The influence of psychological factors on postpartum weight retention 12 months post-birth

Background

During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity.

Objective

The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth.

Methods

Pregnant women (N = 176) completed questionnaires in early–mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR.

Results

Overall, models explained 26–39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR.

Conclusion

While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.     

Maternal burn-out: an exploratory study

Introduction: Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome.

Objective: The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion.

Method: 263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression.

Results: About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress.

Conclusion: This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.     

Support for family diversity: a three-country study

Objective: To understand levels of support for differences between families in terms of sexuality and mode of family formation across three countries.

Background: Previous research has found that attitudes towards family diversity continue to improve over time, although differences remain.

Methods: Subjects were 1605 people living in Australia, the United Kingdom or the United States who completed a questionnaire which sought to explore levels of support for a diverse range of family forms and modes of family formation.

Results: Religiosity, political leanings and beliefs about the importance of genetic relatedness were all correlated with level of support. Gender of participant was a predictor of level of support. Cluster analysis indicated three clusters (unsupportive, neutral and supportive) for level of support, for which both sexuality and parent status were predictors.

Conclusion: Findings highlight the normative status of reproductive heterosex, and demonstrate the considerable value accorded to genetic relatedness.     

Systematic review seeking erythropoietin role for neuroprotection in neonates with hypoxic ischemic encephalopathy: presently where do we stand

Background: Hypoxic ischemic encephalopathy (HIE) is one of the leading causes of neonatal mortality in developing countries and leads to some form of neuro-developmental disability in latter part of life.

Aims: The aim of this study is to evaluate the role of erythropoietin (EPO) in neuroprotection for term newborn having HIE.

Method: The literature search was done for various trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of science, Scopus, Index Copernicus, and other database.

Results: A total of nine studies fulfilled inclusion criteria. EPO has shown to cause reduction in death and disability, better long-term neuro-developmental outcome, improvement in EEG, and reduction in risk of cerebral palsy.

Conclusion: EPO treatment has neuroprotective effects against moderate/severe HIE and improves long-term behavioral neurological developments in neonates.     

Polycystic ovary syndrome and low-grade inflammation with special reference to YKL-40

Objective: To evaluate the plasma level of YKL-40 in a Danish polycystic ovary syndrome (PCOS) population and to investigate whether YKL-40 is associated with CVD risk factors such as waist circumference, body mass index (BMI), insulin resistance (IR), fasting glucose, fasting insulin, blood lipids and CRP.

Design: Cross-sectional study.

Setting: Gynecological clinics at three Danish University Hospitals.

Patients: One hundred seventy-one premenopausal women with PCOS recruited consecutively from April 2010 to February 2012. PCOS was diagnosed according to the Rotterdam criteria.

Main outcome measures: Plasma level of YKL-40 in four phenotypes of PCOS defined by BMI and IR.

Results: No statistically significant difference was observed in the plasma level of YKL-40 across the four BMI/IR-phenotypes. Positive associations were observed between YKL-40 and BMI, total and free testosterone, triglycerides, and CRP. Total and free testosterone were independent predictors of YKL-40.

Conclusion: YKL-40, the marker of low-grade inflammation is not increased in women with PCOS.     

Infant behaviour questionnaire – revised version: a psychometric study in a Portuguese sample

Background: Although the original characteristics of temperament tend to remain constant over the course of development, environmental circumstances may influence infants’ reactions and behaviour. Parents’ reports of infant temperament are rich informants of infant behaviours in different contexts.

Objective: This study aimed to examine the psychometric properties of the Portuguese version of the Infant Behaviour Questionnaire – Revised (IBQ-R) and test the adequacy of the original and other previously published structures to the Portuguese data.

Method: 330 mothers and 81 fathers of children aged between 3 and 12 months completed the Portuguese version of the IBQ-R.

Results: The confirmatory factorial analysis revealed a non-adequate model fit of the IBQ-R original structure to the Portuguese data; nonetheless, it did reveal an adequate model fit of a previous published IBQ-R structure. This structure, although only slightly different from the original one, seems to be more suitable for the Portuguese data.

Conclusion: This study provides data that indicates that the IBQ-R is a reliable questionnaire to evaluate infant temperament in the Portuguese culture.     

A psychological study of male,female related and unexplained infertility in Indian urban couples

Objective: The study intended to see the impact of infertility on experience of emotional trauma, belief pattern and formation of psychopathology and also to explore the psychopathology with respect to degree of infertility related stress impact among male, female and unexplained factor infertility in couples suffering from primary infertility.

Design: This was a clinic-based, cross-sectional comparative study based on a consecutive sampling method.

Subjects: Sixty couples were studied of whom 10 couples had male-related infertility (MF), 10 had female-related infertility (FF) and 10 unexplained infertility (UF). Another 30 fertile couples were also included as comparative group (CG) after matching on certain sociodemographic variables with the clinical groups.

Measures: Impact of Event Scale, Symptom Checklist-90 Revised and Irrational Belief Scale were used.

Results: The impact of emotional trauma and irrational belief was greatest in the male-related infertility couples, and somatisation in the unexplained group, whereas depression and interpersonal sensitivity were higher in the female-related infertility couples. An impact of moderate to severe infertility-related stress on depression and irrational beliefs was also observed. Gender difference was evident with respect to psychopathology and types of infertility.

Conclusion: The impact of infertility is evident with respect to psychopathology with differential impact of various types of infertility groups among Indian couples.     

Postnatal outcome and placental blood flow after plasmapheresis during pregnancy

Purpose: Plasmapheresis in pregnancy adversely affects maternal hemodynamics, however there are studies suggesting it to reduce pregnancy loss in immunological diseases when medication is more harmful to the fetus. The overall optimal plasmapheresis treatment protocol remains unknown.

Materials and methods: A pregnant with neuromyelitis optica was followed up after receiving six volumes of fresh frozen plasma via plasmapheresis.

Results: The placenta compensated the hemodynamic change until the 33rd week of gestation, resulting a small for gestational age, otherwise healthy girl.

Conclusions: More research is needed on plasma exchange during pregnancy because in our observation placental circulation can adapt to the change in blood pressure.     

ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate,results from a prospective observational study

Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP).

Design: Five-year prospective observational study.

Setting: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital – Barcelona.

Patients: TEP cases fulfilling criteria for medical treatment with Methotrexate.

Interventions: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated.

Main outcome measure: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment.

Results: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0–7 and 4–7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0–7 (25%) and 4–7 (20%), respectively.

Conclusion: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.     

Division of parental leave and perceived parenting stress among mothers and fathers

Objective: To explore associations between division of parental leave and perceived parenting stress in mothers and fathers of infants.

Background: In Sweden, both parents have the same right to parental leave, and fathers use about a quarter of the total 480 benefit days. Little is known about the parents’ psychological well-being in terms of stress arising from the parenting role and its association with equal or unequal division of parental leave.

Methods: 280 parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at 6 months and 18 months after childbirth.

Results: Fathers who shared parental leave equally were less affected by perceived parenting stress than those who shared unequally (adjusted B –0.20; 95% CI –0.33 to –0.06). No such association was found among mothers.

Conclusion: Parents’ choices regarding parental leave division were associated with perceived parenting stress among fathers, but not among mothers. Unequal division of leave contributed to parenting stress in fathers.     

Peer support workers’ experiences of supporting women with postnatal depression: a constant comparative exploration

Objective: To explore the lived experiences of peer support workers (PSWs) during their intervention with mothers suffering from postnatal depression (PND).

Background: Postnatal depression is a major public health concern affecting approximately 13% of women worldwide. There is evidence within recent literature that peer support may have a positive effect upon women suffering with PND.

Methods: Written data from the PSW’s logbooks, interviews and supervisory sessions was collected and thematically analysed.

Results: Data were analysed using a constant comparative method and four key themes emerged. These were: changing perspectives of the PSW, their personal self-analysis and recognition, concern about the abandonment of the women that they had been supporting and self-recovery from postnatal depression.

Conclusion: Findings indicate that PSWs choose to offer support based upon their own experiences, rejecting formal counselling therapies. This study found that peer-designed interventions do appear to have some merit.     

Prenatal diagnosis of fetal right and left congenital ventricular aneurysms

Aim: To describe the ultrasonographic appearance of fetal ventricular aneurysm.

Methods: Ultrasound characteristics of two cases of prenatally diagnosed fetal ventricular aneurysm were reviewed.

Results: There was one case of left ventricular aneurysm diagnosed by prenatal ultrasound at 38 weeks of gestation. Another case of fetal right ventricular aneurysm was diagnosed prenatally at 36 weeks of gestation. Both the babies expired in the immediate post-natal period.

Conclusion: Congenital ventricular aneurysm is a rare cardiac malformation characterized by protrusion or out pouching of a portion of the ventricular wall. It is important to differentiate an aneurysm from diverticulum, as the latter has favorable prognosis. The aneurysms are usually large and have broad-based communication with the ventricular cavity in contrast to diverticuli, which are small and connected by a narrow base.     

Incidence and risk factors of postnatal growth restriction in preterm infants

Aim: Preterm infants are often significantly underweight at the time of hospital discharge. Growth impairment during early infancy can have permanent detrimental effects. We aimed to evaluate the incidence and risk factors of postnatal growth restriction (PNGR) in preterm infants.

Methods: This prospective study included 124 preterm infants in neonatal intensive care unit between January 2015 and June 2016.

Results: Of 140 preterm infants screened, postnatal growth retardation was detected in 46 babies (37%). Low gestational age was independent risk factors for PNGR.

Conclusion: Clinicians should be aware of the presence of this morbidity when caring for preterm infants and to provide optimal enteral nutrition.     

Role of ultrasound in the management of diabetes in pregnancy

The purpose of this review is to discuss the established role of ultrasound (US) in the management of pregnancy complicated by diabetes mellitus (DM), as well as new developments with regard to the use of US in this situation. We choose to explore the role of US in pregnancy complicated by DM in three areas:

(1) Role of US in estimation of fetal weight.

(2) Role of US in diagnosis of congenital malformation.

(3) Role of US in monitoring diabetic pregnant patients.     

Owning the birth experience: what factors influence women’s vaginal birth after caesarean decision?

Objective: Our quantitative analysis examined what factors influence pregnant women to choose a vaginal birth after a caesarean (VBAC).

Background: There is growing concern over the high rates of caesarean section; much of the high rate is driven by repeat caesareans. A trial of labour after a previous caesarean is an option for many women increasingly supported by medical literature.

Methods: Survey data from 173 pregnant women who had had only one birth by caesarean were analysed using a hierarchical binary logistic regression model.

Results: Desire for the experience of a vaginal birth strongly predicted choice of VBAC; however, this relationship was dampened among women with a high (versus low) powerful others (e.g. doctors and nurses) locus of control. Prior reason for a caesarean section and practical factors also play a role.

Conclusion: Women may be more likely to choose VBAC if they are encouraged to believe that they can help control the outcome, especially if their desire for a vaginal birth experience is high.     

Clinical significance of primary symptoms in women with placental abruption

Background: To evaluate the clinical significance of primary symptoms in women with placental abruption.

Methods: A retrospective study of 273 cases of placental abruption was performed. The subjects were classified into two groups according to primary symptoms: 210 cases of the vaginal bleeding group and 63 cases of the abdominal pain group. The clinical features, maternal and neonatal outcomes were compared between two groups.

Results: The incidence of preeclampsia and preterm birth in the vaginal bleeding group was significantly lower than abdominal pain group, while the incidence of premature rupture of membrane (PROM) in the former group was higher than that in the latter group. Both fetal and maternal outcomes were significantly poorer in the abdominal pain group than in the vaginal bleeding group in terms of rate of abnormal fetal heart monitoring (FHR), concealed abruption, abruption area over 50%, uteroplacental apoplexy, volume of postpartum hemorrhage, rate of blood transfusion, neonatal asphyxia and acidemia.

Conclusions: Primary symptoms of placental abruption were associated with preterm birth, preeclampsia and PROM, which could predict pregnancy outcomes effectively.     

An examination of the factors affecting intestinal wall integrity in newborns at birth

Background: An understanding of the factors that influence intestinal wall integrity during the transition from fetal to neonatal life is important to elucidate and minimize potential contributions to the development of intestinal pathologies in vulnerable newborns.

Objective: To assess the factors affecting intestinal wall integrity of late preterm and term newborns at birth.

Methods: The concentrations of serum intestinal fatty acid-binding protein (I-FABP) as biomarker of intestinal wall injury, superoxide dismutase (SOD), and glutathione peroxidase (Gpx) as parameters of oxidative stress, and blood gas analyses were measured in the arterial cord blood of 80 newborns, delivered by spontaneous vaginal delivery (labor group) or elective cesarean delivery (non-labor group).

Results: Compared with the non-labor group, I-FABP, SOD, and Gpx levels were significantly higher in the labor group. I-FABP concentration was inversely correlated with pH and BE and positively correlated with SOD and Gpx concentrations, second stage of labor duration, and active pushing time.

Conclusions: This study demonstrates that oxidative stress at birth and prolonged second stage of labor may lead to the intestinal injury, which is reflected in increased serum concentration of I-FABP.     

‘Removed from humanity’: a qualitative analysis of attitudes toward abortion providers in anti-abortion individuals in Canada

Objective: The present study explores the content of abortion provider stigma.

Background: Abortion stigma extends beyond women who have abortions to abortion providers. Previous analyses of anti-abortion bills and rhetoric have revealed stereotypes of abortion providers as dangerous and less trustworthy than other health professionals.

Methods: We present a thematic analysis of one-on-one interviews about attitudes toward abortion providers with Canadian individuals (N = 21) holding an anti-abortion stance.

Results: We found participants held two kinds of beliefs about abortion providers: (1) providers are agentic and intentional actors and (2) providers are non-agentic victims of a larger system. While the former subtype of provider was viewed with hostility and disgust, the latter was viewed with pity, with participants suggesting that restriction of abortion would be beneficial for provider well-being.

Conclusion: We document a new component of abortion provider stigma: the belief that abortion providers are harmed by abortion and that they are to be pitied for this. This ‘abortion harms providers’ attitude parallels recent anti-abortion arguments that abortion harms women. These stigmatising attitudes both construct the provider as untrustworthy and unable to properly care for women.     

Transcervical Foley’s catheter versus Cook balloon for cervical ripening in stillbirth with a scarred uterus: a randomized controlled trial

Objective: To compare the efficacy and safety of the use of transcervical Foley’s catheter versus Cook cervical ripening balloon in pregnant women with stillbirth, unfavorable cervix and scarred uterus.

Design: Randomized controlled study.

Setting: El Minia University Hospital, El Minia, Egypt.

Patients and methods: Two-hundred pregnant women with stillbirth, unfavorable cervix and scarred uterus were recruited into this study. They were randomized into two groups. In group I (n?=?100), cervical ripening was done using Foley’s catheter. In group II (n?=?100), cervical ripening was done using Cook cervical ripening balloon.

Main outcome measures: Balloon insertion to delivery interval, successful ripening rate, cesarean delivery rate, maternal adverse events and maternal satisfaction.

Results: Time from balloon insertion to expulsion and from balloon insertion to delivery was significantly shorter in Foley’s catheter group. However, the difference between the two groups regarding time from balloon insertion to active labor, time from balloon expulsion to delivery, cervical ripening, cesarean section, instrumental delivery, pain score, need for analgesia, hospital stay and maternal satisfaction was not statistically significant.

Conclusions: Foley’s catheter and Cook cervical ripening balloon are comparable regarding efficacy and safety profile when used to ripen the cervix in pregnant women with stillbirth, unfavorable cervix and scarred uterus. However, Foley’s catheter has a shorter induction to delivery interval and is relatively cheaper device.