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Background After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it. Methods The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it. Results The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight. Conclusions Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.

Background: Midline cerebral structures are essential for the normal morphogenesis and function of the fetal brain. However, the diagnosis of congenital anomalies of midline cerebral structures. The Aim of The Work: This study aimed to evaluate the role of 2D versus 4D ultrasound in the diagnosis of midline structures of the fetal brain at the second trimester of pregnancy. Patients and Methods: 200 pregnant women at the second trimester [18-22 weeks] were selected. They were clinically evaluated to check the female and fetal wellbeing. Then a screening of fetal brain midline strictures had been performed by two- and four-dimensional ultrasound, aiming to discover any anomalies of the fetal brain midline structure. Both scans were compared with the postnatal transcranial ultrasound. Results: The 2D ultrasound detected no abnormality in 194 out of 200 fetuses [97.0%], and 4 cases [2.0%] had mega-cisterna magna, and 2 cases [1.0%] had encephalomylocele, which were detected by the 4 D and confirmed by postnatal transcranial ultrasound. The 4 D US discovered 2 cases [1.0%] of Dandywalker malformation, which was confirmed by postnatal transcranial US. There was a complete agreement between prenatal 4D ultrasound and postnatal transcranial ultrasound. The prenatal 2D ultrasound had a sensitivity of 75.0%, specificity of 100.0%, PPV of 100.0%, NPV of 98.7% and overall accuracy of 99.0%. Otherwise, the prenatal 4D ultrasound was 100.0% sensitive and specific. Conclusion: 4D ultrasound showed superiority in the diagnosis and confirmation of the fetal brain midline structure’s abnormalities. Also, the prenatal 4D ultrasound was 100.0% sensitive as postnatal transcranial US.

Introduction and hypothesis Urinary incontinence (UI) is prevalent in antenatal and postnatal women. Pelvic floor muscle training (PFMT) is the first-line treatment for UI. Group-based PFMT provides a way for professionals to deliver this intervention to more women who need to prevent and/or treat UI. This review aims to (1) assess the effectiveness of group-based PFMT in preventing and treating UI in antenatal and postnatal women and (2) explore the characteristics of group-based intervention and factors which had an impact on the success of group-based PFMT. Methods Randomized controlled trials (RCTs) were included in this review. A comprehensive search was conducted in PubMed, Embase, Medline, PsycINFO, Maternity and Infant Care Database, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database. The overall quality was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RCTs which included pregnant and/or postnatal women with or without UI investigating the effectiveness of group-based PFMT were included. Results Five RCTs were included in this review. The overall quality of the results of the included studies was low. Delivering group-based PFMT during pregnancy significantly reduced the prevalence of UI in both the pregnant period [risk ratio (RR) = 0.67, 95% confidence interval (CI) 0.57 to 0.80, P P = 0.0008]. Only one RCT delivered group-based PFMT during the postnatal period. Conclusion Evidence of weak quality supports the effectiveness of undertaking group-based PFMT in pregnancy to prevent UI during pregnancy and the postnatal period. No evidence showed the effectiveness of undertaking group-based PFMT in the postnatal period.

Rachel A Tinius,1 Kristin Yoho,1 Maire M Blankenship,2 Jill M Maples3 1School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, 42101, USA; 2School of Nursing and Allied Health, Western Kentucky University, Bowling Green, KY, 42101, USA; 3Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN, 37920, USACorrespondence: Rachel A TiniusSchool of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, 42101, USATel +1 270-745-5026Email Rachel.tinius@wku.eduBackground: Metabolic dysfunction after pregnancy may have serious consequences for a new mother. The purpose of the study was to characterize basic changes that occur in metabolic profiles from late pregnancy through 4– 6 months postpartum. A secondary purpose was to determine metabolic factors that may be contributing to postpartum weight retention.Methods: Participants (n=25) came in for 2 visits: late pregnancy (∼ 34 weeks gestation) and postpartum (4-6 months). Resting metabolic rate (RMR), respiratory quotient (RQ), and substrate oxidation values were assessed for 15 minutes during fasted conditions. Blood was drawn and skinfold anthropometry was performed to assess additional outcomes (inflammation, insulin resistance, lipid profiles, body composition). The participants completed a number of surveys that examined other lifestyle and demographic data of interest. At the postpartum visit, additional assessments regarding sleep and breastfeeding habits were administered.Results: RMR was lower during postpartum (1517.2± 225.1 kcal/day) compared to pregnancy (1867.9± 302.6 kcal/day) (p< 0.001), and remained lower when expressing RMR per kg body weight (postpartum: 22.3± 2.7 vs pregnant: 23.7± 3.4 kcal/kg, (p=0.034). Relative RMR (RMR per kg body weight) was negatively correlated to insulin resistance (HOMA-IR) during postpartum (r=− .463, p=0.034). Maternal HOMA-IR, inflammation (CRP), triglycerides (TAG), and carbohydrate oxidation were all positively correlated to postpartum weight retention (HOMA-IR: r=0.617, p=0.004; CRP: r=0.477, p=0.039, TAG: r=0.463, p=0.040; Carbohydrate Oxidation: (r=0.469, p=0.018).Conclusion: Metabolic rate is lower during postpartum compared to pregnancy, and may be connected to insulin resistance. Maternal insulin resistance, inflammation, blood lipids, and substrate metabolism are all related to postpartum weight retention.Keywords: postnatal, metabolic rate, insulin resistance, inflammation

Background Provision of contraception to women in the immediate postnatal period has been endorsed by professional bodies, to reduce the incidence of short inter-pregnancy intervals. This study examined the views of postnatal women and practising midwives regarding provision of contraceptive advice and contraceptive methods by midwives, in a region of the United Kingdom. Methods A mixed-method approach using qualitative interviews with midwives, and a postnatal survey followed by qualitative interviews with postnatal women, in five hospitals in the East of England. Twenty-one practising midwives and ten women were interviewed. Two hundred and twenty-seven women returned a survey. Survey data was analysed descriptively, augmented by Student’s t-tests and Chi-squared tests to examine associations within the data. Interviews were recorded, transcribed and analysed guided by the phases of thematic analysis. Results Midwives and women supported the concept of increased midwifery provision of contraceptive advice, and provision of contraceptive methods in the postnatal period. Convenience and an established trusting relationship were reasons for preferring midwifery provision over visiting a doctor for contraception. The best time for detailed discussion was reported to be antenatal and community visits. The Progesterone-only-pill (POP) was the method, in which women indicated most interest postnatally. Concerns for midwives included the need for increased education on contraceptive methods and training in supplying these. Structural barriers to such provision were time pressures, low prioritisation of contraceptive training and disputes over funding. Conclusions Women reported interest in midwives supplying contraceptive methods and expressed the view that this would be convenient and highly acceptable. Midwives are supportive of the concept of providing enhanced contraceptive advice and methods to women in their care, and believe that it would be advantageous for women. Institutional support is required to overcome structural barriers such as poor access to continuous professional development, and to allow contraceptive provision to be fully recognised as integral to the midwifery role, rather than a marginalised addition.

Background Postpartum women are at higher risk of depression compared to the general population. Despite the mental health benefits an active lifestyle can provide, postpartum women engage in low physical activity and high screen time. Very little research has investigated the social ecological (i.e. individual, social and physical environmental) influences on physical activity and screen time amongst postpartum women, particularly amongst those with depressive symptoms. Therefore, this study sought to examine the influences on physical activity and screen time amongst postpartum women with heightened depressive symptoms. Methods 20 mothers (3–9 months postpartum) participating in the Mums on the Move pilot randomised controlled trial who reported being insufficiently active and experiencing heightened depressive symptoms participated in semi-structured telephone interviews exploring their perceptions of the key influences on their physical activity and screen time across various levels of the social ecological model. Strategies for promoting physical activity and reducing screen time were explored with participants. Thematic analyses were undertaken to construct key themes from the qualitative data. Results Findings showed that postpartum women with depressive symptoms reported individual (i.e. sleep quality, being housebound, single income), social (i.e. childcare, social support from partner and friends) and physical environmental (i.e. weather, safety in the local neighbourhood) influences on physical activity. Postpartum women reported individual (i.e. screen use out of habit and addiction, enjoyment) and social (i.e. positive role modelling, social isolation) influences on screen-time, but no key themes targeting the physical environmental influences were identified for screen time. Strategies suggested by women to increase physical activity included mother’s physical activity groups, home-based physical activity programs and awareness-raising. Strategies to reduce screen time included the use of screen time tracker apps, increasing social connections and awareness-raising. Conclusions Amongst postpartum women with heightened depressive symptoms, influences on physical activity encompassed all constructs of the social ecological model. However, screen time was only perceived to be influenced by individual and social factors. Intervention strategies targeting predominantly individual and social factors may be particularly important for this high-risk group. These findings could assist in developing targeted physical activity and screen time interventions for this cohort.

Intimate partner violence (IPV) has been highlighted as one of the challenges to the effectiveness of the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs in rural areas in South Africa. This study aimed at assessing the prevalence of prenatal and postnatal physical as well as psychological IPV, and corresponding time-invariant and time-varying predictors, among HIV-positive women attending PMTCT services in rural South Africa. The Conflict Tactics Scale (CTS) was used to assess IPV at four time points prenatal and postnatal. This study highlighted high levels of physical and psychological IPV experienced by HIV-infected women during pregnancy and in the first year after childbirth. Time-invariant predictors and time-varying predictors of physical IPV and psychological IPV were individual, social, and behavioral factors. Multi-dimensional evidence-based interventions are needed to deal with the high levels of prenatal and postnatal physical as well as psychological IPV experienced by these women.

Question What is the most cost-effective way of providing pelvic floor muscle training (PFMT) to prevent or treat postpartum incontinence? Design Meta-analysis and cost-effectiveness analysis of models of care included in a recent Cochrane systematic review. Participants Pregnant and postnatal women. Intervention Supervised PFMT for preventing or treating urinary and/or faecal incontinence. Outcome measures Postpartum urinary or faecal incontinence. Analysis We examined the comparative incremental cost effectiveness of different approaches to successfully prevent or cure one case of incontinence. Costs were valued in Australian dollars using publicly available market rates and enterprise agreements as of 2019. Comparisons involving group-based treatment approaches were subject to sensitivity analyses where the numbers of patients attending each group were varied to identify thresholds where recommendations change. Results Seventeen trials were included for meta-analysis. Three models of care were clinically effective: individually supervised PFMT during pregnancy to prevent urinary incontinence (Model 1), group-based PFMT during pregnancy to prevent or treat urinary incontinence (Model 2) and individually supervised postnatal PFMT to treat urinary incontinence and prevent or treat faecal incontinence (Model 3). The health service costs per urinary incontinence case prevented or cured were $768 for Model 1, and $1,970 for Model 3. However, Model 2 generated a cost saving of $14 if there were eight participants per session, with greater savings if more participants attend. The health service cost per faecal incontinence case prevented or cured was $2,784 (Model 3). Conclusion Providing group-based PFMT for all women during pregnancy is likely more efficient than individual PFMT for incontinent women postnatally; however, providing PFMT for postnatal women with urinary incontinence should not be discounted because of the added known benefit for preventing and treating faecal incontinence.

Funder: Sackler Trust; FundRef: https://doi.org/10.13039/100015656, Funder: Medical Research Council; FundRef: https://doi.org/10.13039/501100000265, Funder: Autism Research Trust, Funder: Pinsent Darwin Fund, Funder: Autistica; FundRef: https://doi.org/10.13039/501100008161, Funder: NIHR Cambridge Biomedical Research Centre; FundRef: https://doi.org/10.13039/501100018956, Funder: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust, Very little research has looked at how autistic people experience childbirth and the first few months of parenthood. We interviewed 21 autistic and 25 non-autistic women 2-3 months after their baby was born, to find out how they experienced giving birth and being a parent. Some autistic participants found sensory aspects of giving birth difficult, such as noise and being touched. They also wanted healthcare professionals to give them clear information while giving birth. Participants sometimes thought that healthcare professionals did not know enough about autism. Autistic and non-autistic participants both found parenthood difficult at times and autistic parents sometimes had extra difficulties, such as with planning and organising. Autistic participants also felt good at understanding their baby's needs. This research suggests that autistic people would benefit from changes to childbirth and postnatal healthcare such as being communicated with more clearly. It also indicates that healthcare professionals should receive more training about autism.

Background Fetal sex is known to modify the course and complications of pregnancy, with recent evidence of sex-differential fetal influences on the maternal immune and endocrine systems. In turn, heightened inflammation and surges in reproductive hormone levels associated with pregnancy and parturition have been linked with the development of perinatal depression. Here, we examined whether there is an association between fetal sex and maternal depression assessed during the prenatal and postnatal periods. Methods The study included two multi-ethnic, prospective pregnancy cohorts that enrolled women from prenatal clinics in the Northeastern United States between 2001 and 2018. Maternal depressive symptoms were measured during the prenatal and postnatal periods using the Edinburgh Postpartum Depression Scale (EPDS), and newborn sex was reported by the mother following delivery. We used logistic regression to examine associations between fetal sex and maternal depressive symptoms (EPDS > 10) during the prenatal period only, postnatal period only, or both periods versus no depressive symptoms during either period. We considered both unadjusted models and models adjusted for a core set of sociodemographic and lifestyle variables. Results In adjusted models using PRISM data (N = 528), women pregnant with a male versus female fetus had significantly greater odds of depressive symptoms during the postnatal period compared to women without depressive symptoms during either period (odds ratio [OR] = 5.24, 95% confidence interval [CI] = 1.93, 14.21). The direction of results was consistent in the ACCESS cohort, although the findings did not reach statistical significance (OR = 2.05, 95% CI = 0.86, 4.93). Significant associations were not observed in either cohort among women with prenatal symptoms only or women with prenatal and postnatal symptoms. Conclusions Male fetal sex was associated with the onset of depressive symptoms during the postnatal period.

BackgroundChildhood obesity remains a significant public health problem. To date, most research on the causes and correlates of obesity has focused on a small number of direct predictors of obesity rather than testing complex models that address the multifactorial nature of the origins of obesity in early development. We describe the rationale and methods of iGrow (Infant Growth and Development Study) which will test multiple pathways by which (a) prenatal maternal psychobiological risk predicts infant weight gain over the first 6 months of life, and (b) this early weight gain confers risk for obesity at age 2. Infant hormonal and psychobiological risk are proposed mediators from prenatal risk to early weight gain, though these are moderated by early maternal sensitivity and obesogenic feeding practices. In addition, higher maternal sensitivity and lower obesogenic feeding practices are proposed predictors of adaptive child self-regulation in the second year of life, and all three are proposed to buffer/reduce the association between high early infant weight gain and obesity risk at age 2.MethodsiGrow is a prospective, longitudinal community-based study of 300 diverse mothers and infants to be followed across 5 data waves from pregnancy until children are age 2. Key measures include (a) maternal reports of demographics, stress, well-being, feeding practices and child characteristics and health; (b) direct observation of maternal and infant behavior during feeding, play, and distress-eliciting tasks during which infant heart rate is recorded to derive measures of vagal withdrawal; (c) anthropometric measures of mothers and infants; and (d) assays of maternal prenatal blood and infant saliva and urine. A host of demographic and other potential confounds will be considered as potential covariates in structural equation models that include tests of mediation and moderation. Efforts to mitigate the deleterious effects of COVID-19 on study success are detailed.DiscussionThis study has the potential to inform (1) basic science about early life processes casually related to childhood obesity and (2) development of targeted intervention and prevention approaches that consider mother, infant, and family risks and resources.

Background Maternal obesity is an emerging problem in the modern world. Growing evidence suggests that intrauterine high-fat (HF) exposure may predispose progeny to subsequent metabolic challenges. Progeny born to mothers who ate an HF diet also tends to eat an HF diet when growing and aggravate metabolic issues. Thus, the generational transmission of obesity is cyclical. Developing a strategy to prevent the occurrence of metabolic syndrome related to prenatal and/or postnatal HF diet is important. In this study, the reprogramming effects of maternal resveratrol treatment for the progeny with maternal HF/postnatal HF diets were investigated. Methods Sprague-Dawley dams were fed either a control or a high-fat/high sucrose diet (HFHS) from mating to lactation. After weaning, the progeny was fed chow or an HF diet. Four experimental groups were yielded: CC (maternal/postnatal control diet), HC (maternal HF/postnatal control diet), CH (maternal control/postnatal HFHS diet), and HH (maternal/postnatal HFHS diet). A fifth group (HRH) received a maternal HFHS diet plus maternal resveratrol treatment and a postnatal chow diet to study the effects of maternal resveratrol therapy. Results Maternal resveratrol treatment lessened the weight and adiposity of progeny that were programmed by combined prenatal and postnatal HFHS diets. Maternal resveratrol therapy ameliorated the decreased abundance of the sirtuin 1 (SIRT1) enzyme in retroperitoneal tissue and the altered leptin/soluble leptin receptor ratio of progeny. Maternal resveratrol therapy also decreased lipogenesis and increased lipolysis for progeny. Conclusions Maternal resveratrol intervention can prevent adiposity programmed by maternal and postnatal HFHS diets by inducing lipid metabolic modulation. This study offers a novel reprogramming role for the effect of maternal resveratrol supplements against obesity.

BackgroundIncreasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.ObjectivesThe objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.DesignThe design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.SettingThe setting was a single centre in an inner city setting in the south of England.ParticipantsParticipants were women with body mass index scores of > 25 kg/m2at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.Main outcome measuresRecruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.ResultsMost objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively;p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.LimitationsThe trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.ConclusionsIt was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN39186148.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

Background Up to 50% of women in areas of high socio-economic deprivation are at risk of developing depressive symptoms in pregnancy. Feeling well supported, can facilitate good mental health perinatally. A brief, innovative intervention to facilitate access to support and resources was developed and tested. This included one antenatal and one postnatal session, each with three evidence-based components: i) support from a non-professional peer to enable a woman to identify her needs; ii) information about local community services and signposting; and iii) development of a personalised If–Then plan to access that support. The aims were to evaluate the intervention and research methods for feasibility and acceptability for perinatal women, maternity care providers and peers, and provide preliminary effectiveness indications. Methods Pregnant women living in an area of high deprivation were recruited from community-based antenatal clinics and randomised to intervention or control condition (a booklet about local resources). Outcome measures included women’s use of community services by 34 + weeks gestation and 6 months postnatally; mental health and wellbeing measures, and plan implementation. Interviews and focus groups were conducted with women participants, providers, and peers. Data were analysed using framework analysis. Recruitment and retention of peers and participants, intervention fidelity, and acceptability of outcome measures were recorded. Results Peer facilitators could be recruited, trained, retained and provide the intervention with fidelity. One hundred twenty six women were recruited and randomised, 85% lived in the 1% most deprived UK areas. Recruitment constituted 39% of those eligible, improving to 54% after midwifery liaison. Sixty five percent were retained at 6 months postnatally. Women welcomed the intervention, and found it helpful to plan access to community services. Providers strongly supported the intervention philosophy and integrated this easily into services. The study was not powered to detect significant group differences but there were positive trends in community service use, particularly postnatally. No differences were evident in mental health and wellbeing. Conclusions This intervention was well received and easily integrated into existing services. Women living in highly deprived areas could be recruited, randomised and retained. Measures were acceptable. Peer facilitators were successfully trained and retained. Full effectiveness studies are warranted.

Background Preterm delivery is the birth of a baby before 37 weeks of gestation. This global phenomenon is a critical issue of concern especially in developing countries that are resource-constrained when it comes to the management of preterm babies. Complications associated with prematurity contribute significantly to under-five mortality and are linked with feelings of despair, grief, and anxiety among mothers. Methods This was a qualitative descriptive study in an urban setting in the Greater Accra region of Ghana. Eleven mothers whose babies had been discharged from the neonatal intensive care unit in a major hospital and resided in Accra were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis. Results All the mothers had formal education and the mean maternal age was 27.9 years. The majority of the mothers were multiparous. The gestational age at birth ranged from 32 to 34 weeks and the average birth weight of their babies was 1.61 kg. Four major themes emerged which included: Around the clock care; mothers’ self-perceptions and attitudes of significant others; mothers’ health and wellbeing; and support. Most of the mothers experienced physical exhaustion from the extra demands involved with care, had negative emotions, and unmet social needs. Conclusions The findings indicate that home management of preterm babies poses multiple stressors and is associated with poor psychological and physical wellbeing among mothers. Hence, the need for extensive education and identification of other social support systems to augment facility-based care for mothers and their preterm babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03872-9.

Metformin is one of the most easily available medications for diabetes and has a relatively low cost. It is not only used in diabetes but is also effective in polycystic ovarian syndrome (PCOS) and obesity. Although insulin is the first choice when it comes to treating pregnant women with gestational diabetes mellitus (GDM), metformin has also been debated as a good choice after modification of diet. As metformin passes through the placenta, it is essential to know its consequence of leading to insulin resistance in the fetus as well as the impact on postnatal development. The use of metformin during GDM has raised many trials demonstrating that outcomes from the use of metformin are similar to those achieved with insulin. Follow-up studies were also conducted that assessed the impact on children exposed to metformin in utero. This review highlights the experimental evidence relating to the use of metformin during pregnancy for different conditions, and its impact on the growth and development of offspring.

Postpartum fatigue is an important issue that threatens women’s health. The incidence of postpartum fatigue is high. Failure to intervene in time may lead to adverse outcomes such as postpartum depression, premature termination of breastfeeding, child abuse, and low infant development. This article reviews the concepts, characteristics, related factors, adverse effects, and interventions of postpartum fatigue. The aim is to improve doctors’ and nurses’ awareness of on postpartum fatigue in pregnant women, enrich the research content and methods, stimulate the interest of nurses, and actively carry out targeted intervention research to prevent or reduce the occurrence of adverse outcomes.

Introduction: Postnatal hospital stay is decreased by 30% during COVID-19 in developed countries. However, there is paucity of data in developing countries. Hence, this study aims to assess the prevalence of early postnatal discharge during COVID-19 in Jimma Health Centers. Methods: Facility-based cross-sectional study was conducted from 1 February to 30 March 2021. Sample was calculated using single population proportion formula and allocated proportionally to the health centers. Data were interred into Epidata version 3.1 and exported to SPSS version 22.0 for analysis. Multivariable regression was done to identify associating factors at p Result: Three hundred ninety women were included into study making a response rate of 96.8%. Early discharge prevalence was 316 (81.0%). Attending elementary school adjusted odds ratio = 0.26 (confidence interval = 0.087–0.798), plan for postnatal care within a week adjusted odds ratio = 0.410 (confidence interval = 0.221–0.760), knowing postnatal maternal danger sign adjusted odds ratio = 0.258 (confidence interval = 0.141–0.473), women adjusted odds ratio = 0.421 (confidence interval = 0.211–0.838), or husband adjusted odds ratio = 0.051 (confidence interval = 0.014–0.186) made decision of discharge were negatively and distance on foot Conclusion: This study has identified early postnatal discharge is high which can contribute to reduce the risk of acquiring COVID-19. However, the authors recommend further study to differentiate whether early discharge is due to COVID-19 or other reasons.

The postnatal rodent spinal cord in-vitro is a useful model to investigate early pathophysiological changes after injury. While low dose nicotine (1µM) induces neuroprotection, how higher doses affect spinal networks is unknown. Using spinal preparations of postnatal wild-type Wistar rat and Wnt1Cre2:Rosa26Tom double-transgenic mouse, we studied the effect of nicotine (0.5-10µM) on locomotor networks in-vitro. Nicotine 10µM induced motoneuron depolarization, suppressed monosynaptic reflexes, and decreased fictive locomotion in rat spinal cord. Delayed fall in neuronal numbers (including motoneurons) of central and ventral regions emerged without loss of dorsal neurons. Conversely, nicotine (0.5-1µM) preserved neurons throughout the spinal cord and strongly activated the Wnt1 signaling pathway. High-dose nicotine enhanced expression of S100 and GFAP in astrocytes suggesting their response to stress. Excitotoxicity induced by kainate was contrasted by nicotine (10µM) in the dorsal area and persisted in central and ventral regions with no change basal Wnt signaling. When combining nicotine with kainate, the activation of Wnt1 was reduced compared to kainate/sham. The present results suggest that high dose nicotine was neurotoxic to central and ventral spinal neurons as the neuroprotective role of Wnt signaling became attenuated. This also corroborates the risk of cigarette smoking for the foetus/newborn since tobacco contains nicotine.

Background Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. Objective The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. Design The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. Setting The trial took place in Birmingham, UK. Participants Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women’s Hospital or general practices. Nine intervention participants and seven nurses were interviewed. Interventions The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child’s health record (‘red book’) or using the online programme. The behavioural goal was for women to lose 0.5–1 kg per week. The usual-care group received a healthy lifestyle leaflet. Main outcome measures The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop–go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). Results The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. Limitations Fewer participants were recruited than planned. Conclusions Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. Future work Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. Trial registration Current Controlled Trials ISRCTN12209332. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.

Background Anxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers. Methods We used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2–11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS. Results The presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS. Conclusions The EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative.

Background Environmental exposures may alter DNA methylation patterns of T helper cells. As T helper cells are instrumental for allergy development, changes in methylation patterns may constitute a mechanism of action for allergy preventive interventions. While epigenetic effects of separate perinatal probiotic or ω-3 fatty acid supplementation have been studied previously, the combined treatment has not been assessed. We aimed to investigate epigenome-wide DNA methylation patterns from a sub-group of children in an on-going randomised double-blind placebo-controlled allergy prevention trial using pre- and postnatal combined Lactobacillus reuteri and ω-3 fatty acid treatment. To this end, > 866000 CpG sites (MethylationEPIC 850K array) in cord blood CD4+ T cells were examined in samples from all four study arms (double-treatment: n = 18, single treatments: probiotics n = 16, ω-3 n = 15, and double placebo: n = 14). Statistical and bioinformatic analyses identified treatment-associated differentially methylated CpGs and genes, which were used to identify putatively treatment-induced network modules. Pathway analyses inferred biological relevance, and comparisons were made to an independent allergy data set. Results Comparing the active treatments to the double placebo group, most differentially methylated CpGs and genes were hypermethylated, possibly suggesting induction of transcriptional inhibition. The double-treated group showed the largest number of differentially methylated CpGs, of which many were unique, suggesting synergy between interventions. Clusters within the double-treated network module consisted of immune-related pathways, including T cell receptor signalling, and antigen processing and presentation, with similar pathways revealed for the single-treatment modules. CpGs derived from differential methylation and network module analyses were enriched in an independent allergy data set, particularly in the double-treatment group, proposing treatment-induced DNA methylation changes as relevant for allergy development. Conclusion Prenatal L. reuteri and/or ω-3 fatty acid treatment results in hypermethylation and affects immune- and allergy-related pathways in neonatal T helper cells, with potentially synergistic effects between the interventions and relevance for allergic disease. Further studies need to address these findings on a transcriptional level, and whether the results associate to allergy development in the children. Understanding the role of DNA methylation in regulating effects of perinatal probiotic and ω-3 interventions may provide essential knowledge in the development of efficacious allergy preventive strategies. Trial registration ClinicalTrials.gov, ClinicalTrials.gov-ID: NCT01542970. Registered 27th of February 2012—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01542970.

Background: Due to a wide range of stressors during the first postpartum year, this study aimed to develop and validate a self-report measure of stress intensity specific for postpartum. Method: Postpartum women (N= 603) completed the Maternal Postpartum Stress Scale in a cross-sectional online study. They also filled out questionnaires on general stress, depression, and anxiety. Factor analysis, reliability, and validity were examined. Results: Exploratory factor analyses revealed a three-factor structure: Personal needs and fatigue, Infant nurturing, and Body changes and sexuality. The reliability of the total scale and all subscales was good. Significant positive correlation with general stress indicated good convergent validity, and with depression and anxiety good divergent validity. Primiparous mothers had a higher score on the Infant nurturing subscale, and the mothers of infants with health problems had a higher score on the total scale, Personal needs and fatigue, and Infant nurturing. Conclusion: Maternal Postpartum Stress Scale is a new, valid, and reliable 22-items scale that measures stress during the first postpartum year. The total scale and tree subscales can be calculated separately to provide detailed information about stressors that mothers struggle with. The scale can be used for research and practical purposes.