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Background: the objective of this longitudinal study (from pregnancy to the end of the sixth month postpartum) is to elucidate the association between maternal self-efficacy, defined as a mother’s confidence in her ability to breastfeed, and breastfeeding outcomes. Methods: This prospective cohort study was conducted among high-risk pregnant women (including those with conditions such as gestational diabetes, hypertension, pre-eclampsia, and other pathological medical conditions) and normal-risk pregnant women in Greece. The high-risk group included 164 women, while the normal-risk group comprised 154 women. Data were collected using validated psychometric scales, including the Breastfeeding Self-Efficacy Scale-Short Form, State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, Maternal Antenatal Attachment Scale, and Iowa Infant Feeding Attitude Scale. Results: Higher maternal self-efficacy was significantly associated with a longer duration and greater exclusivity of breastfeeding. A statistically significant relationship between the type of breastfeeding and the degree of breastfeeding self-efficacy was observed at multiple postpartum milestones: in the first and third 24 h postpartum, and at the end of the sixth week, third month, and sixth month postpartum. Conclusion: The findings underscore the critical role of maternal self-efficacy in breastfeeding success, influenced by individual psychological factors and broader socio-cultural contexts. Strengthening maternal self-efficacy is essential for improving breastfeeding outcomes.

Background: Few studies have correlated maternal and neonatal Vit D (25(OH)D) levels at birth in Greece. We investigated this potential association, taking into account the administration or not of low doses (400–800 IU) of prenatal Vit D supplements. Our study contributes evidence not only to the small amount of existing literature regarding the above correlation, but also to the topic of maternal and neonatal vitamin D deficiency (VDD) during pregnancy in Mediterranean countries, such as Greece. Methods: A cross-sectional study was conducted on 248 neonates and their mothers from September 2019 to January 2022. Blood samples of 25(OH)D were studied at the time of delivery. Frequency counts and percentages were registered, and logistic regression was used to investigate the independent factors associated with maternal Vit D status. The Chi-square test and the Pearson coefficient were used to demonstrate a possible association between maternal and neonatal 25(OH)D levels. Results: Our findings show a high prevalence of VDD in Greek women and their newborns at birth. This was observed not only in women who did not receive Vit D supplements, but also in all the study groups, especially in the autumn and winter months. We observed that mothers who received low doses (400–800 IU) of prenatal Vit D supplements increased both their own 25(OH)D concentrations and those of their newborns; however, the latter did not seem to be completely covered by the prenatal administration of Vit D because, although their 25(OH)D concentrations increased, they never reached sufficient 25(OH)D levels, unlike their mothers who reached sufficient concentrations. Conclusions: Overall, this study highlights the strong association between maternal and neonatal 25(OH)D concentrations at the end of gestation. However, neonates tended to show even lower 25(OH)D concentrations relative to maternal 25(OH)D concentrations. The same phenomenon was observed irrespective of the administration of Vit D supplements during pregnancy. Moreover, this is what was observed concerning the administration of formulations with 400–800 IU of Vit D, which the doctors in our clinic used in the present study. In any case, more clinical studies related to the administration of higher doses of Vit D supplementation to pregnant women would lead to more reliable conclusions. Without a doubt, the measurement of maternal vitamin D status during pregnancy provides opportunities for preventive and therapeutic interventions in the mother–infant pair.

(1) Background: The ongoing COVID-19 pandemic has led to an increasing number of women giving birth while also grappling with SARS-CoV-2. The objective of this review is to examine the possibility of transmission of the virus from mother to infant through breastfeeding, skin-to-skin contact, and rooming-in and to explore methods for managing COVID-19-positive mother–infant dyads. (2) Methods: A comprehensive search strategy was employed that covered pertinent studies from the Cochrane Library, PubMed Central, and Scopus databases. The Matrix Method and PRISMA guidelines were utilized by the researchers, with the search being updated until 20 December 2021, one year after the initial vaccine delivery. The inclusion criteria for the study involved articles published in English, those employing broad search terms, and those comprising full-text reviews. Additionally, the researchers required that the articles be published from December 2019 onwards. To further analyze the data, a meta-analysis was performed to estimate the rate of infant infection from mothers who engaged in breastfeeding, skin-to-skin contact, and rooming-in practices. (3) Results: Eighteen studies were analyzed in this review, with an infected infant rate of 2.8%. The maternal practices used in these studies ranged from direct separation of the infant to direct skin-to-skin contact, rooming-in, and exclusive breastfeeding. One study investigated the factors associated with positive test results in newborns and found that only the maternal social vulnerability index >90 was a significant predictor. The type of delivery, rooming-in, and the mother’s symptom status were not associated with positive neonatal outcomes. (4) Conclusions: According to current data, the incidence of perinatal infection with SARS-CoV-2 is relatively low. It is advised that mothers adhere to several supportive care measures, including engaging in breastfeeding, skin-to-skin contact, and rooming-in. These measures ought to be complemented by diligent hand hygiene, the wearing of masks, and the cleansing of breasts solely when necessary.

Background: Neonatal bone mass may potentially be influenced by existing maternal vitamin D (25(OH)D) levels. Few studies evaluated maternal vitamin D deficiency (VDD) with neonatal anthropometrics such as weight, height and head circumference (HC), especially in Greece, which is a Mediterranean country with plenty of sunshine and consequently benefits the synthesis of 25(OH)D. We investigated this potential association in Greece, taking into account the administration or not of prenatal vitamin D supplements. The purpose of our study is to ascertain if there is a possible association between maternal VDD and neonatal specific anthropometric characteristics (weight, height and HC) at birth. If this is confirmed by future clinical studies, it would be of interest to develop a prenatal pregnancy selection program that would detect VDD early or during pregnancy in order to improve fetal–neonatal development in a Mediterranean country like ours. Methods: We performed a cross-sectional study on 248 early early term infants (after 37 + 0 to 38 + 6 weeks of gestation) but also on full-term infants (after 39 to 40 weeks of gestation) and their Greek mothers from September 2019 to January 2022. Blood samples of 25(OH)D were taken from the mother at the beginning of labor and cord blood was taken from the newborn. Pregnant women were divided into two groups: those who received or did not receive a normal dose of calcium (500 mg/day) and vitamin D supplements (400–800 IU/day) as instructed by their treating physicians. Results: Our findings revealed a positive association between maternal VDD and low neonate birth weight (LBW) in women receiving vitamin D during pregnancy and no association between maternal VDD and neonatal height or head circumference (HC) at birth. Conclusions: Overall, this study highlighted the association between maternal VDD at the end of gestation and LBW neonates born to mothers who received vitamin D supplementation. We did not find any correlation in two of the three somatometric characteristics studied, height and HC. In any case, more clinical studies are needed to further corroborate any potential association of maternal VDD with other neonatal somatometric characteristics.

Post-traumatic stress disorder symptoms related to work in pediatric departments aremajor public health problems, as they directly affect health organizations, healthcare workers, and, due to the poor quality of care, the patients as well. The post-traumatic symptoms that a healthcare worker may experience are related to intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. The aim of the present investigation was to identify risk factors that contribute to the development of PTSD in pediatric healthcare workers, in order to implement necessary workplace measures. A sample of four hundred and forty-five pediatric workers at seven Greek public hospitals consented to participate in the survey. Socio-demographic data and a post-traumatic checklist (5th edition) were used to diagnose post-traumatic stress disorder. According to the results, risk factors for the development of post-traumatic symptoms include medical or nursing errors, threats to a child’s life, and incidents of workplace bullying. More specifically, 25.2% of the participants had a provisional PTSD diagnosis, 72.8%of the sample experienced an incident involving a medical or nursing error in their workplace related to the treatment or care of a child, 56% experienced an incident involving a child’s death or a threat to a child’s life due to a serious illness or injury, and 55.5% experienced an incident of workplace bullying. In addition, it was found that having a university-level education, master’s, or PhD, working in a circular shift, being assigned to a department by management rather than the worker, and dissatisfaction with salary were associated with post-traumatic stress disorder. The high rates of PTSD symptoms among participants highlight the need for prevention and management measures to protect and support the mental health of workers in pediatric departments. We propose frequent evaluations of the mental health of employees, more time for rest, incentives for professional development, utilization of their specializations and specialties, support from mental health specialists when symptoms are diagnosed, and the option for employees to change departments if they wish or if they show symptoms of mental trauma.

Background: Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. Methods: This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0–12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Results: Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Conclusions: Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments.

Background: The aim of this study is to investigate healthcare professionals’ attitudes and practices when it comes to their recommendations on exercise during the first trimester of pregnancy and to highlight the factors that influence or predict these attitudes. Methods: This cross-sectional study was conducted between January 2022 and March 2023, on a sample of 237 Greek healthcare professionals (midwives and obstetricians) employed in healthcare settings in Attica/Greece. In the statistical analysis, eight independent models of multivariate analyses of variance were conducted. Results: Only half of the participants (54.89%) report that they recommend exercise to pregnant women in the first trimester of pregnancy. The majority do not routinely recommend a specific frequency and duration of exercise. Participants who believe that exercise during pregnancy is of little benefit to pregnant women were less likely to recommend the following, in the first trimester of pregnancy: (a) exercise in general (p = 0.002), (b) resistance/muscle strengthening exercises (p = 0.039), (c) relaxation exercises (p = 0.002), and (d) a specific exercise duration (p = 0.011). Those who report being very familiar with the international guidelines are (a) more likely to recommend exercise in general (p = 0.013), as well as aerobic exercises (p = 0.023); (b) less likely to not recommend a specific frequency (p = 0.027); and (c) more likely to recommend a duration of 30–45 min of exercise in the first trimester (p = 0.017). Conclusions: I this study, a significant proportion of health professionals’ attitudes appear to diverge from the recommendations set forth by international scientific bodies regarding exercise during pregnancy. Furthermore, health professionals’ beliefs regarding the benefits of exercise during pregnancy, along with their familiarity with international guidelines, appear to influence their usual practices in recommending exercise during the first trimester of pregnancy to pregnant women.

Background: This study explores the effect of antenatal education on fathers’ attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers’ demographic and the psycho-emotional characteristics that come with breastfeeding and attachment. Methods: This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020–November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th–28th gestation week and (b) 34th–38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed. Results: The expectant fathers’ scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus. Conclusions: Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal–paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

This is a literature review of ankyloglossia and its correlation with lactation problems. Ankyloglossia, commonly referred to as tongue-tie, brings about functional difficulties and, in some cases, may lead to early weaning. It is crucial to use breastfeeding as the exclusive food source for the first six months of an infant’s life, and the interference of the tongue contributes substantially to success in this regard. Even though there are many publications about ankyloglossia, there are still many controversies about its definition, diagnosis, classification, and treatment decision determined via frenotomy. Some researchers state that the identification of ankyloglossia should be based on morphological and anatomical evidence, while others claim that a short or tight frenulum should be examined in correlation with the impact on the mother–infant dyad during breastfeeding. By encouraging and supporting mothers in coping with feeding difficulties, their lactation experiences are improved, and they can continue breastfeeding.

Background: During the 2019 coronavirus disease (COVID-19) pandemic, lockdown was implemented, which likely reduced maternal 25(OH)D levels in pregnancy due to reduced sun exposure from social distancing measures and confinement at home. At the same time, however, due to the lockdown and the ban on the free movement of vehicles, the emissions of many atmospheric pollutants also decreased. We know that air pollution and low ground level ultraviolet B radiation (UVB; 290–315) can deteriorate the body’s vitamin D status in healthy women living in a polluted area, which plays a significant independent role in vitamin D deficiency (VDD) and, hence, residence can be one of the main reasons of vitamin D status in women. The reduction in air pollution likely produced positive changes in maternal 25(OH)D levels. Methods: We studied serum 25(OH)D in mothers who came for delivery, with stratified random sampling, from 27 September 2019 to April 14, 2021. We divided our sample into the pre-COVID period and the post-COVID period. Quantitative results of 25(OH)D vitamin levels on the mother were converted to qualitative variables assessing lack of 25(OH)D, adequacy, deficiency, and severe deficiency of maternal concentrations and, thus, defined. The results of 25(OH)D are presented as means ± standard deviations or by frequencies and percentages. The Chi-square test was used to find an association between maternal 25(OH)D concentrations within the COVID-19 period. Results: The results of our study showed a paradox. The mean values of 25(OH)D levels of the mothers were statistically significantly higher during the COVID-19 period compared to the pre-COVID-19 period. Conclusions: In conclusion, pregnant women should be encouraged to lead a healthier lifestyle, avoid being outside during rush hours, take nature walks, not smoke, exercise, take leisurely morning walks in the sun, and taking take their vitamin D supplements, which are recommended according to the gestational age, imitating all that they did during the pandemic, in order to avoid VDD.

Introduction: Exclusive breastfeeding until six months of life is the ideal way to feed infants. However, there is a significant number of infants who have never breastfed, despite the beneficial properties of breastfeeding. On the other hand, the coronavirus outbreak had significant effects on people’s health, both mentally and physically, and has also impacted the breastfeeding process. Aim: The aim of this study was to investigate the implication of COVID-19 on breastfeeding through qualitative data from databases. Methods: We searched online databases (PubMed, Google Scholar, PsycINFO) for studies published from 2019 to 2023. ‘Out of the 2598 papers we found, only 12 were included in the review’. More specifically, from the 1558 papers remaining from the title and abstract evaluation as well as duplicates, a further 1546 papers belonging to our exclusion criteria were removed (all types of reviews, letters to editors, and quantitative articles). Results: Our results covered three subjects: breastfeeding support during the pandemic, effects of social containment measures on breastfeeding, and additional outcomes regarding breastfeeding. Most voices found the effects of the pandemic on breastfeeding beneficial, with reduced professional support and a high degree of support from the environment. Additional negative factors were observed, as well as consequences of the pandemic in women’s lives. Conclusions: COVID-19 was the occasion to understand the power of the supportive environment of the woman, especially the partner, in establishing and maintaining breastfeeding. Therefore, policy makers and health professionals, especially midwives, should implement family-centered breastfeeding strategies that are more supportive of the partner role, providing problem counseling when and where deemed necessary.

Background: Several studies have focused on the role of vitamin D in preventing gestational diabetes mellitus (GDM) but also in improving or preventing the unwanted perinatal outcomes of GDM. Even today, efforts to clarify the relationship between vitamin D deficiency (VDD) in pregnancy and GDM continue. Methods: We conducted research to search for systematic reviews (SRs) of randomized controlled trials (RCTs), in databases at PubMed, Google Scholar, Web of Science, Science Direct, Embase, Cochrane, Crossref and CAS, published from 2016 to 2021. These concerned maternal vitamin D status or taking vitamin D supplements, alone or in combination with other vitamins or minerals in pregnancy and their association with GDM. We used the AMSTAR (assessment of multiple systematic reviews) scoring scale quality and scoring checklist, which assessed the quality of each SR, at low medium or high. Results: Seven SRs of RCTS involving 7902 participants were selected. The results suggest that if pregnant women with GDM take vitamin D supplements, they improve blood vitamin D levels, as well as biomarkers related to blood glucose. It was also shown that pregnant women with GDM who took vitamin D supplements (1000–4762 IU/day) improved the primary GDM outcome measurements such as fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), serum insulin and homeostasis model of assessment of insulin resistance (HOMA-IR). In addition, improvements were observed in their lipid profile markers, such as total cholesterol (TC), low-dense lipoprotein (LDL), high-dense lipoprotein levels (HDL) and high-sensitivity C-reactive protein (hs-CRP). Also, the adverse outcomes of GDM in both the mother and the newborn appear to have decreased. However, there are studies that do not support the therapeutic effect of vitamin D intake by pregnant women with GDM. Conclusions: In conclusion, taking vitamin D, during pregnancy, for the prevention or treatment of GDM, is controversial and the real benefit unclear. Further RCTs are necessary.

Background: Secondary PTSD is defined as the natural, consequential behaviors and emotions that result from knowledge about a traumatic event experienced by a significant other deriving from working with suffering individuals. Pediatric health providers with symptoms of PTSD report problems with relationships and general life dissatisfaction as well as and anxiety, depression and burnout syndrome. Aim: The aim of this systematic review was to estimate the risk of developing secondary PTSD among pediatric health care providers as well as all additional contributing factors. In more detail, we investigated the PTSD symptomatology between pediatric health care providers and the extent to which parameters such as the job, gender, department and other factors had an impact on the mental health status of pediatric health care providers. Methodology: We searched all published English papers in PubMed, Google Scholar and the Cochrane Library from September to November 2022. We excluded reviews, systematic reviews and meta-analyses as well as letters to editors. From a total of 748 papers, we included only 12 research articles that met the admission criteria. Results: According to our results, the prevalence of secondary PTSD ranges from 13% to 94%. Burnout, nurses, the female gender, intensive care units, past traumatic life events and a psychiatric history identified as factors contributing to the development of secondary PTSD. Conclusions: Health policy-makers should take the specificity in the working environment of the pediatric sector seriously into consideration, especially emergency departments.

Background: Breastfeeding is very important for the proper nutrition and growth of the child, as well as, the health of the mother. To start breastfeeding, the neonate must have extensive oral capacities for sucking functions but, premature neonates may not have the muscle strength needed to suck successfully. However, the non-nutritive sucking achieved by using a pacifier, has been identified by previous research as a factor associated with shorter duration and exclusivity of breastfeeding. This study aims to perform a systematic review to investigate the relationship between pacifier use in preterm neonates and breastfeeding in infancy. Methods: We included prospective studies, as well as randomized controlled studies that evaluated the association between pacifier use by preterm neonates and of breastfeeding in infancy. Ten research articles from PubMed/Medline, Google Scholar and Crossref were included in the review from a total of 1455 articles. The results differ depending on the type of study.Most prospective studies have shown a negative correlation between pacifier use and breastfeeding, while the randomized controlled studies found a positive correlation. Conclusions: Pacifier use in preterm infants helps transition from tube to oral feeding, breastfeeding, faster weight gain and earlier discharge from the NICU. However, the relationship between pacifiers and breastfeeding is more complicated, as it appears to be influenced by additional risk factors.

The correlation between the kind of cesarean section and post-traumatic stress disorder (PTSD) in Greek women after a traumatic birth experience has been recognized in previous studies along with other risk factors, such as perinatal conditions and traumatic life events. Data from early studies have suggested some possible links between some vulnerable factors and the potential development of postpartum PTSD. The classification of each case in three possible states (PTSD, profile PTSD, and free of symptoms) is typically performed using the guidelines and the metrics of the version V of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) which requires the completion of several questionnaires during the postpartum period. The motivation in the present work is the need for a model that can detect possible PTSD cases using a minimum amount of information and produce an early diagnosis. The early PTSD diagnosis is critical since it allows the medical personnel to take the proper measures as soon as possible. Our sample consists of 469 women who underwent emergent or elective cesarean delivery in a university hospital in Greece. The methodology which is followed is the application of random decision forests (RDF) to detect the most suitable and easily accessible information which is then used by an artificial neural network (ANN) for the classification. As is demonstrated from the results, the derived decision model can reach high levels of accuracy even when only partial and quickly available information is provided.

Background: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. Methods: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015–May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th–28th gestation week, (b) 34th–38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. Results: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. Conclusions: The association between women’s poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.

There is high degree of prevalence and variety of risk factors of postpartum Posttraumatic Stress Disorder (PTSD). However, some postpartum women seem to struggle with their past traumatic life events and previous PTSD can result in them sinking deeper into a new PTSD, a postpartum PTSD. The person who has undergone detoxification has endured a very painful process and there is a strong association between drug addiction and mortality. The aim of this case report study is to raise the understanding of health professionals regarding the impact that these two factors might have on ex-drug addicted women. Data were collected from the Maternity unit of the University Hospital of Larisa in Greece. A mother on day 2 after elective cesarean section confirmed her participation and filled in a Life Events Checklist (LEC-5), Posttraumatic Checklist (PCL-5), Criteria A, and a socio-demographic questionnaire. After the sixth postpartum week, the woman answered via telephone, adapted for postpartum PCL-5. This case study describes vividly and painfully the impact of past drug addiction not only on her cesarean section but also how it affected her postpartum period. Eight past traumatic life events led to the creation of a chronic PTSD, i.e., trauma re-experiencing, avoidance, negative thoughts and feelings, agitation, and reactivity. Unfortunately, in cases of traumatic childbirth, especially cesarean section, when there are past traumatic experiences, such as addiction or sexual abuse, postpartum PTSD is an unbearable experience.

Abstract Repetitive mild traumatic brain injury (r-mTBI) has increasingly become recognised as a risk factor for the development of neurodegenerative diseases, many of which are characterised by tau pathology, metal dyshomeostasis and behavioural impairments. We aimed to characterise the status of tau and the involvement of iron dyshomeostasis in repetitive controlled cortical impact injury (5 impacts, 48 h apart) in 3-month-old C57Bl6 mice at the chronic (12-month) time point. We performed a battery of behavioural tests, characterised the status of neurodegeneration-associated proteins (tau and tau-regulatory proteins, amyloid precursor protein and iron-regulatory proteins) via western blot; and metal levels using bulk inductively coupled plasma-mass spectrometry (ICP-MS). We report significant changes in various ipsilateral iron-regulatory proteins following five but not a single injury, and significant increases in contralateral iron, zinc and copper levels following five impacts. There was no evidence of tau pathology or changes in tau-regulatory proteins following five impacts, although some changes were observed following a single injury. Five impacts resulted in significant gait deficits, mild anhedonia and mild cognitive deficits at 9–12 months post-injury, effects not seen following a single injury. To the best of our knowledge, we are the first to describe chronic changes in metals and iron-regulatory proteins in a mouse model of r-mTBI, providing a strong indication towards an overall increase in brain iron levels (and other metals) in the chronic phase following r-mTBI. These results bring to question the relevance of tau and highlight the involvement of iron dysregulation in the development and/or progression of neurodegeneration following injury, which may lead to new therapeutic approaches in the future.

Summary: Traumatic brain injury (TBI) leaves many survivors with long-term disabilities. A prolonged immune response in the brain may cause neurodegeneration, resulting in chronic neurological disturbances. In this study, using a TBI mouse model, we correlate changes in the local immune response with neurodegeneration/neurological dysfunction over an 8-month period. Flow cytometric analysis reveals a protracted increase in effector/memory CD8+ T cells (expressing granzyme B) in the injured brain. This precedes interleukin-17+CD4+ T cell infiltration and is associated with progressive neurological/motor impairment, increased circulating brain-specific autoantibodies, and myelin-related pathology. Genetic deficiency or pharmacological depletion of CD8+ T cells, but not depletion of CD4+ T cells, improves neurological outcomes and produces a neuroprotective Th2/Th17 immunological shift, indicating a persistent detrimental role for cytotoxic T cells post-TBI. B cell deficiency results in severe neurological dysfunction and a heightened immune reaction. Targeting these adaptive immune cells offers a promising approach to improve recovery following TBI. : Daglas et al. show that granzyme B+CD8+ T cells accumulate in the brain after traumatic brain injury, triggering chronic neurological/motor impairment and myelin pathology. Genetic deficiency/pharmacological depletion of CD8+ T cells, but not B cells, promotes recovery post-injury and offers a therapeutic option to minimize long-term disabilities in trauma patients. Keywords: traumatic brain injury, CD8+ T cells, adaptive immune cells, B cells, autoantibodies, neuroimmunology, granzyme B

Traumatic brain injury (TBI) consists of acute and long-term pathophysiological sequelae that ultimately lead to cognitive and motor function deficits, with age being a critical risk factor for poorer prognosis. TBI has been recently linked to the development of neurodegenerative diseases later in life including Alzheimer’s disease, Parkinson’s disease, chronic traumatic encephalopathy, and multiple sclerosis. The accumulation of iron in the brain has been documented in a number of neurodegenerative diseases, and also in normal aging, and can contribute to neurotoxicity through a variety of mechanisms including the production of free radicals leading to oxidative stress, excitotoxicity and by promoting inflammatory reactions. A growing body of evidence similarly supports a deleterious role of iron in the pathogenesis of TBI. Iron deposition in the injured brain can occur via hemorrhage/microhemorrhages (heme-bound iron) or independently as labile iron (non-heme bound), which is considered to be more damaging to the brain. This review focusses on the role of iron in potentiating neurodegeneration in TBI, with insight into the intersection with neurodegenerative conditions. An important implication of this work is the potential for therapeutic approaches that target iron to attenuate the neuropathology/phenotype related to TBI and to also reduce the associated risk of developing neurodegenerative disease.