Postpartum depression is by definition a major depression with an onset during the first weeks after delivery. In practice, however, the term, postpartum depression is used to characterize all kinds of depressive symptoms after childbirth. The aims of this thesis were to investigate the prevalence of depressive symptoms during late pregnancy, in the puerperium and four years after delivery, and to analyze the mothers’ estimation of personal health and their children’s behavior at the age of four. Additional goals were to test the predictive power of potential associated factors of postpartum depression during pregnancy and the puerperium and finally, to elucidate possible genetic or neuropeptidergic explanatory variables behind the development of postpartum depression. A population-based sample of 1489 women was screened with the Edinburgh Postnatal Depression Scale and the prevalence of depressive symptoms was 17% in late pregnancy and 13% postpartum. Antenatal depressed mood was related to postpartum depression. In a cross-sectional study we later found that postpartum depression was associated with subsequent depressive symptoms and current health problems four years after childbirth. Four-year-old boys of postpartum depressed mothers and children of mothers with a subsequent depressive status had more behavior problems than children of non-symptomatic mothers did, according to the mothers’ opinion. The strongest associated factors for postpartum depression, in a case-control study, were sick leave during pregnancy mainly due to pregnancy complications, e.g. hyperemesis and premature contractions and a high number of visits to the antenatal care clinic. There was no association between delivery complications or complications in the perinatal period and postpartum depression. The theory that depressive symptoms in late pregnancy or postpartum are connected with CYP2D6 genotype could not be confirmed. In a rat model, we found that pregnancy and parturition influence the concentrations of neuropeptide Y, cholecystokinin, substance P and galanin in the rat brain. This result supports the hypothesis that neuropeptidergic systems in the brain influence the mood changes around childbirth. In conclusion, postpartum depression is a common feature with influence on both maternal and child well being. / Pages 26 and 57 containing illustrations are removed from the electronic version. On the day of the public defence the status of article IV was: Accepted for publication.

Urininkontinens är en sjukdom erkänd av Världshälsoorganisationen(WHO)1998. The International Continence of Society(ICS) har definierat urininkontinens: "Det är ett urinläckage som är objektivt påvisbart och utgör ett socialt och hygieniskt problem för individen" urininkontinens drabbar ofta kvinnor i förbindelse med graviditet, förlossning eller kejsarsnitt. Det kan räcka med att bli gravid. Syftet med litteraturstudien var att belysa riskfaktorer som kan orsaka stressinkontinens under graviditet och efter vaginal förlossning. Resultatet visar att vaginal förlossning som avslutas med forceps utgör störst risk att drabbas av stressinkontinens. Det behövs fler studier för att upplysa barnmorskor om hur de kan ge evidensbaserad vård till kvinnor som föder vaginalt för att undvika urodynamiska skador.

Motherhood is an ideal that is ostensibly valued and rewarded in American culture. It is no wonder, then, that a disease which threatens a woman’s ability to adequately fulfill her motherly duties receives a great deal of attention. My study aims to explore how ideas about postpartum depression (PPD) are presented in popular media through an examination of the messages and advice in PPD self-help books. Findings reveal that self-help authors make two significant assumptions: motherhood is a woman’s job that should bring happiness, and when mothers are not happy medical intervention in necessary. Through their gendered assumptions about parents’ roles and their insistence on a biological explanation for PPD, self-help authors prevent a healthy dialogue that examines patriarchal structures in the institutions of family and medicine. By focusing solely on the biological factors at play when women have babies, self-help authors alienate fathers, adoptive mothers, and foster parents who experience depression without biological origins. Only when PPD is discussed within the context of our social realities can we truly understand parenthood and depression.

Women with gestational diabetes (GD) are at higher risk of developing type 2 diabetes (DM) after delivery compared to those without GD. Numerous studies in the general population have identified that adoption of healthy lifestyles can prevent DM; however limited research has focused on women with GD. The purpose of this randomized pilot study was to determine the effectiveness of an educational intervention of SUGAR (Start Understanding Gestational Diabetes and Risk of Type 2 Diabetes), on women’s perceived risk of developing DM, knowledge of DM, self-efficacy to adopt healthy lifestyle behaviors and adoption of healthy lifestyle behaviors after childbirth among women with GD. A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment. Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing. Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed.

Bakgrund: 13 procent av alla kvinnor drabbas av postpartum depression (PPD) efter förlossningen. PPD påverkar inte bara modern som individ utan även barnet och resten av familjen. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans roll i omvårdnadsarbetet med familjer som drabbats av postpartum depression. Metod: Litteraturstudie. Databaserna Pubmed och Cinahl har använts i studien. Tre kvantitativa artiklar har använts och tolv kvalitativa. Resultat: Första mötet mellan sjuksköterskan och kvinnan med PPD har stor betydelse. Mödrarna känner sig trygga och vågar öppna sig mer om de har en bra relation med sjuksköterskan. Mödrarna anser att det är lättare att ta emot råd från en sjuksköterska de har god relation med. Diskussion/Slutsats: God kommunikation, information och kontinuitet bör förbättras i vården. Sjuksköterskorna behöver mer kunskap om PPD för att kunna ge familjerna bästa tänkbara vård. Har sjuksköterskorna god kunskap kommer även relationen med familjen att stärkas.

While up to 45% of women quit smoking during pregnancy, nearly 80% return to smoking within a year after delivery. Current interventions to prevent this return have had limited success. The aim of this study was to use the Theory of Planned Behavior to understand the factors influencing intention to resume smoking postpartum, specifically focusing on the role of subjective norms, or the social environment. During the postpartum hospital stay, we conducted in-depth, individual interviews with 24 women who had quit smoking during pregnancy. Over 300 pages of transcripts were analyzed by all four investigators using qualitative methods to identify common themes facilitated by Atlas.ti software. Respondents were predominately white (63%) and primipara (54%) with a mean age of 26. When reflecting on their experiences of being a smoker, the women emphasized the importance of their social relationships. Common themes were: 1) virtually all were embedded in large, complex social networks of smokers (partners, family, friends, co-workers) that influenced their smoking behavior, 2) the subjective norm (the perceived social pressure) for many women was that, while smoking during pregnancy is unacceptable, smoking after pregnancy is tolerable, and 3) partners were particularly influential on these womens smoking behaviors. In conclusion, we found that social environment played a large role in these women's past smoking behavior and future intentions. Thus, this factor may continue to influence their behavior after pregnancy. Further research is needed to establish the generalizability of these findings; however, our study suggests that the influence of the social environment should be integrated into postpartum smoking interventions.

Reproduction de : Thèse d'exercice : Médecine. Psychiatrie : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f.146-155.

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 135-149). Available also in a digital version from Dissertation Abstracts.

Few studies have measured the changes of postpartum weight retention (PWR), and none of them have assessed the effect of pregnancy on waist circumference (WC) in Taiwanese women. The primary aims of this longitudinal study were to explore the changes in body weight and WC during the first six months postpartum and to identify the explanatory factors of PWR and of WC. A theoretical framework that incorporated Bandura's social learning theory and the results of a literature review was used to guide this study. Structured questionnaires were used for data collection. Postpartum body weight and WC were measured. Data were collected from May 2011 to January 2013 and analyzed using the SPSS 19.0 and Mplus 6.12. A sample of 200 healthy postpartum women was recruited from three clinics in Tainan City, Taiwan. The mean age of the women was 31.19 years, and the majority of them were married (98.0%), primiparas (56%), had a bachelor's degree (52.5%), and planned to have this pregnancy (62.5%). The mean prepregnancy body weight was 55.84 kg, and the mean GWG was 13.76 kg. About one third of the sample gained weight exceeding the GWG recommendations of the IOM. The mean PWR decreased over time from 9.13 kg at hospitalization to 2.73 kg at 6 months postpartum. Approximately 24% of the participants still retained 5 kg or more at 6 months postpartum, and about 44% of the women had at least one kind of weight-related risk--substantial PWR, overweight, or central obesity. Age, prepregnancy BMI, parity, GWG, and place for doing the month significantly affected PWR. The final latent growth curve (LGC) model of PWR explained 91.5% and 33.9% of the variance in initial status and overall change rate in PWR. Age, prepregnancy BMI, parity, GWG, and cesarean delivery significantly affected WC, which explained 84.1% and 38.1% of the variance in initial status and change rate in WC. GWG was the most influential factor in the change rate of PWR and WC. Establishing tailored recommendations for GWG for Taiwanese women is warranted. / text

During the postpartum period, new mothers may experience physical changes, mental disturbances, and adaptation to the maternal role. However, relationships between these three concepts have not been explored as a whole and their influencing factors are not fully studied. Especially for Chinese mothers, social support may be viewed negatively when it comes from parents-in-law. Therefore, the purpose of this study was to understand health and its influencing factors among Chinese mothers. This study involved a cross-sectional and correlational design. The conceptual framework guiding this study integrated a health model and the theory of stress. Well established instruments were used to measure perceived global stress, personal stress and support, importance of support and support received, general physical health, health conditions, depressive symptoms, and maternal competence. The effects of stress and social support on health outcomes were tested. A total of 150 Chinese mothers who were in their first year postpartum completed the survey. Results showed that mothers did not rate their health as good and they experienced an average of 5.03 and 3.91 kinds of health conditions within and after 2 months postpartum, respectively. Mothers did not have high maternal confidence and about 23.5% of mothers had a potential of being depressed. Mothers did not experience high level of stress and did not receive much social support. Mothers living with Chinese in-laws or not did not differ in level of stress and health measures. Mothers’ general physical health, health conditions, depressive symptoms, and maternal competence were correlated with each other. Perceived global stress had effects on all health measures. Support received had effects on general physical health and depressive symptoms, while importance of support had effects on depressive symptoms and maternal competence. Social support had moderating effects on stress and depression, and on stress and general physical health. The results suggested that culturally relevant postpartum care, which includes assessments of maternal health, maternal stress, and social support, should be provided to Chinese mothers. Future studies can focus on interventional studies in promoting maternal health with mothers of ethnic minorities and model testing on the conceptual framework used in this study. / text