Do Postpartum Maternal Iodine Status or Supplementation Affect Thyroid Function After Delivery? A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was, for the first time, to explore whether postpartum maternal iodine status or supplementation is associated with thyroid function after delivery. The MEDLINE/PubMed, Web of Science, Embase, and Scopus were searched up to December 2021 to identify relevant studies. The pooled mean thyroid stimulating hormone (TSH), free thyroxine (fT4), and thyroxine (T4) concentrations and 95% confidence intervals (CIs) were estimated based on maternal urinary iodine concentration (UIC) (< 50, 50-100, 100-200, and > 200 µg/L) or breast milk iodine concentration (BMIC) (< 100 µg/L vs. ≥ 100 µg/L) during postpartum. A fixed/random effects model was used based on the absence/presence of heterogeneity, respectively. The study is registered with PROSPERO, number CRD42022336145. A total of 2175 studies were identified, of which 18 were eligible for the meta-analysis. The pooled values for TSH, fT4, and T4 concentrations in all subgroups were within the normal range; however, except for TSH, comparing the 95% CI showed no statistically significant difference among different subgroups. The pooled mean for TSH concentration in women with UIC > 200 µg/L was 2.23 mIU/L, whereas the corresponding values in women with UIC < 50, 50-100 and 100-200 µg/L were 0.56, 0.56 and 0.95 mIU/L, respectively. Thyroid hormones in women with BMIC < 100 µg/L and ≥ 100 µg/L were within the normal range. Iodine supplementation during postpartum was not associated with any differences in thyroid parameters, compared to non-supplemented women. In conclusion, iodine status or supplementation had no effect on thyroid hormones in postpartum women.

Aromatherapy for Postpartum Depression: A Systematic Review and Meta-Analysis.

Objective: The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in the management of depression. This systematic review and meta-analysis was done to find the effect of aromatherapy on postpartum depression. Materials and methods: Electronic databases like PubMed, Scopus, Cochrane Library and Science Direct since inception till February 2021 were searched using related keywords to obtain eligible studies. Randomised controlled trial studies (RCTs) reporting the effects of aromatherapy therapy in women with postpartum depression were included. Aromatherapy studies conducted on population other than postpartum women were excluded. The primary outcome was depression scores obtained by using valid depression scales. Meta-analysis was performed using the random-effects model of Der Simonian and Laird to produce summary treatment effects in terms of Hedges' g effect sizes with 95% confidence interval (CI). Results: A total of 4 RCTs (n=303) were included. The results indicate that aromatherapy (Hedges' g =-0.94, 95 CI= -2.55, 0.61, I2=88%, p<0.01) reduces depression levels among postpartum women without statistical significance. Conclusion: The available evidences suggest aromatherapy may be effective in reducing post-partum depression. The number of scientific evidences currently available are very limited and more studies with robust study designs are required to strongly recommend aromatherapy in the management of post-partum depressions. However, being a safer intervention with no adverse effects being reported in previous studies, aromatherapy could definitely be added as an effective complementary therapy in the management of post-partum depression along with conventional medicine.

Rehabilitation programme including EMG-biofeedback- assisted pelvic floor muscle training for rectus diastasis after childbirth: a randomised controlled trial.

OBJECTIVE: To evaluate the effect of a comprehensive rehabilitation programme on closure of the rectus diastasis (RD) and quality of life in women after delivery. DESIGN: A randomised controlled trial with blinded assessment. SETTING: A tertiary hospital and participants' homes in Foshan, China. SUBJECTS: Sixty-six women with RD 2-6 months after delivery were recruited into this study (study group n = 33, control group n = 33). The mean age of participants was 29.9 [standard deviation (SD) 4.3] years. INTERVENTIONS: Each participant performed abdominal exercises. Patients in the study group received electromyographic-biofeedback-assisted pelvic floor muscle training (BAPFMT) in combination with neuromuscular electrical stimulation (NMES) of the rectus abdominis, and patients in the control group underwent NMES of the rectus abdominis alone. MAIN OUTCOMES: The main study outcomes were inter-recti distance (IRD) and change in Short-Form Health Survey-36 (SF-36) scores 6 weeks after the intervention. RESULTS: A significant decrease in IRD was observed in the study group at 6 weeks [study group 1.6 (SD 0.3) cm vs control group 2.0 (SD 0.3); mean difference - 0.4, 95% confidence interval (CI) - 0.59 to - 0.26]. Similarly, the physical component summary, an integral component of SF-36, showed a significant improvement in the study group compared with the control group at 6 weeks [study group 45.5 (SD 1.2) vs control group 41.2 (SD 2.6); mean difference 4.3, 95% CI 3.72-4.50]. CONCLUSION: A postpartum programme including BAPFMT for women with RD is feasible and improves the physical domain of quality of life. CLINICAL TRIAL REGISTRATION: ClinicalTrials.fimmu, No: RCT 02561078. CONTRIBUTION OF THE PAPER.

Intake of Vitamin B12 and Folate and Biomarkers of Nutrient Status of Women within Two Years Postpartum.

Background: Little is known about variation in vitamin B12 and folate status among Chinese women 2 years postpartum. This study assessed intake of vitamin B12 and folate and biomarkers of nutrient status among Chinese women postpartum. Methods: Demographic information, multi-/single-nutrient supplementation, dietary data, serum vitamin B12 and serum folate were assessed in 982 women within 2 years postpartum, using ten investigation sites in Zhejiang Province from the National Nutritional Study 2016−2017, which is a nationally representative cross-sectional study, to form a representative provincial sample of Zhejiang Province. The dietary diversity score (DDS) was used for assessing the dietary pattern. Results: Vitamin B12 increased slightly at the early stage of postpartum and then dropped over time. Serum folate level elevated with postpartum time. The median serum vitamin B12 concentration was 494.59 (373.21−650.20) pg/mL, and folate was 7.58 (5.02−10.34) ng/mL. Correspondingly, vitamin B12 levels suggesting marginal deficiency (200−300 pg/mL) and deficiency (<200 pg/mL) resulted as 9.27% and 3.26%, respectively, and folate level suggesting deficiency (<3 ng/mL) was 9.16%. Multi-/single-nutrient supplementation during pregnancy was associated with log-transformed serum vitamin B12 and folate level after adjusting for potential confounders (vitamin B12: ß (SE) = 0.124 (0.028), p < 0.001; folate: 0.128 (0.035), <0.001). Additionally, postpartum nutrient supplementation was associated with log-transformed serum folate level, especially for lactating women (ß (SE) = 0.204 (0.062), p = 0.001). Increased DDS was significantly associated with elevated serum vitamin B12 and folate levels (vitamin B12: ß (SE) = 0.028 (0.011), p = 0.011; folate: 0.030 (0.014), 0.031). In addition, age and educational level were influencing factors for serum vitamin B12 and folate concentrations among postpartum women. Conclusion: Serum vitamin B12 level decreased and folate level increased with postpartum age among Chinese women. Nutrient supplementation during pregnancy was related to elevated serum vitamin B12 and folate concentrations. Postpartum nutrient supplementation was associated with the increased serum folate level of lactating women. Dietary diversity was related to increased serum vitamin B12 and folate levels, especially among postpartum women with younger age and lower educational level.

Iodine status of postpartum women and their infants aged 3, 6 and 12 months: Mother and Infant Nutrition Investigation (MINI).

To alleviate the re-emergence of iodine deficiency in New Zealand, two strategies, the mandatory fortification of bread with iodised salt (2009) and a government-subsidised iodine supplement for breast-feeding women (2010), were introduced. Few studies have investigated mother and infant iodine status during the first postpartum year; this study aimed to describe iodine status of mothers and infants at 3, 6 and 12 months postpartum (3MPP, 6MPP and 12MPP, respectively). Partitioning of iodine excretion between urine and breast milk of exclusive breast-feeding (EBF) women at 3MPP was determined. In total, eighty-seven mother-infant pairs participated in the study. Maternal and infant spot urinary iodine concentration (UIC) and breast milk iodine concentration (BMIC) were determined. The percentage of women who took iodine-containing supplements decreased from 46 % at 3MPP to 6 % at 12MPP. Maternal median UIC (MUIC) at 3MPP (82 (46, 157) µg/l), 6MPP (85 (43, 134) µg/l) and 12MPP (95 (51, 169) µg/l) were <100 µg/l. The use of iodine-containing supplements increased MUIC and BMIC only at 3MPP. Median BMIC at all time points were below 75 µg/l. Infant MUIC at 3MPP (115 (69, 182) µg/l) and 6MPP (120 (60, 196) µg/l) were below 125 µg/l. Among EBF women at 3MPP, an increased partitioning of iodine into breast milk (highest proportion 60 %) was shown at lower iodine intakes, along with a reduced fractional iodine excretion in urine (lowest proportion 40 %), indicating a protective mechanism for breastfed infants' iodine status. In conclusion, this cohort of postpartum women was iodine-deficient. Iodine status of their breastfed infants was suboptimal. Lactating women who do not consume iodine-rich foods and those who become pregnant again should take iodine-containing supplements.

Practice-based evidence: Perspectives of effective characteristics of Australian group-based physical activity programs for postpartum women.

ISSUE ADDRESSED: Many postpartum women often do not achieve recommendations of at least 150 minutes moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has focused on postpartum women's barriers and challenges to being active, with recent research starting to explore the characteristics of PA programs and women who are active during the postpartum period. Yet, little research has focused on the characteristics of key stakeholders and community organisations that support women to sustain their PA engagement during the postpartum period. METHODS: This research generates practice-based evidence to provide essential insights for effective implementation, strategies and actions of community group-based PA programs that recruit and retain postpartum women to ensure future interventions are scalable and sustainable. Ten participants (90% female), ranging in age from 34 to 40 years, were recruited from nine community organisations/businesses. The ten participants engaged in semi-structured interviews for an average length of 31 minutes. RESULTS: Inductive thematic analysis revealed four overarching themes (i) effective practitioners have a history of, and passion for women's health and PA; (ii) low-cost, connected approaches attract postpartum women into community group-based PA programs; (iii) inclusive, flexible, varied, and holistic approaches sustain postpartum women's participation; and (iv) utilise connections to overcome barriers to community group-based PA programs. These four themes were informed by twelve sub-themes relating to the background of stakeholders and practitioners and the approaches that they use to attract and sustain postpartum women in community group-based PA programs. CONCLUSIONS: Practice-based findings should inform future practices and the development of future real-world group-based PA interventions for postpartum women. SO WHAT?: Specifically, interventions will need to be designed and implemented by practitioners who have a history of, and passion for women's health and PA, be low-cost, connected approaches, that are inclusive, flexible, varied, and holistic that prioritise physical, emotional, and social wellbeing.

Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status.

OBJECTIVE: Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN: This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS: Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS: Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS: Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS: There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.

A simple instrument to assess the risk of falling in postpartum women: the SLOPE scale (riSk of faLling in pOstPartum womEn).

The purpose of this study was to introduce a novel instrument aimed at stratifying the risk of falling in postpartum patients. The research was a survey of a sample of 460 midwives working at different hospitals, mainly in Northern Italy, except for a hospital in Rome (Italy). The survey, consisting of 70 items, was conducted among midwives and asked them to express their opinion regarding the increased risk of falling in puerperal women on a Likert scale according to the characteristics listed in the questionnaire. Items were derived from the synthesis of scales available in the literature from settings other than the postpartum period, and interviews were conducted with midwives with great experience in this area. A shortened version was obtained using principal component analysis. A 30-item final scale was obtained, the SLOPE (riSk of faLling in pOst-Partum womEn), ranging from 0 to 100. The scale allows stratification of postpartum women at low (0-10), intermediate (10-20) and high risk (>20) of falling. The development of the SLOPE scale is the first step towards more rational evidence-based management of the risk of falling in postpartum women in current clinical practice.Impact statementWhat is already known on this subject? Falls occurring in the postnatal period are not limited to women because infants are often involved in this adverse event, with several significant consequences. There is a lack of information on this issue due to the absence of both registries and scales for the prevention of falls.What do the results of this study add? The main result of this study is the development of a novel scale to assess the falling risk in postpartum women.What are the implications of these findings for clinical practice and/or further research? The development of this novel scale, even if based on midwives' experience and not on patients' data, is a first step towards a more rational evidence-based management of the risk of falling in postpartum women.

Mercury Exposure Assessment in Mother-Infant Pairs from Continental and Coastal Croatia.

The main source of mercury (Hg) exposure in the general population is fish. Another possible source is dental amalgam. Here, we compare the levels of Hg and selenium (Se) in samples of maternal and fetal origin collected shortly after childbirth of healthy postpartum women in the coastal (n = 96) and continental (n = 185) areas of Croatia related to maternal seafood/fish consumption. We also evaluated Hg concentrations and maternal serum metallothionein (MT2) concentrations in relation to the number of dental amalgam fillings, and MT2A-5A/G (rs28366003) polymorphism. The levels of Hg and Se in maternal hair and blood/serum, placenta and cord blood/serum increased in relation to increasing fish consumption with the highest values in subjects from the coast. The concentrations of each element and between elements correlated across the matrices. Increasing amalgam number correlated linearly with increased Hg levels in maternal and cord serum and was not associated with serum MT2. No association of MT2A-5A/G polymorphism and Hg or Se levels were found. The results confirmed higher fish consumption in coastal vs. continental Croatia and increases of both Hg and Se related to fish consumption in all analyzed samples. Increased blood Hg reflected the predominant MeHg share from seafood, while increased serum Hg matched exposure from dental amalgams.

Clinical Report : Successful Application of Treatments with Kampo Medicine that Focused on liver-qi Stagnation Remedies for three Postpartum Women Experiencing Poor Physical Conditions / 日本東洋医学雑誌

Many postpartum women experience various poor physical conditions and are unresponsive to Western medical treatments. In such cases, treatments with Kampo medicine have so far focused on improving qi deficiency alone or both qi and blood deficiencies. This study describes the three cases of the patients for whom a favorable outcome was achieved despite a relatively poor prognosis by better understanding their status before pregnancy and their conditions during pregnancy and delivery, and by combining treatments for liver­qi stagnation with those for improving prenatal or postnatal qi deficiency.

Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn / Estado nutricional de vitamina A de puérperas de alta e baixa renda e seu efeito sobre o colostro e a necessidade do recém-nascido a termo

Abstract Objective To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. Methods Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20 µg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400 µgRAE/day were considered as insufficient for term newborns. Results The mean maternal vitamin A intake during pregnancy was 872.2 ± 639.2 µgRAE/day in low-income women and 1169.2 ± 695.2 µgRAE/day for high-income women (p < 0.005). The prevalence of vitamin A deficiency was 6.9% (n = 18) in the low-income group and 3.7% (n = 6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3 µgRAE/day (85.8% AI) and 427.2 µgRAE/day (106.8% AI), respectively. Conclusions Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers.

Resumo Objetivo Avaliar o estado nutricional de vitamina A no soro e colostro de puérperas com diferentes condições de renda, comparando os níveis de retinol fornecido através do colostro coma necessidade de vitamina A do recém-nascido. Métodos Estudo transversal com 424 mulheres pós-parto. A ingestão de vitamina A dietética pelas mães foi estimada através de um questionário de frequência do consumo alimentar. Os níveis retinol no soro e colostro foram quantificados por cromatografia líquida de alta eficiência (CLAE). Concentrações de retinol <20 µg/dL no soro foram indicativas de vitamin A deficiency. Os níveis de vitamina A fornecidas pelo colostro < 400 µg/RAE/dia foram considerados insuficientespara os recém-nascidos a termo. Resultados A ingestão média de vitamina A das mães durante a gravidez foi de 872,2 ± 639,2 µgRAE/dia em mulheres de baixa renda e 1169,2 ± 695,2 µgRAE/dia em mulheresde alta renda (p < 0,005). A prevalência de vitamin A deficiency foi de 6,9% (n = 18) no grupo de baixa renda e de 3,7% (n = 6) no grupo de alta renda. A estimativa dos valores médios de ingestão de retinol por lactentes de mães de baixa e alta renda foi de 343,3 µg/RAE/dia (85,8%AI) e 427,2 µg/RAE/dia (106,8% AI), respectivamente. Conclusões A vitamin A deficiency no soro foi prevalente em ambas as populações, entretanto, recém-nascidos de mães de baixa renda foram mais propensos a receberem níveis inferiores de retinol no colostro em comparação com recém-nascidos de mães de alta renda.

Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn.

OBJECTIVE: To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. METHODS: Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20µg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400µgRAE/day were considered as insufficient for term newborns. RESULTS: The mean maternal vitamin A intake during pregnancy was 872.2±639.2µgRAE/day in low-income women and 1169.2±695.2µgRAE/day for high-income women (p<0.005). The prevalence of vitamin A deficiency was 6.9% (n=18) in the low-income group and 3.7% (n=6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3µgRAE/day (85.8% AI) and 427.2µgRAE/day (106.8% AI), respectively. CONCLUSIONS: Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers.

Effects of Meridian Acupressure Massage on Body Composition, Edema, Stress, and Fatigue in Postpartum Women.

OBJECTIVES: This study aims to investigate the effects of meridian acupressure massage on body composition, edema, stress, and fatigue in postpartum women. DESIGN: A quasi-experimental design with a nonequivalent control group was utilized. SETTINGS/LOCATION: The Postpartum Care Center of Women's Hospital in Gwangju City, Republic of Korea. SUBJECTS: The study group consisted of 39 postpartum women, 19 in the experimental group and 20 in the control group, recruited from the postpartum care center of Women's Hospital in Gwangju city, South Korea. INTERVENTIONS: The experimental group was provided with meridian acupressure massage for 90 min daily over 5 days as an experimental therapy. OUTCOME MEASURES: Body composition (body weight, BMI, total body water, ECW ratio, LBM, and body fat) Edema (subjective edema, average girth of the upper limbs, and average girth of the lower limbs), Stress (psychological stress and physical stress), and Fatigue. RESULTS: The experimental group demonstrated a significantly larger decrease compared with the control group in measures of body composition, edema, total subjective stress, psychological stress, and subjective fatigue. CONCLUSIONS: Meridian acupressure massage can hasten the return to original body composition after childbirth.

Daily Consumption of Lipid-Based Nutrient Supplements Containing 250 µg Iodine Does Not Increase Urinary Iodine Concentrations in Pregnant and Postpartum Women in Bangladesh.

Background: Maternal iodine deficiency during pregnancy and lactation is common in Bangladesh.Objective: We evaluated the effect of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on urinary iodine concentration (UIC).Methods: We conducted a cluster-randomized controlled effectiveness trial in which we enrolled 4011 pregnant women at ≤20 gestational weeks. Women in 48 clusters received iron and folic acid (IFA; 60 mg Fe/d + 400 µg folic acid/d) and women in 16 clusters received LNS-PL (20 g/d, 118 kcal) containing 22 vitamins and minerals (including 250 µg I). We randomly selected a subsample of 1159 women for repeated urine sample collection, i.e., at enrollment, at 36 wk of gestation, and at 6 mo postpartum, for UIC analysis, a secondary outcome of the trial.Results: The geometric mean UIC at 36 wk of gestation and at 6 mo postpartum did not differ significantly between the IFA and LNS-PL groups. The median (quartile 1, quartile 3) UIC at 36 wk was 27.4 µg/L (16.9, 52.7 µg/L) in the IFA group and 30.2 µg/L (17.7, 56.6 µg/L) in the LNS-PL group; at 6 mo, these were 23.0 µg/L (10.0, 45.9 µg/L) in the IFA group and 22.2 µg/L (9.1, 50.4 µg/L) in the LNS-PL group.Conclusion: Daily consumption of LNS-PL containing 250 µg I did not increase the UICs of pregnant and lactating women in Bangladesh. Iodine from lipid-based nutrient supplements may have been stored in the thyroid gland or secreted in breast milk instead of being excreted in urine. Additional research that uses other biomarkers of iodine status is needed to determine how to meet the iodine requirements of pregnant and lactating women in Bangladesh and similar settings. This trial was registered at clinicaltrials.gov as NCT01715038.

Effect of routine prenatal supplementation on vitamin concentrations in maternal serum and breast milk.

OBJECTIVE: The aim of the present study was to assess the effect of multivitamin supplements and their different vitamin A sources on retinol concentrations in serum and colostrum milk of postpartum women. METHODS: This was a retrospective cross-sectional study composed of healthy postpartum women attending two Brazilian private maternity wards (N = 100). According to the type of multivitamin taken during pregnancy, the women were assigned to one of four groups: control group (CG; n = 25), formulation 1 (F1; n = 25), formulation 2 (F2; n = 25), and formulation 3 (F3; n = 25). Blood and colostrum samples were collected under fasting conditions and retinol was analyzed by high-performance liquid chromatography. Dietary vitamin A was assessed using a food frequency questionnaire. Retinol concentrations <20 µg/dL (<0.70 µmol/L) in serum and <60 µg/dL (2.10 µmol/L) in colostrum were considered indicative of vitamin A deficiency. RESULTS: Of women in the control group, 12% (n = 3) presented serum retinol levels below the cut-off value for adequacy; this was not observed in the supplemented groups. Evaluating the retinol content in breast milk, supplemented groups F1 and F3 presented 4% (n = 1) of inadequacy cases, whereas F2 presented 40% (n = 10). The concentrations found in the F2 and F3 groups were statistically different (P < 0.05). CONCLUSIONS: The use of multivitamin supplements containing vitamin A during pregnancy prevents vitamin A deficiency regardless of the source administered. In breast milk, supplementation with ß-carotene provided a lower concentration of vitamin A compared with retinol.

[Effects of Auricular Acupressure on Improving the Sleep Quality of Puerperae].

BACKGROUND: Puerperae exhibit generally poor sleep quality. Previous studies have shown auricular acupressure as effective in improving the sleep problems of nurses, college students, and elderly indigenous Taiwanese women. However, no study has yet examined the effectiveness of auricular acupressure in improving the sleep quality of postpartum women. PURPOSE: To explore the efficacy of auricular acupressure (AA) on puerperae who were affected by sleep disturbance. METHODS: A prospective quasi-experimental design was used and 60 puerperae with insomnia who scored at least 5 on the Chinese of version of the Pittsburgh Sleep Quality Index (CPSQI) were recruited at one postpartum centre (a "doing-the-month" care centre) in northern Taiwan. The experimental group (n=30) received pasted auricular magnetic beads and acupressure on the Shenmen, Xin, and Shen points. The control group (n=30) received general nursing directions about insomnia only. All participants were assessed using the CPSQI prior to the intervention and on the 21st post-intervention day. The intervention effects were analysed using the Generalized Estimating Equation (GEE). RESULTS: After three weeks of the AA intervention, the mean global PSQI score had decreased significantly more in the experimental group than in the control group (p<.05). Furthermore, experimental-group participants reported better sleep quality (p<.05), longer total sleep time (p<.001) and lower sleep disturbance (p<.05) than their control-group peers. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The present pilot study found complementary AA to be an effective intervention for treating puerperae with insomnia. This non-pharmacological and nonintrusive intervention for improving sleep disturbance in puerperae promotes the quality of sleep.

The effects of different levels of calcium supplementation on the bone mineral status of postpartum lactating Chinese women: a 12-month randomised, double-blinded, controlled trial.

Increasing dietary Ca intake may prevent the excessive mobilisation of bone mineral in nursing mothers. We aimed to investigate whether higher Ca intake could positively modulate the bone mineral changes in Chinese postpartum lactating women. The study was a 12-month randomised, double-blinded, parallel group trial conducted over 12 months. A total of 150 postpartum women were randomly selected to receive either 40 g of milk powder containing 300 mg of Ca and 5 µg of vitamin D (Low-Ca group) or same milk powder additionally fortified with 300 mg of Ca (Mid-Ca group) or 600 mg of Ca (High-Ca group). Bone mineral density (BMD) for the whole body, the lumbar spine, the total left hip and its sub-regions was measured using dual-energy X-ray absorptiometry. A total of 102 subjects completed the whole trial. The duration of total lactating time was 7·9 (SD 2·8) months on average. The intention-to-treat analysis yielded the following mean percentage changes in BMD for the whole body, the lumbar spine and the total left hip, respectively: -0·93 (SD 1·97), 2·11 (SD 4·90) and -1·60 (SD 2·65)% for the Low-Ca group; -0·56 (SD 1·89), 2·21 (SD 3·77) and -1·43 (SD 2·30)% for the Mid-Ca group; and -0·44 (SD 1·67), 2·32 (SD 4·66) and -0·95 (SD 4·08)% for the High-Ca group. The differences between the groups were not statistically significant (P: 0·5-0·9). The results of the complete case analysis were similar. In sum, we found no significant differences in the bone mineral changes from baseline to 12 months in postpartum lactating women consuming milk powder fortified with different levels of Ca.

Jordanian women's dissatisfaction with childbirth care.

BACKGROUND: Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant. AIM: To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women. METHOD: A descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale. RESULTS: The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour. LIMITATIONS: Findings are limited to Jordanian women accessing public sector perinatal health services. CONCLUSION: The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Development of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.

Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen.

OBJECTIVE: to examine the effectiveness of using back massage to improve sleep quality in postpartum women. DESIGN AND SETTING: randomised controlled trial, conducted at a postpartum centre in Northern Taiwan. PARTICIPANTS: sixty postpartum women reporting poor quality of sleep were recruited from February 2012 to May 2012. INTERVENTIONS: participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for back massage therapy. The intervention group received a single 20-minutes back massage session at the same time each evening for 5 consecutive days. Sessions were administered by a certified massage therapist. MEASURES AND FINDING: the outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was administered pre- and post-test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were significantly lower in the intervention group (B=-3.97, standard error=0.43, p<0.001) than in the control group. CONCLUSIONS: an intervention involving back massage in the postnatal period significantly improved the quality of sleep. IMPLICATIONS FOR PRACTICE: midwives should evaluate maternal sleep quality and design early intervention programs to improve the quality of sleep, to increase maternal health. Midwives interested in complementary therapies should be encouraged to obtain training in back massage and to apply it in postpartumcare.

Effects of Laughter Therapy on Postpartum Fatigue and Stress Responses of Postpartum Women

PURPOSE: The purpose of this study was to examine the effects of laughter therapy on postpartum fatigue and stress respon-ses of postpartum women. METHODS: The research design was a nonequivalent control group non-synchronized design. The participants were 67 postpartum women who agreed to participate in this study, selected by convenience sampling: (experiment group-33 and control group-34). The data were collected from August 5 to September 30, 2010. The experimental group received laughter therapy from a laughter therapy expert for 60 min, twice a week for 2 weeks, a total of 4 sessions. To evaluate the effects of laughter therapy, postpartum fatigue by self-report questionnaire and cortisol concentration in breast milk were measured. The data were analyzed using the SPSS WIN 13.0 Program. RESULTS: The first hypothesis that "the degree of postpartum fatigue in the experimental group participating in laughter therapy would be lower than that of the control group" was accepted. These findings indicate that laughter therapy has a positive effect on decreasing postpartum fatigue. CONCLUSION: The finding provides evidence for use of complementary and alternative nursing in Sanhujori facilities and obstetric units to reduce postpartum women's fatigue.