Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis.

OBJECTIVE: Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth. DATA SOURCES: MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023. STUDY ELIGIBILITY CRITERIA: Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included. METHODS: Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies. RESULTS: Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months. CONCLUSION: This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.

Cesarean delivery is associated with suppressed activities of the stress axes.

Maternal pre- and post-delivery stress levels might be different for vaginal or cesarean deliveries. This study aimed to investigate the effects of type of delivery (vaginal or cesarean) and time of delivery (pre- and post-delivery) on the stress axes of the body, namely the hypothalamic-pituitary adrenal axis (HPA) and autonomic nervous system (ANS).Ninety-one pregnant women were volunteered to participate this prospective study. In these women, pre- and post-delivery HPA and ANS activities were measured noninvasively by salivary cortisol and heart rate variability (HRV), respectively. HRV was measured by 5-min electrocardiogram recording and time- and frequency-domain parameters were computed.Salivary cortisol concentration and HRV parameters were higher in women having vaginal delivery than those having cesarean delivery (p < 0.05). Cortisol levels did not differ between pre- and post-delivery (p > 0.05) but the time-domain parameters of HRV decreased post-delivery (p < 0.05). No interactions were observed between the types and times of delivery (p > 0.05).HPA and ANS axes had different activity patterns throughout the delivery process and they were higher during vaginal delivery, suggesting that they are integral parts of normal birth process and that cesarean delivery perturbs the activity of both axes.

Caesarean delivery and early childhood caries: Estimation with marginal structural models in Brazilian pre-schoolers.

OBJECTIVE: This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. METHODS: This was a historical cohort study of 697 mother-child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio-MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect-ATE coefficients), weighted by the inverse probability (IPW) of exposure. RESULTS: Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70-0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67-0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = -0.35; P = 0.107), controlling for IPW of exposure. CONCLUSION: The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality.

Perfil clínico e epidemiológico da gravidez na adolescência: um estudo ecológico / Clinical and epidemiological profile of pregnancy in adolescence: an ecological study

OBJETIVO: Descrever o perfil clínico e epidemiológico da gestação na adolescência buscando possíveis diferenças em relação à gestação em mulheres adultas. MÉTODOS: Estudo ecológico a partir de dados secundários (DATA-SUS). Foram estudadas três grupos de variáveis: as relacionadas à mãe, as relacionadas ao parto e as relacionadas ao RN. A análise dos dados foi realizada pelo Teste Qui-quadrado de independência, considerando-se significante P ≤ 0,05. Foram utilizadas planilhas do Microsoft Excel, versão 2013, software Epi Info v.7, para a obtenção do Odds Ratio (OR), com intervalo de confiança (IC) de 95%. RESULTADOS: Foram avaliadas 48.277 gestações, sendo 4.453 (9,22%) em adolescentes com idade média de 16,92 anos (+1,16), e 43.824 (90,78%) em mulheres adultas com idade média de 27,89 anos (+ 5,77). As mães adolescentes eram solteiras (54,61%) e brancas (98,02%) em sua maioria e apresentaram gestação única (98,92%). A prematuridade ocorreu em 10,21%, 61,5% dos partos foram vaginais, com 99,73% ocorridos em ambiente hospitalar. Com relação ao recém-nascido, 51,99% eram do sexo masculino e o baixo peso ao nascer foi de 9,57%. Apgar < 7 no 1º minuto foi de 16,63%, e no 5º minuto, 2,14%. A presença de anomalias congênitas em filhos de mães adolescentes foi de 1,15%. CONCLUSÃO: A gravidez na adolescência se associou com menor número de consultas de pré-natal, maiores taxas de prematuridade e baixo peso, com maior ocorrência de parto vaginal e de anomalias congênitas no RN.

OBJECTIVE: To describe the clinical and epidemiological profile of pregnancy in adolescence, searching possible differences in relation to pregnancy in adult women. METHODS: Ecological study based on secondary data (DATA-SUS). Three groups of variables were studied: those related to the mother, those related to childbirth and those related to the newborn. The data analysis was performed by the Qui-square test of independence, being considered significant P ≤ 0.05. Microsoft Excel spreadsheets, version 2013, Epi Info v.7 software were used to obtain the Odds Ratio (OR), with a 95% confidence interval (CI). RESULTS: A total of 48,277 pregnancies were evaluated, of which 4,453 (9.22%) were adolescents aged 16.92 +1.16 years, and 43,824 (90.78%) in adult women aged of 27.89 years +5.77. Adolescent mothers were single (54.61%) and white (98.02%) in the majority, and presented single gestation (98.92%). Prematurity occurred in 10.21%, and 61.5% of deliveries were vaginal. With regard to the newborn, 51.99% were male and the low birth weight occurred in 9.57%. Apgar <7 in the 1st and 5th minute was present in 16.63% and 2.14% respectively. The presence of congenital anomalies in children of adolescent mothers was 1.15%. CONCLUSION: Adolescent pregnancy was associated with: a lower number of prenatal appointments, higher rates of prematurity and low birth weight, higher incidence of vaginal delivery and congenital anomalies

Principales factores de riesgo de la morbilidad y mortalidad neonatales / Main risk factors of neonates morbidity and mortality

Se revisó la bibliografía disponible sobre la morbilidad y mortalidad neonatales, tanto nacional como foránea y se decidió hacer referencia a importantes aspectos relacionados con el tema, entre los cuales figuraron, además de una reseña histórica: clasificación y registro de las causas de muerte (síndrome de dificultad respiratoria, enfermedad de la membrana hialina, infecciones, displasia broncopulmonar y malformaciones congénitas), tipo de parto (complicaciones y prematuridad), así como bajo peso al nacer. De la información obtenida se infirió que el nacimiento de neonatos con insuficiencia ponderal para la edad gestacional, todavía constituye una grave situación de salud en el mundo de hoy, sobre todo en los países tercermundistas, donde no se dispone de recursos suficientes para brindar una adecuada asistencia sanitaria a la población.

The available literature either national or foreign about the neonate morbidity and mortality was reviewed and it was decided to make reference to important aspects related with the topic, among which there were figured, besides a historical review: classification and register of the death causes (distress syndrome, hyaline membrane disease, infections, bronchopulmonary dysplasia and congenital malformations), delivery type (complications and prematurity), as well as low birth weight. Of the obtained information it was inferred that the neonates birth with ponderal inadequacy for the gestational age, still constitutes a severe health situation in today's world, mainly in the third world countries, where enough resources are nor disposable to offer an appropriate health care to the population.