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PubMed2004

Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale?

BACKGROUND: Postpartum depression is a major health issue for many women around the world with well-documented negative health consequences for the mother, child and family. While research has demonstrated the amenability of postpartum depression to treatment, there is preliminary evidence suggesting maternal mood in the immediate postpartum period may be predictive of postpartum depression such that secondary preventive interventions may be implemented. METHODS: A population-based sample of 594 mothers completed the Edinburgh Postnatal Depression Scale (EPDS) at 1, 4 and 8 weeks postpartum. The sensitivity, specificity and predictive power of the 1-week EPDS in relation to identifying mothers with elevated EPDS scores at 4 and 8 weeks was determined. The predictive power of the 1-week EPDS was further assessed using odds ratios and receiver operator characteristic (ROC) curves. RESULTS: At 1 week postpartum, 29.5% of mothers scored >9 on the EPDS, decreasing to 23% at 4 weeks and 20.5% at 8 weeks. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 85.4% mothers at 4 weeks and 82.5% mothers at 8 weeks with or without postpartum depression symptomatology. The 1-week EPDS was significantly correlated to the 4-week (r=0.72, P<0.001) and 8-week (r=0.65, P<0.001) EPDS. Mothers with a 1-week EPDS score >9 were 30.3 times more likely at 4 weeks (95% CI=17.5-42.3) and 19.1 times more likely at 8 weeks (95% CI=11.0-32.9) to exhibit postpartum depression symptomatology. LIMITATIONS: Psychiatric interviews were not completed in collaboration with the EPDS. CONCLUSION: The EPDS administered in the 1st week postpartum was predictive of maternal mood at 4 and 8 weeks postpartum. To identify mothers at high risk for postpartum depression, health care professionals could consider screening all new mothers in the immediate postpartum period such that secondary preventive interventions may be implemented.

Adolescent↗

PubMed1993

Painful thyroiditis in postpartum period.

Destructive thyroiditis commonly occurs during the postpartum period, with a prevalence rate of 5% to 16%, and is mainly due to postpartum autoimmune thyroiditis (PPT) and, very rarely, to subacute thyroiditis. The thyroiditis is similar to Hashimoto's thyroiditis and is generally painless in nature, although cases with painful thyroiditis have been described. We report a case of painful destructive thyroiditis occurring during the postpartum period, which was clinically and biochemically indistinguishable from the variant of painful PPT or subacute thyroiditis. Fine needle aspiration cytology showed multi-nucleated giant cells diagnostic of subacute thyroiditis.

Adult↗

PubMed2004

Do changes in mood and concerns about weight relate to smoking relapse in the postpartum period?

The majority of women who quit smoking during pregnancy will resume smoking during the postpartum period. Little is known, however, about the predictors of postpartum relapses to smoking. Changes in mood and increases in concerns about weight are common during the postpartum period, and these factors may affect women's postpartum smoking behavior. In this paper, we present a model of the relationship among mood, weight concerns and postpartum smoking. Data from previous postpartum relapse prevention trials are reviewed and evidence of a connection between changes in mood and weight concerns to postpartum relapse is presented. Directions for future research on the prevention of smoking relapses during the postpartum period, and the roles of mood and weight concerns in smoking relapse are presented.

Affect↗

PubMed2002

Serum cholesterol levels and mood symptoms in the postpartum period.

During pregnancy, the total serum cholesterol concentration rises up to 43%, followed by a rapid fall after delivery. Mild depressive symptoms ('postpartum blues') are a common complication of the puerperium and affect 30-85% of women in the early postpartum period. Based on these observations, it has been suggested that the sudden fall in cholesterol levels after delivery could serve as a 'natural model' to test the suggested association between cholesterol and mood. The present study was designed to expand the database concerning the association between cholesterol levels and mood in the postpartum period and to address some methodological problems raised by previous studies. Forty-seven healthy primiparous women were interviewed with a structured clinical interview on two occasions: during late pregnancy (median: day -20 before the expected delivery) and during the early postpartum period (median: day 32 after delivery). On both occasions, serum concentrations of total and HDL cholesterol were measured and mood symptoms were assessed with the state form of Spielberger's State-Trait Anxiety Index (STAI), the state form of the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). We found significant, albeit moderate, relationships between serum cholesterol levels and mood symptoms in the postpartum period that were not present during late pregnancy. Lower postpartum levels of total cholesterol were associated with symptoms of anxiety (r=-0.30, P=0.04), anger/hostility (r=-0.31, P=0.04), and depression (r=-0.35, P=0.02), and lower postpartum levels of HDL cholesterol were associated with symptoms of anxiety (r=-0.34, P=0.02). This study confirms that the physiological fall in blood lipids in the postpartum period can be a useful model to test the relationship between serum cholesterol levels and mood.

Adult↗

PubMed2004

Serum paraoxonase activity and lipid parameters in the early postpartum period of dairy cows.

The effect of early lactation on serum paraoxonase activity was studied on 21 postpartum dairy cows and 19 non-pregnant late lactating dairy cows. A significant decrease of the paraoxonase activity was found in the early postpartum period compared to the late non-pregnant lactation. The serum triglyceride, cholesterol and LDL-cholesterol concentration were also markedly reduced during the postpartum period, while the serum HDL-cholesterol concentration showed no significant change. The results indicate that lower serum paraoxonase activity is associated with lipid metabolic disorders in the early postpartum period. A decreased serum paraoxonase activity may lead to the reduction of the antioxidative capacity and antioxidative protection during the early postpartum period.

Animals↗

PubMed1990

[Effects of lactation on pregnancy induced analgesia during the postpartum period in rats].

Activation of an endogenous opioid system has been associated with an elevation in pain threshold during late pregnancy and the early postpartum period in rats. It is well established that endogenous opiates are involved in the physiological regulation on prolactin secretion. This study examined the influence of lactation on pregnancy-induced analgesia during the early postpartum period in rats. Three tests (colorectal distension, tail-flick and hot-plate) were used to assess each animal's response to painful stimuli. After determining pregnant baseline values, one group of rats (lactating, n = 21) were mated and retested on Day 7 and 21 of gestation and 1, 3, 5, 7 and 14 days after parturition. A non-lactating group of animals (n = 14) whose pups were removed immediately after delivery was tested in the same manner. On Day 21 of gestation significantly higher thresholds and longer latencies were observed. On Day 1 and 3 in both lactating and non-lactating rats, the values were still elevated. No significant difference was observed during the early postpartum period between the two groups. This study confirms the existence, in rats, of pregnancy-induced analgesia late in pregnancy and the early postpartum period. The analgesia during the early postpartum period is not influenced by lactation.

Animals↗

PubMed1997

Ultrasound examination of the stomach contents of women in the postpartum period.

This study used ultrasound imaging to compare stomach contents and gastric emptying of women in the postpartum period with those of nonpregnant women. In the first part of the study, the presence or absence of solid food particles was compared between patients presenting for postpartum tubal ligation (n = 28) and those presenting for gynecological surgery (n = 24). In the second part of the study, gastric emptying of solid food in a group of women in the postpartum period (n = 20) was compared with that of a group of nonpregnant volunteers (n = 21). After a standardized meal, the subjects were not allowed any food for 4 h, and the stomach contents were examined by ultrasound. Results of the first part of the study showed that 11 of the 28 patients presenting for postpartum tubal ligation compared with none of the gynecologic patients had solid food particles in the stomach prior to surgery. In the second part of the study, 19 of 20 women in the postpartum group still had food particles in the stomach 4 h after the meal as compared with only 4 of 21 in the non-pregnant group. Both differences were statistically significant. Our results indicate that gastric contents of women in the postpartum period may include food particles and that there is delayed gastric emptying of solid food in the postpartum period.

Adult↗

PubMedDate not supplied

Postpartum depression beyond the early postpartum period.

OBJECTIVE: To review the literature concerning maternal postpartum depression beyond the early postpartum period. DATA SOURCES: A literature search was conducted using Cinahl, Medline, and PsychInfo electronic databases. Keywords included postpartum depression, postpartum depressive symptoms, course, prevalence, incidence, and remission. STUDY SELECTION: Studies selected included incidence of maternal depression or depressive symptoms, existing in the early postpartum period, and measured again at postpartum points from 6 months through 2 1/2 years after delivery. Only studies published in English were included. Twenty-three articles were located, and a recent relevant study conducted by the current author also was included. DATA EXTRACTION: Studies were reviewed and data organized according to year, sample characteristics, time of depression assessment, instrument used, cutoff score, rate of depression, and factors associated with depression at later postpartum time points. DATA SYNTHESIS: For a significant percentage of women, postpartum depressive symptoms continue for months or even years after giving birth. Factors associated with postpartum depression at later time points are identified. CONCLUSIONS: Continued evaluation of women with elevated depression levels at initial screening, and treatment for women whose depression does not remit spontaneously within the first few weeks or months postpartum is recommended. Further research is needed to understand the phenomenon of persistent postpartum depression.

Chronic Disease↗

PubMed1998

Surgical considerations in the contemporary management of biliary tract disease in the postpartum period.

BACKGROUND: Excluding sterilization procedures, no experience with laparoscopic procedures in the postpartum period has been reported. The postpartum patient may have unique characteristics that must be recognized for safe management. METHODS: The authors prospectively studied 1,100 consecutive biliary patients in a private surgical practice since the introduction of laparoscopic cholecystectomy (LC). The group includes 34 patients who presented with biliary tract disease and were operated upon within 6 weeks of obstetrical delivery. Laparoscopic procedures were performed on these 34 patients 1 to 42 days following vaginal (26) or Cesarean (8) deliveries. RESULTS: All patients had calculous cholecystitis. Choledocholithiasis was documented in 10 (29%) patients, including 3 patients (9%) with missed common duct stones, and strongly suggested in 5 (15%) others. Open biliary procedures were required for 2 patients. One patient returned to surgery for an ERCP-related complication. Follow up is known for all patients. There were no delayed complications. CONCLUSIONS: The laparoscopic approach to biliary tract disease in the postpartum period is safe. Recent vertical Cesarean incisions can withstand the strain of a reduced pneumoperitoneum. The high incidence of choledocholithiasis calls for routine cholangiography in the postpartum patient.

Adolescent↗

PubMed2000

Estrogen and progesterone receptors in the ovine cervix during the postpartum period.

Cervical estrogen (E) and progesterone (P) receptors were characterized and quantified during the postpartum period in Corriedale ewes lambing in the late breeding season. Cervices and uteri were collected after ovariohysterectomy at 1 d (n = 2), 5 d (n = 4), 17 d (n = 2) or 30 d (n = 2) post partum. The estrogen and progesterone receptors were measured using binding assays with tritiated hormones, dextran charcoal separation and inverse Scatchard analysis. Similar kinetic parameters in cytosolic binding sites for both hormones were found in all cervical and uterine samples, indicating that the binding protein in both tissues is of the same nature. Receptor concentrations (fmol/mg cytosolic protein) in the cervix of early (1 to 5 d, n = 6) and late (17 to 30 d, n = 4) postpartum ewes were 348 +/- 66 vs 994 +/- 145 (P < 0.05) for E and 618 +/- 126 vs 1170 +/- 201 (P < 0.05) for P, respectively. These data suggest an increased synthesis of receptors, probably due to the presence of ovarian estrogen-active follicles. Cervical E and P receptor concentrations were similar or higher than those in the uterus (1.40 +/- 0.15, n = 10 and 1.51 +/- 0.19, n = 10; for E and P respectively), and these receptor ratios did not differ between the early and late postpartum period. The high ratio between cervical/uterine receptors suggests that the ovine cervix may be a very sensitive to steroid action. In conclusion, it was shown that restoration of steroid receptors during the postpartum period in the ovine cervix is similar to receptor dynamics in the uterus, and is probably associated with the recovery of ovarian cyclicity.

Animals↗

PubMed1992

[The course of postpartum period after mandatory ambulatory labor].

Mandatory early discharge for all normal multiparae was introduced as a trial arrangement in the County of Ringkøbing from 1.1.1990. A total of 113 early discharged women and 90 patients who remained in hospital participated in a questionnaire investigation comprising 41 questions about problems and need for support during the first postpartum period and about satisfaction with the postpartum period. A total of 64% of all the multiparae were early discharged and were discharged 4.2 hours after the delivery. On the whole, the women were satisfied with the postpartum period and only few problems in infants or mothers occurred. The early discharged group, however, as compared with the control group, stated that they had received less satisfactory support concerning breast-feeding (p less than 0.005) and that, in general, they had received less support from friends (p less than 0.01) and hospital staff (p = 0.04). The group of early discharged felt that they had received less satisfactory information (p less than 0.005) and, on the whole, they were less satisfied with the postpartum period (p less than 0.005). In addition, the group who were early discharged had 67% more telephone conversations with and 127% more visits from the midwife, health nurse or practitioner.

Adult↗

PubMed1996

The postpartum period: the key to maternal mortality.

OBJECTIVES: To assess postpartum care at an international level, we reviewed published literature on postpartum maternal deaths. METHODS: Meta-analysis was used to summarize the literature reviewed. Postpartum deaths in developing countries were compared with those in the United States. RESULTS: In both developing countries and the United States, > 60% of maternal deaths occurred in the postpartum period; 45% of postpartum deaths occurred within 1 day of delivery, > 65% within 1 week, > 80% within 2 weeks. In developing countries, 80% of postpartum deaths caused by obstetric factors occurred within 1 week. CONCLUSIONS: The first 24 h postpartum and the first postpartum week is the high risk of postpartum deaths, and the risk remains significant until the second week after delivery. In developing countries, hemorrhage, pregnancy-induced hypertension complications, and obstetric infection are commonest causes of postpartum deaths. We suggest primary prevention, early detection, and secondary prevention of postpartum deaths.

Developing Countries↗

PubMed1992

[Recovery of ovarian function during postpartum period].

To determine the effect of serum prolactin (PRL) on the recovery of ovarian function in the postpartum period, FSH, PRL, estradiol (E2), and 17 alpha-OH-progesterone (17-P) levels were measured in postpartum women and the levels were compared with those in patients treated with bromocriptine. In addition, hMG was given for two days on the 10th and 30th postpartum days to the mothers treated with/without bromocriptine. On the 10th day, FSH levels tended to increase and the E2 and 17-P levels were significantly increased by bromocriptine treatment and these levels are compatible to those on the 30th day in the control group. Although no apparent change in E2 and 17-P levels was observed before and after hMG administration in the control, a significant increase in E2 on the 30th day and in 17-P on the 10th and 30th day was observed when the patients were treated with bromocriptine. These results suggest that high concentrations of PRL in the postpartum period suppressed the ovarian function not only due to the low gonadotropin secretion but also to the poor ovarian response to gonadotropin. 17-P seems to be preceded by estradiol secretion in the recovery of ovarian function during the postpartum period.

17-alpha-Hydroxyprogesterone↗

PubMed2003

Effects of nutrient and food intake on calcaneous bone mass among healthy Japanese women in the predelivery and postpartum periods.

OBJECTIVE: To clarify the dietary factors affecting change in calcaneous bone mass during the predelivery and postpartum periods in healthy Japanese women. METHODS: The calcaneous bone mass was measured as the osteo sono-assessment index (OSI) using the quantitative ultrasound method in 76 Japanese women who were pregnant between February and June 2000. These women subsequently experienced normal pregnancy and labor and could be followed until the sixth month after delivery at an obstetrics and gynecology clinic center located in metropolitan Tokyo. After the intraindividual changes in the OSI during the follow-up period were determined, the relationship between the OSI or OSI change from gestation to the postpartum period and the estimates of nutrient and food intake obtained using a 140-item semiquantitative food frequency questionnaire (FFQ) were analyzed using stepwise multiple regression analysis. RESULTS: Iron intake in gestation was a significant positive correlate with the percentage change in the OSI between week 36 of gestation and day 5 after delivery (p < 0.001) and that between week 36 of gestation and month 6 after delivery (p < 0.001) (partial regression coefficient of energy-adjusted iron intake, beta = 0.493 mg/day and 0.342 mg/day, respectively). Intake of vitamin D and fruits and vegetables during gestation and/or postpartum was positively associated with the OSI change from week 36 of gestation to the postdelivery stage, whereas the OSI change was inversely related to the intake of carotene, sodium chloride, and meat in the gestation or postpartum period. CONCLUSIONS: Sufficient intake of iron, vitamin D, or fruits and vegetables may be important for the preservation of bone mass after delivery.

Adult↗

PubMed1999

Severe nonendemic pemphigus foliaceus presenting in the postpartum period.

The new onset of pemphigus in the postpartum period is exceedingly rare with only 1 case previously reported in the literature. We describe a 31-year-old woman who developed extensive denudation of her skin shortly after delivering her second child. Histologic examination, immunofluorescence testing, and immunoprecipitation with desmoglein 1 confirmed the diagnosis of pemphigus foliaceus. The patient responded to treatment with prednisone, cyclophosphamide, and plasmapheresis. The effect of the postpartum period on the onset and exacerbation of immune-mediated bullous diseases is discussed.

Adult↗

PubMed2004

[Prediction model on mother-infant attachment during the early postpartum period].

PURPOSE: The purpose of this study is to identify the influencing factors of mother-infant attachment and construct a descriptive model that explains mother-infant attachment during the early postpartum period. METHOD: The hypothetical model of this study consisted of 8 variables with 23 constructed paths. The subjects of this study were 152 postpartum women. Data was analyzed to test the hypothetical model using covariance structure analysis. RESULT: The final model which is modified from the hypothetical model improved to Chi-Square 41.92, GFI.95, AGFI.89, RMSR.02, RMSEA.06, NFI.94, and NNFI.95. Mother-infant attachment during the early postpartum period was proven to be influenced directly by neonatal perception, maternal sensitivity, and maternal-fetal attachment and also indirectly by social support, maternal-fetal attachment and maternal identity. These variables accounted for 32% of the variance of the mother-infant attachment during the early postpartum period. CONCLUSION: It is necessary that the nurses provide postpartum women with an intervention using social support for improving maternal identity and alleviating maternal role strain. It can be helpful to improve maternal sensitivity and in the end it will facilitate the mother-infant attachment during postpartum period.

Adult↗

PubMed2006

Panic disorder during pregnancy and postpartum period.

BACKGROUND: Earlier studies on the influence of pregnancy and postpartum period on the course of panic disorder have been inconsistent. The present study aims to quantify panic manifestations in these periods in large sample of women. METHOD: Panic manifestations, including exacerbations and new manifestations of panic disorder, were assessed retrospectively in a sample of 128 women with panic disorder with or without agoraphobia, 93 of whom had had 195 pregnancies. RESULTS: Panic manifestations were fewer during pregnancy and more frequent in the postpartum period when compared with the control period. Women who had never been pregnant had significantly more panic manifestations than women with prior pregnancies. Breastfeeding and miscarriages did not have a significant effect. Women with postpartum panic reported more psychosocial stress events during this period. CONCLUSIONS: Possible reasons for postpartum panic and the protective effects of pregnancy are discussed, including psychosocial or hormonal factors and other neurobiological changes. Postpartum panic coincides with a sudden drop of hormones after delivery.

Adult↗

PubMed1976

Pituitary responses to LRH in the postpartum periods.

Pituitary responses to luteinizing-hormone-releasing-hormone (LRH) in the postpartum periods were studied. Following a subcutaneous injection of 100 mug of synthetic LRH to postpartum subjects, no statistically significant changes in the levels of LH and FSH could be demonstrated in five subjects on postpartum day 1 or 3 and the three subjects on postpartum day 8. A normal elevation of LH and FSH following LRH was demonstrated in one subject 36 days post partum. The findings are in agreement with previous studies demonstrating a persistence of pituitary suppression during the early postpartum period. No correlation could be drawn between the pituitary responses to LRH and the plasma levels of estradiol-17 beta and progesterone.

Estradiol↗