Ny forskning om jente- og kvinnehelse

To evaluate the efficacy of Internet-based cognitive behavioral therapies (iCBTs) for women at high risk for postpartum depression (PPD) and examine the influence of screening tools and intervention timings. PubMed, Embase, Web of Science, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) on iCBT for high-risk PPD through July 2026. Meta-analysis was conducted using RevMan 5.4.1. A total of 11 RCTs involving 4065 participants were included. Meta-analysis revealed that compared with the control, iCBT significantly reduced the incidence rate of PPD in women at high risk for PPD (OR = 0.21, 95%CI [0.14, 0.33], P < 0.01). Regarding symptom scores, the iCBT group exhibited significantly lower depression scores (standardized mean difference [SMD = -0.34, 95% CI [-0.49, -0.19], P < 0.01) and anxiety scores (SMD = -0.24, 95% CI [-0.32, -0.17], P < 0.01) than the control group. Subgroup analyses revealed no significant differences in PPD incidence or depression improvement across screening tools or intervention timings, though further trials are needed to rule out potential moderating effects. Anxiety alleviation assessment may depend on the selected tool. iCBT may reduce PPD incidence and alleviate depression and anxiety symptoms in high-risk women. PROSPERO CRD420251174544.

Postpartum breast cancer (PPBC), diagnosed within 10 years after delivery, exhibits distinct biological-clinical characteristics and is associated with poorer prognosis. This study aimed to explore factors linked to PPBC and identify possible differential prognostic markers. We conducted a retrospective case-control study including women under 45 years. Clinical-reproductive and histopathological data, including previous gynecological pathology and benign breast conditions, were collected through standardized questionnaires and verified with medical records when available. PPBC was compared with non-postpartum breast cancer (non-PPBC) and healthy women. Multivariate analysis identified independent risk factors. Among 2,698 women, 264 (9.8%) had breast cancer, including 134 PPBC and 130 non-PPBC, whereas 2,434 served as healthy controls. Previous gynecological pathology was more frequent among PPBC than healthy mothers (48.9% vs. 25.7%; p < 0.001). Same occurred with previous breast pathology (51.9% vs. 21.7%; p < 0.001). The percentage of women who abruptly discontinued breastfeeding was higher in PPBC (27.5%) compared with healthy mothers (12.6%; p < 0.001). PPBC was more diagnosed at stage II (63.9%); non-PPBC at stage I (64.9%) ( p = 0.002). Early-PPBC (<5 years postpartum) showed higher Ki67-expression ( p = 0.012) and lower estrogen-receptor positivity ( p = 0.002). Previous breast pathology (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.45-3.34; p < 0.001) and abrupt cessation of breastfeeding (OR = 2.6; 95% CI: 1.63-4.08; p < 0.001) were the only factors independently associated with the risk of developing PPBC. PPBC presents distinct features and represents specific tumor entity. Abrupt cessation of breastfeeding appears to be a potentially modifiable risk factor.

Postpartum depression (PPD) can be predicted by biomarkers of 3rd trimester methylation at two estrogen-responsive genes (TTC9B, HP1BP3), but the mechanism(s) by which these epigenetic changes lead to PPD are unknown. We investigated whether clinical characteristics (psychiatric histories, depression onset, stress/anxiety/trauma) differ between those with (BM+) and without (BM-) these biomarkers of PPD risk. Participants (N = 206) completed clinical diagnostic interviews and stress, anxiety, and trauma questionnaires at up to 7 visits during pregnancy and postpartum. Biomarker status was determined using 3rd trimester blood samples. Linear mixed effects models compared outcomes between biomarker groups (positive/negative). Mediation models assessed the average causal mediation effect of anxiety on the relationship between biomarker status and PPD. BM+ individuals were more likely to 1) have a prior history of generalized anxiety (X 2 = 10.06, p = .003) and bipolar II disorder (X 2 = 7.68, p = .01), 2) develop PPD (X 2 = 3.97, p = .04), and 3) be depressed during both pregnancy and postpartum (X 2 = 6.52, p = .02). BM+ individuals scored higher on the perinatal anxiety screening scale (PASS, p = .006), perceived stress scale (PSS, p = .001), and state-trait anxiety inventory (STAI)-trait subscale (p = .02). Anxiety outcomes on the PASS (95% CI: 0.01-0.10, p = .004), PSS (95% CI: 0.007-0.10, p = .03), and STAI-State (95% CI: -0.001-0.06, p = .06) mediated the relationship between biomarker status and PPD development. Findings suggest distinct clinical phenotypes between BM+ and BM- PPD, with BM+ individuals displaying significantly higher anxiety/stress, which may contribute to their higher risk of developing PPD. This presents an opportunity to investigate mechanisms in more homogenous groups based on biomarker status.

To evaluate the association between Edinburgh Postnatal Depression Scale (EPDS) scores on postpartum day 7 and maternal demographic, sociodemographic, obstetric, complication-related, and neonatal factors. This retrospective cohort study included 1,032 women who delivered at a tertiary referral hospital in 2025. Patients were stratified into low-risk (EPDS <13, n = 893) and high-risk (EPDS ≥13, n = 139) groups. Demographic, sociodemographic, obstetric, neonatal, and laboratory variables were compared, and independent predictors of high-risk status were identified by multivariable logistic regression. Of 1,032 patients, 13.5% ( n = 139) screened high-risk. On univariable analysis, any prior abortion was significantly less frequent in the high-risk than in the low-risk group (5.0% vs 11.5%, p = 0.020).Higher education (university 30.2% vs 21.6%, p = 0.041) and employment (41.7% vs 26.9%, p < 0.001) were more frequent in the high-risk group. On multivariable analysis, prior abortion count was the only independent inverse predictor (aOR = 0.536, 95% CI 0.299-0.959, p = 0.036); gestational diabetes did not reach significance (aOR = 0.311, p = 0.053). Sociodemographic variables were analyzed univariately and were not entered into the multivariable model. No other variables differed significantly. In this Turkish obstetric population, a higher prior abortion count was independently associated with a lower likelihood of high EPDS risk on postpartum day 7. This unexpected inverse association is hypothesis-generating and should be interpreted with caution, given the small number of events, the inability to distinguish loss subtypes, and the multiple comparisons performed. Univariate associations of higher education and employment with EPDS risk diverge from Western literature and warrant prospective multicenter confirmation.

Antibiotic resistance genes (ARGs) in livestock feces represent an important environmental reservoir of antimicrobial resistance. Natural product intervention is a potential strategy for regulating the gut microbiome of livestock; however, its effects on the gut resistome of postpartum dairy cows remain poorly understood. In this study, we investigated the effects of Astragalus polysaccharides (APS) supplementation on the fecal microbiome, ARGs, mobile genetic elements (MGEs), virulence factors (VFs), and ARG-carrying metagenome-assembled genomes (MAGs) in dairy cows during postpartum period. Alpha and beta diversity analyses showed that APS supplementation did not significantly alter the global resistome, mobilome, or virulome structure. The content of several ARGs and VFs, including AAC(6')-Iw, qacEdelta1, ast, PM_RS00425, and sdrF, significantly decreased in the APS group, and several plasmid-associated MGEs genes showed group-specific changes. Co-occurrence network analysis revealed complex associations between ARGs, VFs, and core bacterial taxa, with Paludibacter and Parabacteroides identified as potential microbial reservoirs of resistance- and virulence-associated genes. Furthermore, 101 metagenome-assembled genomes (MAGs) were recovered, 42 of which carried multiple ARGs. Bin.1, assigned to Scatovivens, had the highest ARG count. APS supplementation reduced the overall ARG load, particularly the ARG contribution in bin.1. However, APS utilization potential was not significantly correlated with ARG density or ARG load across MAGs. Thus, this study provides new insights into APS supplementation and nutritional strategies that can mitigate the fecal ARG burden in dairy production.

The purposes of the cross-sectional survey were to investigate among a sample of post-partum women in Italy the attitudes and the behaviors about the respiratory syncytial virus (RSV) infant monoclonal antibody and to explore any associations with different characteristics.The survey was conducted between March and April 2025 in teaching and public hospitals randomly selected in Southern Italy. The data were collected using a structured questionnaire through a face-to-face interview for those women in the maternity wards and by telephone for those who were at home.A total of 476 women completed the interview for a response rate of 96.6%. Half (50.8%) reported that the monoclonal antibody was very useful for the protection of the newborn, and this was more likely among mothers who trusted the information they received about vaccinations and those who had not received information from Internet or social media. A total of 86.5% had immunized their newborn against RSV. Women who had received at least one vaccination when pregnant, those who believed that the monoclonal antibody was very useful, those who did not acquire information from Internet or social media, and those who trusted the vaccination information acquired were more likely to have immunized their child.Education and communication strategies must be embedded in pre-natal and maternal health programs, and healthcare workers must be encouraged to actively inform and counsel every new cohort of pregnant women about the role of the RSV immunization to protect their children.

Respiratory syncytial virus (RSV) is a leading cause of pediatric lower respiratory tract infections, yet evidence on vaccine acceptance among Chinese pregnant and postpartum women remains limited. This study examines the willingness, preference and factors influencing neonatal RSV immunization among this population in Lanzhou City, China. The study used a convergent mixed-methods approach, including cross-sectional questionnaires and in-depth interviews, and data were processed through multiple regression analysis and thematic analysis. The results showed that the respondents' knowledge of RSV was generally low, with 56.5% indicating that they had never heard of the virus, and only 40.1% expressing willingness to be vaccinated, with most of them preferring monoclonal antibody after the birth of infants to maternal vaccination during pregnancy. The key factors influencing immunization willingness included education level, occupation, experience of vaccine side effects, health status during pregnancy, previous vaccination history during pregnancy, and RSV knowledge level, while the factors influencing immunization preference included annual per capita household income, RSV understanding level and RSV knowledge level. Qualitative interviews further revealed participants' general concerns about the safety and efficacy of vaccination during pregnancy, with national immunization policy and vaccine cost also being important influencing factors. Pregnant and postpartum women demonstrated limited RSV awareness and generally low willingness for immunization, with a clear preference for infant monoclonal antibody administration over maternal vaccination. Comprehensive interventions in terms of health education, service accessibility, financial subsidies and precise communication are recommended to increase immunization rates and reduce the burden of RSV-related diseases.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. While efforts to prevent and improve the management of PPH, including the use of emergency checklists during a hemorrhage event, have increased, there has been limited attention to the lived experiences of pregnant people. To describe patients' perceptions of their experiences with an inpatient multidisciplinary team response to PPH management when an emergency checklist was utilized. Individuals who experienced PPH, defined as a cumulative blood loss of 1,000 mL or more, were approached to participate in the study. Purposeful sampling was employed to ensure diversity by both self-reported racial and ethnic identity and severity of PPH. Participants completed remotely conducted semi-structured interviews between February and November 2024. A qualitative phenomenological approach was employed to establish a shared understanding of participants' perceptions and lived experiences. Twenty participants completed interviews. PPH imposed a substantial physical and emotional burden on patients. While patients often felt exposed and reported a loss of agency during their PPH, these concerns were eased when the care team maintained a steady presence and clearly articulated their management and interventions. Perception of the emergency checklist, when recalled, provided additional reassurance by reinforcing trust in systematic care and adherence to protocols. Participants emphasized the importance of ongoing education and guidance on PPH treatment and its implications after hospital discharge. Patients who experienced PPH described feelings of vulnerability; however, the care team's composed presence and clear communication were perceived by participants as sources of reassurance during these experiences. Awareness of emergency checklist use, when present, was described by some participants as fostering confidence in team management. Patient support should extend beyond medical management throughout the postpartum period.

The postpartum period carries substantial risk for preventable morbidity, particularly among individuals with high-risk pregnancies complicated by chronic or pregnancy-associated conditions. Despite recommendations for early and ongoing postpartum follow-up, patterns of postpartum and acute care utilization across high-risk conditions remain poorly characterized. We evaluated postpartum and acute care utilization among individuals with high-risk pregnancies versus low-risk pregnancies in an urban safety-net health system. We conducted a retrospective cohort study of individuals who delivered at two campuses of a tertiary academic medical center between 1 June 2018 and 31 May 2022. High-risk pregnancy status was defined using ICD-9/10 codes corresponding to chronic medical or pregnancy-associated conditions; low-risk was defined by the absence of these codes. The primary outcome was attendance of ≥1 postpartum visit (PPV) within 12 weeks of delivery. Secondary outcomes included emergency department (ED) visits and hospital readmissions within 12 weeks postpartum. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs). Of 13,874 included individuals, 9435 (68.0%) had ≥1 high-risk diagnosis, and nearly half had multiple coexisting conditions. High-risk individuals were more likely than low-risk individuals to attend any PPV (59.2% vs. 45.4%) and an early PPV within 21 days (40.5% vs. 24.2%, both p < 0.001). ED visits (16.9% vs. 13.9%) and readmissions (5.4% vs. 2.7%) were also more frequent among high-risk individuals ( p < 0.001). In adjusted analyses, hypertensive disorders of pregnancy (aOR 1.67), mental health conditions (aOR 1.49), cesarean delivery, and greater prenatal care utilization were associated with higher odds of PPV attendance, while gestational diabetes was associated with lower odds (aOR 0.79). High-risk conditions, particularly hypertensive disorders and pregestational diabetes, were associated with increased acute care utilization. Although high-risk individuals were more likely to attend PPVs, overall engagement remained suboptimal and acute care utilization was high. These findings highlight the need for risk-tailored postpartum care and improved care coordination to reduce preventable morbidity.

A Mendelian randomization (MR) study was carried out to investigate the causal relationship between sleep apnea syndrome (SAS) and the risk of obstetric disorders occurring, including postpartum depression, and to evaluate the potential mediating effect of an individual's body mass index (BMI). Using genome-wide association study (GWAS) summary-level data, we utilized two-sample univariate MR analysis to examine the causal association between SAS and seven obstetric disorders. The causal effects of SAS on the selected disorders were primarily estimated using inverse variance weighting (IVW), supplemented by MR-Egger regression, and weighted median, simple mode, and weighted mode methods. Two-step MR mediation analysis was next conducted to assess whether the BMI mediated the identified associations. Sensitivity analyses were also performed, including MR-PRESSO, the MR-Egger intercept test, and leave-one-out analysis. Potential reverse causation was also evaluated using the MR-Steiger directionality test. Univariate MR analysis showed there was a significant positive causal association between SAS and the risk of postpartum depression (PPD) (OR = 1.13, 95% CI: 1.05-1.22, p = 0.006; FDR-adjusted p = 0.006). No significant causal associations were observed between SAS and the other six obstetric disorders investigated. The two-step MR mediation analysis indicated that an individual's BMI mediated a portion of the total effect of SAS on the risk of developing PPD, specifically 11.7% (indirect effect OR = 1.132, 95% CI: 1.053-1.217). This MR study provides evidence that there is a positive causal relationship between SAS and PPD, and suggests that an individual's BMI may partially mediate this link, highlighting the potential role of weight management in strategies to mitigate the risk of PPD in women with SAS, though this hypothesis requires validation in intervention trials.

During the immediate postpartum period, breastfeeding could be challenge for many women due nipple pain and trauma. Non-pharmacological therapeutic strategies that reduce pain and accelerate healing are essential to prevent early weaning and support successful lactation. This study aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in reducing pain and promoting healing of nipple trauma in postpartum women, as well as to assess participants satisfaction with the intervention. This multicentric, controlled, randomized, double-blind clinical trial included 60 women equally divided into an experimental group (2 J of red light at the nipple's central point and 4 J of infrared light in a cross pattern over the areolar region) and a sham group. Pain intensity was measured using the Numeric Rating Scale before, during, and up to 7 days after the intervention, and healing was assessed using a validated instrument. Intention-to-treat analysis was conducted. We found a significant reduction in pain in the experimental group, with relief observed 30 min ( p = 0.0439) after the LLLT application. Pain diary analyses indicated that, compared to the sham group, the experimental group reported lower pain intensity at 1h ( p = 0.0485), 6h ( p = 0.0194), 12h ( p = 0.0033), and 7 days after the intervention ( p = 0.0085). There was no significant difference in the level of satisfaction between groups ( p = 0.652), and no adverse effects were identified. LLLT proved to be a safe, effective, and feasible approach for managing pain associated with nipple trauma in the early postpartum, providing maternal comfort and supporting the continuation of exclusive breastfeeding.

To explore the changes in needs among postpartum women and provide a reference for the development of scientific and effective targeted nursing interventions. We conducted a longitudinal qualitative study of 18 postpartum women who initially experienced normal vaginal deliveries in China. Participants were selected using a purposive sampling method, and semi-structured interviews were conducted at twenty-four hours, three days, two weeks, and forty-two days during the postpartum period. The study was designed using a phenomenological approach and the data were analyzed using a social-ecological framework. The study extracted three main themes and eleven subthemes: the micro system (including needs for scientific newborn care guidance, needs for nursing of maternal physiological discomfort, needs for breastfeeding guidance, and Needs for dynamic psychological care of Postpartum), the meso system (including needs for single - room of the ward environment, needs for online consultation after discharge, needs for health education for family members), and the macro system (including needs for birth certificate policy optimization, needs for comprehensive guidance on vaccination, needs for home visit to optimize, and needs for standardized education implementation and personalized, dynamic learning). This study indicates that the needs of women who have undergone normal vaginal delivery undergo a dynamic change process. Consequently, clinical medical staff should develop health education programs and provide personalized and precise interventions based on varying needs at different stages of the postpartum period.

Parental vaccine hesitancy (VH) remains a significant public health challenge in France, despite mandatory childhood vaccination policies. Motivational interviewing (MI) has shown promise in reducing VH and increasing vaccination intentions. This study aimed to evaluate the sustained impact of an MI-based intervention on VH and vaccination intentions among postpartum mothers in Southeastern France. We conducted a randomized controlled trial (RCT) in two maternity wards in Southeastern France between November 2021 and April 2022. A total of 733 mothers were randomly assigned to receive either a MI session delivered by trained midwives or an educational leaflet. We used the Parent Attitudes about Childhood Vaccines questionnaire to assess VH (0-100 score) and a single question to measure vaccination intentions (1-10 score). Data on VH and vaccination intentions were collected pre-intervention (T0), immediately post-intervention (T1), and seven months later on average (T2). Linear regression models adjusted on potential confounders and Heckman's two-step selection method were used to analyze the data. Seven months post-intervention, we observed a reduction in VH scores (10.1/100 points, p < .0001) and an increase in vaccination intention scores (0.8/10 points, p = .01) compared to the control group. The impact of MI was consistent across different perceived financial situations. Our findings demonstrate that MI has a sustained effect in reducing VH and increasing vaccination intentions among postpartum mothers. MI should be considered as a key strategy to strengthen and sustain vaccine confidence. Further research is needed to test the impact of MI interventions among other under-vaccinated populations, such as pregnant women.

The mental burdens among pregnant and postpartum women were exacerbated by cultural expectations and policy shifts, which can be mitigated by social support. To identify the networks of comorbid somatic and mental health, diverse sources of support (interpersonal and policy), and symptom-support interactions in pregnant and postpartum women. Participants were recruited from seven Chinese tertiary hospitals. Health conditions, supports, and combined system networks were estimated. Core symptoms and support sources were identified via centrality indices. Two thousand nine hundred and eighty-nine participants were included, network analysis identified 'feeling tired/having low energy' and 'suicidal thoughts' in depression symptoms as the most central symptoms. Strongest edges were identified between 'uncontrollable worry-trouble relaxing' (anxiety), 'slowed movement-suicidal thoughts' (depression), and 'feeling your heart pound or race-shortness of breath' (somatic symptoms). Somatic health exhibited strong connections with depression symptoms, especially between 'trouble sleeping' and 'sleep problems'. In the support network, 'my friends offer practical help' and 'fiscal assistance programs' exhibited highest strength centrality, 'friends share joys and sorrows with me' and 'family willingly helps me make decisions' were key mediators with high betweenness. All supports were negatively associated with mental/somatic symptoms. Family and friend support had stronger negative connections with hopelessness. 'Health management', 'reliable friends', and 'family emotional support' presented the strongest negative relationships with mental health. Fatigue and suicidal ideation were identified as interconnected symptoms, informal interpersonal support, and fiscal assistance as key elements. Preventions and interventions should prioritize core symptoms while leveraging the power of support networks, to safeguard maternal health and well-being. Main findings: Fatigue and suicidal ideation were identified as interconnected symptoms in mental health symptoms of pregnant and postpartum women, informal interpersonal support, and fiscal assistance as key elements in the support system. Added knowledge: This study provided a novel blueprint for the network of mental health among pregnant and postpartum women, pinpointing fatigue and suicidality as core treatment targets and clarifying how distinct support sources function as key mediators. Global health impact for policy and action: These findings mapped clear imperatives that preventions and interventions should prioritize core symptoms while leverage the power of support networks, to safeguard maternal mental health and well-being.

Diastasis recti abdominis (DRA) is characterised by a separation of the rectus abdominis muscles, which is common in the postpartum period. This randomised controlled trial investigated the effects of a physiotherapy protocol combining abdominal exercises and physical agents-namely electromagnetic shock waves, transfer of energy capacitive and resistive (TECAR) therapy, and neuromuscular electrical stimulation-on reducing the inter-rectus distance in women with DRA six months after childbirth. Sixty women diagnosed with DRA were randomised into three groups: kinesiotherapy (Group A); electromagnetic shock waves, TECAR therapy, and neuromuscular electrostimulation (Group B); and a combination of both (Group C). The inter-rectus distance (IRD) of participants was assessed before and after treatment, with re-evaluation conducted sixty days after the initial assessment, using ultrasound and abdominal perimeter measurements. group C showed a 0.80 cm reduction in supraumbilical IRD when compared with Group B. In the infraumbilical region, Group C had a 0.74 cm reduction compared to Group A and 0.85 cm compared to Group B. Regarding abdominal perimeter, Groups B and C showed greater reductions in the infraumbilical circumference than Group A, with mean differences of approximately 10 cm. No significant differences were observed in the supraumbilical and umbilical regions. the combination of kinesiotherapy and physical agents is more effective in reducing inter-rectus distance and abdominal circumference than either approach alone in postpartum women with diastasis recti abdominis. After pregnancy, many women develop a condition where the belly muscles separate more than usual. This can lead to weakness, discomfort, and changes in appearance. In our study, we tested physiotherapy treatments in 60 women who were six months postpartum. One group did guided abdominal exercises, another received treatments with special devices that act on the muscles and tissues, and a third group received both. We measured the muscle gap and waist size before and after treatment. The women who did the combined program showed the greatest improvements, suggesting that combining approaches may be more effective than using either one alone.

Postpartum blues (PPB) is considered a prodromal stage of postpartum depression. This randomized controlled trial evaluated the effectiveness of transcutaneous auricular vagus nerve stimulation (taVNS) in alleviating PPB following cesarean delivery. One hundred participants were randomly assigned to receive active (n = 50) or sham (n = 50) taVNS over 5 days, with outcomes monitored through three months postpartum. The primary outcome demonstrated a significantly smaller increase in visual analogue scale scores, reflecting PPB severity, after the mood induction procedure in the active group than in the sham group on postpartum day 5 (median difference, 4.13 cm; 95% CI, 3.39-4.93; mixed-effects model, p < 0.001). The taVNS also significantly improved general postpartum mood on day 5, as assessed by Profile of Mood States (mixed-effects model, p < 0.001) and Stein Maternity Blues Scale (p < 0.001). At 1 month postpartum, the proportion of participants with Edinburgh Postnatal Depression Scale scores ≥13 was lower in the active group than in the sham group (4% vs. 26%; p = 0.003). Active taVNS also lowered postoperative pain scores at 4, 12, 24, 48, and 72 h (all p < 0.001) and improved sleep quality (assessed by the Richards-Campbell Sleep Questionnaire) on postoperative days 1 to 4 (all p < 0.001). These findings indicated that a 5-day taVNS intervention mitigated PPB severity after cesarean delivery and were associated with improved general mood, lower rates of Edinburgh Postnatal Depression Scale scores ≥13 at 1 month postpartum, reduced acute postoperative pain, and improved sleep quality. Chinese Clinical Trial Registry (https://www.chictr.org.cn/indexEN.html), ChiCTR2500108903.

Clinical outcomes in postpartum depression (PPD) are highly heterogeneous, yet the neurobiological mechanisms underlying recovery remain unclear. Identifying network-based biomarkers that reflect the brain's capacity for adaptive reorganization may improve prognostic accuracy and support individualized treatment. We conducted a longitudinal diffusion tensor imaging (DTI) study of 115 PPD patients and 40 healthy postpartum controls. All participants underwent DTI scans and clinical assessments at baseline (Time 1), 3 months (Time 2), and 6 months (Time 3). Based on 6-month outcomes, patients were classified into a recovery group (PPD-R, N = 72) and a non-recovery group (PPD-NR, N = 43). Graph-theoretical analyses assessed network topology across timepoints, focusing on rich-club connections, feeder connections, and local connections, as well as small-world properties. Psychosocial variables including perceived social support were also evaluated. At baseline, both PPD-R and PPD-NR groups showed reduced local connections (F = 13.034, P < 0.001) and small-world properties (F = 17.219, P < 0.001). During follow-up, only the PPD-R group exhibited significant recovery of rich-club connections (t time1-time2 = -3.900, P < 0.001; t time1-time3 = -4.325, P < 0.001), which correlated with initial small-world properties (β rich-club connections = 0.456, P < 0.001; β ∆rich-club connections = 0.405, P < 0.001) and predicted final depression severity (OR = 0.713 [95%CI: 0.568-0.832], AUC = 0.819, P < 0.001). Perceived social support significantly moderated the relationship between small-world properties and rich-club recovery (β perceived social support-small-world properties = 0.223, P = 0.002). Recovery from PPD was associated with selective reorganization of rich-club connections. Efficient small-world topology was related to greater rich-club reorganization, and perceived social support moderated this relationship. These findings suggest that rich-club connections may serve as a potential prognostic marker of recovery in PPD.

Progression to chronic hepatitis C virus (HCV) infection entails loss of HCV-specific CD4+ T cell help, emergence of viral variants that escape recognition by CD8+ T cells and neutralizing antibodies, and exhaustion of CD8+ T cells targeting remaining intact epitopes. Once chronic infection has been established, it is generally lifelong without treatment. However, in some chronically infected women, a surprising postpartum viral load decline has been linked to resurgent functional HCV-specific CD4+ helper T cells. A minority of women even spontaneously clear long-standing chronic infection postpartum. To test whether restored T cell help boosts HCV-specific CD8+ T cell or antibody responses in women with postpartum viral control, we performed serial near-full-length deep sequencing of HCV genomes to assess evolution of viral MHC class I epitopes and antibody epitopes in nine women with significant postpartum viral declines (≥ 1 log 10 at 3 mo postpartum, "controllers") and 12 with more stable levels ("noncontrollers"). Although not associated with mutations arising early postpartum, at 12 to 24 mo postpartum, viral control was strongly associated with amino acid mutations in epitopes predicted to be targeted by CD8+ T cells and neutralizing antibodies. Plasma from controllers also demonstrated a postpartum increase in neutralization of multiple HCV strains. Together, these findings support the hypothesis that postpartum viral control is mediated by CD8+ T cell and antibody pressure.

On July 1, 2021, Taiwan implemented a national policy incorporating gestational diabetes mellitus (GDM) screening into routine prenatal care and adopted a standardized 75-g oral glucose tolerance test (OGTT). This initiative aimed to normalize prenatal GDM screening; however, its impact on postpartum glucose testing behaviors remains uncertain. We assessed changes in postpartum glucose testing after policy implementation. This retrospective cohort study used data from the Taiwan National Health Insurance Research Database. We compared maternal records from 1.5 years before policy implementation (January 1, 2020-June 30, 2021) with those from 1.5 years after implementation (July 1, 2021-December 31, 2022). Outcomes included postpartum glucose testing, timing of testing, and follow-up specialty. After policy implementation, the proportion of women who received postpartum glucose testing within 3 months of delivery increased by 12.10 percentage points. Testing shifted toward the first 3 months postpartum (overall χ 2 (df = 2) = 53.83; p < 0.0001). Follow-up in obstetrics and gynecology increased by 3.02 percentage points, and follow-up in endocrinology increased by 1.74 percentage points (both p < 0.0001). After GDM screening was incorporated into routine prenatal care, postpartum glucose testing occurred earlier and became more concentrated, with postpartum follow-up more frequently occurring in obstetrics and gynecology and endocrinology. Even in the absence of a specific intervention targeting postpartum glucose testing, changes in postpartum testing behavior were observed, suggesting a spillover effect from the integration of GDM screening into routine prenatal care.

Health literacy is a key social determinant of health. Adequate health literacy has been associated with better obstetric and general adult health outcomes. However, its relationship with cardiovascular health during and after pregnancy is not well known. We aimed to estimate associations between health literacy and cardiovascular health in early pregnancy and postpartum. This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) study and its prospective follow-up phase, the nuMoM2b Heart Health Study. Participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) in the second trimester (16-21 weeks of gestation) and a 2-7 year postpartum study visit were included. Health literacy was classified as inadequate (REALM-SF score <7) or adequate (≥7) using standard scoring procedures. The primary outcomes were cardiovascular health in early pregnancy and 2-7 years after the first birth, assessed using a modified Life's Essential 8 (LE8) score, which includes health behaviors (diet, physical activity, sleep health, and nicotine exposure) and health factors (body mass index, blood pressure, blood glucose, and lipid levels). Secondary outcomes included LE8 subcomponents. Multivariable linear regression models, which adjusted for maternal age, insurance type, and family income, were used to evaluate associations of health literacy with LE8 overall scores and its subcomponents. Among 4424 participants eligible for analysis, 3599 (81.4%) had adequate health literacy. Those with adequate health literacy were older, more likely to identify as non-Hispanic White, and more likely to have higher income, higher education, and private insurance coverage. Participants with adequate health literacy had higher early pregnancy LE8 scores (79.9 ± 13.3 vs. 73.0 ± 14.2, p < 0.001), a relationship that persisted after adjustment (aβ 3.6, 95% confidence interval [CI], 1.8-5.4). This association was driven by body mass index, diet, physical activity, and sleep subcomponents. Similarly, LE8 scores 2-7 years after birth were higher among those with adequate health literacy (80.1 ± 13.8 vs. 72.9 ± 14.6, p < 0.001; aβ 3.2, 95%, CI, 0.8-5.6), primarily due to healthier measures of body mass index, diet, physical activity, nicotine exposure, and sleep. Among nulliparous women, adequate health literacy scores in early pregnancy were associated with better cardiovascular health during pregnancy and several years after first birth.

The hypertensive disease of pregnancy, preeclampsia, is a risk factor for future maternal cardiovascular disease while normal pregnancy is cardioprotective in the long term. Trophoblast-derived extracellular vesicles (T-EVs) released by the placenta are implicated in the development of vascular dysfunction and are widely thought to have a role in the pathogenesis of preeclampsia. This study tested the effects of T-EVs from both normotensive and preeclamptic pregnancies on long-term cardiovascular outcomes in a pregnant hypertensive model. Spontaneously hypertensive rats (SHRs) received intravenous vehicle control (CTEV; n = 11), and T-EVs from normotensive (NT; n = 10), early onset preeclamptic (EOPE; n = 10), or late-onset preeclamptic (LOPE; n = 10) pregnancies between days 8.5 and 18.5 of pregnancy (term = 22.5 days). SHRs were monitored during pregnancy and up to 12 mo postpartum, with noninvasive blood pressure plethysmography and echocardiography, followed by wire myography and histology. The NT group demonstrated significantly lower postpartum systolic blood pressure (SBP) compared with CTEV ( P < 0.0001), whereas SBP in the EOPE group was increased ( P < 0.0001). SBP was not significantly different between the CTEV and LOPE groups ( P > 0.05). Terminal wire myography revealed that vessels from the NT group were more vasodilatory in response to acetylcholine ( P = 0.0103) and less contractile in response to phenylephrine ( P = 0.0435) and endothelin-1 ( P < 0.0001). Vascular structure, cardiac function, and cardiac morphology were not different between all four T-EV groups. Exposure to T-EVs during pregnancy continued to influence maternal vascular function long after their administration. These findings confirm the role of T-EVs in regulating maternal vasculature long after the removal of the placenta at birth. NEW & NOTEWORTHY We have shown that normotensive T-EVs reduce blood pressure and promote a provasodilatory vascular phenotype for at least 12 mo after administration during pregnancy in a rat model. Administration of EOPE preeclamptic T-EVs prevented the natural decrease in blood pressure during pregnancy and increased blood pressure long-term. Together, these results suggest T-EVs play a key role in modulating maternal vascular function not only in pregnancy but also in determining future cardiovascular risk.

Postpartum hemorrhage remains a leading cause of maternal mortality, particularly in low-resource settings where experienced birth attendants are scarce. Uterine massage and bimanual uterine compression have been incorporated into care bundles for many decades, yet their efficacy lacks robust supporting evidence. Bimanual uterine compression is invasive and painful for women without neuraxial analgesia. This study aimed to assess whether manual external uterine compression could effectively control postpartum hemorrhage from uterine atony and placental pathologies after vaginal delivery. In this single-center, prospective cohort study of postpartum hemorrhage following vaginal delivery, we assessed the feasibility and efficacy of manual external uterine compression, a technique using the provider's upper body weight to apply pressure to the entire uterus. Once bleeding ceased, compression was maintained for 5 to 10 minutes. The primary outcome was success rate, defined as complete resolution of uterine hemorrhage using abdominal pressure and uterotonics without requiring escalating interventions. Key secondary outcomes included compression duration, use of intrauterine balloon tamponade, blood transfusion, blood loss, hematocrit/hemoglobin change, and acceptability to providers and patients. Outcomes from the early study phase were compared with those from the later phase. Manual external uterine compression was performed in 100 women with postpartum hemorrhage over a 10-month period, achieving an overall success rate of 94% (94/100). In the early phase, the success rate was 87.8% (43/49), as 6 women used intrauterine balloon tamponade following compression. In the later phase, no balloon tamponade was used after application of MEUC. Total compression duration ranged from 2 to 50 minutes (median: 10 minutes). All women tolerated the procedure well. Eight women (8%) received blood transfusions, and none required surgery. One woman experienced delayed uterine bleeding at 145 minutes postpartum. Manual external uterine compression may offer a less-invasive alternative to bimanual uterine compression for managing postpartum hemorrhage after vaginal delivery.

To describe maternity nurses' experiences in screening for postpartum depression (PPD) by administering the Edinburgh Postnatal Depression Scale (EPDS) in clinical practice. This exploratory qualitative study used thematic analysis to describe maternity nurses' experiences in identifying PPD symptoms and administering the EPDS. Data were collected through semi-structured virtual interviews, which were then transcribed verbatim, coded, and analyzed to identify recurring patterns related to identifying PPD symptoms and administering the EPDS. Eleven nurses participated. Four themes were identified including Communication Barriers, Connecting through Compassion, Care Coordination, and Emotional Barriers. Participants noted facilitators and barriers about the accuracy and practicality of the screening process using the EPDS. Participants also expressed suggestions for improving the screening process of PPD symptoms for antepartum and postpartum women. Findings highlight the facilitators and barriers that maternity nurses experience in identifying PPD symptoms and using the EPDS in clinical practice. Participants highlighted the importance of the nursing profession's role in ensuring no mother is left behind when it comes to PPD. This study showcases the importance of PPD screening, especially for vulnerable women.

Peripartum opioid-related mortality has increased in recent years, and social determinants of health (SDOH) are associated with adverse maternal outcomes. We sought to identify risk factors (including SDOH risk factors) for 180-day postpartum readmissions related to opioid use among individuals without a documented diagnosis of opioid use at delivery. We performed a retrospective cohort study using 2016-2021 data from the Nationwide Readmissions Database. Delivery hospitalizations and subsequent 180-day postpartum readmissions with a new opioid-use diagnosis were identified. Newly documented opioid use was defined as opioid dependence, abuse, or overdose documented at readmission without evidence of opioid use disorder at or prior to delivery. SDOH exposures were categorized into domains reflecting education/employment, physical environment, and social factors using International Classification of Diseases (ICD)-10 codes. Temporal trends in opioid use-related postpartum readmissions were evaluated using joinpoint regression to estimate average annual percent change (AAPC) with 95% confidence intervals (CIs). Multivariable logistic regression was used to estimate associations between SDOH and 180-day newly documented opioid use readmission, adjusting for demographic and clinical factors. Among 10,278,674 delivery hospitalizations, 3129 individuals (3.0 per 10,000) experienced a postpartum readmission with newly documented opioid use. The rate of 180-day postpartum opioid-related readmission declined from 3.7 to 2.2 per 10,000 delivery hospitalizations between 2016 and 2021 (AAPC, -10.4%; 95% CI, -13.5% to -7.8%). In unadjusted models, education- or employment-related SDOH (odds ratio [OR], 6.26; 95% CI, 2.70-14.51), SDOH related to the physical environment, housing, or economic circumstances (OR, 20.93; 95% CI, 14.81-29.57), and social SDOH (OR, 4.09; 95% CI, 2.51-6.65) were associated with opioid-related readmission. In adjusted models, only SDOH related to the physical environment, housing, or economic circumstances remained independently associated with opioid-related readmission (adjusted odds ratio [aOR], 4.87; 95% CI, 3.35-7.09). Although postpartum readmissions for newly documented opioid use have declined nationally, individuals experiencing adverse physical environment-related SDOH remain at significantly elevated risk. Early identification of structural vulnerability and linkage to supportive services may help reduce opioid-related postpartum morbidity.