Association between low MCV in early pregnancy and perinatal mental health in the Japan Environment and Children's Study and the possible effect of iron deficiency.

BACKGROUND: Postpartum anemia and iron deficiency are associated with postpartum depression. This study investigated the association between a low mean corpuscular volume (MCV) without anemia (which implies early-stage iron deficiency) in early pregnancy and perinatal mental health outcomes. METHODS: The fixed data from the Japan Environment and Children's Study (JECS), a Japanese nationwide birth cohort, were used. Perinatal mental health was assessed using the Kessler 6-item psychological distress scale (K6) in mid-pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at 1- and 6-months postpartum. RESULTS: Among the 3635 women with MCVs <85 fL in early pregnancy, the proportions of women with K6 scores ≥13 in mid-pregnancy and EPDS scores ≥9 at 1- and 6-months postpartum were 2.7 %, 12.8 %, and 9.9 %, respectively, compared with the 33,242 women with MCVs ≥85 fL at 1.9 %, 11.9 %, and 9.0 %, respectively. Multivariate logistic regression models showed that an MCV <85 in early pregnancy was associated with a K6 score ≥ 13 in mid-pregnancy and an EPDS score ≥ 9 at 1- and 6-months postpartum (adjusted odds ratio (95 % confidence interval): 1.48 (1.16-1.87), 1.14 (1.01-1.28), and 1.09 (0.95-1.24), respectively). LIMITATIONS: Low MCV values do not necessarily represent iron deficiency. Ferritin, currently the best indicator of iron deficiency, was not measured in the JECS. CONCLUSIONS: This study results suggest that a low MCV without anemia in early pregnancy is associated with a slightly increased risk of perinatal mental health deterioration.

Intentions to Use Cannabis Postpartum: A Qualitative Study of Pregnant Individuals Who Used Cannabis During Early Pregnancy.

Objective: To examine plans for postpartum cannabis use among pregnant individuals who used cannabis during early pregnancy. Materials and Methods: Eighteen virtual focus groups were conducted from November 17, 2021, to December 17, 2021, with 23 Black and 30 White pregnant adults in Kaiser Permanente Northern California, who self-reported prenatal cannabis use during early pregnancy. Focus groups were recorded, transcribed, and analyzed using thematic analysis. Results: The sample (N = 53) had a mean age of 30.3 years (standard deviation = 5.2) at recruitment; 70% reported daily, 25% weekly, and 6% ≤ monthly cannabis use at entrance to prenatal care. Some participants viewed cannabis as critical for coping with postpartum mental and physical health challenges, while others questioned whether cannabis use would fit with their parental lifestyle, and some planned to abstain altogether. Most planned to use cannabis postpartum, but with lower frequency than before pregnancy, and in ways consistent with harm reduction (e.g., smoking outside to avoid secondhand or thirdhand smoke exposure). Many were motivated to abstain from cannabis while breastfeeding, and some desired more data on the safety of cannabis and breastfeeding, or intended to "pump and dump," believing it would reduce potential transfer of Δ9-tetrahydrocannabinol (THC) to their infant. Responses from Black and White participants were generally similar, but White participants were more likely to report plans to use cannabis while breastfeeding and to want information about cannabis and breastfeeding. Conclusions: Pregnant individuals with prenatal cannabis use had varied plans for cannabis use postpartum. Many were motivated to abstain or use cannabis less frequently than pre-pregnancy, especially during lactation.

Two babies, two bonds: Frequency and correlates of differential maternal-infant bonding in mothers of twins.

We assessed prevalence and correlates of differential maternal-infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well-being, and pregnancy/birth that have been previously linked with maternal-infant bonding. Participants (N = 108 American women, 88.89% White, 82.41% non-Hispanic, aged 18-45, who gave birth to twins in the past 6-24 weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty-six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps > .05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps > .05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth-related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long-term repercussions of maternal-infant bonding discrepancies.

Evaluamos la prevalencia y factores correlacionados del apego afectivo diferencial materno­infantil (v.g. experimentar un apego más fuerte con un bebé vs. el otro) en madres de gemelos, enfocándonos en aspectos de salud mental materna, bienestar, así como el embarazo/parto que previamente han sido relacionadas con la afectividad materno­infantil. A las participantes (N = 108 mujeres estadounidenses, 88.89% blancas, 82.41% no hispanas, de 18­45 años, que dieron a luz gemelos en las pasadas 6­24 semanas) se les reclutó de los sitios de apoyo posterior al parto en la red. Las participantes completaron una encuesta Qualtrics para evaluar el historial de embarazo/parto, los síntomas de depresión y ansiedad, el sueño, el estrés, la satisfacción con la relación romántica, así como la afectividad posterior al parto. Veintiséis participantes (24.07%) reportaron discrepancia en el apego afectivo. Estas participantes confirmaron síntomas más altos de depresión y ansiedad, más baja satisfacción en la relación, más bajo promedio de apego afectivo posterior al parto, más alto estrés general y de crianza, así como un más largo embarazo (todos los ps > .05). Un mayor grado de discrepancia en el apego afectivo se relacionó con más depresión, un más alto estrés de crianza, un más largo embarazo, así como una más baja satisfacción en la relación (todos los ps > .05). Las madres de gemelos pudieran beneficiarse de un apoyo de salud mental posterior al parto, estrategias de cómo arreglárselas con el estrés e intervenciones para mejorar el apego afectivo. El trabajo futuro debe evaluar el papel de las dificultades de amamantar, el método usado para dar a luz, el trauma relacionado con el nacimiento, la capacidad regulatoria del infante y el temperamento. Estudios longitudinales ayudarán a poner a prueba la causa y el efecto las potenciales repercusiones a largo plazo de las discrepancias en el apego afectivo materno­infantil.

Nous avons évalué la prévalence et les corrélats du lien maternel­bébé différentiel (c'est­à­dire qui font l'expérience d'un lien plus fort avec un bébé par rapport à l'autre) chez les mères de jumeaux ou jumelles, en mettant l'accent sur les aspects de la santé mentale maternelle, le bien­être et la grossesse/naissance ayant précédemment été liés au lien maternel­bébé. Les participantes (N = 108 femmes américaines, 88,89% blanches, 82,41% non­latinas, âgées de 18­45 ans, ayant donné naissance à des jumeaux ou jumelles dans les 6­24 semaines précédentes) ont été recrutées à partir de sites internet de soutien postpartum. Les participantes ont rempli un questionnaire Qualtrics évaluant la grossesse/l'histoire de la naissance, les symptômes de dépression et d'anxiété, le sommeil, le stress, la satisfaction de la relation amoureuse et le lien postpartum. Vingt­six participantes (24,07%) ont fait état d'un écart du lien. Ces participantes ont fait état de plus de symptômes de dépression et d'anxiété, d'une satisfaction avec la relation plus basse, d'un lien postpartum plus bas en moyenne, d'un stress général et parental plus élevé, et d'une grossesse plus longue (tout ps >,05). Un degré plus élevé d'écart du lien a correspondu à plus de dépression, un stress de parentage plus élevé, une grossesse plus longue et une satisfaction de la relation plus basse tous ps > ,05). Les mères de jumeaux ou jumelles peut tirer profit d'un soutien en santé mentale postpartum, de stratégies de gestion du stress, et d'interventions pour améliorer le lien. Dans le futur des recherches devraient évaluer le rôle de difficultés de l'allaitement, la méthode d'accouchement, le trauma lié à la naissance, la capacité régulatoire du bébé et son tempérament. Des études longitudinales permettront de tester la cause et l'effet et les répercussions à long terme potentielle pour les écarts dans le lien maternel­bébé.

Documentation of prenatal contraceptive counseling and fulfillment of permanent contraception: a retrospective cohort study.

BACKGROUND: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. METHODS: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. RESULTS: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24-2.00), 42 days (aOR 1.51, 95% C.I 1.20-1.91), and 365 days (aOR 1.40, 95% C.I 1.11-1.75), compared to patients who had their first documented plan in the third trimester. CONCLUSIONS: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally.

Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical.

Short Term Coping-Behaviors and Postpartum Health in a Population-Based Study of Women with a Live Birth, Stillbirth, or Neonatal Death.

OBJECTIVE: Responding to the National Institutes of Health Working Group's call for research on the psychological impact of stillbirth, we compared coping-related behaviors by outcome of an index birth (surviving live birth or perinatal loss - stillbirth or neonatal death) and, among individuals with loss, characterized coping strategies and their association with depressive symptoms 6-36 months postpartum. METHODS: We used data from the Stillbirth Collaborative Research Network follow-up study (2006-2008) of 285 individuals who experienced a stillbirth, 691 a livebirth, and 49 a neonatal death. We conducted a thematic analysis of coping strategies individuals recommended following their loss. We fit logistic regression models, accounting for sampling and inverse probability of follow-up weights to estimate associations between pregnancy outcomes and coping-related behaviors and, separately, coping strategies and probable depression (Edinburgh Postnatal Depression Scale > 12) for those with loss. RESULTS: Compared to those with a surviving live birth and adjusting for pre-pregnancy drinking and smoking, history of stillbirth, and age, individuals who experienced a loss were more likely to report increased drinking or smoking in the two months postpartum (adjusted OR: 2.7, 95% CI = 1.4-5.4). Those who smoked or drank more had greater odds of probable depression at 6 to 36 months postpartum (adjusted OR 6.4, 95% CI = 2.5-16.4). Among those with loss, recommended coping strategies commonly included communication, support groups, memorializing the loss, and spirituality. DISCUSSION: Access to a variety of evidence-based and culturally-appropriate positive coping strategies may help individuals experiencing perinatal loss avoid adverse health consequences.

Comparing maternal factors associated with postpartum depression between primiparous adolescents and adults: A large retrospective cohort study.

OBJECTIVES: This study aimed to estimate the prevalence of diagnosed postpartum depression (PPD) and the likelihood of PPD among primiparous women. We also evaluated differences in the influence of various maternal factors associated with PPD in adolescent versus adult mothers. METHODS: We conducted a retrospective cohort study using electronic health records linked to birth certificates to evaluate the associations between maternal factors and PPD diagnosis. The study population was stratified into adults and adolescents based on age at delivery. We evaluated socioeconomic, demographic, psychological, and clinical factors associated with PPD in each of the age-defined maternal cohorts using multivariable logistic regression analyses. RESULTS: A total of 61,226 primiparous women, including 6435 (11%) mothers younger than 20 years old, were included in the study. The overall PPD rate was 4.0%, with the age-specific PPD rate measuring 1.6 times higher in adolescents than in adult women (6.1% vs. 3.8%). Compared with adults, adolescents were less likely to obtain firsttrimester prenatal care (33% vs. 16%), more likely to have recent tobacco use (11% vs. 6%), and more likely to have had an infection during pregnancy (5% vs. 1%). In adjusted models, significant factors for PPD in both groups included a history of depression or anxiety, tobacco use, and long-acting reversible contraception use. CONCLUSIONS: In this cohort of first-time mothers, adolescents had higher rates of PPD diagnosis as well as PPD-associated maternal factors than adults. Increased awareness of PPD risk in adolescents and early intervention, including integrating mental healthcare into prenatal care, may help benefit adolescents and reduce the risk and severity of PPD.

Effect of Breastfeeding Education Program and Nurse-led Breastfeeding Online Counseling System (BMUM) for Mothers: A Randomized Controlled Study.

BACKGROUND: Breastfeeding is very important for maternal and infant health. With first pregnancies, many pregnant people face obstacles to achieving their breastfeeding goals. RESEARCH AIMS: We aimed to investigate the outcomes of a breastfeeding education program and nurse-led online breastfeeding counseling system (BMUM) on breastfeeding self-efficacy, attitudes about breastfeeding, breastfeeding problems, breastfeeding frequencies and postpartum depression. METHODS: This study was a randomized controlled trial. Participants were randomly assigned to the intervention group (n = 36), or control group (n = 36). Assessments were conducted during pregnancy, between 32- and 37-weeks gestation, and on postpartum Day 1, Week 1, Week 3, and 6 months. RESULTS: The means of the Breastfeeding Self-Efficacy-Short Form scores, and the Infant Feeding Attitude Scale (IIFAS) scores were similar between the groups at the first assessment (p = 0.733). IIFAS scores in the intervention group were significantly higher in the follow-up measurements on postpartum Day 1, Week 1, Week 3, and 6 months compared to scores in the control group (p = 0.006; p = 0.000; p = 0.002; p = 0.001) Edinburgh Postpartum Depression Scale (EPDS) scores were similar between the two groups at 1 week (p = 0.678). EPDS scores were significantly higher in the control group on Day 1 and at 3 and 6 months postpartum (p = 0.000; p = 0.038; p = 0.042). There was no statistically significant difference in breastfeeding problems between the two groups (p > 0.05 across breastfeeding problems examined). The mean values of breastfeeding frequency were similar between groups on Day 1, and significantly higher in the intervention group on follow-up measurements. CONCLUSION: The results of this intervention appear to promote positive attitudes toward breastfeeding and decrease feelings of postpartum depression. However, further randomized controlled trials are needed to support our outcomes.

Screening and the New Treatment for Postpartum Depression.

In August 2023, the U.S. Food and Drug Administration approved Zurzuvae (zuranolone) as the first oral medication to treat postpartum depression. Despite recommendations to screen and treat depression during pregnancy and after birth, perinatal depression is still considered under-detected and under-treated. In this column, I review screening recommendations and the new pharmacological treatment for postpartum depression, research findings on gaps in the cascade of mental health care, integrative care models, and recommendations from professional organizations on screening and treating postpartum depression within broader systems of mental health care.

Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms.

PURPOSE OF REVIEW: Postpartum depression (PPD) and breastfeeding are important, interrelated health factors. It is established that women who breastfeed exclusively have lowered likelihood of developing significant PPD. Yet, many questions remain around what factors are involved. The purpose of this review is to provide updated information about the relationship between PPD and breastfeeding. RECENT FINDINGS: Both psychological and physiological factors have emerged as important moderators and mechanisms of the relationship between postpartum depression and breastfeeding. Breastfeeding self-efficacy, self-compassion, and engagement with the infant during feeding all modify or mediate the relationship, and a complex dynamic relationship among cortisol, oxytocin, progesterone, and estrogen is involved. Importantly, recent intervention studies suggest psychosocial interventions may impact both breastfeeding and mood. Providers and researchers should recognize the interrelationship between the breastfeeding and PPD and apply this understanding to patient care through integrated education and care for both mood and breastfeeding enhancement.

Assistência à saúde nos transtornos mentais no período de puerpério: revisão integrativa / Health care in mental disorders in the period of puerperium: Integrative Review / Atención sanitaria en los trastornos mentales en el puerpério: Revisión integradora

No puerpério, a mulher passa por intensas mudanças de ordem familiar e social, como também de adaptações psicológicas e biológicas, que são marcadas por alterações metabólicas e hormonais complexas, sendo a fase de maior risco para o desenvolvimento de algum transtorno mental. Objetivo:Realizar uma revisão da literatura paraidentificar a assistência à saúde nos transtornos mentais no período de puerpério. Metodologia:Estudo descritivo na modalidade revisão integrativa, realizado com artigos originais disponíveis nas línguas portuguesa, inglesa e espanhola, publicados nas bases de dados Scientific Electronic LibraryOnline (SCIELO) e Literatura Latino-Americana em Ciências da Saúde (LILACS), no período de 2015 a 2021 com os seguintes descritores: assistência de enfermagem, transtornos mentais e períodopós-parto. Resultados:Foram encontrados 58artigos, dos quais 17foram selecionados ao final do processo. 10 trabalhos evidenciaram fatores associados com transtorno mental, 4 trabalhos descreveram medidas de proteção e 3 abordaram ações assistenciais de saúde na intervenção dos transtornos mentais no puerpério. Conclusões:Após análise da literatura, observa-seque o baixo suporte social e familiar se mostraram como principais fatores de risco associados aos transtornos mentais para a puérpera. Já os fatores de proteção foram relacionados com aumento do apoio familiar e assistencial por meio dos serviços de saúde, bem como a importância da enfermagem na implementação de estratégias preventivas para os transtornos mentais no puerpério (AU).

In the puerperium, women undergoes intense changes of family and social order, as well as psychological and biological adaptations, which are marked by complex metabolic and hormonal alterations, being the phase of greatest risk for the development of somemental disorder. Objective: Conduct a review of the literature to identify health care in mental disorders in the postpartum period.Methodology:Descriptive study in the integrative review modality, carried out with original articles available in Portuguese, English and Spanish, published in the scientific electronic library online (SCIELO) and Latin American literature in health sciences (LILACS) databases, from 2015 to 2021 with the following descriptors: nursing care, mental disorders and postpartum period.Results:Fifty-eight articles were found, of which 17 were selected at the end of the process. 10 studies showed factors associated with mental disorder, 4 studies described protective measures and 3 addressed health care actions in the intervention of mental disorders in the puerperium.Conclusions:After analyzing the literature, we observed that low social and family support were shown to be the main risk factors associated with mental disorders for the puerperal. On the other hand, the protective factors were related to increased family and care support through health services, as well as the importance of nursing in the implementation of preventive strategies for mental disorders in the puerperium (AU).

En el puerperio, la mujer sufre intensos cambios de orden familiar y social, así como adaptaciones psicológicas y biológicas, que se caracterizan por complejas alteraciones metabólicas y hormonales, siendo la fase de mayor riesgo para el desarrollo de algún trastorno mental.Objetivo:Realizar una revisión de la literatura para identificar la atención médica en los trastornos mentales en el período posparto. Metodología: Estudio descriptivo en la modalidad de revisión integradora, realizado con artículos originales disponibles en portugués, inglés y español, publicados en las bases de datos de la biblioteca científica electrónica en línea (SCIELO) y de la literatura latinoamericana en ciencias de la salud (LILACS), de 2015 a 2021 con los siguientes descriptores: cuidados de enfermería, trastornos mentales y puerperio.Resultados: Se encontraron cincuenta y ocho artículos, de los cuales 17 fueron seleccionados al final del proceso. 10 estudios mostraron factores asociadosal trastorno mental, 4 estudios describieron medidas de protección y 3 abordaron acciones de atención sanitaria en la intervención de los trastornos mentales en el puerperio.Conclusiones: Después de analizar la literatura, observamos que el bajo apoyo social y familiar demostró ser el principal factor de riesgo asociado a los trastornos mentales para el puerperal. Por otro lado, los factores protectores se relacionaron con el aumento del apoyo familiar y asistencial a través de los servicios de salud, asícomo la importancia de la enfermería en la implementación de estrategias preventivas para los trastornos mentales en el puerperio (AU).

Estrogen administration and withdrawal in a model of hormone-simulated pregnancy lead to alterations in behavior and gene expression but do not induce depression-like phenotypes in mice.

Pregnancy and the post-partum period are associated with substantial fluctuations in hormone levels and are frequently associated with significant stress. Many individuals also experience affective disturbances during the peri­partum period, including anxiety, the 'baby blues,' and post-partum depression. However, the extent to which these affective changes result from rapidly altering hormone levels, increased stress, or the combination of both remains largely unknown. The current study sought to evaluate the consequences of pregnancy-like hormonal changes on behavior and gene expression in c57BL/6 mice in the absence of stress using a hormone-simulated pregnancy model. Our results reveal that animals receiving hormone injections to simulate the high levels of estrogen observed in late pregnancy and animals withdrawn from estrogen to mimic the rapid decline in this hormone following parturition both exhibit increased anxiety-like behavior compared to ovariectomized controls in the novel open field test. However, no other significant anxiety- or depression-like alterations were observed in either hormone-treated group compared to ovariectomized controls. Both hormone administration and estrogen withdrawal were shown to induce several significant alterations in gene expression in the bed nucleus of the stria terminalis and the paraventricular nucleus of the hypothalamus. In contrast to the estrogen withdrawal hypothesis of post-partum depression, our results suggest that this method estrogen withdrawal following hormone-simulated pregnancy in the absence of stress does not induce phenotypes consistent with post-partum depression in c57BL/6 mice. However, given that estrogen withdrawal does lead to significant gene expression changes in two stress-sensitive brain regions, it remains possible that estrogen withdrawal could still contribute to affective dysregulation in the peri-partum period by influencing susceptibility to stress. Future research is required to evaluate this possibility.

Body Image Assessment Tools in Pregnant Women: A Systematic Review.

Pregnancy is a remarkable time and generates several changes in women in a short period. Body image is understood as the mental representation of the body itself, and, although bodily changes are considered healthy, they can impact pregnant women's body image. Problems related to body image during pregnancy can affect the health of the mother and fetus; thus, it is essential for health professionals to detect potential disorders as soon as possible. The objective of this systematic review was to identify instruments for assessing body image in pregnant women, highlighting their main characteristics. To this end, we applied the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to searches in the EMBASE, PubMed, and American Psychological Association databases from 5 January to 10 August 2021. We included studies on adult pregnant women without comorbidities in the validation and adaptation of (sub)scales that analyze components of body image. We excluded studies that considered nonpregnant, adolescent, postpartum, and/or clinical populations, as well as smoking/drug use studies that were not validation studies or did not assess any aspect of body image. We investigated the quality of the studies using the Quality Assessment Tool for Studies with Diverse Designs. In all, we examined 13 studies. The results point to a growing concern over body image during pregnancy, as there has been an increase in the number of validation and adaptation studies involving scales for different cultures that scrutinize different constructs. The findings suggest that the listed instruments be used in future research.

Postpartum Psychosis or Something Else?

Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the relevant literature to highlight the broad differential diagnosis of postpartum psychosis with atypical features. Recommendations for evaluation, diagnosis, and treatment of patients with complex neuropsychiatric symptoms in the postpartum period are discussed. This case of postpartum psychosis with malignant catatonia highlights the role of immunology in the development and treatment of postpartum psychosis and the need for future research to more accurately define the etiology and best tailor treatment.

Mental health of pregnant and postpartum women during the third wave of the COVID-19 pandemic: a European cross-sectional study.

OBJECTIVE: To describe the mental health of perinatal women in five European countries during the third pandemic wave and identify risk factors related to depressive and anxiety symptoms. DESIGN: A cross-sectional, online survey-based study. SETTING: Belgium, Norway, Switzerland, the Netherlands and the UK, 10 June 2021-22 August 2021. PARTICIPANTS: Pregnant and up to 3 months postpartum women, older than 18 years of age. PRIMARY OUTCOME MEASURE: The Edinburgh Depression Scale (EDS) and the Generalised Anxiety Disorder scale (GAD-7) were used to assess mental health status. Univariate and multivariate generalised linear models were performed to identify factors associated with poor mental health. RESULTS: 5210 women participated (including 3411 pregnant and 1799 postpartum women). The prevalence of major depressive symptoms (EDS ≥13) was 16.1% in the pregnancy group and 17.0% in the postpartum . Moderate to severe generalised anxiety symptoms (GAD ≥10) were found among 17.3% of the pregnant and 17.7% of the postpartum women. Risk factors associated with poor mental health included having a pre-existing mental illness, a chronic somatic illness, having had COVID-19 or its symptoms, smoking, unplanned pregnancy and country of residence. Among COVID-19 restrictive measures specific to perinatal care, pregnant and postpartum women were most anxious about not having their partner present at the time of delivery, that their partner had to leave the hospital early and to be separated from their newborn after the delivery. CONCLUSION: Approximately one in six pregnant or postpartum women reported major depression or anxiety symptoms during the third wave of the pandemic. These findings suggest a continued need to monitor depression and anxiety in pregnancy and postpartum populations throughout and in the wake of the pandemic. Tailored support and counselling are essential to reduce the burden of the pandemic on perinatal and infant mental health.

Postpartum Behavioral Sleep Intervention for Smoking Relapse Prevention: A Pilot Trial.

OBJECTIVES: Rates of postpartum smoking relapse are high (70-90%) but standard relapse prevention interventions are not effective postpartum. This pilot study evaluated effects of a combined relapse prevention and sleep intervention on sleep and relapse to smoking. METHODS: Twenty-eight postpartum mothers were assigned to the intervention group-combined relapse prevention and behavioral sleep intervention-or to the comparison group-relapse prevention alone. Questionnaires and actigraphy were completed at baseline (1-week postpartum), post-treatment (8-weeks postpartum), and follow-up (12-weeks postpartum). Sleep diaries were completed weekly for the first 8 weeks postpartum and once at 12 weeks postpartum. To corroborate abstinence, CO levels in expired air were measured weekly for the first 8 weeks postpartum and at follow-up. Timeline Followback (TLFB) and salivary cotinine analysis were conducted at baseline, post-treatment, and follow-up to assess for nicotine and other substance use (TLFB) and to further corroborate abstinence (salivary cotinine analysis). RESULTS: The sleep intervention lengthened maternal nighttime actigraphic sleep by an average of 48 minutes nightly; lengthened the longest bout of consolidated actigraphic sleep by an average of 42 minutes nightly; increased actigraphic sleep efficiency into the healthy range (> 85%); and lowered subjective ratings of sleep disturbance (ps < .05). Findings were inconclusive regarding whether better sleep was associated with abstinence. Post Hoc analyses identified the presence of an additional support person in the home as well as social and emotional support as being positively correlated with smoking abstinence (p < .05; p < .01). CONCLUSIONS FOR PRACTICE: (1) Postpartum sleep can be improved with behavioral interventions in women with a history of smoking. (2) Social-emotional postpartum support is an important factor in preventing smoking relapse for these women.

Percepções e vivências de mulheres acerca da sexualidade durante o período de amamentação / Perceptions and experiences of women about sexuality during the breastfeeding period / Percepciones y experiencias de las mujeres sobre la sexualidad durante el período de lactancia materna

Objetivo: apreender como as mulheres percebem e vivenciam a sexualidade durante o período da amamentação. Método: estudo descritivo de abordagem qualitativa, realizado com mulheres lactantes ou que já haviam amamentado, em seis Unidades Básicas de Saúde de município da região Sul do Brasil. Os dados foram coletados no período de maio a agosto de 2018, mediante entrevistas semiestruturadas, áudio-gravadas, realizadas em local reservado nas unidades de saúde. As informantes foram 18 mulheres com filhos de até 12 meses de vida, que estava sendo ou tivesse sido amamentado ao seio por algum tempo, e que compareceram à Unidade de Saúde para puericultura ou consulta com pediatra durante o período da coleta de dados. Foram excluídas as mulheres que referiram não ter iniciado a prática sexual no período de amamentação. Os dados produzidos foram submetidos à análise de conteúdo modalidade temática. Resultados: as mulheres percebem e vivenciam a sexualidade durante a amamentação por meio de mudanças na autoimagem, na autoestima e no relacionamento com o parceiro. As modificações mamárias foram bem percebidas no período gestacional e no início da amamentação, porém, com o decorrer do tempo, algumas mulheres as perceberam de forma negativa, sobretudo aquelas que tiveram mais dificuldade na retomada do peso pré-gravídico. Os resultados mostraram também que as mulheres passaram por um período de incertezas e inseguranças em relação a sexualidade e que mudanças da dinâmica conjugal foram necessárias neste período de transição para o exercício da sexualidade, considerando necessidades do suporte nutricional e afetivo do bebê. Conclusão: as mulheres percebem e vivenciam dificuldades em conciliar a sexualidade com a amamentação, visto que a nova dinâmica familiar decorrente do nascimento de um filho, associada as alterações na estética corporal, podem repercutir de forma negativa na sexualidade.(AU)

Objective: To understand how women perceive and experience sexuality during the breastfeeding period. Method: Descriptive study with a qualitative approach carried out with lactating women or women who had already breastfed, having as field of study six Basic Health Units (UBS) of a municipality in the southern region of Brazil. Data were collected from May to August 2018, through semi-structured interviews, audio-re-corded and held in a reserved place at the UBS. The informants were 18 women with children aged up to 12 months who were being or had been breastfed for some time and who attended the UBS for childcare or consultation with a pediatrician during the pe-riod of data collection. Women who reported not having started sexual practice during the breastfeeding period were excluded. The data produced were submitted to content analysis ­ thematic modality. Results: Women perceive and experience sexuality du-ring breastfeeding through changes in self-image, self-esteem, and relationship with the partner. Breast changes were well perceived during the gestational period and at the beginning of breastfeeding; however, over time, some women perceived the changes in a negative way, especially those who had more difficulty regaining their pre-pregnancy weight. The results also showed that the women went through a period of uncertain-ties and insecurities in relation to sexuality and that changes in the marital dynamics were necessary in this transition period for the exercise of sexuality, considering the nutritional and affective support needs of the baby. Conclusion: Women perceive and experience difficulties in reconciling sexuality with breastfeeding, since the new family dynamics resulting from the birth of a child and changes in body aesthetics can have a negative impact on sexualit.(AU)

Objetivo: aprender cómo las mujeres perciben y viven la sexualidad durante el período de la lactancia materna. Método: estudio descriptivo con abordaje cualitativo, realizado con mujeres lactando o que ya habían lactado, en seis Unidades Básicas de Salud de un municipio de la región sur de Brasil. Los datos fueron recolectados en el período de mayo a agosto de 2018, a través de entrevistas semiestructuradas y grabadas en audio, realizadas en un lugar reservado en las unidades de salud...(AU)

Associations between psychological distress and hair cortisol during pregnancy and the early postpartum: A meta-analysis.

Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [- 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.

Educational intervention for the maintenance of exclusive breastfeeding in adolescent mothers: A feasibility study.

PURPOSE: The purpose of this study was to evaluate the feasibility of implementing the nursing intervention Breastfeeding Counseling (5244) in first-time adolescent mothers and its effect on the knowledge and maintenance of exclusive breastfeeding in the first 6 months of life. METHODS: Randomized, controlled feasibility study with 166 first-time mothers between 14 and 19 years of age, from 20 to 30 weeks of gestation, assigned to an experimental group (nursing intervention: breastfeeding counseling) or a control group (usual education plus nursing intervention not related to breastfeeding). The rate of abandonment of exclusive breastfeeding and the level of knowledge about breastfeeding were evaluated. FINDINGS: The inclusion was 91.7% (166/181), dropout during the intervention was 39.75% (n = 66), and loss in the follow-up was 8.43% (n = 14). Compliance with the intervention protocol was 100%. The pregnant women and family members were satisfied with the intervention and perceived the health benefits for the mothers and their children. Outcome measures in the experimental group did not reveal a significant effect on breastfeeding abandonment rates at 2, 4, and 6 months postpartum, but they did manage to improve and maintain the level of knowledge about breastfeeding. CONCLUSIONS: It was found that it is feasible to implement the nursing intervention: "Breastfeeding counseling" in prenatal classes, achieving an increase in the level of knowledge about breastfeeding in adolescent mothers, but without a reduction in the rate of abandonment of breastfeeding. Nursing professionals need to know and address barriers to exclusive breastfeeding in adolescents. IMPLICATIONS FOR NURSING PRACTICE: The nursing intervention "Breastfeeding counseling (5244)" and the outcome "Knowledge: Breastfeeding (1800)" supported the processes of education and knowledge assessment on breastfeeding in pregnant adolescents, which should be instituted in perinatal nursing care.

OBJETIVO: Evaluar la factibilidad en la implementación de la intervención de enfermería Asesoramiento en la lactancia (5244), en madres adolescentes primerizas y su efecto en el conocimiento y mantenimiento de la lactancia materna exclusiva en los primeros seis meses de vida. MÉTODOS: Estudio de factibilidad controlado aleatorizado con 166 madres primigestantes entre 14 y 19 años, de 20 a 30 semanas de gestación, asignadas a un grupo experimental (intervención de enfermería: asesoramiento en la lactancia) o a un grupo control (educación habitual más intervención de enfermería no relacionada con la lactancia materna). Se evaluó la tasa de abandono de la lactancia materna exclusiva y el nivel de conocimiento sobre la lactancia. RESULTADOS: La inclusión fue del 91.7% (166/181), la deserción durante la intervención del 39.75% (n = 66) y en el seguimiento del 8.43% (n = 14). El cumplimiento del protocolo de intervención fue del 100%. Las gestantes y familiares se encontraron satisfechos con la intervención y percibieron los beneficios en la salud de las madres y sus hijos. Las medidas de resultado en el grupo experimental no revelaron un efecto significativo en las tasas de abandono de lactancia materna a los 2,4 y 6 meses posparto, pero sí logró mejorar y mantener el nivel de conocimientos sobre lactancia materna. CONCLUSIONES: Se encontró que es factible implementar la intervención de enfermería: "Asesoramiento en la lactancia" en las clases prenatales, logrando incrementar el nivel de conocimientos sobre lactancia en las madres adolescentes, pero sin disminución de la tasa de abandono de la lactancia materna. Los profesionales de enfermería requieren conocer y abordar las barreras para la lactancia exclusiva en adolescentes. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: La intervención de enfermería "Asesoramiento en la lactancia (5244)" y el resultado "Conocimiento: lactancia materna (1800)" apoyaron los procesos de educación y evaluación del conocimiento sobre lactancia materna en gestantes adolescentes, por lo cual deberían ser instituidos en el cuidado de enfermería materno perinatal.

Seguimiento domiciliario de mujeres con consumo problemático de sustancias durante el puerperio y los primeros años de crianza / Home follow-up of women with substance abuse during the puerperium and early years of parenting

El consumo problemático de sustancias es una problemática de abordaje complejo que afecta no sólo la salud individual, también tiene una repercusión a nivel poblacional, y el estigma social del consumo durante el embarazo y el puerperio hace que la aproximación a las pacientes que lo padecen sea aún más difícil. En este artículo la autora realiza una búsqueda bibliográfica acerca de los potenciales beneficios de las estrategias orientadas al seguimiento domiciliario de mujeres puérperas con consumo problemático y sus hijos/as a partir de una consulta en un centro periférico de salud. (AU)

Problematic substance use is a problem of complex approach that affects not only individual health, but also has repercussions at a population level, and the social stigma of substance abuse during pregnancy and puerperium makes the approach to patients who suffer from it even more difficult. In this article, the author conducts a literature search on the potential benefits of strategies aimed at home follow-up of postpartum women with problematic substance use and their children based on a consultation in a peripheral health center. (AU)