Association of Maternal Mood Symptoms in Pregnancy with Exclusive Breastfeeding at Six Weeks Postpartum: A Cross-Sectional Study

Background: Previous studies have shown that postpartum depression negatively affects breastfeeding practices. However, it is not clear whether maternal mood symptoms during pregnancy affect exclusive breastfeeding (EBF) behavior. Our study aimed to quantify the relationship between maternal mood symptoms (depression/anxiety) during pregnancy and EBF.Methods: A cross-sectional study was conducted at Baoan Maternal and Child Health Hospital, Shenzhen, China, from January 1, 2016, to December 31, 2016, among women who had delivered in the hospital and completed the 6-week postpartum visit. A structured questionnaire was designed to collect information on maternal mood symptoms during pregnancy and EBF status at 6 weeks postpartum. Logistic regression models were used to evaluate the associations between maternal mood symptoms (depression/anxiety) during pregnancy and EBF at 6 weeks postpartum.Results: In total, 6324 women were included in this study. In univariate analysis, we observed that depression during pregnancy was associated with a reduced risk for EBF (OR = 0.66; 95% CI: 0.54-0.81; P < 0.001). In the fully adjusted model, depression during pregnancy was still significantly associated with a reduced risk of EBF (OR=0.69; 95% CI: 0.56–0.86; P < 0.001). However, there was no significant difference in the rate of EBF between the anxiety and non-anxiety groups of women (OR=0.88; 95% CI: 0.77–1.01; P > 0.05). Conclusion: We believe that our findings confirm the adverse impact of maternal depression during pregnancy on EBF behavior. Therefore, to improve conditions for breastfeeding of infants, additional attention should be paid to women with depressive symptoms during pregnancy.

Causes of early postpartum complications that result in visits to the emergency department

Objective This study aimed to review the reasons why postpartum women present to the emergency department (ED) over a short term (≤10 days post-delivery) and to identify the risk factors associated with early visits to the ED. Methods This retrospective chart review included all women who delivered at a regional health system (William Osler Health System, WOHS) in 2018 and presented to the WOHS ED within 10 days after delivery. Baseline descriptive statistics were used to examine the patient demographics and identify the timing of the postpartum visit. Univariate tests were used to identify significant predictors for admission. A multivariate model was developed based on backward selection from these significant factors to identify admission predictors. Results There were 381 visits identified, and the average age of the patients was 31.22 years (SD: 4.83), with median gravidity of 2 (IQR: 1–3). Most patients delivered via spontaneous vaginal delivery (53.0%). The median time of presentation to the ED was 5.0 days, with the following most common reasons: abdominal pain (21.5%), wound-related issues (12.6%), and urinary issues (9.7%). Delivery during the weekend (OR 1.91, 95% CI 1.00–3.65, P = 0.05) was predictive of admission while Group B Streptococcus positive patients were less likely to be admitted (OR 0.22, CI 0.05–0.97, P<0.05) Conclusions This was the first study in a busy community setting that examined ED visits over a short postpartum period. Patient education on pain management and wound care can reduce the rate of early postpartum ED visits.

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation

Objective To assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). Study Design A retrospective case–control study of patients with HDP delivering at a single academic institution (2014–2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. Results Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14–2.17), severe HDP (aOR: 1.94, 95% CI: 1.44–2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43–2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47–0.97), and public insurance (aOR: 0.65, 95% CI: 0.45–0.93) compared with private insurance. Conclusion Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. Key Points

Labour after caesarean counselling documentation: a quality improvement intervention on labour and delivery

BackgroundMost women who have had previous caesareans are eligible to have labour after caesarean (LAC), but only 11.9% do so. Studies show the majority of women have already decided about future mode of birth (FMOB) before a subsequent pregnancy. Hence, providing women with LAC counselling soon after birth may help women plan for future pregnancies. Prior to our intervention, our hospital had no method of ensuring that women received LAC counselling after caesarean section. The purpose of this QI initiative was to assess whether formal LAC documentation on labour and delivery (L&D) improves rates of LAC counselling post partum.MethodsOur three-part intervention included: (1) surgeon’s assessment of LAC feasibility in the operative note, (2) written LAC education for women in discharge paperwork and (3) documentation of LAC counselling in the discharge summary. We implemented these changes on L&D in January 2019. We conducted phone surveys of 40 women after caesarean preintervention and postintervention. Surveys included questions regarding three primary outcomes: whether or not they had received LAC counselling either in the hospital or at a postpartum visit, and whether or not they would pursue LAC as FMOB. Surveys also assessed two secondary outcomes: (1) women’s understanding of the indications for surgery and (2) their involvement in the decision process. We used a χ2 analysis to assess primary outcomes and a Fisher’s exact test to assess secondary outcomes. We also surveyed providers about the culture of LAC counselling at our hospital.ResultsAfter our intervention, there was a significant difference between the number of women reporting LAC postpartum counselling (30.77% vs 53.8%, p=0.04). There was also a significant difference in the number of women feeling involved in the decision-making process (68% vs 95%, p=0.03). Providers reported improved knowledge/confidence around LAC counselling (58%–100%). Providers universally stated that LAC counselling has become more ingrained in the culture on L&D.ConclusionsDocumentation of LAC counselling improved the consistency with which providers incorporated LAC counselling into postpartum care. Addressing FMOB at the time of pLTCS and documenting that counselling may be an effective first step in empowering women to pursue LAC in future pregnancies.

Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

Background Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. Methods All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. Results Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. Conclusions Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review. Graphic abstract

Perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content: Evidence from the Listening to Mothers in California survey

Objective Postpartum visits are an important opportunity to address ongoing maternal health. Experiences of discrimination in healthcare can impact healthcare use, including postpartum visits. However, it is unknown whether discrimination is associated with postpartum visit content. This study aimed to examine the relationship between perceived discrimination during the childbirth hospitalization and postpartum visit attendance and content. Research design Data were from Listening to Mothers in California, a population-based survey of people with a singleton hospital birth in California in 2016. Adjusted logistic regression models estimated the association between perceived discrimination during the childbirth hospitalization and 1) postpartum visit attendance, and 2) topics addressed at the postpartum visit (birth control, depression and breastfeeding) for those who attended. Results 90.6% of women attended a postpartum visit, and 8.6% reported discrimination during the childbirth hospitalization. In adjusted models, any discrimination and insurance-based discrimination were associated with 7 and 10 percentage point (pp) lower predicted probabilities of attending a postpartum visit, respectively. There was a 7pp lower predicted probability of discussing birth control for women who had experienced discrimination (81% vs. 88%), a 15pp lower predicted probability of being asked about depression (64% vs. 79%), and a 9 pp lower predicted probability of being asked about breastfeeding (57% vs. 66%). Conclusions Amid heightened attention to the importance of postpartum care, there is a need to better understand determinants of postpartum care quality. Our findings highlight the potential consequences of healthcare discrimination in the perinatal period, including lower quality of postpartum care.

Faktor–Faktor yang Mempengaruhi Kunjungan Nifas Lengkap di Indonesia: Analisis Lanjut Data Riskesdas 2018

Abstrak Latar Belakang: Perawatan nifas dibutuhkan pada periode setelah persalinan untuk mendeteksi dini masalah atau mengobati penyakit pascapersalinan. Lebih dari 65% kematian ibu terjadi selama 42 hari pertama pascapersalinan. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi kunjungan nifas lengkap di Indonesia. Metode: Penelitian menggunakan data Riset Kesehatan Dasar (Riskesdas) 2018. Unit analisis penelitian ini adalah ibu yang melahirkan anak terakhir dalam kurun 2013 sampai wawancara Riskesdas 2018. Hasil: Berdasarkan hasil regresi logistik, faktor predisposisi yang memiliki peluang untuk mempengaruhi kunjungan nifas lengkap adalah umur ibu 20-35 tahun (OR 0,885), pendidikan tinggi (OR 1,167), paritas ≤ 2(OR 1,090), persalinan secara sesar/vacuum/forceps, dll (OR 1,491), persalinan di fasilitas kesehatan (OR 1,489), pemeriksaan kehamilan lengkap (OR 1,613), dan regional Sumatera (OR 0,510). Faktor pemungkin yang memiliki peluang untuk mempengaruhi kunjungan nifas lengkap adalah status tidak bekerja (OR 0,954) dan memiliki jaminan kesehatan (OR 1,141). Faktor kebutuhan yang memiliki peluang untuk mempengaruhi kunjungan nifas lengkap adalah memiliki riwayat komplikasi kehamilan (OR 0,948). Kesimpulan: Faktor-faktor yang mempengaruhi kunjungan nifas lengkap adalah umur ibu, pendidikan, paritas, metode persalinan, tempat persalinan, pemeriksaan kehamilan, regional tempat tinggal, status pekerjaan, kepemilikan jaminan kesehatan, dan riwayat komplikasi kehamilan. The Determinants of Fully Postpartum Visit in Indonesia: Further Analysis of Riskesdas 2018 Abstract Background: Post-natal care is needed during postpartum for early detection or to cure disease or any problem of postpartum. More than 60% of maternal mortality happens during 42 days of postpartum. This research is intended to analyse the determinant factors of fully postpartum visit in Indonesia. Method: This research uses the data from Riskesdas 2018. The unit of analytic research is mothers having last birth happened from 2013 until Riskesdas interview on 2018. Result: Based on the result of logistic regression, predisposition factors that have chance to affect the fully postpartum visit are mothers on age 20-35 years old (OR 0,885), advance education (OR 1,167), parity ≤2 (OR 1,090), laboring through caesar, vacuum, forceps et all (OR 1,491), labor using medical facility (OR 1,489), fully pregnancy checkup (OR 1,613) and region Sumatera (OR 0,510). Enabling factors that have chance to affect the fully postpartum visit are unemployment (OR 0,954) and owning health insurance (OR 1,141). Need factor that has chance to affect fully postpartum visit is having history of pregnancy complications (OR 0,948). Conclusion: The factors affecting fully postpartum visit are age, education, parity, labor method, place of labor, pregnancy checkup and region of province, job status, health insurance ownership and history of pregnancy complication.