La santé et la fertilité des vaches laitières sont au cœur des préoccupations de la filière professionnelle dans un objectif d’efficience, de quantité et de qualité de la production de lait. La mise en place d’une lactation performante se superpose aux profonds changements hormonaux et métaboliques de la période postpartum, se traduisant par une balance énergétique négative. Les conséquences en sont souvent une altération de la fertilité et une immunodépression qui accroit la susceptibilité aux pathologies. Dans les élevages, il existe encore une grande variabilité d’état général et de performances chez les vaches laitières malgré la sélection génomique. Il est proposé que des modifications de la méthylation de l’ADN puissent contribuer à cette variabilité phénotypique individuelle. En effet, la méthylation de l’ADN, en tant que processus épigénétique, est impliquée dans la régulation transcriptionnelle des gènes, et présente une certaine plasticité face aux contraintes environnementales. Nous avons fait l’hypothèse que des signatures épigénétiques portées par les cellules du sang, pourraient refléter l’état de santé des vaches et pourraient être modifiées en réponse à différents facteurs intrinsèques (parité, stades physiologiques…) et aux contraintes environnementales. Ces signatures ont été recherchées dans une population de cellules du sang particulière : les monocytes. Ces cellules, accessibles par prélèvements sanguins et purification en présence d’un anticorps spécifique, constituent la première ligne de réponse d’immunité innée face aux infections aigües participant à la dégradation de l’état de santé des vaches en postpartum. Pour tester l’hypothèse de signatures épigénétiques monocytaires, une analyse du méthylome par « Reduced Representation Bisulfite Sequencing », (RRBS) dans diverses situations d’élevage a été réalisée. En utilisant des ADN génomiques de vaches incluses dans plusieurs protocoles, 22 banques ont été construites et séquencées. Leur analyse a été réalisée en utilisant un pipeline d’analyses bioinformatique et biostatistique développé au laboratoire.En moyenne 1 250 000 CpG sont pris en considération et permettent l’identification et la localisation de cytosines différentiellement méthylées (DMC) : i) 27143 DMC en comparant les méthylomes de différents types cellulaires (monocytes versus fibroblastes et PBMC) ii) 4788 DMC en réponse à un challenge nutritionnel basé sur la distribution du complément alimentaire GENIAL®, fabriqué et distribué en élevage par nos partenaires PILARDIERE et XR-Repro. iii) 2615 et 4616 DMC en réponse au challenge infectieux pour le groupe de vaches témoins et le groupe en restriction alimentaire respectivement (protocole coordonné par Christine Leroux et José Pires (RUMINFLAME, INRA, Theix) combinant une restriction alimentaire et un challenge immunitaire, par injection de LipoPolySaccharide). iv) 4420 DMC issues de la comparaison entre méthylomes de vaches à génome constant (issues du transfert nucléaire, clones) et de vaches à génome variable mais de même âge et élevées dans les mêmes conditions que les clones. Pour certaines régions différentiellement méthylées (DMR) ciblant le promoteur de gènes, le statut de méthylation a été confirmé par conversion bisulfite et pyroséquençage. L’expression des gènes associés a été étudiée. Une anti corrélation significative est observée entre méthylation et expression signant la fonctionnalité de ces régions.En comparant les 11 méthylomes monocytaires, il est montré que 21% des CpG sont extrêmement stables et ne présentent qu’une faible variation de méthylation entre échantillons ( 20%). L’ensemble de ces informations peut être pris en considération pour la conception d’un outil d’épigénotypage. A l’avenir, il serait aussi possible d’utiliser cet outil en routine afin d’appréhender les variations du méthylome monocytaire dans différentes conditions d’élevage. / In dairy breeding, the health and fertility of cows are the main concern with the aims to maintain milk quantity and quality and to reduce the interval between calving in a high competitive economical context. Postpartum period is marked by major hormonal and metabolic changes that affect productivity, immune responses and fertility. The consequences of immune response deterioration are an increasing susceptibility to diseases (mastitis, metritis, endometritis…). Genomic selection in livestock improves the performance of the population but does not exclude phenotypic variability at the level of livestock and the individual. It is proposed that DNA methylation could contribute to this individual phenotype variability. Indeed, DNA methylation is an epigenetic process involved in transcriptional regulation of genes displaying certain plasticity in front of environmental constraints.We assumed the epigenetic signatures carried by blood cells, could reflect overall health and could be modified in response to intrinsic factors (parity, stages …) and to environmental changes. These signatures were researched in a particular blood cells subpopulation: the monocytes. These cells, obtained by blood sampling and purification with a specific antibody, are the first line of defense against acute infections participating in health status deterioration of postpartum cows.To test the monocyte epigenetic signatures hypothesis, monocyte methylome were analyzed by « Reduced Representation Bisulfite Sequencing » (RRBS), in various breeding conditions. Using genomic DNA form cows included in several protocols, 22 libraries were constructed and sequenced. Their analyses were accomplished using a « homemade » pipeline which integrates bioinformatics and biostatistics analyses. On average, 1 250 000 CpGs were analyzed in order to identify differentially methylated cytosines (DMCs): i) 27143 DMC by comparison between different cells types (monocytes versus fibroblasts and PBMC) ii) 4788 DMCs in response to nutritional challenge based on the dietary supplement, GENIAL®, produced and distributed in breeding by our partner PILARDIERE and XR-Repro (in collaboration with Marion Boutinaud, INRA, Rennes). iii) 2615 and 4616 DMCs in response to infectious challenge with LipoPolySaccharide injection for control cows group fed normal diet and for dietary restriction cows group, respectively (collaboration with Christine Leroux and José Pires, RUMINFLAME, INRA, Theix; and Gilles Foucras (ENVT, Toulouse)). iv) 4420 DMCs from the comparison between constant genomic cow (Somatic cell nuclear transfer, clones) and variable genomic cows but with the same age and raised in the same conditions than clones.From DMCs, we identified differentially methylated regions (DMRs) defined as region with at least 3 DMCs inside 100 bp. For some DMRs targeting gene promoter, the methylation status was validated by bisulfite conversion and pyrosequencing. Gene associated expression were also investigated. A significant negative correlation has been observed between methylation and expression, highlighting the functional relevance of these DMRs in gene transcription control.By comparing the 11 monocyte methylomes, 21% of CpGs present a remarkable constant methylation level with weak variability between samples (20%).Taking together, these data can provide a list of relevant DMCs for an epigenetic tool conception. In the future, it would be possible to use this tool for a routine analysis in order to grasp monocyte methylome variations in different breeding management.

Bakgrund: I Sverige drabbas cirka 10 000 nyblivna mödrar av postpartum depression (PPD) varje år. Att bli förälder är någonting som förknippas med en glädjefylld händelse men denna bild kan ibland stå i stark kontrast till verkligheten. Det är en omställning att bli förälder och i vissa fall kan det vara svårt att anpassa sig till livets nya riktning. Tiden efter förlossningen är en period av ökad sårbarhet både psykologiskt och biologiskt. Sårbarheten för depression varierar beroende på psykologiska och/eller biologiska faktorer vilket får till följd att olika individer kan reagera olika på samma påfrestning. Symtomen kan komma allt från någon vecka efter förlossningen men det kan också dröja upp till ett år. Det är viktigt att den som drabbats av PPD får en diagnos i ett tidigt skede då det ger en bättre förutsättning för ett tidigt tillfrisknande och mindre risk för att barnet ska ta skada. En del kvinnor som drabbats av PPD söker inte vård då de skäms över sina känslor och är rädda för att bli stigmatiserade vilket i slutändan kan leda till allvarliga och oönskade konsekvenser. Syfte: Syftet med detta arbete var att belysa hur biologiska och psykosociala faktorer påverkar risken för att utveckla PPD. Metod: Metoden som användes var en litteraturöversikt där sammanlagt 15 vetenskapliga artiklar inkluderades. Artiklarna var högst tio år gamla, peer reviewed, svarade på syftet och etiskt granskade. Artikelsökningen genomfördes i databaserna PubMed, CINAHL och PsycINFO. Även manuella sökningar förekom. Författaren klassificerade och utförde kvalitetsbedömning på samtliga artiklar. Resultat: De biologiska faktorerna som ingick i de genomgångna artiklarna i litteraturöversikten var hormoner, sömn och barnets temperament. De psykosociala faktorerna som ingick var socioekonomiska faktorer och socialt stöd. Det sammanställda resultatet visade på att dessa faktorer kan öka risken för att drabbas av PPD. Slutsats: Resultatet i föreliggande studie pekar på att hormonella faktorer, sömn, barnets temperament, socio-ekonomiska faktorer och brist på socialt stöd är riskfaktorer för att utveckla PPD. Det är därmed av stor vikt att vårdpersonal på mödravård, förlossning och BVC är uppmärksamma på dessa riskfaktorer samt tidiga symtom. Det är också viktigt att den gravida kvinnan/ nyblivna mamman, partnern och anhöriga känner till både riskfaktorer och symtom för att få hjälp i ett tidigt skede.

Bakgrund   Förlossningsdepression är en sjukdom som drabbar 8 till 15 procent av alla kvinnor efter förlossningen. Detta kan leda till långvariga konsekvenser för både kvinnan och barnet. För många kvinnor kan hjälpsökandeprocessen vara svår, vilket leder till att flertalet inte får den vård de behöver. Förlossningsdepression är en komplex sjukdom med flera allvarliga symtom. Därför är det viktigt för sjuksköterskor och annan vårdpersonal att ha kunskap om sjukdomen för att kunna ge adekvat vård.  Syfte Syftet var att belysa kvinnors erfarenheter av vården vid förlossningsdepression.  Metod Designen för detta arbete var en litteraturöversikt. Författarna för arbetet har genomfört sökningar i databaserna PubMed samt CINAHL för att hitta relevanta forskningsstudier som besvarade syftet. Totalt 16 vetenskapliga artiklar inkluderades och analyserades samt granskades av författarna. De vetenskapliga artiklarna var främst baserade på kvalitativ forskning med inslag av kvantitativa delar. Data analyserades med hjälp av en integrerad analys. Resultat Resultatet av litteraturöversikten visade att många kvinnor med förlossningsdepression är missnöjda med den vård som erbjuds och hur de blir bemötta av vården. Vidare visade resultatet att information om var kvinnor kan söka hjälp var bristfällig. Flertalet kvinnor uppgav att de inte blivit tagna på allvar samt att de upplevt att stigmatiseringen i samhället som så stor att de inte vågat söka hjälp trots symtom. Ett annat resultat är att kvinnor upplevde att sjukvården inte tagit hänsyn till deras åsikter om önskad behandling.   Slutsats Utifrån resultatet kan slutsatsen dras att stigmatiseringen i samhället påverkar kvinnor i deras hjälpsökande, något som bör förändras. Sjukvården behöver utveckla vården vid förlossningsdepression på flera sätt, bland annat genom att göra den mer lättillgänglig. Sjukvårdspersonalen bör även lyssna mer på kvinnorna och anpassa behandlingen utifrån deras behov och önskemål. / Background Postpartum depression is a disease that affects 8-15 percent of all women after childbirth. This can lead to long-term consequences for both the woman and the child. For most women, the help-seeking process can be difficult, leading to the majority not receiving the care they need. Postpartum depression is a complex disease with various serious symptoms. Therefore, it is important for nurses and other healthcare professionals to have knowledge of the disease in order to provide adequate care. The Edinburgh Postnatal Depression Scale (EPDS) screening tool is used to diagnose postpartum depression. Aim The purpose was to shed light on women's experiences of the healthcare in the event of postpartum depression. Method The design for this study was a literature review. The authors have conducted searches in the databases PubMed and CINAHL to find relevant research studies that answered the aim. A total of 16 scientific articles were included and analysed and reviewed by the authors. The scientific articles were mainly based on qualitative research with elements of quantitative parts. The data were analysed using an integrated analysis. Results The results of the literature review showed that the majority of women with postpartum depression are dissatisfied with the care provided and the treatment. Furthermore, the results showed that information on where women can seek help was deficient. The majority of women stated that the healthcare professionals had not taken the women seriously and that the stigma felt so big in society that they did not dare to seek help. The results of the literature review also showed that women felt that the health service did not take into account their views on the desired treatment. Conclusions Based on the results, it can be concluded that the stigma in society affects women in their search for help, something that should change. The healthcare system needs to develop care for postpartum depression in several ways, including by making it more accessible. Healthcare professionals should also listen more to women and adapt treatment based on their needs and wishes. Keywords

Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning.  Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise.  Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.

Bakgrund: Postpartumdepression är ett globalt förekommande fenomen, ungefär 20 procent av immigranter lider av sjukdomen. Det behövs mer kunskap kring postpartumdepression hos immigranter. Syfte: Syftet med denna litteraturöversikt var att syntetisera kvalitativ forskning om hur immigranter upplever sin livssituation och behov av stöd från vården i samband med en postpartumdepression. Metod: Kvalitativ litteraturöversikt med tematisk analys. Resultat: Fyra teman identifierades. De var rädsla för stigma, uppfattningen om postpartumdepression, upplevelsen av vårdsammanhang samt behov av stöd. Resultatet visade att immigranter hade brist på kunskap för postpartumdepression och upplevde att de inte får tillräckligt med stöd varken från familj och sjukvård. Slutsats: Det finns fortfarande en stigmatisering hos immigranter att hantera psykisk ohälsa. Känslor som skuld och skam är ofta orsaker att inte våga träda fram eftersom att bli mamma är förknippat med lycka. Det leder till utmaningar att fånga upp dem med symtom som tyder på postpartumdepression. Sjukvården behöver mer kompetens att ge personcentrerad vård till patienter med olika kulturella bakgrunder. Mer forskning om effekten av hembesök skulle förbättra immigranters hälsa och upptäcka postpartumdepression i tid. / Background: Postpartum depression is a global occurring phenomenon, where approximately 20 percent of immigrants suffer from it. More knowledge is needed about postpartum depression in immigrants.  Purpose: The aim of this literature review was to synthesize qualitative research on how immigrants’ experience their life situation and need for support from healthcare in association with postpartum depression. Methods: A qualitative literature review with thematic analysis.  Results: Four themes were identified. These were fear of stigma, the perception of postpartum depression, the experience of care context and need of support. Result shows that immigrants don’t have enough knowledge about postpartum depression. Furthermore, they lack support from both family and healthcare.  Conclusions: There is still a stigma among immigrants’ dealing with mental illness. Emotions such as guilt and shame are often reasons for not coming forward because becoming a mother is associated with happiness. These factors lead to challenges identify those symptoms that indicates postpartum depression. The healthcare needs more education to provide individual care to patients with different cultural backgrounds. More research on the effect of home visits can improve immigrants' health to detect postpartum depression in time.

BACKGROUND: Both mood and anxiety disorders are more prevalent in women than men with the onset typically occurring during adolescence or early childbearing years. These disorders are particularly prevalent during pregnancy and the postpartum period. While depression during the perinatal period has received significant attention recently, anxiety has not received the same amount of attention. METHODS: The current study was a secondary analysis of a prospective cohort study that followed 91 women with mood disorders through pregnancy and the postpartum period. Our objective was to determine if a correlation existed between anxiety and suicidality. We hypothesized that pregnant women with a history of a mood disorder and comorbid anxiety are more likely to be suicidal than those without comorbid anxiety. The presence of anxiety was determined using the anxiety subscale of the Edinburgh Postnatal Depression Scale, EPDS; a cut off score of six or greater was used to indicate significant anxiety. Suicidality was determined using three separate measures: question ten on the EPDS, question eighteen on the Inventory of Depressive Symptomatology, and question ten on the Montgomery-Asberg Depression Rating Scale. ANALYSIS: Chi square tests were used to compare the demographics of the anxious and non-anxious women based on both diagnosis of anxiety disorders and symptoms of anxiety. Z proportion tests were then used to compare the proportion women with anxiety versus those without anxiety who were suicidal. Lastly, binary logistic regression was used to determine if patients with anxiety were more likely to be suicidal. RESULTS: Among the women in this study, 62 (68.1%) had a diagnosis of major depressive disorder and 29 (31.9%) had a diagnosis of bipolar disorder based on DSM-IV-TR diagnostic criteria. In addition, 45 (49.5%) had a lifetime history of an anxiety disorder. The prevalence of significant anxiety symptoms, as determined by the anxiety subscale on the EPDS, ranged from 9.1-37.5% depending on the time point. Suicidality prevalence also varied depending on both the time point and the scale used: 0-17.5% using the MADRS, 6.7-24.7% using the EPDS, and 2.4-14.7% using the IDS. Using a binary logistic regression, we determined that anxiety was a risk factor for suicidality at time T3 (OR 2.106; 95% CI 1.274-3.481) and M1 (OR 2.057; 95% CI 1.179-3.586) on the MADRS and at T3 (OR1.758; 95% CI 1.219-2.535) on the EPDS.

Despite PPD’s global extent, scarce research that addresses culturally competent alternative interventions exists. The purposes of this thesis were to 1) analyze the existing literature on non-pharmacological treatment of PPD in the US and across selected cultures; 2) determine the effectiveness of cross-cultural non-pharmaceutical therapy; and 3) examine and suggest ways health care providers can integrate non-pharmacologic interventions into PPD treatment in the US. The systematic electronic search comprised the databases Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO and SAGE Research Methods. Searches were limited to English language, peer reviewed, and research articles between 2007 and 2017. A second search was performed through global Healthcare Organizations websites. The World Bank’s country classifications by income level were adopted to present the findings. This review found that passing el calor to the newborn, yoga; and cognitive-behavioral, interpersonal, family, and bright light therapies are successful interventions. Further, seclusion periods were identified as adequate interventions only when women voluntarily adopt the practice and have family support, with less social restrictions. While other non-pharmacological treatments’ effectiveness was not ascertained, this thesis encourages healthcare professionals to integrate cultural traditions congruent with clients’ preferences. Recommended nursing interventions and suggestions for improvement of current practice are also discussed.

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Objective 1: To examine the influence of maternal depression and/ or anxiety on infant, maternal and dyadic FFSF task performance Objective 2: To investigate the changes in infant and maternal FFSF task performance before and after Cognitive Behavioural Therapy (CBT) treatment of maternal depression / Background: Research suggests that postpartum depression (PPD) and postpartum anxiety (PPA) impact both mothers and their infants, leading to adverse behavioural outcomes across the lifespan. The face-to-face still-face (FFSF) task is a validated observational tool used to measure the quality of mother-infant interactions. This thesis aimed to investigate the differences in responses to the FFSF task between dyads consisting of mothers with PPD and/or PPA and healthy dyads. Another goal was to examine whether PPD treatment could improve mother and infant FFSF outcomes. Methods: A systematic search was performed in PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science. Meta-analyses were conducted to examine the differences in infant, maternal and dyadic FFSF outcomes in mothers with PPD, PPA or comorbid PPD and PPA in comparison to healthy control dyads. Second, we examined whether group cognitive behavioural therapy (CBT) for PPD could help improve infant and maternal FFSF outcomes. A case-control design study was conducted with three different assessment points (i.e., pre-CBT treatment, immediately after CBT and three months post-CBT). Results: Meta-analyses suggested that the infants of mothers with PPD display lower levels of positive affect during the play and reunion phases compared to the infants of healthy non-depressed mothers. Also, mothers with PPD may engage less positively with their infants at the reunion phase, and mother-infant dyads affected by PPD show less positive interactive matching during the play phase compared to healthy control dyads. Finally, object/environment engagement was higher in infants of PPA mothers compared to healthy controls at still-face. Conclusion: The results suggest that mothers with PPD and/or PPD (and their infants) may exhibit different interaction patterns compared to healthy dyads. Also, it appears that the benefits of CBT for maternal PPD may extend to their infants through reductions in maladaptive infant withdrawn behaviours to normal, healthy levels. / Thesis / Master of Science (MSc) / Maternal postpartum depression (PPD) and postpartum anxiety (PPA) are the most common mental health complications of birth. Apart from unfavourable effects PPD and PPA have on mothers, it may also impact the mother-infant relationship, leading to adverse infant outcomes. Given the relatively high prevalence of maternal PPD, PPA, and comorbid PPD and PPA, this thesis aimed to examine the differences in how mothers suffering from PPD and/or PPA and their infants coordinate their behaviour, in comparison to healthy mothers and their infants using a validated observational task (face-to-face still-face [FFSF] task). Another goal of this thesis was to investigate whether the benefits of maternal treatment for PPD with cognitive behavioural therapy may extend to infants and improve mother, as well as infant behaviour. These investigations may provide new insights on how maternal PPD and/or PPA affects mother-infant interactions, and consequently, infant socio-emotional development.