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1.
Trop Anim Health Prod ; 53(1): 73, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33400003

RESUMO

In postpartum buffaloes, the process of uterine involution and changes in blood metabolic profile has not been studied in relation to development of subclinical endometritis (SCE). In this study, buffaloes (n = 100) approaching calving were identified. Weekly blood samples were collected on the day of calving up to 6 weeks post-calving. The diameter of uterine horns and onset of ovarian cyclicity (corpus luteum) were recorded through ultrasonography. On the basis of polymorphonuclear cell (PMN) cell count in endometrial cytology at days 45-50 postpartum, buffaloes were divided into two groups, viz., with SCE (> 5% PMN; n = 38) and without SCE (≤ 5% PMN; n = 62). Buffaloes with SCE took longer (P < 0.05) time to complete uterine involution and had larger (P < 0.05) uterine horn diameter between 3rd and 6th weeks postpartum and lower prostaglandin F2α metabolite (PGFM) concentration on the day of calving (P < 0.05) and 1 week (P < 0.001) post-calving than without SCE group. Buffaloes with SCE had lower (P < 0.001) concentration of glucose at weeks 2 and 3, higher (P < 0.001) ß-hydroxybutyric acid (BHBA) at week 3, and lower serum albumin concentration throughout the sampling period (P < 0.05 to 0.001) except at 1 week post-calving as compared to without SCE group. The urea concentration was significantly lower (P < 0.05 to 0.001) in buffaloes with SCE from 4 weeks post-calving onwards than without SCE group. The calcium concentration was lower in buffaloes with SCE at weeks 5 (P < 0.001) and 6 (P < 0.05) postpartum, whereas the concentration of magnesium and phosphorus was uniform between the two groups. No significant (P > 0.05) difference in onset of ovarian cyclicity between the 2 groups was observed, whereas buffaloes with SCE had longer (P = 0.001) median days open (141 days) than their counterpart (117 days). The first service conception rate, cumulative pregnancy rate, and pregnancy rate at 150 days postpartum were lower (P < 0.05) in buffaloes with SCE than without SCE group. In summary, higher BHBA and lower serum concentrations of glucose, albumin, urea, and calcium control onset of subclinical endometritis which in turn has negative impact on fertility of buffaloes.


Assuntos
Búfalos/fisiologia , Endometrite/veterinária , Fertilidade , Período Pós-Parto/sangue , Útero/anatomia & histologia , Ácido 3-Hidroxibutírico/sangue , Animais , Glicemia/metabolismo , Búfalos/sangue , Cálcio/sangue , Endometrite/epidemiologia , Endometrite/fisiopatologia , Endométrio/citologia , Endométrio/metabolismo , Feminino , Magnésio/sangue , Fósforo/sangue , Período Pós-Parto/fisiologia , Gravidez , Prevalência , Albumina Sérica/análise , Ultrassonografia/veterinária , Ureia/sangue , Útero/diagnóstico por imagem , Útero/fisiologia
2.
PLoS One ; 15(12): e0244449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382776

RESUMO

Dietary changes during pregnancy (DP) and post-partum are essential for women's nutrition status and the health of their offspring. We compared the diet quality DP and at 3-year post-partum (3YPP) and assessed the relationship between maternal diet quality and nutritional status using a prospective cohort design among women in East Jakarta. In total, 107 women were recruited from the study in 2014 and followed up at 3YPP in 2018. The mid-upper arm circumference (MUAC), weight, and height were evaluated. Food consumption data were collected from repeated 24-h recalls. The validated US Diet Quality Index-Pregnancy (DQI-P) scores with eight components were calculated using the food consumption data and compared between DP and 3YPP. Associations of the DQI-P score with the MUAC and weight gain DP and body mass index (BMI) at 3YPP were analyzed using multivariable linear and logistic regression. The median of the DQI-P score DP was significantly higher than at 3YPP [35 (27; 42) versus 27 (19; 30); p-value <0.001, respectively]. The higher DQI-P score was associated with increased weight gain DP of 3.3 kg (adjusted ß = 3.30, 95% confidence interval = 1.06-5.54) after adjusting for the mother's age and household income. The DQI-P score was not associated with an increased risk of chronic energy deficiency DP and overweight-obesity at 3YPP. Thus, the diet adequacy was associated with weight gain DP but did not affect the MUAC DP and BMI at 3YPP. The DQI-P score DP was slightly better than the diet at 3YPP; however, the overall diet quality was inadequate. In conclusion, a higher DQI-P score was associated with increased weight gain DP of 3.3 kg but was not associated with other nutritional status indices in DP and 3YPP. Innovative dietary quality improvement programs are required to reduce malnutrition risk in pregnant and reproductive-age women.


Assuntos
Ganho de Peso na Gestação/fisiologia , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Obesidade/epidemiologia , Período Pós-Parto/fisiologia , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Indonésia/epidemiologia , Avaliação Nutricional , Estado Nutricional/fisiologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Gravidez , Estudos Prospectivos , Adulto Jovem
3.
JAMA Netw Open ; 3(12): e2030815, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351087

RESUMO

Importance: Maternal morbidity and mortality are increasing in the United States, most of which occur post partum, with significant racial disparities, particularly associated with hypertensive disorders of pregnancy. Blood pressure trajectory after a hypertensive disorder of pregnancy has not been previously described. Objectives: To describe the blood pressure trajectory in the first 6 weeks post partum after a hypertensive disorder of pregnancy and to evaluate whether blood pressure trajectories differ by self-reported race. Design, Setting, and Participants: This prospective cohort study included deliveries between January 1, 2018, and December 31, 2019. Women with a clinical diagnosis of a hypertensive disorder of pregnancy were enrolled in a postpartum remote blood pressure monitoring program at the time of delivery and were followed up for 6 weeks. Statistical analysis was performed from April 6 to 17, 2020. Main Outcomes and Measures: Mixed-effects regression models were used to display blood pressure trajectories in the first 6 weeks post partum. Results: A total of 1077 women were included (mean [SD] age, 30.2 [5.6] years; 804 of 1017 White [79.1%] and 213 of 1017 Black [20.9%]). Systolic and diastolic blood pressures were found to decrease rapidly in the first 3 weeks post partum, with subsequent stabilization (at 6 days post partum: mean [SD] peak systolic blood pressure, 146 [13] mm Hg; mean [SD] peak diastolic blood pressure, 95 [10] mm Hg; and at 3 weeks post partum: mean [SD] peak systolic blood pressure, 130 [12] mm Hg; mean [SD] peak diastolic blood pressure, 85 [9] mm Hg). A significant difference was seen in blood pressure trajectory by race, with both systolic and diastolic blood pressure decreasing more slowly among Black women compared with White women (mean [SD] peak systolic blood pressure at 1 week post partum: White women, 143 [14] mm Hg vs Black women, 146 [13] mm Hg; P = .01; mean [SD] peak diastolic blood pressure at 1 week post partum: White women, 92 [9] mm Hg vs Black women, 94 [9] mm Hg; P = .02; and mean [SD] peak systolic blood pressure at 3 weeks post partum: White women, 129 [11] mm Hg vs Black women, 136 [15] mm Hg; P < .001; mean [SD] peak diastolic blood pressure at 3 weeks post partum: White women, 84 [8] mm Hg vs Black women, 91 [13] mm Hg; P < .001). At the conclusion of the program, 126 of 185 Black women (68.1%) compared with 393 of 764 White women (51.4%) met the criteria for stage 1 or stage 2 hypertension (P < .001). Conclusions and Relevance: This study found that, in the postpartum period, blood pressure decreased rapidly in the first 3 weeks and subsequently stabilized. The study also found that, compared with White women, Black women had a less rapid decrease in blood pressure, resulting in higher blood pressure by the end of a 6-week program. Given the number of women with persistent hypertension at the conclusion of the program, these findings also appear to support the importance of ongoing postpartum care beyond the first 6 weeks after delivery.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea/fisiologia , Hipertensão Induzida pela Gravidez , Período Pós-Parto/fisiologia , Adulto , Afro-Americanos/estatística & dados numéricos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/etnologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Determinação de Necessidades de Cuidados de Saúde , Serviços Preventivos de Saúde , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia
5.
Transplantation ; 104(8): 1675-1685, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732847

RESUMO

BACKGROUND: The incidence of pregnancy in kidney transplantation (KT) recipients is increasing. Studies report that the incidence of graft loss (GL) during pregnancy is low, but less data are available on long-term effects of pregnancy on the graft. METHODS: Therefore, we performed a meta-analysis and systematic review on GL and graft function, measured by serum creatinine (SCr), after pregnancy in KT recipients, stratified in years postpartum. Furthermore, we included studies of nulliparous KT recipients. RESULTS: Our search yielded 38 studies on GL and 18 studies on SCr. The pooled incidence of GL was 9.4% within 2 years after pregnancy, 9.2% within 2-5 years, 22.3% within 5-10 years, and 38.5% >10 years postpartum. In addition, our data show that, in case of graft survival, SCr remains stable over the years. Only within 2 years postpartum, Δ SCr was marginally higher (0.18 mg/dL, 95%CI [0.05-0.32], P = 0.01). Furthermore, no differences in GL were observed in 10 studies comparing GL after pregnancy with nulliparous controls. Systematic review of the literature showed that mainly prepregnancy proteinuria, hypertension, and high SCr are risk factors for GL. CONCLUSIONS: Overall, these data show that pregnancy after KT has no effect on long-term graft survival and only a possible effect on graft function within 2 years postpartum. This might be due to publication bias. No significant differences were observed between pre- and postpartum SCr at longer follow-up intervals.


Assuntos
Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto/fisiologia , Transplante de Rim/efeitos adversos , Período Pós-Parto/fisiologia , Complicações na Gravidez/epidemiologia , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Humanos , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Fatores de Risco
6.
PLoS One ; 15(8): e0238232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853233

RESUMO

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Estudos de Coortes , Aconselhamento/métodos , Revelação , Feminino , Humanos , Estudos Longitudinais , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Pesquisa Qualitativa , Estigma Social , Apoio Social , Tanzânia , Carga Viral/fisiologia , Adulto Jovem
7.
PLoS One ; 15(8): e0237852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853242

RESUMO

Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson's total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level.


Assuntos
Utilização de Instalações e Serviços , Serviços de Saúde , Doenças do Recém-Nascido/epidemiologia , Período Pós-Parto/fisiologia , Transtornos Puerperais/epidemiologia , População Rural , Adolescente , Adulto , Peso ao Nascer , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Adulto Jovem
8.
Diabetes Res Clin Pract ; 166: 108309, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32650034

RESUMO

AIMS: This study evaluates the adherence to postpartum type 2 diabetes mellitus (T2DM) screening in women with previous gestational diabetes (GDM) and identifies elements associated with poor attendance. METHODS: We retrospectively collected data from 650 consecutive women with GDM between 2016 and 2018, who should had 75 g-OGTT, 4-12 weeks after delivery. Impaired glucose regulation (IGR) was defined according with ADA criteria. RESULTS: Only 41% of women had postpartum OGTT. Of these, 1.9% received T2DM diagnosis, with IGR prevalence of 18%. After introducing a recommendation letter, adherence to screening increased (47% in 2017 and 43% in 2018 vs. 32% in 2016). Screening procedure was less common in women with: no-family history of T2DM (38% vs. 46%; p < 0.05), age <35 (33% vs. 47%; p < 0.01), lower level of education (32% no-high-school-diploma vs. 35% high-school-diploma vs. 49% university-degree; p < 0.01) and unstable employment (35% vs. 44%; p < 0.05). At multivariate logistic regression analysis, age <35 years (OR 1.61; 95%CI: 1.14-2.28) and lowest educational level (OR 1.64; 95% CI: 1.13-2.37, compared to University degree) were independently associated with non-adherence. CONCLUSION: Only 41% of women had postpartum T2DM screening. Women with lower attendance are those with age <35 years or low educational level. Further strategies are needed to implement postpartum test.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional/epidemiologia , Período Pós-Parto/fisiologia , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
9.
PLoS One ; 15(7): e0230992, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722725

RESUMO

BACKGROUND: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.


Assuntos
Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Ocitocina/sangue , Parto/fisiologia , Parto/psicologia , Feminino , Humanos , Comportamento Materno , Serviços de Saúde Materna , Tocologia , Modelos Biológicos , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Apoio Social , Estresse Fisiológico
10.
Medicine (Baltimore) ; 99(28): e20815, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664074

RESUMO

BACKGROUND: The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential. OBJECTIVE: To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women. METHODS: A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively. RESULTS: At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = -11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ = 23.353, P < .001; χ = 11.853, P < .001; χ = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = -3.801, P < .001). CONCLUSION: The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery. CLINICAL TRIAL REGISTRATION: ChiCTR1900026006 .


Assuntos
Aleitamento Materno/psicologia , Cesárea/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , China/etnologia , Cultura , Feminino , Humanos , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , Satisfação do Paciente/etnologia , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto/fisiologia , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
11.
Rev Lat Am Enfermagem ; 28: e3293, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578751

RESUMO

OBJECTIVE: to investigate female sexual function in women six months postpartum and to compare sexual function among women who had and who did not have severe maternal morbidity (SMM). METHOD: a cross-sectional study conducted with 110 women in the postpartum period, with and without SMM. Two instruments were used, one for the characterization of sociodemographic and obstetric variables and the Female Sexual Function Index (FSFI) for sexual function. Univariate, bivariate and regression model analyses were performed. RESULTS: FSFI scores showed 44.5% of female sexual dysfunction, of which 48.7% were among women who had SMM and 42.0% among those who had not. There were significant differences between age (P=0.013) and duration of pregnancy (P<0.001) between women with or without SMM. Among the cases of SMM, hypertensive disorders were the most frequent (83%). An association was obtained between some domains of the FSFI and the following variables: orgasm and self-reported skin color, satisfaction and length of relationship, and pain and SMM. CONCLUSION: white women have greater difficulty in reaching orgasm when compared to non-white women and women with more than 120 months of relationship feel more dissatisfied with sexual health than women with less time in a relationship. Women who have had some type of SMM have more dyspareunia when compared to women who have not had SMM.


Assuntos
Satisfação Pessoal , Período Pós-Parto/fisiologia , Comportamento Sexual/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Período Pós-Parto/psicologia , Comportamento Sexual/psicologia , Saúde Sexual , Sexualidade , Fatores Socioeconômicos , Inquéritos e Questionários
12.
PLoS One ; 15(5): e0230704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32357152

RESUMO

BACKGROUND: Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. METHODS: In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test. FINDINGS: During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96). CONCLUSION: Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.


Assuntos
Hipnose/métodos , Dor do Parto/terapia , Parto/metabolismo , Terapia de Relaxamento , Adulto , Analgesia Obstétrica/efeitos adversos , Parto Obstétrico , Feminino , Humanos , Hidrocortisona/metabolismo , Dor do Parto/metabolismo , Dor do Parto/fisiopatologia , Trabalho de Parto/fisiologia , Parto/fisiologia , Satisfação do Paciente , Período Pós-Parto/metabolismo , Período Pós-Parto/fisiologia , Gravidez , Cuidado Pré-Natal , Saliva/metabolismo
13.
Medicine (Baltimore) ; 99(18): e20045, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358387

RESUMO

Previous studies have demonstrated that cognitive dysfunction is associated with neurophysiological changes in postpartum period. This study aimed to investigate the intrinsic functional connectivity (FC) pattern within the default mode network (DMN) and its associations with cognitive dysfunction in postpartum women without depression revealed by resting-state functional magnetic resonance imaging (fMRI).Resting-state fMRI scans were acquired from 21 postpartum women and 21 age- and education-matched nulliparous women. The posterior cingulate cortex (PCC) was selected as the seed region to detect the FC patterns and then determine whether these changes were related to specific cognitive performance.Compared with the nulliparous women, postpartum women had a significantly decreased FC between the PCC and the left medial prefrontal cortex (mPFC). After correcting for age and education, the reduced FC between the PCC and the left mPFC was positively correlated with the poorer Clock-Drawing Test (CDT) scores in postpartum women (r = 0.742, P < .001).The present study mainly demonstrated decreased resting-state FC pattern within the DMN regions that was linked with impaired cognitive function in postpartum women. These findings illustrated the potential role of the DMN in postpartum women that will provide novel insight into the underlying neuropathological mechanisms in postpartum period.


Assuntos
Encéfalo/fisiologia , Disfunção Cognitiva/fisiopatologia , Período Pós-Parto/fisiologia , Adulto , Mapeamento Encefálico , Feminino , Humanos , Imagem por Ressonância Magnética , Testes de Estado Mental e Demência , Fatores Socioeconômicos , Adulto Jovem
15.
PLoS Med ; 17(5): e1003104, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32427997

RESUMO

BACKGROUND: The relation between prepregnancy average glucose concentration and a woman's risk of severe maternal morbidity (SMM) is unknown. The current study evaluated whether an elevated preconception hemoglobin A1c (A1c) is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (DM). METHODS AND FINDINGS: A population-based cohort study was completed in Ontario, Canada, where there is universal healthcare. The main cohort included 31,225 women aged 16-50 years with a hospital live birth or stillbirth from 2007 to 2015, and who had an A1c measured within 90 days before conception, including 28,075 women (90%) without known prepregnancy DM. The main outcome was SMM or maternal mortality from 23 weeks' gestation up to 42 days postpartum. Relative risks (RRs) were generated using modified Poisson regression, adjusting for the main covariates of maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. The mean maternal age was 31.1 years. Overall, SMM or death arose among 682 births (2.2%). The RR of SMM or death was 1.16 (95% CI 1.14-1.19; p < 0.001) per 0.5% increase in A1c and 1.16 (95% CI 1.13-1.18; p < 0.001) after adjusting for the main covariates. The adjusted relative risk (aRR) was increased among those with (1.11, 95% CI 1.07-1.14; p < 0.001) and without (1.15, 95% CI 1.02-1.29; p < 0.001) known prepregnancy diabetes, and upon further adjusting for body mass index (BMI) (1.15, 95% CI 1.11-1.20; p < 0.001), or chronic hypertension and prepregnancy serum creatinine (1.11, 95% CI 1.04-1.18; p = 0.002). The aRR of SMM or death was 1.31 (95% CI 1.06-1.62; p = 0.01) in those with a preconception A1c of 5.8%-6.4%, and 2.84 (95% CI 2.31-3.49; p < 0.001) at an A1c > 6.4%, each relative to an A1c < 5.8%. Among those without previously recognized prepregnancy diabetes and whose A1c was >6.4%, the aRR of SMM or death was 3.25 (95% CI 1.76-6.00; p < 0.001). Study limitations include that selection bias may have incorporated less healthy women tested for A1c, and BMI was unknown for many women. CONCLUSIONS: Our findings indicate that women with an elevated A1c preconception may be at higher risk of SMM or death in pregnancy or postpartum, including those without known prepregnancy DM.


Assuntos
Idade Gestacional , Hemoglobina A Glicada/metabolismo , Mortalidade Materna , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Nascimento Vivo/epidemiologia , Masculino , Idade Materna , Pessoa de Meia-Idade , Período Pós-Parto/fisiologia , Gravidez , Fatores de Risco , Adulto Jovem
16.
Sci Rep ; 10(1): 8546, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32444809

RESUMO

Sleep and local field potential (LFP) characteristics were addressed during the reproductive cycle in female rats using long-term (60-70 days) recordings. Changes in homeostatic sleep regulation was tested by sleep deprivation (SDep). The effect of mother-pup separation on sleep was also investigated during the postpartum (PP) period. First half of the pregnancy and early PP period showed increased wakefulness (W) and higher arousal indicated by elevated beta and gamma activity. Slow wave sleep (SWS) recovery was suppressed while REM sleep replacement was complete after SDep in the PP period. Pup separation decreased maternal W during early-, but increased during middle PP while did not affect during late PP. More W, less SWS, higher light phase beta activity but lower gamma activity was seen during the post-weaning estrus cycle compared to the virgin one. Maternal sleep can be governed by the fetuses/pups needs and their presence, which elevate W of mothers. Complete REM sleep- and incomplete SWS replacement after SDep in the PP period may reflect the necessity of maternal REM sleep for the offspring while SWS increase may compete with W essential for maternal care. Maternal experience may cause sleep and LFP changes in the post-weaning estrus cycle.


Assuntos
Estro/fisiologia , Homeostase , Período Pós-Parto/fisiologia , Privação do Sono/fisiopatologia , Sono/fisiologia , Vigília/fisiologia , Desmame , Animais , Feminino , Gravidez , Ratos
17.
PLoS One ; 15(5): e0232901, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396578

RESUMO

During pregnancy, an array of changes occurs in women body to enable the growth and development of the future baby and the consequent delivery. These changes are reflected in the range of motion of trunk, pelvis, lower limbs and other body segments, affect the locomotion and some of these changes may persist to the postpartum period. The aim of this study was to describe the changes affecting the gait during pregnancy and to determine the effect of tested footwear on kinematic gait characteristics during pregnancy as previous studies indicate that special orthopaedic insoles and footwear might be useful in prevention of the common musculoskeletal pain and discomfort related to pregnancy. Participants from the control group (n = 18), without any intervention, and the experimental group (n = 23), which was wearing the tested shoes, were measured at their 14, 28 and 37 gestational weeks and 28 weeks postpartum to capture the complete pregnancy-related changes in gait. The gait 3D kinematic data were obtained using Simi Motion System. The differences between the control and experimental group at the first data collection session in most of the analysed variables, as well as relatively high standard deviations of analysed variables indicate large individual differences in the gait pattern. The effect of tested footwear on kinematic gait pattern changes may be explained by its preventive effect against the foot arches falling. In the control group, changes associated previously with the foot arches falling and hindfoot hyperpronation were observed during advanced phases of pregnancy and postpartum, e.g. increase in knee flexion or increase in spinal curvature. For the comprehensive evaluation of the tested footwear on pregnancy gait pattern, future studies combining the kinematic and dynamic plantographic methods are needed.


Assuntos
Desenho de Equipamento/métodos , Marcha/fisiologia , Dor Musculoesquelética/prevenção & controle , Período Pós-Parto/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Órtoses do Pé , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle
18.
Phys Ther ; 100(9): 1681-1689, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32367136

RESUMO

OBJECTIVE: There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12 months postpartum. METHODS: This study used a prospective cohort design. At 6 weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30 min/wk) were compared with 120 nonexercisers (mean age = 29 years, SD = 4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). RESULTS: No differences were found between exercisers (n = 57) and non-exercisers (n = 120) at 6 weeks postpartum on vaginal resting pressure (B = -0.04 [95% CI = -3.4 to 2.1]), PFM strength (B = 0.03 [95% CI = -4.7 to 7.4]), PFM endurance (B = -0.02 [95% CI = -59 to 46]), or symptoms of SUI (OR = 0.51 [95% CI = 0.25 to 1.1]) or POP (OR = 0.62 [95% CI = 0.26 to 1.5]) measured at 12 months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and >30 were more likely to report SUI 12 months postpartum (OR = 2.2 [95% CI = 1.0 to 4.7] and OR = 3.3 [95% CI = 1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12 months postpartum (OR = 3.0 [95% CI = 1.2 to 7.3]). CONCLUSIONS: This study suggests that regular exercise 6 weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. IMPACT: Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6 weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. LAY SUMMARY: First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.


Assuntos
Exercício Físico/fisiologia , Doenças Musculares/epidemiologia , Diafragma da Pelve/fisiologia , Período Pós-Parto/fisiologia , Adulto , Feminino , Humanos , Manometria , Força Muscular/fisiologia , Ocupações , Sobrepeso/complicações , Paridade , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/etiologia , Gravidez , Prevalência , Estudos Prospectivos , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/etiologia , Vagina/fisiologia
19.
Medicine (Baltimore) ; 99(17): e19863, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332648

RESUMO

BACKGROUND: Pregnancy is one of the main risk factor of pelvic floor muscle dysfunction. Postpartum women with extremely weak muscle strength have difficulty to do voluntary pelvic floor muscle training. This study aims to evaluate the effects of different protocols of electrical stimulation in the treatment of postpartum women with extremely weak muscle strength. METHODS: A total of 67 women were randomized into 2 groups: group A received transvaginal electrical stimulation (TVES) for 5 times, and group B received TVES for 3 times with electromyogram (EMG)-triggered neuromuscular stimulation twice. Subjects were evaluated before and after treatment. Pelvic muscle strength was measured by both digital vaginal palpation and EMG variables, and quality of life was investigated by 4 kinds of pelvic floor disease-related questionnaires. RESULTS: According to the intention-to-treat principle, compared with baseline, in group A, EMG of contractile amplitude of endurance phase was significantly elevated (P = .03), variation of contractile amplitude in tonic phase was more stable after treatment (P = .004), and EMG of mean value of final rest was significantly elevated after treatment (P = .047). After 5 times treatments, the incidence of correct pelvic floor muscle contraction in group A was significantly elevated (P = .045). No significant difference of muscle strength test by digital vaginal palpation was detected between the 2 groups, so did questionnaires. CONCLUSION: For postpartum women with extremely weak muscle strength, TVES for 5 times might be more benefit for control ability of pelvic muscle contractions and elevating muscle strength even in short-time treatment.


Assuntos
Terapia por Estimulação Elétrica/métodos , Debilidade Muscular/fisiopatologia , Debilidade Muscular/reabilitação , Distúrbios do Assoalho Pélvico/fisiopatologia , Distúrbios do Assoalho Pélvico/reabilitação , Período Pós-Parto/fisiologia , Adulto , Protocolos Clínicos , Eletromiografia , Feminino , Humanos , Análise de Intenção de Tratamento , Força Muscular/fisiologia , Estudos Prospectivos , Método Simples-Cego , Adulto Jovem
20.
PLoS One ; 15(4): e0231018, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240241

RESUMO

AIM: We aimed to assess the association between postpartum weight retention (PPWR) in the fourth week after delivery and the risk of gestational diabetes mellitus (GDM) in a subsequent pregnancy. METHODS: We performed a retrospective cohort study of the obstetric records of women who gave birth to their second singleton between 32 and 41 weeks of gestation at the National Hospital Organization Kofu National Hospital between January 2013 and September 2019. The exclusion criteria were missing data, twin pregnancy, diabetes in pregnancy, and delivery before 22 weeks in the first pregnancy. We calculated PPWR as the BMI 4 weeks after the first birth minus the BMI before the first pregnancy and grouped the subjects into the stable PPWR (gain of <1 BMI unit) and non-stable PPWR groups (gain of ≥1 BMI units). We used the χ2 test and multivariable logistic regression analysis to investigate the association between weight retention at the postpartum checkup and GDM. RESULTS: We included 566 women in this study (mean age, 31.7±4.8 years; mean maternal pre-pregnancy BMI, 21.3±3.5 kg/m2; term delivery, n = 544 [96.1%]). The overall prevalence of GDM during the second pregnancy was 7.4% (42/566), and 33.9% (192/566) of women had stable PPWR. Non-stable PPWR was not significantly associated with GDM in the second pregnancy (adjusted odds ratio, 1.93; 95% confidence interval, 0.84-4.46) after controlling for each variable. CONCLUSION: PPWR measured in the fourth week after delivery was not associated with an increased risk of GDM in the second pregnancy.


Assuntos
Peso Corporal/fisiologia , Diabetes Gestacional/fisiopatologia , Ganho de Peso na Gestação/fisiologia , Período Pós-Parto/fisiologia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Sobrepeso/fisiopatologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
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