Original research publications

Quantitative blood loss (QBL) is widely used to identify postpartum hemorrhage. Although higher blood loss is expected to be associated with greater hemoglobin (Hb) decline, the strength of this relationship and the diagnostic performance of commonly used thresholds for postpartum anemia are not well defined. Further evaluation is needed to define the utility and limitations of QBL in the postpartum assessment. To evaluate the association between QBL and postpartum hematologic outcomes, including postpartum anemia and Hb decline, and to assess the diagnostic performance of commonly used QBL thresholds. This retrospective cohort study included singleton deliveries at an urban safety-net hospital in 2023 with documented QBL and available baseline and postpartum Hb values. Patients with baseline anemia, transfusion before postpartum Hb measurement, or conditions expected to substantially alter bleeding risk or Hb levels independently of delivery blood loss were excluded. Multivariable logistic regression was used to evaluate associations between QBL and postpartum anemia, defined as Hb<10 g/dL, and multivariable linear regression was used to evaluate Hb decline. Diagnostic performance of QBL thresholds was assessed separately by delivery mode using sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic analysis. Among 769 deliveries, postpartum anemia occurred in 22.0% (169/769), and severe postpartum anemia, defined as Hb<8 g/dL, occurred in 0.5% (4/769). In adjusted models, compared with QBL<500 mL, higher QBL categories were associated with increased odds of postpartum anemia: 500 to 999 mL, adjusted odds ratio (aOR) 5.13 (95% confidence interval [CI], 2.59-10.13; P <.001), 1000 to 1499 mL, aOR 6.10 (95% CI, 1.94-19.23; P =.002), and ≥1500 mL, aOR 14.42 (95% CI, 2.26-91.95; P =.005). Each 500-mL increase in QBL was associated with greater Hb decline (adjusted mean difference, 0.53 g/dL; 95% CI, 0.39-0.68; P <.001). Discrimination was modest in both delivery modes. The area under the receiver operating characteristic curve was 0.646 (95% CI, 0.571-0.721) for vaginal deliveries and 0.593 (95% CI, 0.523-0.663) for cesarean deliveries, with no significant difference between delivery modes ( P =.313). At the ≥500-mL threshold, sensitivity was 22.4% (17/76) and specificity was 96.3% (394/409) for vaginal deliveries, compared with sensitivity of 90.3% (84/93) and specificity of 16.8% (32/191) for cesarean deliveries. Among patients without baseline anemia, higher QBL was associated with postpartum anemia and greater Hb decline; however, QBL alone had limited screening performance. Overall, the ≥500-mL threshold failed to identify 40.2% (68/169) of postpartum anemia cases, and its sensitivity and specificity varied markedly by delivery mode. Postpartum complete blood count testing decisions should be individualized and incorporate QBL alongside baseline Hb, maternal symptoms, delivery characteristics, and clinical judgment.

Postpartum depression (PPD) affects 17.22% of women worldwide and represents a major public‑health concern. Cognitive-behavioral therapy (CBT) is a recommended intervention for PPD. However, evidence regarding its overall efficacy, additional clinical benefits, and real‑world performance across heterogeneous delivery formats remains insufficient. This meta‑analysis quantifies the efficacy of CBT compared with usual care, assesses the certainty of evidence, and descriptively explores intervention‑mode characteristics across included trials. We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus from inception to December 13, 2025. Eligible randomized controlled trials (RCTs) were included in the meta-analysis, and all statistical analyses were performed using STATA 18.0 software (StataCorp LLC, College Station, TX, USA). Eight RCTs (1811 PPD participants) were included. CBT significantly reduced Edinburgh Postnatal Depression Scale (EPDS) scores (SMD = -0.59, 95% CI: -0.77 to -0.41) and increased the EPDS‑defined clinical improvement rate (RR = 1.84, 95% CI: 1.59 to 2.12). It may improve perceived social support, mitigating infant‑focused maternal anxiety and generalized anxiety symptoms. No group difference was found for infant surgency temperament (IBQ‑R‑SUR, SMD = 0.17, 95% CI: -0.04 to 0.38). Findings from this meta-analysis point to potential benefits of CBT for core PPD-related symptoms and secondary outcomes. The certainty of evidence ranges from very low to moderate. Future research should prioritize high‑quality, long‑term trials of non‑specialist‑delivered digital CBT models to develop accessible perinatal mental‑health services.

Hypertensive disorders during pregnancy and postpartum are major causes of maternal morbidity and mortality, yet associations with social determinants of health, including neighborhood deprivation, remain understudied. We examined the association of periconceptional neighborhood deprivation with the risk of gestational and postpartum hypertensive disorders in a population-based cohort of 281,621 pregnant individuals aged 15-44 years without chronic hypertension who delivered at Kaiser Permanente Northern California from 2011 to 2020. Neighborhood deprivation index (NDI) quartiles were assigned based on geocoded residential addresses before and in early pregnancy. Gestational hypertension and preeclampsia/eclampsia were identified from 20 gestational weeks through delivery, postpartum preeclampsia/eclampsia through six weeks postpartum, and postpartum hypertension through one year postpartum. Modified Poisson regression estimated adjusted relative risks (aRRs) across NDI quartiles. Overall, 16.2% versus 25.3% resided in the least (Q1) versus most deprived (Q4) neighborhoods. Greater neighborhood deprivation was associated with higher risk of gestational hypertension (Q4 vs Q1: aRR, 1.12 [1.07-1.17]), gestational preeclampsia/eclampsia (1.18 [1.12-1.24]), postpartum preeclampsia/eclampsia (1.30 [1.02-1.66]), and postpartum hypertension (1.67 [1.42-1.97]), with dose-response patterns across NDI quartiles. After adjusting for pre-pregnancy body mass index, associations attenuated, remaining significant only for postpartum hypertension (Q4 vs Q1: 1.30 [1.11-1.54]). Stratified analyses showed similar patterns among individuals with overweight/obesity but not those with underweight/healthy weight. These findings underscore the importance of considering neighborhood-level social determinants alongside individual-level risk factors when assessing risk of gestational and postpartum hypertensive disorders and the need for targeted interventions to reduce disparities and improve maternal health outcomes.

Postpartum depression (PPD) is a common but severe psychiatric condition following childbirth, and its underlying causes and degree of heritability remain unclear. We aimed to examine the heritability of PPD among parous female twin pairs. We linked data from the Danish Twin Register to nationwide health registers. Zygosity was defined as monozygotic (MZ) or dizygotic (DZ) based on validated questionnaires, and PPD was defined using hospital diagnosis of depressive disorders or filled prescriptions of antidepressant medication during the first year postpartum. We used a classic twin design to estimate genetic variance in PPD liability, applying probandwise concordance rates, tetrachoric correlations, and biometric modeling to decompose phenotypic variance into genetic and environmental components. The study included 10,418 female twins (5209 pairs) born from January 1949 to December 2000. There were 68 PPD-discordant and 10 PPD-concordant MZ pairs and 85 PPD-discordant and 5 PPD-concordant DZ pairs. The probandwise concordance rates were 0.22 (95% confidence interval (CI) 0.13-0.35) for MZ twins and 0.11 (95% CI 0.05-0.23) for DZ twins. The heritability (additive genetic effect) of PPD was 0.60 (95% CI 0.46-0.75) with a corresponding unique environment variance of 0.40 (95% CI 0.25-0.54). The results indicate that heritability explains a substantial part of PPD risk. This knowledge is pivotal to understanding the role of genetics and to reducing the stigma of PPD among new mothers. However, the contribution of environmental and other possible modifiable factors emphasizes the importance of targeted prevention initiatives.

The postpartum period is characterised by significant physiological and anatomical changes that may mimic pathology on imaging. Exposure to puerperal imaging varies between healthcare systems and may depend on whether postnatal ultrasound is performed primarily by radiologists or obstetricians/gynaecologists. Differentiating normal postpartum appearances from true complications can therefore be challenging, particularly when clinical presentations are non-specific. This review summarises normal and abnormal postpartum imaging findings and describes a structured checklist to systematically evaluate the pelvic organs.

To describe a case of postpartum hemoperitoneum caused by uterine laceration in an unscarred uterus, likely secondary to sustained transabdominal uterine massage. We report a case of postpartum hemorrhage resulting from a partial myometrial and serosal laceration in an unscarred uterus following vaginal delivery. Initial uterine atony was managed with uterotonics and transabdominal massage. However, the patient subsequently developed hypovolemic shock and abdominal tenderness. Bedside ultrasonography revealed hemoperitoneum, and exploratory laparotomy confirmed a superficial uterine laceration, likely related to sustained uterine massage. Uterine massage rarely causes myometrium injury and should be the first-line management approach for postpartum hemorrhage. Early diagnosis and timely intervention for myometrium laceration caused by uterine massage allowed for successful surgical repair, thereby avoiding irreversible injury.

This review article prepares emergency physicians to recognize and manage critical illness in postpartum patients, a population at heightened risk of preventable morbidity and mortality in North America amid persistent racial/geographic disparities and shrinking obstetric access. It highlights key physiologic changes after delivery that complicate patient management. The article focuses on 3 immediate postpartum emergencies (postpartum hemorrhage, postpartum preeclampsia, and amniotic fluid embolism) and 3 subacute (pulmonary embolism, peripartum cardiomyopathy, and spontaneous coronary artery dissection). It concludes with system-level strategies to improve safety and outcomes.

Polyhydramnios is a condition defined as an increase of amniotic fluid volume. Common causes include maternal diabetes, multiple pregnancies, and congenital anomalies. Congenital type C esophageal atresia is one of the causes and often presents with a visible stomach, making prenatal diagnosis difficult. A 37-year-old woman with monochorionic diamniotic twin pregnancy was hospitalized for threatened preterm labor at 26 weeks of gestation. She was also diagnosed with gestational diabetes mellitus and her glucose levels were consistently high during pregnancy despite the initiation of insulin therapy. After admission to hospital, the amniotic fluid volume of the leading twin remained at the lower limit of the normal range, while polyhydramnios appeared in the following twin. Persistent amniotic fluid discordance raised concern for a possible evolving intertwin transfusion process, although the diagnostic criteria for twin-to-twin transfusion syndrome were not met. An emergency cesarean section was performed at 28 weeks due to onset of labor. After birth, twin B showed mild cardiomegaly and polycythemia, findings compatible with recipient-like pathophysiology. Furthermore, the same twin showed a coiled nasogastric tube on chest X-ray and was diagnosed with type C esophageal atresia postnatally. This case illustrates polyhydramnios in the setting of overlapping etiologies, gestational diabetes mellitus, esophageal atresia, and twin amniotic fluid discordance suggestive of an evolving intertwin transfusion process. Clinicians should consider multifactorial causes when managing unexplained polyhydramnios and perform comprehensive fetal evaluations.

Childhood sexual maltreatment is a well-documented risk factor for adverse perinatal physical and mental health outcomes, which are worse in women of color compared to white women. Yet, the pathways through which early sexual trauma influences childbirth experiences and the role of ethnicity/race in these associations are insufficiently understood. This study examined the relationship between childhood sexual maltreatment and negative childbirth experiences, with a focus on the potential mediating roles of late-pregnancy posttraumatic stress symptoms (PTSS) and fear of childbirth. Ethnic/racial group differences were also evaluated. Women (N = 433) were drawn from the Michigan Prenatal Stress Study, a large longitudinal, prospective study of the influence of prenatal stressors on mother and infant outcomes. Participants reported on childhood sexual maltreatment, PTSS, fear of giving birth (third trimester), negative childbirth experiences, and ethnic/racial identity. Childhood sexual maltreatment was significantly associated with more negative childbirth experiences, and late-pregnancy PTSS mediated this association. Although this PTSS-mediated pathway did not significantly differ by ethnic/racial groups, it was only significant among women of color. Findings highlight the importance of addressing trauma-related stress during pregnancy to improve perinatal outcomes for all women with a history of childhood sexual maltreatment. Targeted interventions aimed at reducing PTSS in pregnancy may mitigate the impact of childhood sexual trauma on childbirth experiences and promote maternal and infant well-being.

The prevalence of restless legs syndrome (RLS) among Japanese pregnant women surveyed from 2020 to 2021 was 17.2%, which is higher than that in the general adult population. The onset of this condition involves various factors against a background of genetic predisposition. The presence of the ALDH2*2 allele has been linked to Parkinson's disease, but its association with RLS remains unexamined. This study aimed to clarify the relationship between ALDH2 polymorphism as well as ADH1B polymorphism-already reported to be associated with RLS-and RLS in pregnant women. This study included 200 pregnant women in their third trimester. The survey was conducted from September 2023 to July 2025. Participants answered questionnaires on background factors and sleep/wake patterns, and DNA was extracted from somatic cells obtained by swabbing buccal mucosa using a cotton swab. The ALDH2 rs671 and ADH1B rs1229984 polymorphisms were determined. The prevalence of RLS (95% confidence interval) during the survey period was 24.5% (18.7-21.1%). No association was identified between ALDH2 and ADH1B polymorphisms and RLS. Furthermore, no correlation was observed between ALDH2 and ADH1B polymorphisms and variables such as sleep duration, chronotype, insomnia symptoms, or daytime sleepiness, except for the relationship between ADH1B polymorphism and evening chronotype. The prevalence of RLS among pregnant women has increased compared to the previous survey conducted using the same methodology. The ADH1B polymorphism was suggested to be linked with chronotype; however, no association was found between the ADH1B or ALDH2 polymorphisms and other sleep-wake phenotypes, including RLS.

This study evaluated the reproductive performance and clinical safety of a novel recombinant eCG (r-eCG) in ewes. Two weeks prior to study onset (Day 0: intravaginal progesterone device insertion), 45 ewes were randomly assigned to negative control (NC; no eCG; n = 10), positive control (PC; 400IU commercial non-recombinant eCG; n = 20), or treatment group (T; 400IU r-eCG; n = 15). Ewes were inseminated with fresh-diluted semen (200 × 10 6 sperm). Ultrasonography assessed follicle count/diameter (days 11, 13), ovulation (day 13), corpus luteum (CL) number/characteristics (day 20), and pregnancy (day 44). Serum progesterone was measured on day 20; Group T underwent clinical/hematological evaluations (days 0, 20, and 44). Estrus signs were more frequent (P < 0.01) in T (100%) than NC (50%), while PC (85%) did not differ. Ovulation rates were similar between T (93%) and PC (95%), but higher than NC (50%; P < 0.05). On day 13, largest follicle diameter did not differ (P > 0.05) among groups; however, fewer follicles > 2 mm occurred in PC than NC and T (P < 0.05). CL number was higher in T than PC (2.0 ± 0.3 vs. 1.0 ± 0.0, P < 0.01), while NC did not differ (1.0 ± 0.25). Conversely, pregnancy rate was higher (P < 0.05) in PC (70%) than T (28.6%) and NC (20%). Among ovulated ewes, progesterone concentration and progesterone/CL ratio did not differ among groups (P = 0.92 and P = 0.08, respectively). No relevant r-eCG-related clinical or hematological alterations occurred. In conclusion, 400IU r-eCG effectively induces estrus and ovulation without adverse effects; however, the discrepancy between ovulatory response and pregnancy rate underscores the need for further study refinement to improve fertility.

Incarcerated postpartum individuals with opioid use disorder (OUD) are vulnerable to poor health outcomes, but care provision in custody for this population is variable. Addressing their distinct needs is crucial for improving correctional health care for postpartum people. In this paper wea document challenges jail staff experience providing postpartum care, and describe shifts in jail staff knowledge and practice changes related to postpartum care that may be attributable to participation in a training resource for perinatal OUD in corrections. We developed a web-based resource for jail staff called "Maternal Opioid Use Disorder Management and Care Resources in Custody" (MOMCARE). From May 2024 to January 2026, we conducted a 12-month pilot MOMCARE intervention at five jails of varying sizes across the United States. We collected facility data on postpartum services, provided ongoing facilitation activities, and conducted qualitative interviews with jail staff to explore postpartum care challenges and opportunities. Through a needs assessment survey and qualitative interviews with staff at baseline, we documented gaps and challenges in service provision for postpartum people. Through ongoing interviews and facilitation activities, jail staff reported promising practice changes including systematically screening for postpartum status at intake, streamlining lactation support processes, and assessing postpartum mental health using validated screening tools. Jail staff also learned that it is safe and recommended for postpartum people to breastfeed while on medications for OUD. Jail staff were receptive to educational and support tools. MOMCARE prompted jails to make changes that align with best practices for postpartum care.

Sexual dysfunction is highly prevalent during the postpartum period but remains underdiagnosed and insufficiently addressed in clinical practice. Reduced sexual desire is one of the most frequently reported sexual complaints during the postpartum period and is commonly associated with impaired female sexual function. This study aimed to determine the prevalence of low sexual desire (LSD) and identify associated factors in postpartum women receiving care in a public healthcare setting. This cross-sectional study was conducted in a tertiary university hospital in Brazil between February and December 2025. Data were collected through structured interviews using validated instruments, including the Female Sexual Function Index, Rosenberg Self-Esteem Scale, and Visual Analog Scale for pain. The primary outcome was the prevalence of LSD and its association with sociodemographic, clinical, psychosocial, sexual function, and self-esteem variables. Statistical analyses included parametric and non-parametric tests, post hoc power analysis, and Holm-Bonferroni adjustment for multiple comparisons. Low sexual desire was identified in 56.25% of participants. Lower self-esteem, impaired sexual arousal, and lower overall Female Sexual Function Index scores remained significantly associated with LSD after adjustment for multiple comparisons. No significant associations were observed for age ( P = .967), marital status ( P = .586), mode of delivery ( P = .940), or parity ( P = .762). Low sexual desire was highly prevalent among postpartum women and was primarily associated with psychosocial factors and impaired sexual function rather than sociodemographic or obstetric characteristics. Although the cross-sectional design precludes causal inference and the relatively small sample recruited from a single tertiary public healthcare center in urban Brazil may limit the generalizability of these findings beyond similar clinical settings, the results support the incorporation of routine sexual health assessment and psychosocial evaluation into postpartum care to facilitate early identification and management of women experiencing LSD.

The postpartum period is a critical time period for both cardiovascular health (CVH) and psychosocial health among women. While depression is a recognized cardiovascular risk factor in non-pregnant populations, the association between depression and CVH in the postpartum period has been understudied. To examine the association between depression and CVH among reproductive-age women and whether postpartum status modifies this association. We analyzed cross-sectional data from non-pregnant women aged 20-44 years in the National Health and Nutrition Examination Survey (NHANES) 2007-2020. We evaluated whether CVH scores varied by postpartum status and depression status (Patient Health Questionnaire-9 [PHQ-9] scores ≥10). CVH was defined using the American Heart Association's Life's Essential 8 framework (blood pressure, glucose, lipids, body mass index [BMI], diet, physical activity, nicotine exposure, sleep; scores 0-100). We evaluated CVH scores by postpartum and depression status and tested for effect modification, adjusted for age and sociodemographics. The study population included 7208 women, representing 47,249,817 women at the population level (weighted n = 4253,164 postpartum; n = 42,996,653 not postpartum). Most postpartum women had an overall CVH score that was moderate (67%) or high (28%). Postpartum women had significantly worse CVH scores for physical activity (48.7 vs. 54.3, p-value 0.017) and BMI (57.3 vs. 63.3, p-value 0.014) compared to non-postpartum women. Among reproductive-age women, depression status was associated with lower scores for overall CVH and for most of the individual CVH metrics. Postpartum status modified the association between depression and CVH for sleep only (p-value 0.005). Postpartum women had similar overall CVH compared to reproductive-age women who were not postpartum, but lower CVH scores for physical activity and BMI. Multi-component interventions that also target depression along with health behaviors may have a greater impact on CVH promotion in reproductive-age women.

This study evaluated the influence of postpartum disorders, parity, stage of lactation, and season on estimated enteric methane emissions in dairy cows from northwestern Spain using dairy herd improvement (DHI) data. A total of 2,440 lactating Holstein cows from 50 commercial dairy farms were included. Data from four official monthly DHI controls conducted in 2017 included daily milk yield, milk composition, parity, and postpartum disorders recorded within 21 days in milk. Methane emissions (MEE; g CH₄/day) were estimated using a prediction equation based on energy-corrected milk, and methane emission intensity (MEEI) was calculated as g CH₄/kg of daily milk yield. MEEI was highest in early lactation and declined as milk yield increased. Retained placenta, metritis, subclinical mastitis, and abomasal displacement were associated with higher MEEI, whereas ketosis was associated with higher milk yield and total MEE but not with MEEI. Multiparous cows had higher total MEE but lower MEEI than primiparous cows. During warm months, cows produced less milk and had lower total MEE but higher MEEI than during cold months. These findings indicate that DHI-based methane estimates can be used as practical indicators of emission efficiency in dairy herds. Differences in methane intensity were mainly associated with milk production efficiency and were influenced by health status, parity, lactation stage, and season. Improving early-lactation health and reducing seasonal stress may help lower methane emissions per unit of milk, although direct methane measurements are needed to validate these estimates. Future studies should validate these estimates using direct on-farm methane measurements.

Intimate partner violence (IPV) and depressive symptoms are major public health concerns during the preconception, prenatal, and postpartum periods and are shaped by both interpersonal and structural conditions, including economic hardship and food insecurity. State-level Supplemental Nutrition Assistance Program (SNAP) eligibility policies, including eliminating the SNAP asset test and increasing the SNAP income limit under broad-based categorical eligibility (BBCE), influence access to food assistance and may be associated with maternal well-being. We conducted a repeated cross-sectional analysis of data from 66,677 women with lower income in the 2016-2020 Pregnancy Risk Assessment Monitoring System. We categorized states as having two BBCE policies, one BBCE policy, or no BBCE policies, reflecting more expansive SNAP eligibility. We conducted log-binomial regression with generalized estimating equations to calculate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs), estimating associations of state BBCE policies with preconception and prenatal physical IPV and postpartum depressive symptoms. Compared to women in states with no BBCE policies, those in states with both BBCE policies had a lower prevalence of preconception and prenatal physical IPV (PR: 0.79, 95% CI: 0.66-0.94) and postpartum depressive symptoms (PR: 0.83, 95% CI: 0.75-0.93). Estimates for states with one BBCE policy were smaller and less precise but also suggested a decreased prevalence of preconception and prenatal physical IPV and postpartum depressive symptoms compared to states with no BBCE policies (PR = 0.80, 95% CI: 0.64-1.00; PR = 0.91, 95% CI: 0.81-1.03, respectively). Results suggest that structural conditions shaping access to economic resources may represent a pathway through which risk for IPV and maternal mental health challenges can be prevented.

Postpartum depression (PPD) poses risks to maternal health and family relationships, making identification of high-risk individuals important. Most PPD prediction models treat clinical variables as an undifferentiated set and rarely use the clinical grouping structure of risk factors. Using perinatal and postpartum data from 1138 women, including clinical characteristics, biochemical indicators, and psychological assessments such as the Eysenck Personality Questionnaire (EPQ) and Beck Depression Inventory (BDI), with PPD defined as an Edinburgh Postnatal Depression Scale (EPDS) score of at least 11 at 6 weeks postpartum, we incorporated clinical feature grouping into Feature Tokenizer + Transformer (FT-Transformer) and developed Clinical-Group FT for PPD risk prediction. Clinical-Group FT divides predictors into four clinical feature groups, learns within-group representations, and integrates information through inter-group cross-attention and gated fusion. Models were evaluated using an 8:2 stratified split and five-fold cross-validation. F1 score was selected as the primary metric because PPD screening requires identifying positive cases while limiting false positives. Paired bootstrap testing was used for F1 comparisons. On the independent test set, Clinical-Group FT achieved an accuracy (ACC) of 0.851, an area under the curve (AUC) of 0.887, and an F1 score of 0.734, demonstrating the best performance among the nine evaluated models. Ablation experiments supported the contribution of the proposed components. Dual-level interpretability analyses highlighted mother-in-law's care in postpartum, antenatal depression, and the neuroticism dimension of the EPQ as important contributors. These findings indicate that Clinical-Group FT improves PPD risk prediction while providing interpretable information for screening support.

This study investigated the association between gestational serum adiponectin (APN) levels and postpartum glycaemic outcomes in women with gestational diabetes mellitus (GDM). A total of 96 GDM patients were enrolled. Baseline demographic and biochemical data were collected. Serum APN levels were measured longitudinally across three gestational stages and postpartum using an enzyme-linked immunosorbent assay. Based on 1-year follow-up data, patients were classified into favourable (normal glucose metabolism) and unfavourable (prediabetes or type 2 diabetes mellitus [T2DM]) outcome groups. Statistical analyses included t -tests, non-parametric tests, Cox proportional hazards models, and Kaplan-Meier survival curves to assess the associations between APN levels and outcomes. At 1-year follow-up, 54.17% had favourable outcomes with higher APN levels, while 45.83% had unfavourable outcomes characterised by older age, higher BMI, and a higher prevalence of family history. T2DM patients had lower APN than those with prediabetes. Cox regression identified postpartum APN as an independent protective factor (Hazard Ratio [HR] = 0.720, 95% confidence interval [CI]: 0.60-0.85, P < 0.001), with each 1-μg/mL increase reducing risk by 27%. Significant risk factors included age (HR = 1.10, 95% CI: 1.01-1.20), pre-pregnancy BMI (HR = 2.06, 95% CI: 1.03-4.14), family history (HR = 2.58, 95% CI: 1.22-5.46), fasting glucose (HR = 1.41, 95% CI: 1.17-1.70), and 1-hour OGTT glucose (HR = 1.20, 95% CI: 1.02-1.40). The low-APN group showed significantly higher cumulative incidence of metabolic dysfunction. Gestational APN levels are strongly associated with postpartum metabolic outcomes in GDM. Low APN is an independent risk factor for adverse outcomes, and its dynamic changes reflect metabolic recovery capacity. Gestational diabetes poses immediate health risks to both pregnant women and their offspring and is associated with an elevated long-term risk of glucose metabolism disorders, including type 2 diabetes. Research indicates that women who experience gestational diabetes are six to seven times more likely to develop type 2 diabetes postpartum compared with those without the condition during pregnancy. This study seeks to investigate the relationship between adiponectin levels during pregnancy and postpartum health outcomes, specifically focusing on whether blood glucose levels normalise or whether there is progression to type 2 diabetes. The findings may contribute valuable scientific insights for the long-term health management of women following a GDM-affected pregnancy.

Magnesium (Mg) infusion is the first-line agent for seizure prophylaxis in patients with preeclampsia with severe features (PESF). However, no guidance exists regarding utility of an additional course of Mg for patients with an exacerbation of PESF (defined as an acute worsening of clinical status) who already completed an initial course of Mg. We aimed to determine the national trend among academic institutions for administration of a second course of Mg in patients with an exacerbation of PESF. A REDCap survey, developed to identify institutional protocols and anticipated response to clinical scenarios related to Mg administration, was sent to Maternal-Fetal Medicine program directors (or surrogate if no response) using publicly available contact information. Participants received a $10 incentive. Responses were received from 66 of 95 institutions (69%), representing all 12 ACOG districts. A standard institutional protocol for postpartum Mg was reported by 70% ( N = 46) of respondents, with 85% ( N = 56) routinely administering Mg for 24 h. Overall, 68% ( N = 45) would give a second course of Mg for an exacerbation of PESF, with no geographic variation ( p = 0.969). When faced with specific clinical scenarios, most would administer a second course of Mg if the patient had a headache ( N = 52, 79%) or hypertensive urgency with systolic blood pressure (BP) ≥180 mmHg and/or diastolic BP ≥120 mmHg ( N = 35, 53%). The decision for a second course of Mg was not influenced by worsening laboratory values, gestational age at delivery, latency from delivery, or maternal demographics. Although there are no standardized guidelines for seizure prophylaxis in the setting of postpartum exacerbations of PESF, this national survey suggests that most academic programs favor giving a second course of Mg, especially in patients with headache or severe BP. A randomized trial comparing outcomes in patients who did or did not receive an additional course of Mg is warranted.

Gestational Diabetes (GD) is associated with cognitive dysfunction, anxiety, and post-partum depression. The mechanisms underlying such changes are poorly understood. It is not known whether animal models of GD can replicate the dysfunction observed in humans. In this pilot study, we evaluated whether a streptozotocin (STZ)-induced model of gestational diabetes reproduces postpartum anxiety-like behavior and learning and memory impairments. Female Wistar rats were assigned to the control (n = 14) and STZ (n = 10) groups. After weaning, maternal anxiety behavior was evaluated using the Elevated Plus Maze and Open Field, memory using Novel Object Recognition and Morris Water Maze, and learning using Morris Water Maze. As a post hoc analysis, given its association with memory and learning, hippocampal neurogenesis was evaluated by RT‑qPCR of mRNA levels of Cdk5, Reln, Bdnf, and Gad1 and by estimating the numerical density of DCX‑immunoreactive neurons in the dentate gyrus. No robust behavioral differences were detected between STZ dams and controls in the anxiety-, learning-, and memory-related tasks. Exploratory molecular and histological analyses suggested increased hippocampal BDNF mRNA expression and higher DCX-positive neuronal density in STZ dams, warranting further investigation of hippocampal plasticity-related mechanisms following gestational diabetes.

Uterine compression sutures (UCS) serve as a uterus-preserving option for the management of postpartum hemorrhage (PPH); however, the clinical characteristics associated with the need for additional treatment after UCS remain incompletely characterized. This study aimed to explore clinical factors associated with escalation to additional treatment after UCS. We conducted a single-center retrospective cohort analysis of 33 patients who underwent UCS for PPH during cesarean delivery between January 2011 and July 2025. Patients were categorized based on management with UCS alone or the requirement for additional interventions, including transcatheter arterial embolization (TAE) or emergency peripartum hysterectomy (EPH). UCS alone achieved hemostasis in 23 patients (69.7%), whereas 10 patients (30.3%) required additional treatment (TAE, n = 3; EPH, n = 7). The incidence of suspected placenta accreta spectrum (PAS) was higher among patients requiring additional treatment than among those managed with UCS alone (60.0% vs. 8.7%; p = 0.004). Six of the eight patients with PAS (75.0%) required escalation, whereas all four patients with placental abruption achieved hemostasis with UCS alone; however, this finding should be interpreted cautiously because of the small number of cases. The estimated blood loss and intensive care unit admission rates were higher in the group requiring additional treatment. Ultimately, uterine preservation was achieved in 26 (78.8%) patients. In this small retrospective cohort, UCS achieved hemostasis in many patients with PPH during cesarean delivery. Suspected PAS, particularly when complicated by placenta previa or a low-lying placenta, was associated with a higher need for additional treatment after UCS. However, because of the small sample size and limited number of events, these findings should be interpreted as hypothesis-generating rather than as definitive predictors of UCS failure.

The perinatal period is marked by heightened vulnerability to mental health difficulties, including the onset of self-harm ideation (SHI). We aimed to (a) estimate the prevalence of self-harm ideation among perinatal women, (b) explore sociodemographic, clinical, and psychosocial correlates of SHI. This is a cross-sectional study involving pregnant ( n = 5,087) and postpartum women ( n = 6,550). SHI was measured using item 10 of the Edinburgh Postnatal Depression Scale (EPDS), depressive symptoms using the remaining 9 EPDS items (EPDS-9), and anxiety symptoms using the Generalised Anxiety Disorder-7. Prespecified multivariable logistic models were fitted separately for pregnancy and postpartum. SHI prevalence was 2.3% during pregnancy and 1.1% postpartum. In pregnancy, risk was independently associated with depressive symptom severity (OR = 1.27, 95%CI [1.21-1.33], p <.001) and immigrant status (OR = 2.08, 95%CI [1.15-3.75], p =.015), whereas better economic conditions were protective (OR = 0.53 per category increase, 95%CI [0.36-0.78], p =.001). In the postpartum period, depressive symptoms remained strongly associated with SHI (OR = 1.32, 95%CI [1.24-1.40], p <.001), and stable paid employment was protective (OR = 0.41, 95%CI [0.23-0.74], p =.003). Phase-specific models showed good to excellent discrimination (AUC pregnancy =.86; AUC postpartum =.91) and acceptable calibration. No clinically meaningful EPDS-9 × phase interaction emerged. A portion of perinatal women experience SHI and report it when asked directly (i.e. through the EPDS self-harm item). Routine screening should include explicit questions about self-harm thoughts and should continue through the first postpartum year. Combining mood screening with assessment of socioeconomic adversity may further improve the identification of individuals who could benefit from additional support.

Maternal behaviour is characterized by increased motivation for pups, which facilitates the expression of behaviours promoting offspring survival and development. Motivated behaviours are critically dependent on brain dopamine systems, thus, understanding its functioning is necessary to elucidate maternal reward brain processing. The activity of dopamine systems is controlled by the inhibitory GABA cells of the tail of the ventral tegmental area or rostromedial tegmental nucleus (tVTA/RMTg). This brain region is involved in reward and avoidance behaviour, among other functions, however, its role in maternal behaviour remains poorly understood. In the present study, we assess the effect of pharmacological manipulation of the tVTA/RMTg on maternal behaviour in postpartum female rats. To this end, pregnant Sprague-Dawley female rats underwent stereotaxic implantation of a guide cannula in the tVTA/RMTg. During the first week after delivery, female rats received intra-tVTA/RMTg microinjections of vehicle and/or several pharmacological agents (glutamate, DAMGO, muscimol, oxytocin or atosiban) in a cross-design. Our results reveal that pharmacological activation and inhibition of the tVTA/RMTg can increase or decrease maternal behaviour, respectively, by altering some specific behaviours, such as pup retrieval, pup exploration or time spent in nest. Otherwise, modulation of the oxytocinergic transmission at the tVTA/RMTg reveals mild effects on maternal behaviour and the observed effect depend on the oxytocin dose. Overall, our results reveal an involvement of the tVTA/RMTg in maternal reward processing, since its activation or inhibition can critically modulate maternal behaviour.

This study aimed to systematically evaluate the effects of psychological interventions during pregnancy on the intervention outcomes and incidence rate in women with postpartum depression. Databases (PubMed, Medline, Web of Science, Cochrane Library, EMBASE) were searched from inception to December 2024 for randomised controlled trials assessing prenatal psychological interventions (e.g., mindfulness, psychosocial support) in pregnant women without severe mental illness. Primary outcomes included Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale-10 (PSS-10), Spielberger State-Trait Anxiety Inventory (STAI) scores, and PPD incidence within 6 weeks postpartum. Quality was assessed using the Cochrane risk-of-bias tool; meta-analysis was performed with RevMan 5.3. A total of 10 articles were included, with 6700 study subjects in total, including 3345 in the intervention group and 3355 in the control group, all of which were randomised controlled trials. The incidence rate of postpartum depression in the intervention group was significantly reduced (OR = 0.73, 95% CI [0.57-0.95], P = 0.02). The scores of EPDS, PHQ-9, PSS-10, and STAI in the intervention group were all lower than those in the control group. Psychological interventions during pregnancy can significantly reduce postpartum depression-related scale scores and incidence rates, and improve depressive symptoms, anxiety, and perceived stress. However, due to the heterogeneity of intervention types, this study cannot determine the optimal intervention method and thus provides preliminary evidence for clinical prevention. Clinicians should select interventions based on resource availability and individual characteristics of pregnant women, while future studies should focus on direct comparisons of different intervention types to provide more targeted guidance. Postpartum depression is a common mental health problem that affects many women after childbirth. It can harm both the mother’s well-being and the baby’s development. This study combined data from ten clinical trials, including 6,700 participants, to evaluate whether psychological interventions during pregnancy can help prevent postpartum depression. The results showed that women who received psychological support—such as mindfulness training, counselling, or group therapy—had fewer depressive symptoms, lower anxiety and stress levels, and a significantly reduced incidence rate compared with those who received routine care. These findings suggest that providing psychological care during pregnancy is an effective way to reduce the risk of postpartum depression and to promote mental health for both mothers and infants. Early psychological support should be considered an important part of prenatal care.

PurposePostpartum pain and depression often occur together. Analyzing their combined effects on new parents' functional impairment, self-care, and infant care can enhance healthcare practice. Nurses are often the first to assess and treat postpartum patients, ensuring that birthing individuals' experiences and needs are acknowledged and addressed. This study aimed to clarify how these two challenges interfere with self-care and infant care, and to identify essential healthcare resources to support individuals facing this dual struggle.MethodsThe sample included 20 racially and ethnically diverse birthing individuals identifying as women, all of whom experienced postpartum pain and depressive symptoms. Data were collected between August 2022 and January 2024. Thematic analyses were conducted using NVivo.Major FindingsThe findings showed that experiencing postpartum pain and depressive symptoms negatively affects individuals' ability to care for themselves and their infants. This often leads to difficulties with infant bonding and neglect of self-care. Additionally, these dual conditions hinder essential health behaviors that contribute to overall well-being and parenting behaviors, such as breastfeeding. Participants highlighted the need for healthcare support, including access to resources, information about the dual challenges of postpartum pain and depression, and home visiting services.ConclusionPostpartum pain and depressive symptoms hinder new parents' self-care, which can compromise recovery and parenting behaviors that support optimal infant development. Nurses can help birthing individuals anticipate and manage the risks associated with the co-occurrence of postpartum pain and depression.

The aims of the study were to evaluate factors influencing the resumption of postpartum ovarian activity and to compare hormone concentrations among mares with physiological/pathological postpartum period and cyclic non-lactating mares. Follicular dynamics were monitored ultrasonographically in 38 postpartum mares from foaling or admission (Tpp/Ta) every other day until the emergence of a dominant follicle (Td), then daily until ovulation (To). Blood samples were collected at Tpp/Ta, Td, and To in postpartum mares and at Td and To in cyclic mares to determine serum estradiol, progesterone, leptin and cortisol concentrations. Ovulation occurred in 34/38 (90%) mares. The χ 2 test showed that ovulation was significantly more frequent in mares with physiological postpartum (p = 0.005), in multiparous (p = 0.03) and in lactating mares (p = 0.00011). Age and foaling month were not associated with ovulation. In physiological postpartum mares, estradiol and progesterone concentrations decreased significantly over time (p = 0.002; p = 0.004 respectively), whereas leptin and cortisol remained unchanged. No significant temporal changes were observed for any hormone in mares with pathological postpartum or in cyclic mares. Hormone concentrations did not differ significantly among groups at any time point. Progesterone concentrations at Tpp/Ta were lower in primiparous mares (p = 0.048). Overall, parity, type of postpartum and lactation status influenced the likelihood of postpartum ovulation. Although hormone concentrations were largely comparable among groups, pathological postpartum mares exhibited delayed or absent ovulation, suggesting that postpartum disorders may affect the resumption of ovarian activity.

BackgroundBrazil has recognized the need to investigate the health context of Indigenous Peoples by (a) collecting data on service coverage, barriers, needs, and gaps in access to health care; (b) developing, funding, and implementing plans and strategies for multilingual service delivery (c) reducing gender, social, and cultural inequalities as well as geographical barriers that hinder equitable access to quality health services; and, (d) incorporating an intercultural-intersectoral approach in the development of policies and inclusive-participatory research.PurposePropose an original conceptual framework for action research on the socio-cultural aspects of pregnancy, childbirth, and the postpartum cycle among Brazilian Indigenous women.ResultsAn online consultation with healthcare professionals was conducted (April-June 2024) using audio recorded narratives to gather information about the health of pregnant and postpartum Indigenous women. The Canadian model of population health promotion guided information analysis. Fourteen healthcare professionals with experience working in four Brazilian states and with 11 ethnic groups were consulted. A total of 23 modifiable situations were identified, and an original conceptual framework was developed that encompasses the following health promotion areas as modifiable situations: structure of the healthcare network; administrative barriers in healthcare management; operationalization of care delivery; and clinical and social contexts.ConclusionThis article conceptualizes areas for innovative and socially responsive solutions to amend vulnerabilities in Brazilian Indigenous maternal health. The conceptual framework proposed offers a useful operational foundation for designing future interventions in Indigenous maternal health and for strengthening action research as a transformative methodological strategy in contexts marked by persistent historical and social inequalities.