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At least 109 records · Page 6Linked to original sources
PubMed2004

Cerebral artery reactivity changes during pregnancy and the postpartum period: a role in eclampsia?

Eclampsia is thought to be similar to hypertensive encephalopathy, whereby acute elevations in intravascular pressure cause forced dilatation (FD) of intrinsic myogenic tone of cerebral arteries and arterioles, decreased cerebrovascular resistance, and hyperperfusion. In the present study, we tested the hypothesis that pregnancy and/or the postpartum period predispose cerebral arteries to FD by diminishing pressure-induced myogenic activity. We compared the reactivity to pressure (myogenic activity) as well as factors that modulate the level of tone of third-order branches (<200 microm) of the posterior cerebral artery (PCA) that were isolated from nonpregnant (NP, n = 7), late-pregnant (LP, 19 days, n = 10), and postpartum (PP, 3 days, n = 8) Sprague-Dawley rats under pressurized conditions. PCAs from all groups of animals developed spontaneous tone within the myogenic pressure range (50-150 mmHg) and constricted arteries at 100 mmHg (NP, 30 +/- 3; LP, 39 +/- 4; and PP, 42 +/- 7%; P > 0.05). This level of myogenic activity was maintained in the NP arteries at all pressures; however, both LP and PP arteries dilated at considerably lower pressures compared with NP, which lowered the pressure at which FD occurred from >175 for NP to 146 +/- 6.5 mmHg for LP (P < 0.01 vs. NP) and 162 +/- 7.7 mmHg for PP (P < 0.01 vs. NP). The amount of myogenic tone was also significantly diminished at 175 mmHg compared with NP: percent tone for NP, LP, and PP animals were 35 +/- 2, 11 +/- 3 (P < 0.01 vs. NP), and 20 +/- 7% (P < 0.01 vs. NP), respectively. Inhibition of nitric oxide (NO) with 0.1 mM N(omega)-nitro-l-arginine (l-NNA) caused constriction of all vessel types that was significantly increased in the PP arteries, which demonstrates significant basal NO production. Reactivity to 5-hydroxytryptamine (serotonin) was assessed in the presence of l-NNA and indomethacin. There was a differential response to serotonin: PCAs from NP animals dilated, whereas LP and PP arteries constricted. These results suggest that both pregnancy and the postpartum period predispose the cerebral circulation to FD at lower pressures, a response that may lower cerebrovascular resistance and promote hyperperfusion when blood pressure is elevated, as occurs during eclampsia.

Animals↗
PubMed1996

Lymphocytic infundibulohypophysitis presenting in the postpartum period: case report.

BACKGROUND: Lymphocytic adenohypophysitis is a well-known autoimmune disorder affecting the anterior pituitary gland. Posterior pituitary gland function can be impaired by a similar autoimmune disorder called lymphocytic infundibulohypophysitis. Only very few cases have been reported. CLINICAL PRESENTATION: We present a patient with central diabetes insipidus in the postpartum period. On radiologic and endocrine evidence lymphocytic involvement of the pituitary stalk and infundibulum was suspected. INTERVENTION: A diagnostic pterional craniotomy was performed. The diagnosis of lymphocytic infundibulohypophysitis was confirmed by biopsy. CONCLUSION: We present a case of lymphocytic infundibulohypophysitis. In view of its autoimmune pathophysiology the occurrence of this disorder in the postpartum period is not surprising, even though it has not been reported before. This rare disorder should be distinguished from the more common lymphocytic adenohypophysitis.

Adult↗
PubMed2004

[Evolution of tobacco habits during pregnancy and postpartum period].

OBJECTIVE: To describe how smoking evolved during pregnancy and a long postpartum period, with analysis of the factors associated with giving up tobacco. DESIGN: Retrospective, descriptive study. SETTING: Badia del Vallès Primary Care Centre (Barcelona). PARTICIPANTS: Women with pregnancies coming to term over a 3-year period (n=309, 68% of the target population). MAIN MEASUREMENTS: Tobacco dependency before pregnancy. Giving up during pregnancy and related factors (social and personal, nature of tobacco habit, health beliefs). Backsliding after birth. RESULTS: 50% smoked before pregnancy. 46% of these gave up smoking during pregnancy and 44% cut down. In primigravidae, there was greater risk of their continuing to smoke, the greater their previous tobacco consumption was (OR=5.3 if > or =20 cigarettes a day and OR=4.7 for 10-19 cigarettes a day) or if they did not believe in the effect of tobacco on the baby's health (OR=3.9). In women pregnant for the second time or more, it was associated with not giving up tobacco in previous pregnancies (OR=43.8) and with their partner's tobacco habit (OR=7.2). In the 2 years after birth 80% of those who gave up relapsed. CONCLUSIONS: In our milieu a high prevalence of smokers before pregnancy coexists with a high rate of giving up during pregnancy. In all, 1 in every 4 women smokes during pregnancy. Giving up tobacco was related to factors such as dependency, motivation, environment and prior experience.

Adolescent↗
PubMed2001

Appropriateness of antibiotic use in the postpartum period.

OBJECTIVE: To determine the appropriateness of current postpartum antibiotic use in clinical practice. METHODS: Medical records were reviewed for all patients delivering in a 3-month period who received postpartum antibiotics during the delivery hospitalization. Subjects were excluded if they received a single postpartum antibiotic dose as part of a mitral valve prolapse prophylaxis protocol, or if they received no more than one postpartum antibiotic dose for surgical prophylaxis. Characteristics of postpartum antibiotic use were abstracted. RESULTS: Two hundred and eleven of 1537 (14%) delivering patients met the inclusion criteria. Seventy-four (35%) delivered vaginally and 137 (65%) delivered by Cesarean section. Postpartum fevers were found in 40 (54%) of vaginal delivery cases and 80 (58%) of women delivering by Cesarean section who received postpartum antibiotics (p = 0.54). For vaginal deliveries there were no differences in the duration of antibiotic use or number of antibiotic doses based on fever status. For Cesarean deliveries, a fever was associated with more antibiotic doses and a longer duration of antibiotic use. Physician justification for antibiotic use was documented in only 116 cases (55%). CONCLUSIONS: The high proportion of women receiving postpartum antibiotics having no evidence for infection or documented indication for therapy suggests that antibiotics may not be appropriately used in the postpartum period.

Adult↗
PubMed2003

Prediction of depression in the postpartum period: a longitudinal follow-up study in high-risk and low-risk women.

AIM: The present study investigates both the antenatal prediction of the occurrence of depression during the first year postpartum and the course of depression in populations at different degrees of risk. METHODS: In a population-based prospective study, 1618 women were screened during mid-pregnancy for risk factors with regard to depression. High-risk and low-risk women were identified, and depression (Research Diagnostic Criteria, RDC) was assessed at 32 weeks gestation and at 3, 6, and 12 months postpartum. RESULTS: In the high-risk group (n=97), 25% of the women were depressed during the first year postpartum compared to 6% of the low-risk women (n=87). At 3 months postpartum, significantly more high-risk (17%) than low-risk women (1%) were depressed. While prevalence rates decreased after 3 months postpartum in the high-risk group, no significant fluctuations of prevalence rates were found in the low-risk group. Two risk factors were independently predictive of depression during the postpartum period: a personal history of depression, and high depressive symptomatology during mid-pregnancy. CONCLUSIONS: Women at high risk and low risk for depression during the early postpartum period can be detected during pregnancy. High-risk women were only at particular risk during the first 3 months postpartum.

Adult↗
PubMed1989

Identification during the postpartum period of infants who are at high risk of child maltreatment.

To determine whether clinicians correctly identify newborn infants who are at high risk of child maltreatment, we examined the outcomes of high-risk and non-high-risk children. Infants who were born at Yale-New Haven Hospital from 1979 to 1981 and who were referred by clinicians during the postpartum period to the hospital's child abuse registry because they were considered at high risk of child abuse or neglect became the high-risk group. For each high-risk infant, a comparison infant was selected and matched according to date of birth, gender, race, and method of payment for the hospitalization. For both groups, the occurrence of maltreatment was ascertained by reviewing the medical records until the child's fourth birthday. Each injury for which medical care was sought was classified into one of seven categories (from definite child abuse to accident) by a pediatrician who was unaware of the child's risk status. Information also was recorded about nonorganic failure to thrive and changes in the child's caretaker. Maltreatment (defined as abuse or neglect) occurred more frequently in the high-risk group than the comparison group (adjusted matched odds ratio = 4.3; 95% confidence interval = 1.41, 6.93; p less than 0.001), as did poor weight gain from a nonorganic cause (matched odds ratio = 7.0; 95% confidence interval = 1.59, 30.79; p less than 0.01) and changes in the child's caretaker (matched odds ratio = 9.0; 95% confidence interval = 3.80; 20.55; p less than 0.001). We conclude that as early as the postpartum period, clinicians can identify some families who are at high risk of maltreatment and other major adverse outcomes resulting from poor parenting.

Child Abuse↗
PubMed2005

Plasma cocaine levels, metabolites, and locomotor activity after subcutaneous cocaine injection are stable across the postpartum period in rats.

Plasma levels of cocaine (COC) and two of its principle metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME) were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS) in samples collected up to 3 h after a subcutaneous injection of cocaine (10 mg/kg) on six different days between days 4 and 24 postpartum, a period of dramatic change in the endocrine state of the female rat. Locomotor activity was measured in the same animals during this period using automated animal activity monitors. Additional measures in males provide a link to existing literature. We found that plasma levels of cocaine and its metabolites, as well as their respective time courses, are remarkably uniform across the postpartum period in female rats, as are the effects of cocaine on locomotor activity. Data from males show accord with prior published values. COC and BE, but not EME levels, were higher in males, and the time courses of COC and BE levels after injection varied somewhat between postpartum females and males; however, neither baseline nor cocaine-induced locomotor activity differed between postpartum females and males. We conclude that in the postpartum rat, there are no significant differences in the peripheral processing or general accessibility of cocaine to the brain to activate motor systems across the postpartum period. These data are critical to our understanding of differences in the reward salience of cocaine across the postpartum period and in other adult rat models [Mattson BJ, Williams S, Rosenblatt JS, Morrell JI. Comparison of two positive reinforcing stimuli: pups and cocaine throughout the postpartum period. Behav Neurosci 2001;115:683-94, Mattson BJ, Williams SE, Rosenblatt JS, Morrell JI. Preferences for cocaine- or pup-associated chambers differentiate otherwise behaviorally identical postpartum maternal rats. Psychopharmacology (Berl) 2003;167:1-8].

Animals↗
PubMed2005

3alpha-reduced neuroactive steroids and their precursors during pregnancy and the postpartum period.

Allopregnanolone (ALLO) and pregnanolone (PREG), the 3alpha-reduced metabolites of progesterone (PROG), are potent modulators of gamma-aminobutyric acid type A receptors that may function as endogenous anxiolytics. They are purported to be involved in the etiology or expression of clinical depression. In the present study we quantified ALLO and PREG, as well as PROG, 5alpha-dihydroprogesterone (5alpha-DHP), 5beta-dihydroprogesterone (5beta-DHP), epiallopregnanolone and pregnenolone (PREGNEN), in plasma from healthy women at five time points during pregnancy and the postpartum period. Analysis was by gas chromatography/electron capture - negative chemical ionization - mass spectrometry. Neuroactive steroids increased significantly from 10 to 36 weeks of pregnancy, except for 5beta-DHP and PREGNEN which did not change significantly. PROG was the most abundant steroid throughout pregnancy, followed by 5alpha-DHP and ALLO. Metabolite to precursor ratios differed depending on the enzyme and substrate: the turnover of PROG to 5alpha-DHP (catalyzed by 5alpha-reductase) was stable while the conversion of PROG to 5beta-DHP (catalyzed by 5beta-reductase) decreased later in pregnancy. 3alpha-Hydroxysteroid oxidoreductase-mediated turnover of 5alpha- and 5beta-DHP to their metabolites ALLO and PREG, respectively, rose during pregnancy, but the turnover of 5alpha-DHP to ALLO dropped at the late prenatal visit. At 6 weeks postpartum all steroids were significantly reduced compared with late prenatal values, with 5alpha-DHP being the most abundant postpartum steroid. These results provide the basis for further study of neuroactive steroids in psychiatric conditions of pregnancy and the postpartum period.

5-alpha-Dihydroprogesterone↗
PubMed2001

Changes in markers of anemia and iron metabolism and how they are influenced by antianemics in postpartum period.

BACKGROUND: The object of this study was to examine the occurrence of iron deficiency anemia in women after spontaneous delivery, changes in clinical and laboratory indicators of anemia in postpartum period and their possible control by administration of peroral antianemics. METHODS: Ninety pregnant women at 35th to 39th week of gestation were randomly divided into three groups and extensively examined in a laboratory. After delivery, the mothers were examined four times at monthly intervals until the end of the third postpartum month. At the same time, they were examined for their subjective feeling of health, with some focus on typical anemic symptoms. Women in the first group were treated with 80 mg of elemental iron a day for the first two months after childbirth. Women in the second group were treated with 80 mg of elemental iron+0.35 mg of folic acid a day for the same period of time. Women in the control group did not use any medication. McNamara test was used to evaluate the portion of anemic and sideropenic women and for comparison between individual groups. RESULTS: Findings of the study have shown a faster adjustment of laboratory and clinical indicators of postpartum anemia in women treated with iron. We did not observe the only, sovereign marker of iron deficiency (sideropenic) anemia in the early postpartum period. CONCLUSIONS: We recommend flat administration of iron to all women after spontaneous delivery. Postpartum substitution with iron should last at least three months because of long-lasting sideropenia. Adding folic acid to iron does not have any significant impact during the postpartum period.

Adult↗
PubMed2000

Increased susceptibility to malaria during the early postpartum period.

BACKGROUND: Pregnancy is associated with increased susceptibility to malaria. It is generally agreed that this increased risk ends with delivery, but the possible persistence of increased susceptibility during the puerperium had not been investigated. METHODS: From June 1, 1990, to December 31, 1998, we monitored exposure to malaria, parasitemia, and morbidity among the residents of a village in Senegal in which the rate of transmission of malaria was high. In this population we analyzed 71 pregnancies in 38 women from the year before conception and through one year after delivery. RESULTS: Among the 38 women, there were 58 episodes of clinical Plasmodium falciparum malaria during 61,081 person-days of observation. The incidence of malaria was 20.2 episodes per 1000 person-months during the year preceding conception and 12.0 episodes per 1000 person-months during the period from 91 to 365 days after delivery. The incidence of episodes of malaria increased significantly during the second and third trimesters of pregnancy and reached a maximum of 75.1 episodes per 1000 person-months during the first 60 days after delivery. The adjusted relative risk of an episode of malaria was 4.1 (95 percent confidence interval, 1.8 to 9.5) during the first 60 days post partum, as compared with the year preceding pregnancy. The duration of fever during the episodes of malaria was longer and the prevalence and density of asymptomatic malarial parasitemia were significantly higher during pregnancy and the early postpartum period than during the other periods. CONCLUSIONS: Among women who live in areas with high rates of transmission of malaria, the susceptibility to malaria is highest during the second and third trimesters of pregnancy and the early postpartum period.

Adolescent↗
PubMed1994

Relationship between silent thyroiditis and recurrent Graves' disease in the postpartum period.

We carried out a close follow-up study of 96 episodes of postpartum hyperthyroidism, which developed in women with a history of Graves' disease. Hyperthyroidism had developed 1-6 months (mean +/- SD, 2.3 +/- 1.4) after delivery. Radioiodine uptake (RAIU) values during the thyrotoxic phase, determined after a 1-week restriction of iodine-rich diet, ranged from very low to very high (1-70%). The group with low RAIU values (group L: < 10%, n = 26) and the normal group (group N: 10-40%, n = 33) showed significantly higher urinary excretion of iodine (UI) than the high group (group H: > 40%, n = 37), and UI in group L was comparable to that in patients with silent thyroiditis. TSH binding inhibiting antibody (TBIAb) values were determined in 87 patients at the RAIU testing, and were above normal in most of them: all in group H, 68% in group N, and 52% in group L. The mean TBIAb value in group H was significantly higher than that in group N or L (P < 0.0001 for both). Fifty-one patients in group L and group N were observed without treatment. Of these, hyperthyroidism resolved spontaneously in 39 patients (76%), in whom transient hypothyroidism developed with substantial frequency. Hyperthyroidism subsequently resumed in 18 (46%) of these 39 between 4 and 9 months (mean +/- SD, 7.1 +/- 2.1) after delivery and did not resume in the other 21. RAIU values, determined again during this later phase of hyperthyroidism, were high enough to indicate Graves' hyperthyroidism in all but one patient. During the postpartum period, TBIAb values increased and then declined in the majority of the patients irrespective of the course of hyperthyroidism. Of the 21 patients who maintained euthyroidism after spontaneous resolution of hyperthyroidism, transient increase in TBIAb was observed in 14. These findings suggest that silent thyroiditis commonly develops concomitantly with the activation of Graves' disease and delays or masks the development of Graves' hyperthyroidism.

Autoantibodies↗
PubMed1999

Analyses of mothers' sleep logs in postpartum periods.

In order to investigate mothers' sleep-wake patterns from five to 12 weeks in the postpartum period, we analyzed continuous sleep logs. Data for 341 days from seven mothers were analyzed for each postpartum week. There were significant differences in total sleep time and wake time at night. Wake time at night gradually decreased from the fifth to the twelfth week. These results from continuous sleep logs support the results of our previous polysomnographic findings based on intermittent measurements. A transition from interrupted sleep to noninterrupted sleep was observed from the ninth to twelfth week of postpartum. The mothers' sleep-wake patterns are discussed focusing on their relationships to the infants' sleep-wake patterns and feeding rhythm.

Adult↗
PubMed1994

[Changes of plasma motilin concentration in pregnancy and early postpartum period].

Plasma motilin concentration were determined by radioimmunoaction from 180 women during pregnancy and early postpartum period as compared with 20 healthy non-pregnant women. The results showed that mean plasma motilin concentration (384.40 +/- 110.30 ng/L) was higher in the first trimester of pregnancy than that of healthy non-pregnant women (366.12 +/- 96.23 ng/L), however, this difference did not reach statistical significance (P > 0.05). The mean plasma motilin concentration (323.90 +/- 125.10 ng/L) was lower in the second trimester of pregnancy than in the first trimester of pregnancy (P < 0.05), while the mean plasma motilin concentration in the third trimester of pregnancy (121.04 +/- 27.00 ng/L) was significantly lower than in second (P < 0.01) and the mean plasma motilin concentration in 3-5 d after delivery (443.05 +/- 140.79 ng/L) reached an even higher value (P < 0.01). Our results suggests that pregnancy appears to have a profound inhibitory effect on plasma motilin and this may in part be responsible for the gastrointestinal hypomotility during pregnancy.

Adult↗
PubMed1998

The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period.

OBJECTIVES: We sought to determine whether pregnant women with abnormal antepartum cervical cytologic findings differ in their postpartum rates of regression with respect to mode of delivery. STUDY DESIGN: Between 1990 and 1997, 446 pregnant women with antepartum abnormal cervical cytologic findings were identified. Complete demographic, clinical, and cytologic reports were available for 138 women. Papanicolaou smear data were collected and separated into three groups by use of the Bethesda classification system (atypical squamous cells of undetermined significance, low-grade squamous intraepithelial cells, and high-grade intraepithelial cells). Postpartum regression rates of antepartum Papanicolaou smears, with respect to degree of squamous epithelial cell abnormality and mode of delivery, were analyzed by Fisher's exact and Wilcoxon rank sum tests. RESULTS: Of the 138 women, 109 (79%) were delivered vaginally and 29 (21%) by cesarean section. No statistically significant difference was found between women delivered vaginally and those delivered by cesarean section with respect to age, parity, and smoking history within the three groups (atypical squamous cells of undetermined significance, low-grade squamous intraepithelial cells, and high-grade squamous intraepithelial cells). The overall postpartum regression rate for the 59 women with antepartum high-grade squamous intraepithelial cells was 48%. Of the 47 women with high-grade squamous intraepithelial cells who were delivered vaginally, 28 showed regression in the postpartum period versus none of the 12 women delivered by cesarean section (60% vs 0%, p < 0.0002). CONCLUSION: Postpartum spontaneous regression of Papanicolaou smears consistent with high-grade squamous intraepithelial cells occurs with increased frequency among women who are delivered vaginally versus by cesarean section.

Adult↗
PubMed1991

Gastric emptying in the postpartum period.

We measured gastric emptying, using the technique of paracetamol absorption, in eight women on their first and third postpartum day. Gastric emptying was rapid and there was no difference between the first and third day in the time to peak plasma concentration of paracetamol. Six women returned after six weeks for a further study. Gastric emptying was still rapid but the metabolism of paracetamol appeared to be slower than that found during the immediate postpartum period. These findings suggest that fluid fasting guidelines in patients more than one day postpartum need not be different from those in non-pregnant patients.

Absorption↗
PubMed1983

Brain beta-endorphin during pregnancy, parturition, and the postpartum period.

Brain beta-endorphin (beta-EP) was measured in the rat during pregnancy, parturition, and the postpartum period. beta-EP increased in the hypothalamus, midbrain, and amygdala during gestation and remained elevated through delivery until 1-2 days postpartum. The concentration of beta-EP increased in the hypothalamus from 31.8 +/- 1.4 (+/- SE) ng/mg protein in nonpregnant controls to 41.4 +/- 1.8 and 39.2 +/- 1.9 during early (8-10 days) and late (18-20 days) pregnancy, respectively, and in the midbrain from 3.20 +/- 0.17 to 5.21 +/- 0.30 and 5.25 +/- 0.64 ng/mg protein (P less than 0.01). In another experiment, the brain content of beta-EP expressed as nanograms per region, increased from 12.6 +/- 0.29 to 14.7 +/- 0.33 in the hypothalamus, from 4.09 +/- 0.44 to 6.03 +/- 0.34 in the midbrain, and from 0.93 +/- 0.11 to 1.32 +/- 0.06 ng in the amygdala at 16-17 days of gestation compared with that in nonpregnant controls (P less than 0.01). When hypothalamic beta-EP was measured 1 week postpartum in lactating and nonlactating rats, a significant decline in the beta-EP concentration of both groups was noted compared with that measured during pregnancy; beta-EP levels were similar in the lactating and nonlactating rats. We conclude that pregnancy and parturition are associated with significant changes in brain beta-EP and suggest that beta-EP of central rather than peripheral origin may mediate changes in pain perception and maternal behavior during pregnancy.

Animals↗