Effect of music intervention on perinatal depressive symptoms: A meta-analysis.

BACKGROUND: Little is known about the effect of music intervention on perinatal depressive symptoms (PDS), especially the effectiveness of specific aspects of the intervention. This meta-analysis aimed to evaluate the effectiveness of music intervention and explore the role of different intervention features. METHODS: Six databases were searched from inception to May 21, 2024, to identify randomized controlled trials evaluating the effect of music intervention on PDS. The Cochrane Risk of Bias (RoB) 2.0 tool was used to assess RoB. RESULTS: The meta-analysis of 10 studies including 988 participants showed that music intervention significantly improved PDS (standardized mean difference (SMD): 0.61, 95% confidence interval (CI): 0.91, -0.32), with statistical heterogeneity among the studies (I2 = 78%). Subgroup analysis showed significant effects on pregnant and postpartum women, and women with or without perinatal complications. Effects were also significant in low- and middle-income countries (SMD: 0.79, 95% CI: 1.16, -0.42), music medicine (SMD: 0.82, 95% CI: 1.17, -0.47), and total intervention length of less than 6 weeks (SMD: 0.85, 95% CI: 1.25, -0.45), but not in high-income countries, music therapy, or total intervention length of 6 weeks or more. Hospital intervention (SMD: 0.86, 95% CI: 1.41, -0.31) showed greater effects compared with home intervention and hospital combined with home intervention. Six studies had a high overall RoB and four had some concerns. CONCLUSIONS: Music intervention is effective in alleviating PDS. Interventions in low- and middle-income countries, music medicine, total intervention length of less than 6 weeks, and hospital intervention may be advisable.

Nutrient and metabolite characteristics of the husk, bran and millet isolated from the foxtail millet (Setaria italica L.) during polishing.

The utilization of byproducts from foxtail millet polishing can reduce food loss and waste. Thus, it is necessary to know the chemical compounds from the millet and the segregation of the layers. The nutrients including minerals were compared among the husk, bran, and millet, and a LC-MS metabolomics analysis was also performed among them. The results showed that the protein, crude fat and 4 fatty acids, seven minerals, the nitrogen-containing compounds and phenolic acids were at much higher levels in the bran part than the husk and millet, whereas the husk only contained higher levels of dietary fibre, and some minerals. The millet section, as the edible part, contained the lowest level of chemical constituents. It illustrated that the bran part contained more functional and nutritional components than the millet and husk part. Therefore, the bran of the foxtail millet should be a food resources instead of wasting.

Uptake rate of interventions among women who screened positive for perinatal depression: A systematic review and meta-analysis.

BACKGROUND: Perinatal depression is a global public health problem that seriously affects the health of perinatal women. This study evaluated the pooled uptake rate of interventions among women who screened positive for perinatal depression to provide a basis for clinical intervention. METHODS: We systematically searched four databases (PubMed, Embase, Cochrane Library and Web of Science) from the establishment of the database to May 1, 2023. All included studies were used to derive the pooled uptake rate. We also performed meta-regression and subgroup analysis to explore the potential sources of heterogeneity using STATA 17.0. RESULTS: Of 15024 retrieved articles, only 41 met the inclusion criteria. The overall uptake rate was 55 % (95 % CI 43-67 %). Meta-regression and subgroup analyses both showed that the uptake rate in high-income countries 57 % (95 % CI 50-65 %) was higher than that in low and middle-income countries 37 % (95 % CI 18-56 %). LIMITATIONS: First, only English publications were included. Therefore, articles in other languages were likely missed. Second, of the 41 studies included, there were only six randomized controlled trials, with limited quality of evidence. Third, we could not adequately explain the source of heterogeneity because there were too many mediating variables, although further subgroup and sensitivity analysis were performed. CONCLUSIONS: About a half of women did not receive interventions after screening positive, and the uptake rate of interventions in high-income countries was higher than that in low and middle-income countries.

Cyclopeptide moroidin inhibits vasculogenic mimicry formed by glioblastoma cells via regulating ß-catenin activation and EMT pathways.

Glioblastoma (GBM) is a highly vascularized malignant brain tumor with poor clinical outcomes. Vasculogenic mimicry (VM) formed by aggressive GBM cells is an alternative approach for tumor blood supply and contributes to the failure of anti-angiogenic therapy. To date, there is still a lack of effective drugs that target VM formation in GBM. In the present study, we evaluated the effects of the plant cyclopeptide moroidin on VM formed by GBM cells and investigated its underlying molecular mechanisms. Moroidin significantly suppressed cell migration, tube formation, and the expression levels of α-smooth muscle actin and matrix metalloproteinase-9 in human GBM cell lines at sublethal concentrations. The RNA sequencing data suggested the involvement of the epithelial-mesenchymal transition (EMT) pathway in the mechanism of moroidin. Exposure to moroidin led to a concentration-dependent decrease in the expression levels of the EMT markers N-cadherin and vimentin in GBM cells. Moreover, moroidin significantly reduced the level of phosphorylated extracellular signal-regulated protein kinase (p-ERK) and inhibited the activation of ß-catenin. Finally, we demonstrated that the plant cyclopeptide moroidin inhibited VM formation by GBM cells through inhibiting the ERK/ß-catenin-mediated EMT. Therefore, our study indicates a potential application of moroidin as an anti-VM agent in the treatment of GBM.

Insights into the starch and proteins molecular structure changes of foxtail millet sourdough: Effect of fermentation from grains of cereal to pre-meal.

This study investigated the effects of foxtail millet sourdough fermentation time (0, 8, 16, and 24 h) on the protein structural properties, thermomechanical, fermentation, dynamic rheological, starch granules crystalline regions molecular mobility, and starch microstructural characteristics. The fermentation led to a significant increase in the concentration of free amino acids from protein hydrolysis. Fourier transform infrared spectroscopy (FTIR) revealed changes in protein secondary structure and the presence of functional groups of different bioactive compounds. The result of thermomechanical properties showed a significant increase in the stability (0.70-0.79 min) and anti-retrogradation ability (2.29-3.14 Nm) of lactic acid bacteria (LAB) sourdough compared to the control dough, showing a wider processing applicability with radar profiler index. In contrast, sourdoughs with lower tan δ values had higher elasticity and strength. Scanning electron microscopy showed that the surface of the starch appeared from smooth to uneven with patchy shapes and cavities, which declined the crystallinity from 34.00 % to 21.57 %, 23.64 %, 25.09 %, and 26.34 % respectively. Fermentation changed the To, Tp, Tc, and ΔH of the starch. The results of the study will have great potential for application in the whole grain sourdough industry.

Is the digital economy empowering high-quality tourism development? A theoretical and empirical research from China.

How digital economy (DE) empowers high-quality development of tourism (HQDT) has become a common concern among scholars. Given this, this study clarifies the theoretical connotation of DE enabling HQDT,and finds that: Micro, DE promotes efficiency improvements in tourism enterprises, with its economies of scale and Matthew effect reducing average costs, its economies of scope meeting diversified demand, and its long-tail effect improving supply-demand matching mechanism. Meso, DE can transform and upgrade tourism industry structure through industrial digitization and digital industrialization, and also form a new tourist industry form and value chain through cross-border integration. Macro, DE can stimulate innovation and flexibility of market players, increase new factor inputs in tourism, improve factor allocation efficiency, and advance macro regulation of the tourism market. Accordingly, the study conducts an empirical test based on panel data for 31 provinces in mainland China during 2011-2020. Results show that: ① DE positively influences HQDT, and the sub-dimensions all positively influence HQDT. ② DE has a heterogeneous impact on HQDT and shows spatial spillover effects. Finally, the study concludes with effective paths for DE promoting HQDT: "Promote digital infrastructure construction, accelerate tourism digital transformation, strengthen integration and innovation development, and overcome the challenges of tourism enterprises".

Immunoregulatory role of the gut microbiota in inflammatory depression.

Inflammatory depression is a treatment-resistant subtype of depression. A causal role of the gut microbiota as a source of low-grade inflammation remains unclear. Here, as part of an observational trial, we first analyze the gut microbiota composition in the stool, inflammatory factors and short-chain fatty acids (SCFAs) in plasma, and inflammatory and permeability markers in the intestinal mucosa of patients with inflammatory depression (ChiCTR1900025175). Gut microbiota of patients with inflammatory depression exhibits higher Bacteroides and lower Clostridium, with an increase in SCFA-producing species with abnormal butanoate metabolism. We then perform fecal microbiota transplantation (FMT) and probiotic supplementation in animal experiments to determine the causal role of the gut microbiota in inflammatory depression. After FMT, the gut microbiota of the inflammatory depression group shows increased peripheral and central inflammatory factors and intestinal mucosal permeability in recipient mice with depressive and anxiety-like behaviors. Clostridium butyricum administration normalizes the gut microbiota, decreases inflammatory factors, and displays antidepressant-like effects in a mouse model of inflammatory depression. These findings suggest that inflammatory processes derived from the gut microbiota can be involved in neuroinflammation of inflammatory depression.

Effect of eHealth interventions on perinatal depression: A meta-analysis.

BACKGROUND: Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND. AIM: This meta-analysis aimed to determine the effect of eHealth interventions on PND. METHODS: Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model. RESULTS: A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy. CONCLUSIONS: The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

Efficacy and Safety of Oral Propranolol or Topical Timolol for the Treatment of Superficial Infantile Hemangiomas.

Infantile hemangiomas (IHs) are the most common benign soft tissue tumors of infancy. Oral propranolol has become a first-line treatment option since the unexpected discovery of its surprising efficacy in the treatment of IHs in 2008. However, oral propranolol causes systemic complications, including hypotension, bradycardia, and hypoglycemia. To minimize systemic adverse effects of oral propranolol, timolol maleate, a nonselective ß-blocker similar to propranolol, has been used as a topical agent to treat superficial IHs. The authors evaluated the efficacy and safety of oral propranolol or topical timolol in 60 patients with IHs. Of the 60 patients recruited, 30 patients were treated using orally administrated propranolol and an additional 30 patients received topical timolol. The efficacy rate of the oral propranolol and topical timolol was 96.7% and 93.3%, respectively. There were no significant differences between the two treatment patterns for the efficacy rate. The incidence of systemic adverse effects for patients treated with oral propranolol was significantly higher than that for cases received topically timolol treatment. Topical timolol maleate is effective and well-tolerated in the treatment of IHs. It could be considered as the first-line treatment choice, especially for superficial IHs.

Kerr nonlinearity assisted magnetically induced transparency in cavity magnon polaritons.

We investigate optical transmission in cavity magnon polaritons and discover a complex multi-window magnetically induced transparency and a bistability with magnetic and optical characteristics. With the regulation of Kerr nonlinear effects and driven fields, a complex multi-window resonant transmission with fast and slow light effects appears, which includes transparency and absorption windows. The magnetically induced transparency and absorption can be explained by the destructive and constructive interference between different excitation pathways. Moreover, we demonstrate the bistability of magnons and photons with a hysteresis loop, where magnetic and optical bistabilities can induce and control each other. Our results pave a new way, to the best of our knowledge, for implementing a room-temperature multiband quantum memory.

Gint4.T-siHDGF chimera-capped mesoporous silica nanoparticles encapsulating temozolomide for synergistic glioblastoma therapy.

Due to glioblastoma (GBM) being the most intractable brain tumor, the continuous improvement of effective treatment methods is indispensable. The combination of siRNA-based gene therapy and chemotherapy for GBM treatment has now manifested great promise. Herein, Gint4.T-siHDGF chimera-capped mesoporous silica nanoparticles (MSN) encapsulating chemotherapy drug temozolomide (TMZ), termed as TMSN@siHDGF-Gint4.T, is developed to co-deliver gene-drug siHDGF and TMZ for synergistic GBM therapy. TMSN@siHDGF-Gint4.T possesses spherical nucleic acid-like architecture that can improve the enzyme resistance of siHDGF and increase the blood-brain barrier (BBB) permeability of the nanovehicle. The aptamer Gint4.T of chimera endows the nanovehicle with GBM cell-specific binding ability. When administered systemically, TMSN@siHDGF-Gint4.T can traverse BBB and enter GBM cells. In the acidic lysosome environment, the cleavage of benzoic-imine bond on MSN surface leads to an initial rapid release of chimera, followed by a slow release of TMZ encapsulated in MSN. The sequential release of siHDGF and TMZ first allows siHDGF to exert its gene-silencing effect, and the downregulation of HDGF expression further enhances the cytotoxicity of TMZ. In vivo experimental results have demonstrated that TMSN@siHDGF-Gint4.T significantly inhibits tumor growth and extends the survival time of GBM-bearing mice. Thus, the as-developed TMSN@siHDGF-Gint4.T affords a potential approach for the combination treatment of GBM.

The effect of heat moisture treatment times on physicochemical and digestibility properties of adzuki bean, pea, and white kidney bean flours and starches.

The effects of heat moisture treatment (HMT) times on the physicochemical properties of three bean flours and their starch were analyzed. The colors of L*, b* and ΔE values increased significantly with time. The adzuki bean and pea flours showed better WAI and SP, and better gelation of starch at 2 h. The rheological properties of mixed HMT dough (3:7) exhibited the typical solid-like weak gel behavior. HMT had a significantly decreased on the pasting viscosity of bean flour starch with treated time. HMT caused the starch granules damage, but did not radically change the crystal type. FTIR results showed more proteins attached to the surface of starch granules, and the short-range molecular order decreased the DO at 2 h. In vitro digestibility inferred that RDS converted into SDS and RS. These results indicated that HMT significantly affected the digestibility and physicochemical properties of bean flours.

Group-based PFMT programme for preventing and/or treating UI in pregnant women: protocol of a randomized controlled feasibility study.

BACKGROUND: Urinary incontinence (UI) is a prevalent health problem in women worldwide. Many women experience UI during pregnancy. The National Institute for Health and Care Excellence (NICE) recommended pelvic floor muscle training (PFMT) as the first-line conservative treatment for UI. However, it is not widely implemented due to the limited number of healthcare trainers. Group-based PFMT has been used with older women and a limited number of maternity studies. But the effectiveness of the group-based PFMT needs to be investigated because the overall quality of the studies is low. Therefore, this study aims to assess the feasibility of delivering a group-based PFMT programme for pregnant women in Nanjing city. METHODS: This feasibility study will be conducted in Nanjing Maternity and Child Health Care Hospital in China, using a mixed methods design to investigate the feasibility and acceptability of delivering group-based PFMT to pregnant women. Pregnant women with or without the symptoms of UI will be included. This study aims to recruit 48 pregnant women with 24 in each arm. Participants will receive either the group-based PFMT delivered by a midwife or usual antenatal care which includes only verbal instruction on PFMT. The study will assess the completion rates, acceptability of outcome measures, recruitment and retention rate and calculate an appropriate sample size for a future study. DISCUSSION: The results of this study will inform the design and implementation of a definitive randomized clinical trial to explore the effectiveness of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05242809.

An acetyltranferase moonlights as a regulator of the RNA binding repertoire of the RNA chaperone Hfq in Escherichia coli.

Bacterial small RNAs (sRNAs) regulate gene expression by base-pairing with their target mRNAs. In Escherichia coli and many other bacteria, this process is dependent on the RNA chaperone Hfq, a mediator for sRNA-mRNA annealing. YhbS (renamed here as HqbA), a putative Gcn5-related N-acetyltransferase (GNAT), was previously identified as a silencer of sRNA signaling in a genomic library screen. Here, we studied how HqbA regulates sRNA signaling and investigated its physiological roles in modulating Hfq activity. Using fluorescent reporter assays, we found that HqbA overproduction suppressed all tested Hfq-dependent sRNA signaling. Direct interaction between HqbA and Hfq was demonstrated both in vivo and in vitro, and mutants that blocked the interaction interfered with HqbA suppression of Hfq. However, an acetylation-deficient HqbA mutant still disrupted sRNA signaling, and HqbA interacted with Hfq at a site far from the active site. This suggests that HqbA may be bifunctional, with separate roles for regulating via Hfq interaction and for acetylation of undefined substrates. Gel shift assays revealed that HqbA strongly reduced the interaction between the Hfq distal face and low-affinity RNAs but not high-affinity RNAs. Comparative RNA immunoprecipitation of Hfq and sequencing showed enrichment of two tRNA precursors, metZWV and proM, by Hfq in mutants that lost the HqbA-Hfq interaction. Our results suggest that HqbA provides a level of quality control for Hfq by competing with low-affinity RNA binders.

Nonlinear Landau-Zener-Stückelberg-Majorana tunneling and interferometry of extended Bose-Hubbard flux ladders.

The nonlinear Landau-Zener-Stückelberg-Majorana (LZSM) tunneling dynamics and interferometry of an extended Bose-Hubbard flux ladder are studied. Based on the mean-field theory, the dispersion relation of the system is given, and it is found that loop structures periodically appear in the band structure and the nonlinear LZSM interference occurs naturally without Floquet engineering, which can be effectively modulated by atomic interactions. The nonlinear energy bands and the unique chirality feature of the flux ladder system can be identified through the dynamics of nonlinear Landau-Zener tunneling. Remarkably, the critical position of the noise in the interference pattern can be employed to identify the loop structure in the energy band, establishing an effective link between the nonlinear loop structure and LZSM interferometry. The position, intensity, symmetry, and width of interference patterns strongly depend on the magnetic field, atomic interactions, rung-to-leg coupling ratio, and energy bias, which provides an effective way to measure these parameters using the nonlinear LZSM interferometry. This paper further expands the dynamics of flux ladder systems to complex interaction regions and has potential applications in the precise measurement of related nonlinear systems.

σ28-dependent small RNA regulation of flagella biosynthesis.

Flagella are important for bacterial motility as well as for pathogenesis. Synthesis of these structures is energy intensive and, while extensive transcriptional regulation has been described, little is known about the posttranscriptional regulation. Small RNAs (sRNAs) are widespread posttranscriptional regulators, most base pairing with mRNAs to affect their stability and/or translation. Here, we describe four UTR-derived sRNAs (UhpU, MotR, FliX and FlgO) whose expression is controlled by the flagella sigma factor σ28 (fliA) in Escherichia coli. Interestingly, the four sRNAs have varied effects on flagellin protein levels, flagella number and cell motility. UhpU, corresponding to the 3´ UTR of a metabolic gene, likely has hundreds of targets including a transcriptional regulator at the top flagella regulatory cascade connecting metabolism and flagella synthesis. Unlike most sRNAs, MotR and FliX base pair within the coding sequences of target mRNAs and act on ribosomal protein mRNAs connecting ribosome production and flagella synthesis. The study shows how sRNA-mediated regulation can overlay a complex network enabling nuanced control of flagella synthesis.

Correlation of Lung Immune Prognostic Index With Efficacy of PD-1/PD-L1 Inhibitor Combined With Chemotherapy and Prognosis in Patients With Advanced Non-Small Cell Lung Cancer.

OBJECTIVE: Non-small cell lung cancer (NSCLC) is a devastating but universal class of lung carcinoma with an unfavorable prognosis. This paper mainly investigated the correlation between lung immune prognostic index (LIPI) score and combined treatment of immune checkpoint inhibitor and chemotherapy (CHT) in patients with advanced NSCLC. METHODS: Totally, 301 advanced NSCLC patients with programmed death-ligand 1 (PD-L1) expression ≥1% were assigned into good LIPI group (N=113), intermediate LIPI group (N=101), and poor LIPI group (N=87) based on LIPI scoring system, followed by treatment of CHT plus programmed cell death-1 (PD-1)/PD-L1 inhibitor. The differences in clinical parameters between subgroups of NSCLC patients were analyzed by χ 2 test, 1-way analysis of variance, and Kruskal-Wallis H test. All patients were followed up until June 30, 2022, and objective response rate, disease control rate, progression-free survival (PFS), and overall survival (OS) were recorded. The independent associations of LIPI score with PFS and OS were assessed via the Cox regression model. RESULTS: There were evident differences in clinical stage and lymphocyte among the 3 subgroups of NSCLC patients. The efficacy of PD-1/PD-L1 inhibitor combined with CHT was better in patients with good LIPI score, manifested by higher objective response rate and disease control rate. Moreover, LIPI score was an independent factor influencing PFS and OS in patients with advanced NSCLC, with longer PFS and OS in patients with good LIPI score. CONCLUSION: LIPI score has a predictive value for combination therapy of PD-1/PD-L1 blockade and CHT in advanced NSCLC patients.

Effect of psychological interventions on mental health, personal relationships and quality of life of women who have subjectively experienced traumatic childbirth.

BACKGROUND: No targeted review has assessed the effect of psychological interventions on the mental health, personal relationships, and the quality of life of women who have subjectively experienced traumatic childbirth. METHODS: Eight databases were searched from inception to January 2023. Study selection, data extraction, quality appraisal, and data analysis were conducted by two researchers independently. RESULTS: In total, eight studies were included. The results indicated that psychological interventions could effectively alleviate post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in women who have subjectively experienced traumatic childbirth. The interventions were more effective in alleviating PTSD symptoms than depression or anxiety. The subgroup analysis results showed that the effect of multiple sessions might be better than that of a single session. There was insufficient evidence supporting the effect of psychological interventions to improve personal relationships and the quality of life. LIMITATIONS: Study limitations included the small number of studies included for meta-analysis, substantial heterogeneity, and the retrieval of only studies written in English or Chinese. CONCLUSIONS: Psychological intervention is a promising method for the mental health of women who have subjectively experienced traumatic childbirth, but more studies are needed to confirm the effects. More studies are also required to explore the impact of psychological interventions on personal relationships and the quality of life. Future studies should focus on comparing which specific type of psychological intervention is most effective. Additional investigations should include the potential adverse effects and long-term effects of psychological interventions and details, such as content, process, and timing.

Research progress on ion channels and their molecular regulatory mechanisms in the human sperm flagellum.

The ion channels in sperm tail play an important role in triggering key physiological reactions, e.g., progressive motility, hyperactivation, required for successful fertilization. Among them, CatSper and KSper have been shown to be important ion channels for the transport of Ca2+ and K+ . Moreover, the voltage-gated proton channel Hv1, the sperm-specific sodium-hydrogen exchanger (sNHE), the epithelial sodium channel (ENaC), members of the temperature-sensitive TRP channel family, and the cystic fibrosis transmembrane regulator (CFTR) are also found in the flagellum. This review focuses on the latest advances in ion channels located at the flagellum, describes how they affect sperm physiological function, and summarizes some primary mutual regulation mechanism between ion channels, including PH, membrane potential, and cAMP. These ion channels may be promising targets for clinical application in infertility.

Utility of the capability, opportunity, and motivation behaviour (COM-B) model in explaining the negative association between pre-pregnancy body mass index and exclusive breastfeeding at six weeks postpartum.

The mechanisms underlying the negative associations between pre-pregnancy body mass index (BMI) and exclusive breastfeeding remain poorly understood. Thus, the study aimed to determine whether the negative associations between high pre-pregnancy BMI and exclusive breastfeeding at six weeks postpartum are mediated by components of the capability, opportunity, and motivation behaviour (COM-B) model. In this prospective observational study, we assigned 360 primiparous women to a pre-pregnancy overweight/obese group (n = 180) and a normal-BMI group (n = 180). A structural equation model was designed to study how capabilities (onset of lactogenesis II, perceived milk supply, breastfeeding knowledge, and postpartum depression), opportunities (pro-breastfeeding hospital practices, social influence, social support), and motivations (breastfeeding intention, breastfeeding self-efficacy, and attitudes towards breastfeeding) affected exclusive breastfeeding at six weeks postpartum in groups of women with different pre-pregnancy BMIs. In all, 342 participants (95.0%) possessed complete data. Women with high pre-pregnancy BMI were less likely to exclusively breastfeed at six weeks postpartum than women with a normal BMI were. We observed a significant negative direct effect of high pre-pregnancy BMI on exclusive breastfeeding at six weeks postpartum and a significantly negative indirect effect of high pre-pregnancy BMI via the explanatory mediating variables of capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy) on exclusive breastfeeding at six weeks postpartum. Our findings support certain capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy), partially explaining the negative association between high pre-pregnancy BMI and exclusive breastfeeding outcome. We suggest that interventions aimed at promoting exclusive breastfeeding among women with high pre-pregnancy BMI should address the capacity and motivation factors specific to this population.