Post-partum weight change patterns in the WHO Multicentre Growth Reference Study

The interplay of factors that affect post‐partum loss or retention of weight gained during pregnancy is not fully understood. The objective of this paper is to describe patterns of weight change in the six sites of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) and explore variables that explain variation in weight change within and between sites. Mothers of 1743 breastfed children enrolled in the MGRS had weights measured at days 7, 14, 28 and 42 post‐partum, monthly from 2 to 12 months and bimonthly thereafter until 24 months post‐partum. Height, maternal age, parity and employment status were recorded and breastfeeding was monitored throughout the follow‐up. Weight change patterns varied significantly among sites. Ghanaian and Omani mothers lost little or gained weight post‐partum. In Brazil, India, Norway and USA, mothers on average lost weight during the first year followed by stabilization in the second year. Lactation intensity and duration explained little of the variation in weight change patterns. In most sites, obese mothers tended to lose less weight than normal‐weight mothers. In Brazil and Oman, primiparous mothers lost about 1 kg more than multiparous mothers in the first 6 months. In India and Ghana, multiparous mothers lost about 0.6 kg more than primiparas in the second 6 months. Culturally defined mother‐care practices probably play a role in weight change patterns among lactating women. This hypothesis should stimulate investigation into gestational weight gain and post‐partum losses in different ethnocultural contexts.     

Evaluation of the clinical effect of an on-line course for community nurses on post-partum emotional distress: a community-based longitudinal time-series quasi-experiment

About 14% of Icelandic women suffer post-partum from frequent depressive symptoms, and of those, 12% also report a high degree of parenting stress. Education of nurses and midwives on post-partum distress is crucial in reducing its degree. The purpose of the study is to evaluate the clinical effect of an on-line course for community nurses on post-partum emotional distress. A community-based, longitudinal, time-series quasi-experiment was conducted in four stages from 2001 to 2005. Mothers attending 16 health centres throughout Iceland and scoring ≥ 12 on the Edinburgh Postnatal Depression Scale (EPDS) at the 9th week post-partum were eligible to participate. Health centres were divided into experimental (EHC) and control centres (CHC), and control centres were crossed over to experimental centres the following year and new control centres recruited. Nurses at EHC attended an on-line course on post-partum emotional distress. Participating mothers answered the EPDS; the Parenting Stress Index/Short form and the Fatigue Scale. Nursing diagnoses and interventions were recorded at all study centres. Of the women who were eligible (n = 163), 57% (n = 93) participated. At baseline, 9 weeks post-partum, there were no significant differences between groups of women in the rate of depressive symptoms, fatigue or parenting stress. Women in all groups improved on all distress indicators over time; however, those from the EHC improved statistically and clinically significantly more on depressive symptoms than those from the CHC. Documentation of particular nursing diagnoses and interventions was significantly more frequent at the EHC, but referrals to specialists were significantly less frequent. On-line education for nurses on post-partum emotional distress is feasible and is related to improvement in post-partum depressive symptoms.     

The relationship between maternal depression and adverse infant health outcomes in Zambia: a cross‐sectional feasibility study

Background Post‐partum depression affects many new mothers. In the developing world, there may be an association between post‐partum depression and adverse mortality‐related infant health. Such associations have been found in South Asia; however, findings are inconsistent in Africa. This study aimed to investigate the feasibility of such research in rural Zambia, and investigate associations between maternal depression and adverse infant health outcomes. Methods A cross‐sectional study was undertaken in a rural district of Zambia. Consecutive women with infants between 2 and 12 months were recruited from under five clinics in three locations. Depression was assessed using the Self‐reporting Questionnaire. Outcomes of infant size (actual weight and length, and as ≤5th percentile) and infant health (serious illness, diarrhoeal episodes, incomplete vaccination) were obtained. Relative risk, step‐wise logistic regression and linear regression were used to analyse the data. Results Two hundred seventy‐eight of 286 women agreed to take part (97.1%). The proportion with a high risk of depression was 9.7%. Adverse infant health outcomes were all proportionally greater in infants of ‘depressed’ mothers, and the associations with adjusted mean difference in weight (0.58 kg, CI 0.09–1.08) and length (1.95 cm, CI 0.49–3.50) were statistically significant. Other independent associations with episodes of diarrhoea (maternal education, older infant age, supplementary feeding) and incomplete vaccination (location, older infant age) were identified. Conclusion It is feasible to conduct a study on this subject in a rural area of Zambia. The results show that reduced infant weight and length were significantly associated with maternal ‘depression’. Other adverse outcomes may be and need investigating in an appropriately powered study.     

The impact of anesthesia and mode of delivery on the urinary bladder in the postdelivery period

Objective

To evaluate the effect of regional anesthesia and mode of delivery on the function of the urinary bladder. The primary outcome was the time taken for urinary bladder sensation to return following various modes of delivery and analgesia/anesthesia. The secondary outcome was the volume of urine present in the bladder when sensation returned.

Methods

The study was conducted at the Birmingham Women's Foundation Trust, Birmingham, UK. A total of 120 postnatal patients were studied between January 2007 and March 2008. The volume of urine in the bladder when sensation first returned was measured by release of a clamp for women fitted with an indwelling catheter, and/or estimated using ultrasound.

Results

The median times for sensation to return to the bladder in patients who had a vaginal delivery without epidural analgesia, vaginal delivery with epidural analgesia, and after elective cesarean delivery under spinal anesthesia were 122 minutes (IQR, 112-136 minutes), 234 minutes (IQR, 202-291 minutes), and 374 minutes (IQR, 311-425 minutes), respectively. The median urine volumes were 144 mL (IQR, 112-192 mL), 200 mL (IQR, 136-336 mL), and 152.5 mL (IQR, 125-270 mL), respectively.

Conclusion

These results should be taken into consideration when formulating a postdelivery bladder care protocol.