Background The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother–infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis.

Background: Knowledge of the incidence of tuberculosis (TB) and hospitalization postpartum could reduce maternal morbidity and mortality. TB infections are prevalent in pregnant women living with Human immunodeficiency virus (HIV) compared to women not living with HIV in South Africa. Adherence to Antiretroviral Therapy (ART) is poor among pregnant and postpartum women living with HIV (WLHIV), thus making WLHIV at a higher risk of hospitalization postpartum, due to the increased risk of Cesarean delivery (CD) and obstetric conditions as a result of HIV. The prevalence of TB among pregnant and postpartum women is poorly defined including in high prevalence TB and HIV locations, indicating limited evidence. The aim is to explore the incidence of TB and hospitalization within four years postpartum among WLHIV, including associated risk factors. Methodology: The study population is from phase 2 of the Maternal and Child HealthAntiretroviral Therapy (MCH-ART) study. It is a single-arm observational cohort study of 628 WLHIV who attended antenatal care (ANC). Enrolment into phase 1 began in March 2013, the final deliveries from phase 2 were in December 2014, and the final follow-up visits were completed in 2016. MCH-ART is an ongoing study with global approval examining strategies for providing HIV care and treatment to HIV-infected women who initiate ART during pregnancy and their HIV-exposed infants. This study took place at the Midwife-Obstetric Unit (MOU) at Gugulethu Community Health Centre, Western Cape South Africa. It consists of three connected study designs and three phases through the antenatal and postnatal periods. Phase 1 is a cross-sectional study, phase 2 is a cohort study and phase 3 is a randomized trial. Kaplan-Meier survival analysis was used to assess the incidence of TB and hospitalization over time among ix WLHIV up to four years postpartum and Cox regression was used to measure the effect of risk factors on the incidence of TB and hospitalization. Results: Thirty-five (35) WLHIV developed TB postpartum at a total person-time of 2365.1 woman-years. The incidence rate (IR) of developing TB among WLHIV postpartum was 1.48 (95% CI=1.03-2.06) cases per 100 woman-years from 2013 to 2018. Twenty-three (23) WLHIV was hospitalized postpartum and a total person-time of 552.8 woman-years was spent. The IR of hospitalization among WLHIV postpartum was 4.16 (95% CI=2.64-6.24) cases per 100 womanyears from 2013 to 2018. The IR of TB and hospitalization among WLHIV postpartum is statistically significant. Adjusting, for other risk factors, the history of diabetes at ANC, the history of TB at ANC and CD4 count (200 - <500) cells/mm3 at ANC also significantly increases the incidence of TB postpartum, whereas, obstetric reasons is associated with the hospitalization of WLHIV.

BACKGROUND: Intelligence, as a measure of cognitive ability, is influenced by genetics and environment. Fluid intelligence, as an aspect of general intelligence, describes the ability to solve novel problems and is less reliant on previous knowledge and experience compared to other aspects of intelligence. Fluid intelligence is a particular useful indicator in studies of diverse populations, as fluid intelligence indicators are less likely than indicators of other aspects of intelligence to be significantly influenced by cultural factors, educational level, and language. Although fluid intelligence was previously thought to be primarily modulated by genetics, recent studies have shown that environment and its many factors have a greater role in shaping this aspect of cognition. Factors associated with a low-income environment, including dietary habits, are of interest when investigating effects on fluid intelligence in mothers from a low socioeconomic status population. METHODS: Participants were used from the Transgenerational Health Research InitiatiVE at Boston Medical Center. The Automated Self-Administered 24-Hour Dietary Assessment Tool online reporting questionnaire was used to collect self-reported dietary intake from mothers two times during participation in the study, once prenatally and once postpartum. The Weschler Abbreviated Scale of Intelligence Second Edition subtests of matrix reasoning and block design were used to assess fluid intelligence and were administered either prenatally or postpartum. A paired t-test was performed for determining statistical significance of fatty acid intake in the prenatal period versus postpartum period. Regression analysis was performed using stepwise selection to measure the correlation between fluid intelligence composite scores and fatty acid intake. RESULTS: No significant correlation was found between fluid intelligence composite scores and dietary intake of stearic, oleic, linoleic, and linolenic acid. Significant differences were found between prenatal and postpartum intake of oleic acid (omega-9) (p=0.0325) and linolenic acid (omega-3) (p=0.0065). CONCLUSION: The findings from this study suggest no correlation between fluid intelligence composite scores and dietary intake of stearic, oleic, linoleic, and linolenic acid. However, the findings do suggest a significant difference between prenatal and postpartum dietary intake of oleic (omega-9) and linolenic (omega-3) acid. Repeating this study on a larger sample population with complete data (demographics, diet intake, and fluid intelligence) could provide additional evidence for a correlation between fatty acid intake and fluid intelligence.

Currently, about 1 in 3 women of reproductive age are obese (Flegal, Kruszon-Moran, Carroll, Fryar, & Ogden, 2016). Obesity in pregnancy has been associated with adverse maternal and infant outcomes (“Clinical Management Guidelines for Obstetrician–Gynecologists. Number 49, December 2003,” 2003) and maternal overweight and obesity have been implicated as increasing the risk for early childhood obesity (Ramonienė et al., 2017). Obesity is defined by the World Health Organization as having a body mass index (BMI) greater than 30 kg/m2, however, there is mounting evidence that BMI is not an accurate measure of adiposity (Kennedy, Shea, & Sun, 2009), which is one of the leading clinical concerns surrounding obesity. Understanding the associations between maternal body composition and infant body composition could begin to answer questions regarding the underpinnings of intergenerational obesity and offer a modifiable factor such as body composition as a target of opportunity to improve maternal and infant outcomes. This secondary analysis of 372 mother-infant dyads examines the associations of maternal body composition, as measured by BMI, fat mass and lean mass, with infant body composition, as measured by fat mass, lean mass, and BMI z-scores. Fat and lean masses were derived from dual-energy x-ray absorptiometry (DXA). Correlations between maternal BMI and maternal fat and lean mass were explored at one month postpartum. Associations between maternal body composition exposures at one month postpartum and infant body composition outcomes at one, four, and seven months postpartum were explored in the entire cohort and then stratified in two separate analyses by maternal BMI and infant sex to determine the potential for effect modification. Maternal BMI was strongly correlated with maternal fat mass at one month postpartum (r=0.91), and less strongly correlated with maternal lean mass (r=0.71). Maternal lean mass was positively associated with infant lean mass at four months postpartum. In obese women, maternal BMI was negatively associated with infant lean mass at seven months postpartum. In overweight women, maternal fat mass and maternal lean mass were positively associated with infant lean mass. In obese women, maternal fat mass was negatively associated with infant lean mass at four months postpartum. Maternal fat mass and lean mass were positively associated with infant lean mass at four and seven months postpartum in females but not in male infants. An increase in maternal lean mass was also found to be associated with a significant increase in female infant BMI z-scores at seven months postpartum but were not associated with male infants’ BMI z-scores. This study found that obese women with increased adiposity, as measured by BMI and fat mass, tended to have infants with less lean mass at four and seven months postpartum, while overweight women with increased lean mass tended to have infants with greater lean mass at all postpartum through seven months postpartum. It was also found that female infants born to mom’s with larger fat mass or larger lean mass tended to have increased lean mass at four and seven months postpartum, while there seemed to be no associations with maternal and infant body composition in male infants. These results confirm that the first year of life is an important time in infant development and potential programming, but they also suggest that this programming may be associated with lean mass accrual in early infancy as opposed to fat mass or adiposity. The complexity of the relationships between maternal and infant body composition in the postpartum period may involve other factors such as sex differences, genetics and nutrition, and should be further explored in future studies.

Bakgrund: Sexuell hälsa innefattar fysiskt, psykiskt, socialt och emotionellt välbefinnande. Tidigare forskning visar att den sexuella hälsan ofta påverkas efter förlossning, och är något som många kvinnor inte är förberedda på. Dock finns lite forskning angående kvinnors behov av att samtala om sexuell hälsa med barnmorska på eftervårdsbesöket. Syfte: Kartlägga kvinnors sexuella hälsa samt eventuella behov av att samtala om relationer, intimitet, närhet, sexlust, sexliv och preventivmedel under eftervårdsbesöket på mödrahälsovården. Metod: Tvärsnittsstudie, med kvantitativ ansats utformad som en webbenkät. Publicerades i en Facebook-grupp för kvinnor med barn. Resultatet redovisades med deskriptiv statistik. Resultat: Arbetet inkluderade 75 kvinnor. Resultatet visade att 53% av kvinnorna hade ett behov av att samtala om den sexuella hälsan på eftervårdsbesöket, dock hade endast 37% samtalat om detta. Kvinnor som hade stöd och kunde samtala med partnern om sexuell hälsa skattade högre sexuell hälsa samt hade ett mindre behov av att samtala med barnmorska, än kvinnor som inte hade stöd eller kunde samtala med partnern. Slutsats: Det fanns ett större behov av att samtala om sexuell hälsa än som tillgodosågs på eftervårdsbesöket. Att samtala och få stöd från partnern var viktigt för hur kvinnor upplevde sexuell hälsa. Riktlinjerna för eftervårdsbesöket bör justeras för att inkludera samtal om sexuell hälsa.

The effect of genotype on the occurrence of ovulation and estrus during the interval from lambing to ovulation accompanied by estrus (postpartum interval) was measured in White-Face and Black-Face ewes that lambed during the breeding season in 1986 and 1987. A group of St. Croix ewes was added to the study in 1987. The influence of lactation on the events of the postpartum interval was measured by comparing intact and mastectomized White-Face and Black-Face ewes. The effect of prolactin on postpartum interval was measured in these two genotypes and in a group of bromocriptine-treated Black-Face ewes that lambed in 1986. 1. The interval between parturition and first ovulation was not influenced by genotype or lactation but differed between years (P<.05). 2. The number of ovarian cycles (estimated by progesterone levels) and the interval between parturition and ovulation accompanied by estrus was not different among treatment groups, but the bromocriptine-treated ewes had a shorter postpartum interval (P<.05). 3. The interval from lambing to conception, conception rate and number of estrous cycles to conception (not measured in St. Croix ewes) did not differ among treatments or years. The results of this experiment suggest that the events of the postpartum interval and time from lambing to conception are not influenced by genotype or lactation and that the earlier occurrence of estrus does not reduce the time of conception. The results of hormone profiles suggest that the low LH levels present during early postpartum (around day 10) are sufficient to induce ovulation and estrus. Prolactin secretion on the day of lambing is independent of the presence of the mammary gland and decreases within a week in nonlactating ewes. Concentration of prolactin apparently does not contribute to the length of the postpartum interval.

Bakgrund: Föräldraskapet förknippas med glädje, självförverkligande och hopp om framtiden. Ibland blir inte den första tiden med barnet vad den nyblivna modern tänkt sig, en del kvinnor känner sig nedstämda medan andra upplever att de inte är förberedda för allt vad föräldraskapet innebär. Kvinnan kan bli rädd för att inte behärska den nya rollen som mor. I Sverige drabbas varje år cirka 10000 kvinnor av depression de första månaderna efter barnets födelse. Symtomen är nedstämdhet, känsla av att vara värdelös, oro, trötthet, svårt att känna glädje för sitt barn och tankar på att skada barnet. Inom hälso- och sjukvården har barnmorskan en viktig roll att screena för postpartum depression, mot bakgrund av att av psykosociala eller psykologiska insatser kort efter förlossningen kan förebygga depression. Postpartum depression påverkar inte bara kvinnan utan även barnet och kvinnans partner. Syfte: Syftet var att belysa mödrars upplevelser av en postpartum depression. Metod: Metoden som användes var en litteraturöversikt. Sexton kvalitativa vetenskapliga artiklar inkluderades och analyserades genom en beskrivande metasyntes som metod. Resultat: I resultatet identifierades fem teman omställning till föräldraskap, de upplevda symtomen, relationen till barnet, upplevelse av stöd, att komma tillbaka. Resultatet visade att tiden som nybliven mor innebar förändringar som kvinnorna inte kände sig förberedda på. Tiden efter barnets födelse präglades av oro inför att skada sitt barn, saknat självförtroende och känslor av att tappa bort sig själva. Kvinnorna upplevde avsaknad av stöd och rädsla inför att anförtro sig till sjukvården med konsekvensen att ses som en inkompetent mor och bli fråntagen sitt barn.

I Sverige drabbas åtta till femton procent av de nyblivna mödrarna av en postpartum depression, som ofta debuterar inom tre månader upp till ett år efter en förlossning. Det är inte bara den nyblivna modern som drabbas av konsekvenserna av en postpartum depression utan även det nyfödda barnet, partnern och övrig familj blir påverkade. Syftet var att belysa sjuksköterskors stöd till kvinnor med postpartum depression och deras familjer. En litteraturstudie valdes som metod. Resultatet av litteraturstudien grundades på 15 vetenskapliga artiklar från sju olika länder. Fem teman kunde urskiljas; på vilket sätt relationen mellan sjuksköterskor, mammor och familjer påverkar upplevelsen av stödet, kontinuitetens betydelse för stödet, mammors och familjers upplevelse av sjuksköterskors stöd, information och praktiska råd som stöd vid postpartum depression och sjuksköterskors stödsamtal som behandlingsalternativ. Mammorna upplevde att en god relation till sjuksköterskorna var viktig för att kunna beskriva sin livssituation. För att kunna prata om sin livssituation på ett djupare plan var en kontinuerlig kontakt med sjuksköterskan en viktig aspekt för mammorna. Mammorna upplevde att stödet från sjuksköterskan varierade från att vara ett bra stöd till att mammorna upplevde brist på stöd. I flera studier kunde mammorna tala om vilket stöd de hade önskat och hur de hade velat att sjuksköterskan skulle ha agerat för att vara en god stödjare. Att mammorna fick information och praktiska råd om postpartum depression upplevde både mammor och pappor som viktigt och det ledde till att föräldrarna sökte hjälp för vård och behandling. I sju studier beskrev mammorna och papporna att stödsamtal var ett bra behandlingsalternativ. Slutsatsen som författarna kom fram till var att, för att föräldrarna ska kunna ta emot stöd är det viktigt att mammorna känner sig trygga i sin relation med sjuksköterskan. Vården präglas av ett respektfullt partnerskap, med kontinuitet, mellan sjuksköterskan och familjen. Sjuksköterskan bör ge stöd utifrån hela familjens behov. En av uppgifterna som sjuksköterskor har, är att ge informativt stöd om tidiga symptom och tips på hantering av en postpartum depression. Detta kan vara avgörande för hur familjen kommer att klara av sin situation. Stödsamtal visade sig vara en mycket effektiv behandlingsform och uppfattades, av mammorna, som en mer acceptabel behandling än medicinering.

Philosophiae Doctor - PhD / Postpartum family planning (PPFP) is the initiation of family planning methods among postpartum women, within 12 months after delivery. During this period, the women are a vulnerable group of people with high unmet need for family planning. They are exposed to the risks of unwanted pregnancy, which potentially, could increase maternal mortality, due to the consequences of too frequent pregnancies. Studies have revealed a consistent low use of family planning during the postpartum period. Additionally, it has been documented that the low use of postpartum family planning, most likely, was attributed to inadequate services that had been rendered at healthcare centres, as well as poor motivation by those providing family planning services.

Bakgrund: Psykisk ohälsa hos nyblivna mödrar är ett omfattande folkhälsoproblem. Att få barn innebär för många nyblivna mödrar en stor omställning och att drabbas av psykisk ohälsa som exempelvis depression efter förlossningen är vanligt. Specialistsjuksköterskan på barnavårdscentralen har möjlighet att tidigt kunna identifiera psykisk ohälsa hos nyblivna mödrar och vidta hälsofrämjande åtgärder. Syfte: Att belysa erfarenheter hos specialistsjuksköterskor inom barnavårdscentralen gällande det hälsofrämjande arbetet kring psykisk ohälsa hos nyblivna mödrar. Metod: Semistrukturerade intervjuer genomfördes med sex specialistsjuksköterskor från fyra olika barnavårdscentraler i två olika län i Mellansverige. Intervjuerna analyserades enligt kvalitativ manifest innehållsanalys.Resultat: De huvudsakliga resultaten presenterades genom tre huvudkategorier för att belysa specialistsjuksköterskornas erfarenheter: mötet med den nyblivna modern, identifiera psykiska ohälsa hos den nyblivna modern och samverkande insatser i omvårdnadsarbetet. Huvudkategorierna indelades i två respektive underkategorier: att etablera en omvårdnadsrelation, att stödja moderns förutsättningar, att använda strategier och verktyg, att besöka modern i hemmet, att arbeta i team samt att främja sociala relationer. Resultatets övergripande tema sågs vara relationens hälsofrämjande betydelse för den psykiska hälsan. Diskussion: Alliansen i omvårdnadsrelationen var det mest väsentliga i det hälsofrämjande omvårdnadsarbetet gällande psykisk ohälsa hos nyblivna mödrar, vilket kopplas an till Peplaus omvårdnadsteori. Den sociala jämförelsen modern gjorde till sin omgivning kunde på olika sätt stärka och försämra den psykiska hälsan. Slutsats: Specialistsjuksköterskan på barnavårdscentralen behöver i relationsskapandet ha i beaktning hur olika sårbarhetsfaktorer kan påverka den psykiska hälsan hos nyblivna mödrar och tillämpa omvårdnadsstrategier utifrån mödrarnas sammanhang. / <p>2023-05-30</p>