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PubMed2004

Management of bipolar disorder during pregnancy and the postpartum period.

OBJECTIVE: Bipolar disorder affects 0.5%-1.5% of individuals in the United States. The typical age at onset is late adolescence or early adulthood, placing women at risk for episodes throughout their reproductive years. General guidelines for the treatment of bipolar disorder are available from the American Psychiatric Association, but additional issues arise when these guidelines are applied in the treatment of peripartum women. The authors summarize knowledge regarding the management of bipolar disorder during pregnancy and the postpartum period, with a focus on managing mania, hypomania, and the psychotic components of the illness. METHOD: An expert panel reviewed articles that address the management of bipolar disorder and the consequences of the use of mood stabilizers during pregnancy, and a consensus document was generated. RESULTS: The treatment of bipolar disorder in pregnant women involves significant challenges. Some mood stabilizers, e.g., sodium valproate and carbamazepine, are human teratogens. On the other hand, the teratogenicity associated with lithium may have been overestimated in the past. CONCLUSIONS: Since treatment can be managed most effectively if pregnancy is planned, clinicians should discuss the issue of pregnancy and its management with every bipolar disorder patient who has childbearing potential, regardless of future reproductive plans. Additional research should address the risks of disturbed sleep to pregnant and postpartum women with bipolar disorder, as well as structural and behavioral consequences to offspring when mood stabilizers are used during pregnancy. Longitudinal and cohort studies can promote these efforts. Given the rate of bipolar disorder in the general population, research efforts will need to be broad based and include multiple collaborating centers.

Adolescent↗

PubMed1992

A study of autoimmune gastritis in the postpartum period and at a 5-year follow-up.

The presence of autoimmune gastritis was investigated in 54 women with postpartum thyroiditis. Parietal cell antibodies (PCA) specific against H+, K(+)-adenosine triphosphatase (EC 3.6.1.36) were found in 18 women during pregnancy; in 10 of them, a 2-9-fold increase in the PCA level was observed in the postpartum period. At a 5-year follow-up, the initially PCA-positive women still had elevated antibody levels. Hypergastrinemia and low pepsinogen levels were noted in 4 women. In 2 of these women low serum vitamin B12 levels had developed. In 6 of 9 PCA-positive women examined by gastroscopy, biopsy specimens from the gastric body mucosa contained mononuclear cells, mainly T lymphocytes (CD3+) and macrophages (Leu-M3+) combined with an aberrant epithelial expression of HLA-DR. In four patients with chronic gastritis, all parietal cells, as defined by a specific monoclonal antibody, were found to have immunoglobulin G (IgG) deposits by a double-immunostaining method. Three of them had microscopic evidence of atrophy, whereas in 1 patient the body mucosa was intact. In 1 further patient with intact glands at histological examination, the basolateral membrane of some oxyntic glands was coated with IgG. The selective in situ deposition of antibodies associated with histologically intact parietal cells may support the concept that specific autoantibodies participate in the early pathogenesis of parietal cell destruction.

Adenosine Triphosphatases↗

PubMed2004

A multistage model for maternal morbidity during antenatal, delivery and postpartum periods.

There is acute dearth of information regarding factors affecting complications during different stages of childbearing in Bangladesh. This study employs a multistage model that involves transitions at different stages to complications. The proposed model appears to display more meaningful explanation concerning the impact of different factors on the incidence of complications taking into account types of transitions. Two alternative models are also presented in this paper in order to demonstrate possible simplifications of the proposed model. This study uses data from a prospective survey on Maternal Morbidity in Bangladesh. The survey was conducted during the period 11 1992-12 1993. A total of 1020 pregnant women were followed during pregnancy, delivery and 90 days after delivery. This study reveals some very important findings regarding the potential impact of antenatal visits, economic status, whether the index pregnancy was desired or not and number of pregnancies prior to the index pregnancy. It is observed that slightly more than 50 per cent of the women suffer from at least one of the major complications (haemorrhage, excessive vomiting, oedema and fits/convulsion) during pregnancy. It is noteworthy that if a woman suffers from one or more of the major complications during pregnancy, then it is more likely that she will suffer from complications during delivery. This study reveals that the women who suffer from one or more of the major complications during pregnancy are expected to have a substantially higher risk of suffering from complications during postpartum period, irrespective of no complications or complications during delivery. Generally speaking, higher economic status can reduce the complications at the postpartum stage, although women belonging to higher economic status may suffer from complications during pregnancy and delivery at a higher rate. It is surprising that antenatal visit is positively associated with incidence of complications during pregnancy and delivery, but antenatal visit reduces complications at the postpartum stage.

Bangladesh↗

PubMed2005

The effect of herbal medicine Toki-shakuyaku-san on blood pressure in an Nomega-nitro-L-arginine methyl ester-induced pre-eclampsia rat model during pregnancy and the postpartum period.

The chronic inhibition of nitric oxide (NO) synthesis with N(omega)-nitro-L-arginine methyl ester (L-NAME) in pregnant rats induces a pre-eclampsia-like syndrome, including hypertension. We have previously reported the beneficial effects of Toki-shakuyaku-san (TS) in this model. In the present study we demonstrated the anti-hypertensive effect of TS in pre-eclampsia produced by prolonged L-NAME-infusion during the postpartum period. Analysis of blood sex steroids suggested that the level of progesterone differs between the TS-effective (gestational day 19 and postpartum day 7) and TS-ineffective (postpartum day 1) periods. Co-administration of TS and progesterone inhibited L-NAME-induced hypertension on postpartum day 1. Furthermore, the anti-hypertensive effect of TS on postpartum day 6 disappeared in the presence of a co-administered progesterone antagonist mifepristone. These data suggest that a certain level of progesterone may be an indispensable prerequisite for an anti-hypertensive effect of TS. Finally, the effects of TS are apparently unrelated to blood levels of NO, calcitonin gene-related peptide, and endothelin-1, which have been reported to modulate systolic blood pressure in the L-NAME-induced pre-eclampsia model. Thus, the use of TS may provide a new therapeutic strategy for pre-eclampsia, although elucidation of the mechanism of action of TS would be necessary to optimize treatment protocols.

Animals↗

PubMed1987

Physical and emotional responses of expectant fathers throughout pregnancy and the early postpartum period.

A comparative, repeated measures survey design was used to monitor the physical and emotional health of 81 expectant fathers and 66 non-expectant men over the course of a year at monthly intervals. A total of 877 monthly data collection episodes were completed. Compared to non-expectant men, expectant fathers were found to experience relatively similar patterns of both physical and emotional symptoms throughout the three trimesters of pregnancy. However, expectant fathers' health was found to differ significantly from that of non-expectant men during the immediate postpartum period with a greater incidence of emotional discomforts as well as total number of symptoms, their duration and perceived seriousness. Included are recommendations for anticipatory health counseling to promote health in expectant fathers.

Adult↗

PubMed1984

Effect of suckling and ovariectomy on the control of luteinizing hormone secretion during the postpartum period in beef cows.

Twenty-two mature pluriparous beef cows were randomly assigned to one of six treatments in a 2 X 3 factorial experiment in order to study the role of suckling and ovarian factors on control of the tonic and episodic release of luteinizing hormone (LH). Twelve cows remained intact (INT) and 10 were ovariectomized (OVX) within 4 days following the day of parturition (Day 0). The suckling intensities were nonsuckled (0), suckled once daily for 30 min (1) and suckled ad libitum by two calves (2). Blood samples were collected at 15-min intervals for 6 h weekly, from Days 6 to 76 postpartum. The postpartum intervals to initiation of ovarian luteal function were 31 +/- 3, 41 +/- 4 and 67 +/- 1 days (means +/- SEM) for INT cows with 0, 1 and 2 suckling intensities, respectively. Mean LH concentrations and frequency of LH pulses increased as time of ovulation approached in INT cows. In OVX animals, both mean LH concentrations and frequency of LH pulses increased as time postovariectomy progressed. No differences were detected in mean LH concentrations or frequency of LH pulses between the two suckled OVX groups. Mean LH in the OVX-0 cows was greater on Days 13, 20 and 27 postpartum when compared to the respective days in suckled OVX cows. Frequency of LH pulses tended to be lower (P less than 0.10) in both suckled OVX groups when compared with OVX-0 cows from Day 6 to Day 55 postpartum. It is postulated that suckling and ovarian factors act together during the postpartum period to suppress LH levels and frequency of LH pulses in beef cows.

Animals↗

PubMed2001

Localization and regulation of IL-1alpha in rat myometrium during late pregnancy and the postpartum period.

Interleukin-1 (IL-1) has been implicated as a participant in preterm labor that is induced by bacterial infection. Previously, we showed that serotonin-induced production of IL-1alpha by myometrial smooth muscle cells in vitro is also essential for the synthesis of interstitial collagenase. It is therefore likely that IL-1alpha production in uterine tissues has implications for both the normal physiology of involution and for the pathophysiological mechanisms of preterm labor. The objective of this study was to characterize the serotonin-induced production of IL-1alpha by myometrial cultures in vitro and to assess the production of IL-1alpha and its relationship to collagenase production in vivo during pregnancy and the postpartum period. Immunohistochemistry demonstrated IL-1alpha protein in the nuclei and cytoplasm of serotonin-treated myometrial cells. IL-1alpha levels were decreased by treatment with progesterone or IL-1-receptor antagonist but were unaffected by lipopolysaccharide. Western analysis of myometrium from pregnant rats showed low levels of IL-1alpha during midpregnancy with increased concentrations at days 21 and 22 and postpartum. IL-1alpha mRNA levels also increased from days 15 to 22. Levels of mRNA for IL-1beta also increased, although to a lesser degree than IL-1alpha. Both mRNAs decreased postpartum. Conversely, mRNA for interstitial collagenase was barely detectable at term but increased postpartum. Together, these data show that serotonin stimulates IL-1alpha production in vitro and indicate that normal myometrium from pregnant rats is an identifiable source of IL-1 during late pregnancy. The findings are consistent with the possibility that myometrial IL-1alpha participates in normal labor as well as the postpartum production of interstitial collagenase.

Animals↗

PubMed2003

[Determination of nosocomial infection incidence in mothers and newborns during the early postpartum period].

BACKGROUND: We wished to determine the incidence of nosocomial infections in the mother and the newborn during the early postpartum period. MATERIAL AND METHODS: Over a three-month period, the same investigator collected 50 different clinical and microbiological, standardized data related to infectious diseases in parturients and their newborns. RESULTS: Data were collected on 804 deliveries. The overall rate of nosocomial infection was 2.9% (23/804). For vaginal deliveries, the rate was 1.9% (12/615) and for deliveries by Cesarean section, the rate was 5.8% (11/189). Of 745 newborns followed until discharge from hospital, 0.7% (5/745) had a nosocomial infection. CONCLUSION: These results are in line with previously published rates of nosocomial infections, which varied between 0.2% to 2.3% for vaginal deliveries, 1.6% to 18.9% for Cesarean section, and 0.2 to 4% in newborns. Regular surveys of the incidence or the prevalence of nosocomial infections are necessary to monitor the effectiveness of educational programs, aimed to reduce hospital acquired infections.

Adolescent↗

PubMed2000

Levator ani muscle activity in pregnancy and the postpartum period: a myoelectric study.

The levator ani (LA) is a muscle of evacuation and acts as well to support the pelvic viscera. An increase of the intra-abdominal pressure beyond the physiologic limits and visceral overload are speculated to interfere with LA functional activity. This consideration was a stimulus to study the effect of pregnancy on the LA muscle. The EMG activity of the LA muscle was recorded before and during pregnancy and after delivery in 36 women (mean age 27.2+/-3.1 years, 20 multigravida, 16 primigravida). A needle electrode was inserted into the muscle and LA activity was recorded at rest, and on squeezing and straining in both the erect and recumbent position. In the erect position, the resting and squeezing EMG activity during the first 8 weeks of pregnancy, showed no significant difference (p>0.05) from that before pregnancy, and after that, increased progressively and significantly until delivery. On straining, the EMG activity showed no significant difference from that before pregnancy in the first 8 weeks, and after that, decreased progressively and significantly till delivery. In the recumbent position, the LA EMG registered similar activity to that in the erect position but with significantly lower values (p<0.05). The reduction in the LA EMG activity was more evident in the multi-than in the primigravida. In the postpartum period, no LA EMG activity was recorded in the first month; the activity increased progressively after that time to reach the pre-pregnancy level in the forth postpartum month. In conclusion, pregnancy interferes with EMG and functional activity of the LA from the 8th week onwards due to the progressively increasing size and weight of the uterus. This effect was most marked in the last 12 weeks. Delivery seems to maximally inhibit the LA activity in the first postpartum month. Excessive LA traumatization may eventually lead to levator dysfunction syndrome.

Adult↗

PubMed1999

Cervical human papillomavirus deoxyribonucleic acid persists throughout pregnancy and decreases in the postpartum period.

OBJECTIVE: Our goal was to determine the persistence of human papillomavirus infection of the cervix in a prospectively evaluated cohort of pregnant women observed from the first trimester until after delivery. STUDY DESIGN: A group of 232 women were enrolled in the first trimester of pregnancy and had cervico-vaginal lavage specimens collected for detection of the deoxyribonucleic acid of human papillomavirus. They underwent sampling again in the third trimester (146 patients available) and at 4 to 12 weeks after delivery (83 patients available). Human papillomavirus deoxyribonucleic acid was detected by means of the Hybrid Capture assay. RESULTS: In the first trimester of pregnancy, 31% of the patients had positive test results for human papillomavirus deoxyribonucleic acid, whereas 35.6% had positive results in the third trimester (P = 1.0). A comparison of first-trimester test results with postpartum results (paired data available from 83 patients) showed a decline from 39.8% positivity to 26.5% (P =.04). Comparing third-trimester results with postpartum results (paired data available from 74 patients) showed a decline from 35.1% to 25. 7% positivity (P =.12). When specimens positive for human papillomavirus were divided between those containing "high cancer risk" types (9 virus types often associated with dysplasia or malignancy) and "low cancer risk" types (5 types usually found in benign lesions), similar trends were seen, although not all comparisons were statistically significant. CONCLUSION: The increased prevalence, during pregnancy, of detectable human papillomavirus deoxyribonucleic acid, which was previously reported (Fife et al, Am J Obstet Gynecol 1996;174:1487-93), persists at a similar level throughout pregnancy but declines in the postpartum period. This observation is most consistent with activation of the virus by the physiologic changes of pregnancy.

Adult↗

PubMed1991

Weight changes during pregnancy and the postpartum period.

Weight gain during pregnancy is considered a major determinant of fetal growth. Low maternal weight gain is associated with an increased incidence of low birth weight infants who are at higher risk for increased mortality. For the past twenty years, weight gain recommendations have been centered around one value (11 kg) as representative of a weight gain objective. Newer recommendations are based on what is considered optimal infant outcomes and not necessarily on maternal health considerations. These recent recommendations indicate the importance of pregravid weight in setting weight gain goals with overweight gravida advised to gain less than normal weight or underweight gravida. When confounding variables are controlled, maternal weight gain is similar in adolescents and older women. Reports on weight loss during the postpartum period indicate a high degree of variability in total weight change. In general, with current levels of weight gain, each successive birth adds about 1 kg of body weight above that normally gained with age. There is very little evidence to suggest that breast feeding as compared to other methods of infant feeding, causes body weight to return to prepregnancy levels at a faster rate.

Adolescent↗

PubMed1993

Incidence of abnormal voiding parameters in the immediate postpartum period.

One hundred eighty-four patients were assessed prospectively by uroflowmetry and postmicturition ultrasonography on a daily basis in the immediate postpartum period to assess the incidence of abnormal voiding parameters, their predisposing factors, and whether the combination of two screening tests was more helpful than either alone as a screening test of abnormal voiding in the puerperium. The incidence of abnormal voiding parameters was 43%. The majority of these were asymptomatic. Of those patients who had an abnormality, 68% had normal voiding parameters by the time they went home, and all of those who returned for follow-up had normal parameters. Operative delivery, perineal trauma, and epidural anaesthesia all increased the incidence of abnormal voiding parameters. Residual urine was a feature in 70 of the 79 patients found to be abnormal, and the incidence of an abnormal flow rate was not significantly greater than in the nonpregnant population. This suggests that the addition of uroflowmetry does not confer any benefit over postmicturition assessment of residual urine by ultrasonography in the detection of patients with postpartum voiding dysfunction.

Anesthesia, Epidural↗

PubMed2003

Exercise in pregnancy and the postpartum period.

OBJECTIVE: To design Canadian guidelines advising obstetric care providers of the maternal, fetal, and neonatal implications of aerobic and strength-conditioning exercises in pregnancy. OUTCOMES: Knowledge of the impact of exercise on maternal, fetal, and neonatal morbidity, and of the maternal measures of fitness. EVIDENCE: MEDLINE search from 1966 to 2002 for English-language articles related to studies of maternal aerobic and strength conditioning in a previously sedentary population, maternal aerobic and strength conditioning in a previously active population, impact of aerobic and strength conditioning on early and late pregnancy outcomes, and impact of aerobic and strength conditioning on neonatal outcomes, as well as for review articles and meta-analyses related to exercise in pregnancy. VALUES: The evidence collected was reviewed by the Society of Obstetricians and Gynaecologists of Canada (SOGC Clinical Practice Obstetrics Committee) with representation from the Canadian Society for Exercise Physiology, and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS: 1. All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy. (II-1,2B) 2. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness or train for an athletic competition. (II-1,2C) 3. Women should choose activities that will minimize the risk of loss of balance and fetal trauma. (III-C) 4. Women should be advised that adverse pregnancy or neonatal outcomes are not increased for exercising women. (II-1,2B) 5. Initiation of pelvic floor exercises in the immediate postpartum period may reduce the risk of future urinary incontinence. (II-1C) 6. Women should be advised that moderate exercise during lactation does not affect the quantity or composition of breast milk or impact infant growth. (I-A) VALIDATION: This guideline has been approved by the SOGC Clinical Practice Obstetrics Committee, the Executive and Council of SOGC, and the Board of Directors of the Canadian Society for Exercise Physiology. SPONSORS: This guideline has been jointly sponsored by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Society for Exercise Physiology.

Adult↗

PubMed1975

Cortisol metabolism in the baboon during pregnancy and the postpartum period.

The metabolism of iv-administered 14C-cortisol (F) by pregnant baboons (107, 124 and 150 days gestation) was compared with that previously reported for nonpregnant animals and with that of animals examined 6-18 h after spontaneous vaginal delivery (178 plus or minus 4 days). Unconjugated, glucuronoside (beta-glucuronidase) and sulfate (H2SO4-ethyl acetate) fractions were extracted with ethyl acetate from urine containing more than 80% of injected 14C. Metabolites of interest were isolated by paper partition chromatography and purified by crystallization and derivative formation. Compared with nonpregnant animals, the following changes (P less than 0.05) were observed in pregnancy: (1) an increase in the percent urinary 14C in the unconjugated fraction and a decrease in the proportion of 14C appearing in the glucuronoside fraction; (2) an increase in excretion of metabolites more polar than the cortols; (3) a decrease in excretion of metabolites less polar than cortisone in the glucuronoside fraction; (4) an increase in unconjugated F excretion. Production rate of F (11.9 plus or minus 0.7 mg/day) estimated by isotope dilution and percent urinary 14C in tetrahydrocortisol and tetrahydrocortisone from the glucuronoside fraction were as in nonpregnant animals. With the exception of an increase in F production (22.7 plus or minus 0.8 mg/day), presumably the result of the stress of labor, F metabolism in the immediate postpartum period was strikingly similar to timals indicates that changes in the mother alone can account for the altered metabolic disposition of F in pregnancy and suggests that the fetus takes little part in metabolism of maternal circulating F.

Animals↗

PubMed1984

Autoimmune thyroid dysfunction in the postpartum period.

The prevalence of thyroid disease was investigated in 460 Caucasian women after delivery. Thyroid microsomal antibodies (MsAb) were found in 44 (9.6%) of the women. These women appeared to have autoimmune thyroiditis. The changes in MsAb titers followed a predictable pattern with maximal values around 5-7 months postpartum. At this time 20 of these women had transient hypothyroidism and in some this was preceded by a thyrotoxic episode. The extent of postpartum hypothyroidism correlated well with the titers of MsAb in early pregnancy and in the postpartum period. Transient thyrotoxicosis occurred in eight women 5-7 months postpartum. TSH-receptor stimulating antibodies and/or high radioiodine uptake, suggesting Graves' disease, were detected in four of these women. Thus, after delivery, manifestations of autoimmune thyroid disorders, are remarkably common. In patients with autoimmune thyroiditis measurements of MsAb provide a good prognostic marker for the development of transient hypothyroidism.

Adult↗

PubMedDate not supplied

[Changes in spectral coherent characteristics of EEG in the early postpartum period in mothers with anxious and depressed mood].

Postpartum EEG spectral and coherence characteristics were estimated in mothers with or without postpartum depressions. In mothers without affective disorders the power of oscillations in the delta, theta, and alpha 1 frequency bands was increased as compared to controls. Intrahemispheric EEG coherence between the left frontal and adjacent derivations in the delta and theta bands and interhemispheric coherence in the central areas was increased and decreased over the remaining cortical surface. These changes led to a significant decrease in EEG asymmetry. It is suggested that during normal postpartum the influence of the limbicodiencephalic and lower brainstem structures on the cortex is augmented and a certain kind of dominanta is formed. In mothers with postpartum depressions the EEG alpha-band power was lower than in the control and normal groups, coherence changes in the delta and theta bands diminished the EEG asymmetry. The insufficiency of limbicodiencephalic influence and impairment of adaptive brainstem reactions are suggested to be responsible for problems in the formation of maternal dominanta, which results in the development of postpartum depressions.

Adult↗

PubMed2005

Persistence of nevirapine exposure during the postpartum period after intrapartum single-dose nevirapine in addition to zidovudine prophylaxis for the prevention of mother-to-child transmission of HIV-1.

OBJECTIVE: To determine nevirapine (NVP) plasma levels during the postpartum period after a single intrapartum NVP dose for the prevention of mother-to-child transmission. METHODS: Plasma samples at delivery and during days 8 to 45 postpartum were obtained from HIV-infected Thai women who received an intrapartum NVP dose in the Perinatal HIV Prevention Clinical Trial-2 (PHPT-2) for the prevention of perinatal HIV transmission. These data were combined with NVP concentration data from 2 phase 1 studies of NVP for a population analysis. RESULTS: The median NVP level fell to 68 ng/mL (range: <50-228, n = 43) 8 to 14 days after dosing and to 51 ng/mL (range: <50-166, n = 25) between 15 and 21 days. During the second and third weeks postpartum, NVP levels were below the limit of quantitation in 23% and 44% of samples, respectively. Between 21 and 45 days, no sample had a quantifiable NVP concentration. A simulation derived from the population analysis predicts that NVP concentration falls to less than 10 ng/mL in 5% of women by 11 days, in 50% of women by 17.5 days, and in 95% of women by 28 days. CONCLUSIONS: Significant NVP concentrations remained for up to 20 days in these Thai women. To ensure that coverage is maintained until NVP concentrations fall to nonsuppressive levels, 1 month of additional antiretroviral treatment after delivery should be considered to prevent the emergence of resistant viruses.

Adolescent↗

PubMedDate not supplied

Candida sepsis in pregnancy and the postpartum period.

Colonization of the vagina by Candida is common during pregnancy, while candida sepsis in pregnancy is rare. A case of candida sepsis complicating an abortion prompted us to review seven additional cases that occurred during pregnancy or the postpartum period. In four women candidemia developed during pregnancy or following abortion, while in the other four it developed postpartum. Seven women had an apparent predisposing factor, such as antibiotic treatment or an intrauterine device. The clinical course was difficult in four patients and ended in death in three instances. Both amphotericin B and 5-fluorocytosine proved effective for treatment.

Abortion, Septic↗