Self-harm thoughts among postpartum women - associated factors.

BACKGROUND: Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM: We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD: 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS: Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION: The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

"We are in this together" - Polish midwives' reflections on perinatal care for Ukrainian women after the outbreak of war.

BACKGROUND: February 24, 2022, the beginning of Russia's invasion of Ukraine, was also the beginning of an exceptional situation and a challenge for the Polish health care system, the health care workers and Polish citizens. This study aims to conduct a qualitative analysis of midwives' experiences of maternity care for Ukrainian women after the outbreak of war. PARTICIPANTS AND PROCEDURE: Eight midwives with experience working with both Ukrainian patients and Ukrainian war refugees (who came to Poland after February 24, 2022) participated in a semi-structured interview. The interview data were transcribed and thematically analysed to identify the observations, challenges and medical personnel needs. RESULTS: The most frequently observed reactions in Ukrainian patients included crying, increased anxiety and irritability, fear, withdrawal, and constant information seeking about the current situation. Breastfeeding problems understood as a consequence of chronic stress were also observed and assisted by the midwives. All respondents pointed out the language barrier and their involvement, showing empathy and attentiveness to the patients' situation. No hospital introduced additional support for midwives. A high level of emotional burden on midwives was observed. CONCLUSIONS: The midwives were eager to help Ukrainian patients - they emphasized the more frequent need to make themselves available for them. However, the emotional involvement of the midwives is accompanied by the risk of traumatization and burnout, which are associated with exposure to the difficult experiences of patients. Implementation of training in trauma-informed care and supervision could support midwives in their work and prevent the consequences of long-term stress. Systemic solutions concerning translators' presence and hospital documents' translation are also essential.

The risk of anxiety disorders in women in the first year postpartum - the results from the postpartum depression prevention program ?Next Stop: MUM". / Ryzyko zaburzen lekowych u kobiet w pierwszym roku po porodzie ­ wyniki programu profilaktycznego depresji poporodowej "Przystanek MAMA".

OBJECTIVES: The purpose of the study was to examine the severity of anxiety symptoms and the co-occurrence of anxiety disorders and mood disorders in a group of women in the first year after childbirth participating in the program for the prevention of postpartum depression. METHODS: The study included 1,514 women who were screened by midwives during a patronage visit and were followed up, and 10,454 women who took part in an online screening conducted on the project website. The Edinburgh Postpartum Depression Scale was used for screening, including factor analysis to assess the anxiety subscale, and the GAD-2 questionnaire was used too. RESULTS: The risk of anxiety disorders was observed in 9.5% of women during the patronage visit and, depending on the survey method, 21.2% (ESDP 3 A) or 13.2% (GAD-2) in the follow-up study up to 9 months postpartum. In the online study, 62.8% of women obtained results indicating a high risk of anxiety disorders. For comparison, the result of 12 points and more indicating the risk of depression was obtained by 6.3% in the first month after childbirth and 14.3% in the follow-up study. The results show that anxiety disorders and mood disorders are significantly related (r = 0.631; p < 0.01). CONCLUSIONS: The risk of having anxiety disorders after childbirth is higher or similar to that of mood disorders. It is warranted to extend screening to anxiety disorders and to develop a rapid pathway of early psychological/psychiatric intervention for women in need.

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol.

Background: The aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services). Method: An international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale-revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support. Conclusion: This study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT05654987.

'Next Stop: Mum': Evaluation of a Postpartum Depression Prevention Strategy in Poland.

In the article we present a mid-point evaluation of the postpartum depression (PPD) prevention strategy in Poland. As PPD is associated with potential negative consequences for the mother and infant, the need to introduce screening and treatment is vital. The project covered over 21,500 women in the first year postpartum. The average score in the Edinburgh Postnatal Depression Scale (EPDS), in a screening provided in direct contact, was 4.73 (SD = 4.14, n = 7222), and increased in 55% of women in the follow-up study. In online screening the average score in the EPDS assessment was 16.05 (SD = 5.975, n = 10,454). The 'probable depression' rate (EPDS > 12) in 'direct' contact is 7.3%, and on the online platform-77%. Additionally, 26% of possibly affected mothers assessed in 'direct' contact benefited from psychological consultations. The average score in the EPDS among mothers who benefitted from consultations is 16.24 (SD =4.674, n = 231). Approx. 82% of healthcare providers raised their knowledge of PPD after training sessions. Maintaining the assumptions of the program: training for medical staff, screening conducted throughout the first twelve months postpartum, online platform with the possibility of self-screening and early psychological intervention seem to be justified actions, leading to a higher number of women with risk of PPD referred.

Anemia of Chronic Disease and Iron Deficiency Anemia in Inflammatory Bowel Diseases: Pathophysiology, Diagnosis, and Treatment.

Anemia coexists with inflammatory bowel disease (IBD) in up to two-thirds of patients, significantly impairing quality of life. The most common types of anemia in patients with IBD are iron deficiency anemia and anemia of chronic disease, which often overlap. In most cases, available laboratory tests allow successful diagnosis of iron deficiency, where difficulties appear, recently established indices such as soluble transferrin-ferritin ratio or percentage of hypochromic red cells are used. In this review, we discuss the management of the most common types of anemia in respect of the latest available data. Thus, we provide the mechanisms underlying pathophysiology of these entities; furthermore, we discuss the role of hepcidin in developing anemia in IBD. Next, we present the treatment options for each type of anemia and highlight the importance of individual choice of action. We also focus on newly developed intravenous iron preparations and novel, promising drug candidates targeting hepcidin. Concurrently, we talk about difficulties in differentiating between the true and functional iron deficiency, and discuss tools facilitating the process. Finally, we emphasize the importance of proper diagnosis and treatment of anemia in IBD. We conclude that management of anemia in patients with IBD is tricky, and appropriate screening of patients regarding anemia is substantial.

LL-37: Cathelicidin-related antimicrobial peptide with pleiotropic activity.

Antimicrobial peptides (AMPs) is a large family of compounds serving as natural antibiotics, widely distributed across the organism, mainly in mucus layers. They are designed to prevent pathogens from colonization. Among them, defensins and cathelicidins could be found. LL-37, the sole human cathelicidin draws particular attention because of its outstanding abilities. In addition to being a broad spectrum antibiotic, LL-37 has potent chemotactic and immunomodulatory properties. In this review, we discussed the potency of LL-37 as a therapeutic agent in four systems: immunological, respiratory, gastrointestinal and in the skin. We analyzed the main molecular pathways dependent on human cathelicidin and related them to specific diseases. We conclude that LL-37 shows a great potential to be further investigated and developed as a drug with clinical use.

Current overview of extrinsic and intrinsic factors in etiology and progression of inflammatory bowel diseases.

Inflammatory bowel diseases (IBD) are chronic, relapsing disorders affecting gastrointestinal (GI) tract and associated with intestinal mucosa damage and inflammation. The principal therapeutic goals in IBD include control of the intestinal inflammation and treatment of the major symptoms, mainly abdominal pain and diarrhea. Current therapeutic strategies for IBD rely on the use of non-specific anti-inflammatory agents and immunosuppressive drugs (e.g. aminosalicylates, monoclonal antibodies, and antibiotics), which cause severe side effects, and - in a significant number of patients - do not induce long-term benefits. In this review, we summarize the epidemiology and the most important risk factors of IBD, including genetic, immunological and environmental. Our main focus is to discuss pharmacological targets for current and future treatments of IBD.