Gestational weight gain and eating-related disorders.

This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from January to November 2018. In the second day postpartum, 463 healthy at term puerperae, 122 (26.35%) with inadequate gestational weight gain (GWG), 210 (45.46%) with adequate GWG, and 131 (28.29%) with excessive GWG, were studied by EAT-26, through distinguishing three factors: 'Dieting', 'Bulimia and food preoccupation', and 'Oral control'. EAT-26 Global score increased from inadequate, to adequate, and excessive GWG puerperae, resulting significantly higher in excessive GWG group (p = .0029, Anova's). In addition, among EAT-26 subscales 'Dieting' scores significantly increased from inadequate, to adequate, and to excessive GWG category women, resulting significantly higher in excessive GWG group (p = .006, Anova's). It was found that excessive GWG is a warning indicator of unhealthy eating and 'Dieting' disorders. This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon GWG.Excessive gestational weight gain across an uncomplicated pregnancy is a warning indicator of unhealthy eating and dieting disorders.IMPACT STATEMENTWhat is already known on this subject? Pregnancy represents a time of rapid trimester-specific changes in body weight and size.What do the results of this study add? Excessive gestational weight gain is a warning indicator of unhealthy eating and dieting disorders.What are the implications of these findings for clinical practice and/or further research? This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon gestational weight gain.

Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity.

The objective of this study was to characterise pre-discharge maternal pain and stress severity after vaginal delivery and associations with parity. This is a descriptive analysis with 148 women in the early post-partum period (84 primiparae and 64 secondiparae) after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Psychological Stress Measure (PSM). Vaginal delivery in primiparae women was associated with MGPQ, significantly higher pain scores. Sensorial, affective and mixed pain descriptive categories were also significantly higher. Pain location involved lower abdomen, vagina and perianal area. In addition, their PSM showed a significantly higher 'Sense of effort and confusion' subscale scores. In conclusion, this study provides important information on the quality of care implications of hospital-to-home discharge practices in puerperae after vaginal delivery, a critical time characterised by qualitatively and quantitatively high pain and stress in primiparae.Impact statementWhat is already known on this subject? Pain and fatigue are the most common problems reported by women in the early postpartum period.What the results of this study add? Primiparae who delivered vaginally presented at the time of hospital-to-home discharge significantly higher pain and stress, as compared to secondiparae. Pain involved lower abdomen, vagina and perianal area, whereas the stress was quantitatively higher in the 'sense of effort and confusion'.What the implications are of these findings for clinical practice and/or further research? Awareness of problematic pain and stress associations with parity may offer the opportunity to better support puerperae to develop maternal orientation and adjust to motherhood.

Postpartum bonding: the impact of stressful life events during pregnancy.

OBJECTIVE: We aimed to determine if and to what extent a woman's exposure to stressful life events were associated with impaired maternal bonding by using a sample of high-income Italian women. METHODS: In the second day postpartum, 425 healthy puerperae responded to Life Experiences Survey (LES), Mother-to-Infant Bonding Scale (MBS), and to the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Analysis revealed that the stressful life events scored by LES were a significantly predictor of impaired bonding as measured by MIBS (ß = 0.04; t = 3.45; p < .001) and of postpartum depression symptoms as measured by EPDS total score (ß = 0.32; t = 4.86; p < .001) as well as its subscales Anhedonia (ß = 0.059; t = 4.99; p < .001), Anxiety (ß = 0.03; t = 5.72; p < .001), and Depression (ß = 0.05; t = 6.53; p < .001). Moreover, the partial correlation between EPDS total score and MIBS accounting for LES positive and negative scores was statistically significant (r = 0.208; n = 332; p < .001). CONCLUSION: The findings emphasize the importance of identifying mothers with negative experiences toward pregnancy and delivery to address possible interventions beyond hospital-based antenatal care to improve bonding and maternal mental outcomes.

The role of gestational weight gain disorders in symptoms of maternal postpartum depression.

OBJECTIVE: To examine the association of gestational weight gain (GWG), categorized according to 2009 IOM guidelines as adequate, inadequate, and excessive, with symptoms of mental disorders perceived by mothers after childbearing as anhedonia, anxiety, and depression, defined by the Edinburgh Postnatal Depression Scale (EPDS). Previous studies indicated that disorders related to GWG are associated with an increased risk of postpartum psychological distress. METHODS: A prospective cohort study took place at the Policlinico Abano Terme, Italy, from May 2016 to November 2018. RESULTS: The sample included 1268 healthy at term puerperae, 557 (43.9%) with adequate, 388 (30.6%) with inadequate, and 323 (25.5%) with excessive GWG. Mean EPDS scores were comparable among inadequate, adequate, and excessive GWG groups. However, mean factor scores for anhedonia and anxiety were significantly higher (P = 0.041 and P = 0.001, ANOVA) in mothers with excessive GWG. Conversely, factor scores for depression were significantly higher (P = 0.008, ANOVA) in mothers with inadequate GWG. CONCLUSION: It was found that excessive GWG across an uncomplicated pregnancy is a warning sign of symptoms of anhedonia and anxiety, whereas inadequate GWG is a significant indicator of symptoms of depression. These relationships highlight the potential for interventions directed toward psychosocial support to have beneficial effects upon GWG.

Psychological impact of COVID-19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period.

OBJECTIVE: To explore whether quarantine measures and hospital containment policies among women giving birth in a COVID-19 "hotspot" area in northeastern Italy enhanced psycho-emotional distress in the immediate postpartum period. METHODS: We designed a non-concurrent case-control study of mothers who gave birth during a COVID-19 quarantine period between March 8 and May 3, 2020 (COVID-19 study group), with an antecedent group of matched postpartum women (control group) who delivered in the same period in 2019. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) on the second day postpartum. RESULTS: The COVID-19 study group (n=91) had significantly higher mean EPDS scores compared with the control group (n=101) (8.5 ± 4.6 vs 6.34 ± 4.1; P<0.001). Furthermore, 28.6% of women in the COVID-19 group had a global EPDS score above 12. Analysis of three EPDS subscales revealed significantly higher scores among the COVID-19 group compared with the control group for anhedonia (0.60 ± 0.61 vs 0.19 ± 0.36; P<0.001) and depression (0.58 ± 0.54 vs 0.35 ± 0.45; P=0.001). CONCLUSIONS: Concerns about risk of exposure to COVID-19, combined with quarantine measures adopted during the COVID-19 pandemic, adversely affected the thoughts and emotions of new mothers, worsening depressive symptoms.

Prepregnancy Body Mass Index shift across gestation: primary evidence of an association with eating disorders.

Objective: Previous studies indicated that gestational weight gain-related disorders share many similarities with feeding and eating disorders (EDs).Design: To examine the association of prepregnancy Body Mass Index (BMI), defined according to 2009 Institute of Medicine (IOM), and its shift across gestation with symptoms of feeding and EDs, defined by EDE-Q.Setting: This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from Jannuary 2015 to October 2015.Population and sample: The sample included 655 healthy at term puerperae.Main outcomes measures: We correlated gestational BMI in different women categories to EDE-Q Global score and Restrain, Eating concern, Shape concern, and Weight concern subscales, by Spearman's correlation test.Results: Among 655 women, 59 (9.0%) were categorized as underweight, 463 (70.7%) normal weight, 98 (15.0%) overweight, and 35 (5.3%) as obese in prepregnancy period. At the end of gestation, underweight women category disappeared, normal weight women lightened to one third, overweight women tripled, and obese women doubled. At the same time, EDE-Q global scores increased from normal weight (0.25 ± 0.41), to overweight (0.47 ± 0.58), and to obese (0.72 ± 0.70) puerperae. In addition, EDE-Q global scores were significantly correlated with gestational BMI increase in Global score (rho = 0.326; p < .001) and in the four subscales: Restrain (rho = 0.161; p < .001), Eating concern (rho = 0.193; p < .001), Shape concern (rho = 0.335; p < .001), and Weight concern (rho = 0.365; p < .001), respectively.Conclusions: It was found that the shift of woman BMI across an uncomplicated pregnancy is a warning indicator of unhealthy eating and feeding symptoms.

Maternity blues: a risk factor for anhedonia, anxiety, and depression components of Edinburgh Postnatal Depression Scale.

Background: Women undergo adaptive physical and psychological changes during pregnancy, which make them vulnerable to psychological disorders.Methods: This study used a prospective observational design and included concurrent validation analysis of the 16-item Maternity Blues Scale (MBS) Dutch version to determine the direction and magnitude on the Edinburgh Postnatal Depression Scale (EPDS) symptoms, including three factors, anhedonia, anxiety, and depression in 320 puerperae early after childbirth.Results: We found a statistically significant correlation between MBS and EPDS global scores (0.22, p < .001). Moreover, Negative affect was significantly correlated with the EPDS global score (0.23, p < .001), anhedonia (0.12, p < .05), and anxiety (0.25, p < .001); Positive affect with the EPDS global score (0.14, p < .05) and depression (0.13, p < .05); and Depression subscale with EPDS global score (0.15, p < .05), anhedonia (0.12, p < .05), and anxiety (0.12, p < .05), and depression (0.12, p < .05). In addition, the subgroup of women (n = 33, 10.3%) with EPDS > 12 presented significantly higher global MBS score (2.51 ± 0.38 versus 2.26 ± 0.38, p = .01), with negative affect (2.88 ± 0.67 versus 2.62 ± 0.38, p=.04), positive affect (2.52 ± 0.69 versus 2.32 ± 0.38, p = .04), and depression (2.09 ± 0.75 versus 1.82 ± 0.36, p = .02).Conclusion: These findings together suggest that women with higher maternity blues scores may represent a distinct subgroup at increased risk of depression.

First-time fathers' coping strategies at elective cesarean delivery: A quantitative study.

BACKGROUND: Considerable studies have been undertaken to assess fathers' feelings and experiences during labor and delivery of their partner, however, investigation describing first-time fathers' coping strategies at elective cesarean delivery remains under explored. AIM: To assess and determine the Coping Strategies of first-time fathers at elective cesarean delivery, by looking at both first-time and second time fathers, separately. STUDY DESIGN: A quantitative design was utilized in this investigation. SUBJECTS: A total of 52 fathers, of whom 28 first-time fathers, whose partner had planned elective cesarean section, and 54 fathers, of whom 25 first-time fathers, whose partner had scheduled induction of labor at term. OUTCOME MEASURES: The Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990) was the main tool used to explore by Task-, Emotion- and Avoidance-oriented coping subscales, the feelings and experiences of the expectant fathers relative to the labor and delivery of their partners. RESULTS: Findings indicated that Avoidance-oriented coping values were significantly higher in first-time fathers at elective cesarean section compared to those at in first-time fathers at scheduled induced vaginal delivery (50.93 ±â€¯12.80 vs 40.71 ±â€¯9.38, p < 0.001), presenting with the highest percentile (82° centile). In addition, the Avoidance-oriented coping subscale significantly correlated with the subscales assessing Avoidance through Social interaction (rho = 0.90, p < 0.001) and Avoidance based on distraction (rho = 0.63, p < 0.001). CONCLUSION: Findings revealed that first-time fathers at elective cesarean section presented significantly higher Avoidance-oriented coping strategies, through Social interaction and based on distraction, in comparison to first-time fathers whose partner had scheduled induction of labor at term.

The role of elective and emergency cesarean delivery in maternal postpartum anhedonia, anxiety, and depression.

OBJECTIVE: To compare levels of anhedonia, anxiety, and depression in women following elective and emergency cesarean delivery. METHODS: An observational study was conducted between January 1, 2015, and May 31, 2017, among Italian women who delivered healthy neonates at term at the Policlinico Abano Terme, Italy, by vaginal, elective cesarean delivery (ElCD) or emergency cesarean (EmCD) delivery. The women completed the Edinburgh Postnatal Depression Scale (EPDS), including specific factors within each category, 2 days post-delivery to measure postpartum depressive symptomatology. RESULTS: Of the 2234 women enrolled in the study, 1702 (76.2%) had a vaginal delivery and 532 (23.8%) a cesarean delivery, of which 264 (11.8%) were emergency and 268 (12.0%) were elective. Mean EPDS scores (P=0.075) and the number of women with EPDS scores >12 (P=0.718) were comparable among the delivery groups. However, mean anxiety factor scores were significantly higher in the ElCD group (P=0.031), and conversely, mean anhedonia factor scores were significantly higher in the EmCD group (P=0.001). CONCLUSION: Postpartum depressive symptomatology of women who have had a cesarean delivery was characterized by higher levels of anxiety after ElCD and by higher levels of anhedonia after EmCD.

Short hospitalization after caesarean delivery: effects on maternal pain and stress at discharge.

PURPOSE: To characterize predischarge maternal pain and stress after caesarean delivery and short hospitalization. MATERIALS AND METHODS: This is a descriptive study with 60 women in the postoperative period of caesarean section and 60 control women after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Stress Measure (Psychological Stress Measure (PSM)), respectively, at mother-infant dyad discharge, scheduled at 36 hours after delivery. RESULTS: Caesarean section was the delivery modality with the highest MGPQ pain and sensorial, evaluative and mixed pain descriptive categories scores. The pain location involved lower abdomen, with associated localizations at back, breast and shoulders. Conversely, vaginal delivery was the delivery modality with the highest stress scores. CONCLUSION: This study provides important information on the quality of care implications of early discharge practices in puerperae after caesarean delivery, a critical time characterized by qualitatively and quantitatively high pain and stress.

Maternal areola pH: A chemical basis for mother-infant recognition.

BACKGROUND: The human female's areolar region is the point of arrival of a natural progression from birth to breastfeeding continuum, supported by numerous functional features. AIMS: The aim of this study was to look more closely into the areola' skin chemical signals that are uniquely important for mother-infant chemoemission, chemoreception, and breastfeeding continuum. STUDY DESIGN: A dermatological study of the areolae and corresponding breast quadrants was undertaken on 71 healthy, at-term women. Areolar and corresponding breast quadrant pH were assessed pre-partum and 1 and 2 days post-partum using a corneometer (Soft Plus 5.5; Callegari S.P.A., Parma, Italy). RESULTS: Pre-partum, the pH of the areola was significantly higher than the pH of the breast quadrant (4.25 ±â€¯0.26 vs. 4.06 ±â€¯0.44, p < 0.015). Post-partum, the pH of the areola was significantly higher that the pH of the breast quadrant both on day one (4.28 ±â€¯0.31 vs 4.01 ±â€¯0.25, p < 0.001) and on day two (4.39 ±â€¯0.19 vs 4.01 ±â€¯0.16, p < 0.001), respectively. In addition, pre-labor pH of the areola increased on day one post-partum and significantly on day two postpartum (4.25 ±â€¯0.26 vs 4.39 ±â€¯0.19, p 0.004). Moreover, the pH of the areola increased significantly from day one to day two post-partum (4.28 ±â€¯0.31 v s 4.39 ±â€¯0.19, p < 0.041). CONCLUSIONS: Our findings show, for the first time, that the areola has a higher pH than the surrounding breast skin, and this increases from day one to day two postpartum. We believe that the pH changes of the areolar region may act as a unique chemical signal to guide the infant directly to the nipple.

Emu oil-based lotion effects on neonatal skin barrier during transition from intrauterine to extrauterine life.

Both appropriate hydration and skin surface pH are fundamental in preventing baby skin barrier damage during transition from intrauterine to extrauterine life. However, effects of topical moisturizers on neonatal stratum corneum temperature, pH, hydration, and elasticity have not been scientifically evaluated in vivo. We checked 31 full-term breastfeeding neonates by non-invasive bioengineering method, which is able to evaluate the basal skin barrier (left heel), and assessed at 6±1 hours after birth, and at 1 and 24 hours after emu oil-based topical treatment. The basal skin barrier of right heel (no oil exposure) of each newborn was considered as control. We found that a single application of an emu oil-based lotion was effective in improving heel stratum corneum hydration, which increases both skin pH and elasticity without any effect on temperature. Further studies are needed to confirm long-term beneficial effects of this treatment in a very sensitive patient population.

Cohort study of the depression, anxiety, and anhedonia components of the Edinburgh Postnatal Depression Scale after delivery.

OBJECTIVE: To investigate the applicability of the Edinburgh Postnatal Depression Scale (EPDS) for identifying depressive symptoms following vaginal or cesarean delivery. METHODS: The present observational study included consecutive Italian-speaking women who underwent vaginal or cesarean deliveries of uncomplicated singleton pregnancies at term at Policlinico Abano Terme, Abano Terme, Italy, between February 1, 2014, and May 31, 2015, who completed the EPDS 2 days after delivery. EPDS scores and the depression, anxiety, and anhedonia subscale items were compared between delivery methods to identify factors predictive of high EPDS scores. RESULTS: There were 950 patients included in the analysis; 694 (73.1%) and 256 (26.9%) patients underwent vaginal and cesarean deliveries, respectively. Total EPDS scores were higher among patients who had cesarean deliveries compared with vaginal deliveries (6.95±4.80 vs 6.05±4.20; P=0.007); the depression (0.53±0.72 vs 0.37±0.65; P=0.007), anxiety (1.07±0.88 vs 1.16±0.93; P=0.021), and anhedonia (0.32±0.59 vs 0.19±0.48; P=0.009) subscale scores were all higher among patients who underwent cesarean deliveries. CONCLUSION: Women who underwent cesarean deliveries demonstrated higher EPDS scores and could be at increased risk of developing early postpartum depressive symptomatology, particularly anhedonia, anxiety, and depression.

Influence of elective and emergency cesarean delivery on mother emotions and bonding.

BACKGROUND: Previous studies have indicated that mode of delivery could have a negative effect on bonding. AIMS: To assess feelings towards newborn infants in mothers who delivered by cesarean delivery, elective (ElCD) or emergency (EmCD). STUDY DESIGN: This observational prospective study took place at the Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy, from September 2014 to April 2015. SUBJECTS: The sample included 573 puerperae divided into three groups: women undergone ElCD (n=73; 12.73%), women undergone EmCD (n=81; 14.13%) and women who underwent vaginal delivery (VD) (n=419; 73.12%). OUTCOME MEASURES: The instrument used was the Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a self-report test to measure mother's feelings towards her baby. High scores indicate worse mother-to-infant bonding and a score≥2, established as cut-off, indicates an altered bonding. RESULTS: The mean MIBS global score was 0.50±1.05 in the VD mothers, 0.67 (±1.14) for ElCD mothers and 0.92 (±1.05) for EmCD mothers, resulting significantly higher in EmCD mothers (p<0.001). The percentage of altered bonding (Score≥2) in the three groups was of 11.21% (n=47) in VD, 17.80% (n=13) in ElCD and 23.45% (n=19) in EmCD, significantly higher in EmCD women (p<0.006). In addition, EmCD mothers scored significantly higher Joyful (0.074±0.26 vs 0.185±0.39; p<0.005) and Disappointed (0.063±0.25 vs 0.123±0.36; p<0.008) subscales. CONCLUSIONS: It was found that EmCD negatively affects mother bonding and opening emotions, and originates in mother feelings like sadness and disappointment for the unplanned delivery evolution.