to barriers to and preferences for the timing and location of the postpartum visit and receipt of contraception. We also examined providers’ current prenatal and postnatal care practices for promoting the use of postpartum care and their attitudes toward alternative approaches for delivering contraceptive services in the postpartum period. Methods Qualitative face-to-face interviews were completed with 20 postpartum women and in-depth qualitative phone interviews were completed with 12 health care providers who had regular contact with postpartum women. Interviews were coded using Atlas.ti software and themes were identified. Results Women believed that receiving care during the postpartum period was an important resource for monitoring physical and mental health and also strongly supported the provision of contraception earlier than the 6-week postpartum visit. Providers reported barriers to women’s use of postpartum care on the patient, provider, and system levels. However, providers were receptive to exploring new clinical practices that may widen the reach of postpartum care and increase access to postpartum contraception. Conclusion Approaches that increase the flexibility and convenience of postpartum care and the delivery of postpartum contraception may increase the likelihood that women will take advantage of essential postpartum services.     

Postpartum depression: a review

Postpartum depression is a disorder that is often unrecognized and undertreated. Many psychosocial stressors may have an impact on the development of postpartum depression. The greater risk of postpartum depression is a history of major depression and those who have experienced depression during past pregnancies. Untreated maternal depression can have a negative effect on child development, mother-infant bonding, and risk of anxiety or depressive symptoms in infants later in life. Management of postpartum depression is a vital part of adequate medical care. The obstetrician and pediatrician can serve important roles in screening for and treating postpartum depression. To prevent adverse outcomes associated with depression and its impact on the child, it is important that all health care professionals and nurse practitioners are aware of specific signs and symptoms, appropriate screening methods, and proper treatment. This review article covers major traits of postpartum depression.     

深圳地区产后抑郁现状及危险因素分析

目的 调查深圳市产后抑郁发病现状，分析产后抑郁发病相关影响因素，为预防产后抑郁的发生及早期筛查提供科学依据。方法 选取2019年5月—2019年12月在深圳市妇幼保健院及深圳市中医院进行产后健康检查产妇为研究对象，填写产后抑郁自拟量表，对产后抑郁相关影响因素进行单因素方差分析后，再采用多因素二元logistic回归分析探讨产后抑郁与各项影响因素之间的关系。结果 共4 431名产妇参加调查和评估，产后抑郁发生率为11.6%。将单因素分析后有统计学差异的15个因素纳入多因素二元logistic回归分析。最终结果提示初产妇、婆媳关系欠佳、夫妻关系欠佳、产妇性格内向、纯母乳喂养、孕期未接受宣教、孕期焦虑、孕期抑郁、孕产期不良生活事件发生9个因素对产后抑郁的发生有负面影响。结论 深圳市产后抑郁发生率在全国范围内较低，家庭成员应对产妇予以更多的关注，同时医院应当加强产前、产时和产后全程心理辅导，并积极进行早期筛查。     

Postpartum weight loss and infant feeding

BACKGROUND: Women are often advised that lactation accelerates loss of the excess weight gained during pregnancy, but the evidence underlying this advice is sparse and conflicting. To help fill this gap, we assessed differences in the rate of postpartum weight loss in the first 9 months postpartum according to method of infant feeding. METHODS: Two hundred thirty-six women attending two public health clinics in Montreal were weighed in one to four routine infant immunization visits up to the 9th postpartum month. After each weighing, we administered a telephone questionnaire assessing the method of infant feeding (predominantly breast-feeding, mixed-feeding, or predominantly bottle-feeding) and potential confounders. Data were analyzed using unbalanced multivariate repeated measures linear regression. RESULTS: Infant feeding was not associated with statistically significant differences in the rate of weight loss. Gestational weight gain, postpartum smoking, and maternal birthplace were important predictors of postpartum weight change. CONCLUSION: Although our results cannot exclude an effect of more exclusive or more prolonged breast-feeding, breast-feeding as commonly practiced does not appear to influence the rate of postpartum weight loss. This information should be useful in counseling new or prospective mothers and in avoiding unrealistic expectations.     

产后抑郁诱发因素临床探讨

目的：调查产后抑郁症的诱发因素,提高产后妇女的健康水平。方法：对本院2012年10月-2013年10月1800例产妇进行临床资料分析,采用本院自行设计的调查问卷、爱丁堡产后抑郁量表（EPDS）、抑郁自评量表（SDS）进行调查,其中236例产后抑郁症患者。结果：产后抑郁症的发生率为13．11％,产后抑郁症诱因为年龄、文化程度、地域、分娩方式、新生儿的性别、孕期产前教育、婚姻情况、异常孕产史、产后并发症等,其中文化程度、孕期情况、婚姻情况及产后并发症是主要危险因素。结论：多种因素可诱发产后抑郁症,重点加强产前健康教育,进行心理疏导干预能降低产后抑郁的发生,减少对母婴和家庭的影响。     

产后出血64例临床分析

目的：探讨产后出血的相关因素及处理措施。方法：回顾64例产后出血原因及处理措施。结果：产后出血的主要原因见宫缩乏力,占57．81％,其次是胎盘因素,占31．12％。结论：正确估计产后出血,早期诊断和治疗,可预防和减少产后出血,降低孕产妇死亡率。     

产后抑郁症影响因素的分析

目的探讨孕妇产后抑郁症发病的影响因素。方法应用抑郁自评量表(SDS)、艾氏产后抑郁问卷(EPDS)及自制问卷对352名产妇进行调查。结果调查的产妇中,EPDS总分≥13分的43例,产后抑郁症发生率为12.2%;经多因素非条件logistic回归分析,经济状况差、婴儿性别为女性、产妇身体状况差、产妇年龄大、婴儿健康状况差和婚姻满意度低6种因素为抑郁症发病的危险因素,RR值分别为5.124、4.125、3.785、3.277、2.787和1.958,母乳喂养是产后抑郁症发病的保护性因素(OR=0.424)。结论选择最佳的生育年龄,满足孕产妇的经济、情感需求,提倡母乳喂养,确保婴儿健康,是降低产后抑郁发生的重要措施。     

Guidelines and Interventions Related to the Postpartum Visit for Low-Risk Postpartum Women in High and Upper Middle Income Countries

Objectives A two-part review was undertaken to: (1) summarize current guidelines on the timing and frequency of postpartum follow-up care for generally healthy, non-high risk postpartum women and to delineate the evidence on which these guidelines are based; and, (2) summarize the results of intervention studies focused on increasing utilization of the postpartum visit for generally healthy, non-high risk postpartum women. Methods A review of guidelines from high and upper middle income countries published between 2000 and 2016 in English related to non-high risk postpartum follow-up visits was conducted in 2014–2016 using four databases and additional sources. In addition, articles published between 1990 and 2016 which evaluated interventions from high to upper middle income countries related to increasing attendance at the postpartum visit were gathered using three databases. Results This review located eight guidelines, all of which relied on expert opinion/group consensus as the evidence for their recommendations regarding the timing of the postpartum visit. The review located 19 intervention studies focused on increasing use of the postpartum visit; in 12 there was statistically significant evidence that these approaches improved utilization. However, no intervention strategy was evaluated more than a few times and many of the evaluations were relatively dated. Conclusions Guidelines for the timing of the postpartum visit are variable and are typically based on weak evidence; however, there is support for increased flexibility to meet women’s needs. Additionally, while there is a diverse set of promising interventions to increase utilization of the postpartum visit, there is limited evaluative information. Future initiatives should focus on more rigorous evaluation.     

产后返岗护士的人性化管理举措

通过静脉药物配置中心有计划、有系统地培训和科学的安排、人性化的管理,帮助医院解决了产后返岗护士哺乳期只能上白天班的问题,使产后返岗护士的心理、生理、工作等问题得以有效解决。     

Maternal Stress Predicts Postpartum Weight Retention

Postpartum weight retention (PPWR) is a significant contributor to the development of overweight and obesity in women of childbearing age. Stress may be a key mechanism making it more difficult for mothers to lose weight in the year following delivery. The aim of this study was to assess whether specific aspects of parenting stress and life stress influence postpartum weight retention in new mothers. Women in late pregnancy or up to 2 months postpartum (n = 123) were enrolled in the study and followed through the first year postpartum. Linear regression models evaluated the associations of parenting stress (isolation, attachment and depressive symptoms) as well as overall life stress at 2, 6, and 12 months postpartum with PPWR at 6 and 12 months. During the first year postpartum, higher depression and life stress were significantly associated with greater PPWR. As the effect of depression diminished, the effect of life stress became significant. Contrary to hypothesized relationships, fewer problems with attachment and less social isolation were significantly associated with greater PPWR. Higher gestational weight gain and African American race were also significantly associated with greater PPWR at both 6 and 12 months. Different types of stress predict weight retention in first time mothers during the first year postpartum. Understanding the relationships between parenting stress, concurrent life stress and PPWR can enhance the development of future interventions that specifically target self-identified stressors, leading to improved weight related outcomes.     

健康教育对产后抑郁症的有效干预

产后抑郁症严重影响产妇身心健康和婴儿生长发育,其发病因素可分为生理和心理社会两大类。健康教育是减低产后抑郁症发病率的重要手段,具体内容包括:孕期教育,入院教育,产时教育,产后指导,出院指导,完善产褥期家庭访视。定期开展健康教育,不仅提高了孕妇自身的素质,提高应激能力,而且端正了孕妇及家庭对生育的态度,预防、缓解了孕妇外部压力,体现了社会的关怀和支持。有利于形成其家庭的支持和保护性环境,可极大地降低产后抑郁症的发病率,提高妇、婴健康水平。     

Views of Women and Clinicians on Postpartum Preparation and Recovery

To explore important domains of women’s postpartum experiences as perceived by postpartum mothers and obstetricians/midwives, and to investigate how postpartum care could enhance patient preparation for the postpartum period. Qualitative research study was conducted to explore women’s and clinicians’ perceptions of the postpartum experience. Four focus groups of postpartum women (n = 45) and two focus groups of obstetric clinicians (n = 13) were held at a large urban teaching hospital in New York City. All focus groups were audio recorded, transcribed, and analyzed using grounded theory. Four main themes were identified: lack of women’s knowledge about postpartum health and lack of preparation for the postpartum experience, lack of continuity of care and absence of maternal care during the early postpartum period, disconnect between providers and postpartum mothers, and suggestions for improvement. Mothers did not expect many of the symptoms they experienced after childbirth and were disappointed with the lack of support by providers during this critical time in their recovery. Differences existed in the major postpartum concerns of mothers and clinicians. However, both mothers and clinicians agreed that preparation during the antepartum period could be beneficial for postpartum recovery. Results from this study indicate that many mothers do not feel prepared for the postpartum experience. Study findings raise the hypothesis that capturing patient-centered domains that define the postpartum experience and integrating these domains into patient care may enhance patient preparation for postpartum recovery and improve postpartum outcomes.     

Postpartum relapse to smoking: a prospective study

A substantial proportion of women who quit smoking during pregnancy will relapse in postpartum. In order to better understand the psychosocial factors which precipitate relapse to smoking we conducted a prospective study of postpartum smoking relapse among a cohort (N = 106) of women who quit smoking during pregnancy. Participants were surveyed by telephone after the 28th week of pregnancy, and at 6 weeks and 6 months postpartum. Point prevalence estimates of smoking relapse indicated that at 6 weeks and 6 months follow-up, 24% (n = 26) and 40% (n = 42), respectively, of the women had returned to regular smoking. Spouse's smoking status, social support, decreases in self-efficacy, and the types of coping strategies used to resist smoking in pregnancy and postpartum predicted relapse to smoking in postpartum. Longitudinal data indicated that relapse occurred relatively gradually suggesting that early postpartum is not too late to encourage new mothers to remain abstinent.