Postpartum care in a cardio-obstetric clinic after preterm preeclampsia: patient and healthcare provider perspectives.

BACKGROUND: Despite the significant disruption and health implications of preterm preeclampsia with severe features for birthing people, little is known about how the system of postpartum care might be strengthened for affected families. Multidisciplinary cardio-obstetric clinics are emerging; however, there is limited research on patient and healthcare provider perspectives. OBJECTIVE: To describe patient and healthcare provider perspectives of services in a cardio-obstetric clinic following preterm preeclampsia with severe features. STUDY DESIGN: Individuals who experienced preterm preeclampsia with severe features and presented to a cardio-obstetric clinic were approached for study participation. Providers were approached if they provided postpartum care to patients with preterm preeclampsia with severe features and considered a referral to the cardio-obstetric clinic. Participants completed a remotely conducted, semistructured interview between March 2022 and April 2023. The interviews were audio-recorded, professionally transcribed, and checked for accuracy. Responses were inductively coded for content analysis around the study questions of clinical referrals, patient education, visit expectations, and care coordination in relation to ambulatory clinical services. RESULTS: Twenty participants (n=10 patients and n=10 providers) completed interviews. Healthcare system navigation was difficult, particularly in the context of postpartum needs. When patients are informed about their diagnosis, the information could both increase anxiety and be useful for long-term healthcare planning. Language concordant care did not always occur, and both patients and providers described gaps in quality services. Within the theme of responsibility, patients described needing to be vigilant, and providers recognized the gaps in referral and care coordination systems. Comprehensible patient education provided with birthing parents' companions and enhanced systems for care coordination were areas for further improvement in providing postpartum cardio-obstetric care following preterm preeclampsia. CONCLUSION: This qualitative study identified patients' struggles with a confusing postpartum healthcare system and captured providers' concerns about maintaining consistent care and improving access to long-term healthcare services to improve outcomes for patients at risk of cardiovascular disease.

Promoting Health for Latino Immigrant Families-A Call for Improved Systems and Policies.

This Viewpoint examines existing systems affecting Latino immigrant families' access to health care and offers potential policy solutions to promote the health and well-being of Latino immigrant families.

Perinatal use of lurasidone for the treatment of bipolar disorder.

Atypical antipsychotics are commonly prescribed for the treatment of severe mental illnesses during pregnancy. Evidence regarding the impact of physiologic changes during pregnancy on the concentration of atypical antipsychotics is limited, specifically in the case of lurasidone. Data to guide dosing in pregnancy that maximizes efficacy and minimizes adverse effects are lacking. This case report presents perinatal changes in the concentration of lurasidone and the implications for Bipolar Disorder (BD) illness course in a primiparous woman. Monitoring of lurasidone serum concentrations and recurrence of BD symptoms after the second trimester of pregnancy until the third postpartum month was completed. Lurasidone serum concentrations ranged from 0 to 4.7 ng/mL during pregnancy and increased to 10-12 ng/mL postpartum. The subject presented with worsening anxiety and depressive symptoms during the second trimester of pregnancy which resulted in a 40 mg daily dose increase during the second half of her pregnancy. Despite the decrease in lurasidone to the preconception dose post-delivery, the concentrations were higher postpartum compared to pregnancy. The decrease in lurasidone serum concentrations during pregnancy may increase the risk of worsening BD symptoms and suggests the need for determination of whether therapeutic monitoring and dose titration during pregnancy decreases illness exacerbation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Use of Antipsychotic Drugs During Pregnancy.

PURPOSE OF REVIEW: Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes. RECENT FINDINGS: The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments. SUMMARY: In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.

Transgenerational Effects of Bisphenol A on Gene Expression and DNA Methylation of Imprinted Genes in Brain.

Bisphenol A (BPA) is a ubiquitous man-made endocrine disrupting compound (EDC). Developmental exposure to BPA changes behavioral and reproductive phenotypes, and these effects can last for generations. We exposed embryos to BPA, producing two lineages: controls and BPA exposed. In the third filial generation (F3), brain tissues containing the preoptic area, the bed nucleus of the stria terminalis, and the anterior hypothalamus were collected. RNA sequencing (RNA-seq) and subsequent data analyses revealed 50 differentially regulated genes in the brains of F3 juveniles from BPA vs control lineages. BPA exposure can lead to loss of imprinting, and one of the two imprinted genes in our data set, maternally expressed gene 3 (Meg3), has been associated with EDCs and neurobehavioral phenotypes. We used quantitative polymerase chain reaction to examine the two imprinted genes in our data set, Meg3 and microRNA-containing gene Mirg (residing in the same loci). Confirming the RNA-seq, Meg3 messenger RNA was higher in F3 brains from the BPA lineage than in control brains. This was true in brains from mice produced with two different BPA paradigms. Next, we used pyrosequencing to probe differentially methylated regions of Meg3. We found transgenerational effects of BPA on imprinted genes in brain. Given these results, and data on Meg3 methylation in humans, we suggest this gene may be a biomarker indicative of early life environmental perturbation.

Interviewing Neuroscientists for an Undergraduate Honors Project.

Honors projects that supplement standard coursework are a widely used practice in undergraduate curricula. These projects can take many forms, ranging from laboratory research projects to performing service learning to literature analyses. Here we discuss an honors project focused on interviewing neuroscientists to learn about individual scientific practice and career paths, and synthesizing the resulting information into a personal reflection essay. We detail step-by-step instructions for performing this type of project, including how to develop interview questions, a sample project timeline, deliverables, learning objectives and outcomes, and address potential pitfalls. We provide sample interview questions, an interview solicitation email, and in the supplemental materials an example student reflection essay, assessment rubrics, and the transcription of a student-conducted interview of Drs. John Godwin and Santosh Mishra of North Carolina State University. This type of project is a promising method to enable student-researcher communication, and potentially useful to a broad spectrum of both honors and non-honors neuroscience coursework.