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BackgroundPregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of depression and anxiety symptoms in pregnancy during the pre-vaccine COVID-19 pandemic.MethodsThis is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires, screening tools for depression and anxiety, at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of elevated depressive and anxiety symptoms at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and those with elevated depression or anxiety symptoms.Results317 participants were included. The prevalence of elevated antepartum depression symptoms was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of elevated anxiety symptoms was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p's

Background: Rates of perinatal depression and anxiety increased during the COVID-19 pandemic. It remains unclear how the COVID-19 pandemic influenced risk perception and help-seeking behaviours among pregnant and postpartum individuals. Objectives: To explore pregnant and postpartum individuals' decision-making process about when and how to seek support for feelings of depression and/or anxiety during the COVID-19 pandemic. Design: A qualitative descriptive design was used. Methods: The current study is a secondary analysis of qualitative data collected for a larger mixed-methods project that recruited participants who gave birth from 1 May 2020, to 1 December 2021, in Ontario and British Columbia, Canada, using maximum variation and purposive sampling. Seventy-three semi-structured interviews were conducted over Zoom or telephone. This analysis focuses on 56 individuals who discussed their self-identified feelings of prenatal or postpartum depression and/or anxiety. Conventional (inductive) content analysis was employed with iterative stages of open coding, focused coding and cross-checking themes. Results: Most participants recognized their need to seek help for their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle. Nearly all participants accessed informal social support for these feelings, which sometimes entailed social contact in contravention of local COVID-19 public health policies. Many also attempted to access formal mental healthcare, encountering barriers both related and unrelated to the pandemic. Participants described the pandemic as having the dual effect of causing or exacerbating their feelings of depression and/or anxiety while also constraining their ability to access timely professional care. Conclusion: Participants struggled to address their feelings of perinatal depression and anxiety during the COVID-19 pandemic, with many describing a lack of readily available resources and limited access to professional mental healthcare. This study highlights the need for improved provision of instrumental mental health support for pregnant and postpartum populations. Plain language summary: Seeking mental health support for feelings of perinatal depression and/or anxiety during the COVID-19 pandemic: A qualitative descriptive study of decision-making It is not unusual for pregnant and postpartum individuals to experience feelings of depression and/or anxiety. Studies have shown that this became more common during the COVID-19 pandemic. Depression and anxiety can be challenging to recognize and treat in pregnant and postpartum individuals but may lead to long-term negative effects if not addressed. The COVID-19 pandemic brought on public health measures, including social distancing, which created barriers to accessing mental health professionals or social interactions. In this study, we wanted to understand when and how pregnant and postpartum people chose to seek support for their feelings of depression and/or anxiety during the COVID-19 pandemic. We interviewed people who gave birth during the pandemic in either Ontario or British Columbia, Canada and asked them about whether they experienced feelings of perinatal anxiety or depression, and how they chose to seek help for those feelings. Most participants acknowledged their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle, even though many experienced barriers to accessing these supports. Nearly all participants interacted with friends or family outside of their household to cope with their feelings, which sometimes meant acting against local COVID-19 public health policies. Although some participants talked about facilitators for accessing mental health professionals, many who tried also encountered challenges, and a few were unsuccessful. Participants in this study shared that the pandemic sometimes caused or worsened feelings of depression and/or anxiety while also making it harder to access the support they felt was necessary to cope with their feelings. These findings show that there is a need for more frequent conversations about mental health during healthcare appointments and more readily accessible mental health resources for pregnant and postpartum people. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events. STUDY DESIGN: We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events. RESULTS: Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677). CONCLUSIONS: Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification.

This article explores the challenges of studying the effects of elective induction of labor (eIOL) compared to expectant management (EM) during pregnancy. The authors discuss the methodological issues in comparing outcomes between the two approaches due to differences in time at risk. They highlight the findings of the ARRIVE study, which found associations between eIOL and neonatal morbidity and caesarean birth, but stress the importance of considering time at risk when interpreting these results. The article suggests using measures of frequency that account for varying times at risk to enable valid comparisons and calls for further research to determine the best approach for comparing outcomes between eIOL and EM. [Extracted from the article]

Introduction: Pregnancy involves a number of endocrine interactions. In our study to observe the possibility of physiological changes of IOP which could be a predisposing factor or development, early detection, changes in IOP during pregnancy and also in management of glaucoma during pregnancy. Objective: To determine the intraocular pressure between normotensive and preeclampsia women in peripartum period. Methodology: The present case control study was carried out at NMCH Raichur involving total 40 pregnant women (20 normotensive s and 20 preeclamptic) in peripartum period. Results: Mean prepartum IOP in right eye of the normotensive and preeclamptic patients was 15.38±1.02 and 18.44±1.42 (p<0.05). Mean prepartum IOP in left eye of the normotensive and preeclamptic patients was 15.82±1.04 and 19.42±1.88 (p<0.05). Mean postpartum IOP in right eye of the normotensive and preeclamptic patients was 15.48±1.04 and 20.52±1.92 (p<0.05). Mean postpartum IOP in right eye of the normotensive and preeclamptic patients was 16.02±1.14 and 20.34±1.78 (p<0.05). Conclusion: Compared with normotensive women, preeclamptic women have significantly increased intraocular pressure in the peripartum period. [ABSTRACT FROM AUTHOR]

BACKGROUND: Heart failure (HF) is considered the leading cause of cardiac-related morbidity and mortality during pregnancy. Peripartum cardiomyopathy (PPCM) presents diagnostic challenges, often mirroring dilated cardiomyopathy (DCM). The aim of the study is to evaluate echocardiographic features, including global and segmental longitudinal strain values, in pregnant women with a history of newly diagnosed left ventricular systolic dysfunction (LVSD) in the third trimester of pregnancy. METHODS: This cross-sectional study, conducted in two referral cardio-obstetric clinics in Isfahan, Iran, enrolled pregnant women with newly diagnosed LV systolic dysfunction in the third trimester of pregnancy. A multidisciplinary pregnancy heart team assessed the patients. Reevaluation of patients and advanced echocardiographic investigation, including speckle tracking echocardiography (STE), were performed at least six months after delivery. RESULTS: The study included 26 pregnant women. Baseline characteristics revealed varying NYHA functional classes and etiologies, including DCM or non-dilated LV cardiomyopathy and PPCM. Undiagnosed DCM with exacerbation during pregnancy or non-dilated LV cardiomyopathy were the most probable causes for LV systolic dysfunction (65.4%). In five cases, peripartum cardiomyopathy was more relevant. The mean global longitudinal strain (GLS) was -16.94% and -13.95% in PPCM and DCM, respectively. Significantly different regional longitudinal strain numbers among different LV segments in PPCM were observed (P=.042), whereas the segmental strain in DCM patients did not differ. CONCLUSION: When LVSD is discovered late in pregnancy, it is not easy for the authors to differentiate between peripartum cardiomyopathy and other cardiomyopathies. Advanced echocardiographic techniques, particularly GLS analysis, may be valuable in differentiating between these conditions. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular diseases represent an important cause of morbidity and mortality during pregnancy, cardiomyopathy is notable as a syndrome of heart failure. Objective: To characterize patients with peripartum cardiomyopathy according to clinical and epidemiological variables of interest for the investigation. Methods: A descriptive and cross-sectional study of 18 patients with diagnosis of peripartum cardiomyopathy was carried out. They were assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from October, 2015 to December, 2022. Results: In the series there was a prevalence of patients over 35 years (32.6 average age), besides African descendant (50.0 %), chronic hypertension (44.4 %) and multiparity (8.9 %) as risk factors and the left ventricle failure as clinical manifestation. The ejection fraction of this ventricle was regularly diminished and the pharmacological treatment response was satisfactory in all the sample. Conclusions: Peripartum cardiomyopathy is of low incidence in this center; however, due to its seriousness, the early diagnosis and the specialized staff intervention are necessary to avoid complications. [ABSTRACT FROM AUTHOR]

Negative energy balance (NEB) is a serious problem in most dairy cows. It occurs most frequently after calving, when cows are unable to consume sufficient DM to meet their energy requirements during early lactation. During NEB, the breakdown of fat stores releases non−esterified fatty acids (NEFAs) into the bloodstream. High blood concentrations of NEFAs cause health problems such as ketosis, fatty liver syndrome, and enhanced susceptibility to infections. These issues may substantially increase premature culling from the herd. Serum NEFA concentrations are often used as a direct marker of energy metabolism. However, because the direct measurement of serum NEFAs is difficult under commercial conditions, alternative indicators, such as milk components, have been increasingly investigated for their use in estimating energy balance. The objectives of this study were to (1) evaluate the relationships between serum NEFA concentrations and selected milk components in cows from two farms during the first 5 weeks of lactation, and to (2) develop a model valid for both herds for predicting serum NEFA concentrations using milk components. A total of 121 lactating Holstein cows from two different farms were included in the experiment. Blood samples were collected for NEFA analysis on days 7 (± 3), 14 (± 3), 21 (± 3), and 35 (± 3) after calving. Composite milk samples were collected during afternoon milking on the same days as blood sampling. Concentrations of fat, protein, lactose, and milk fatty acids (FAs) were determined using Fourier-transform IR spectroscopy analysis. The strongest correlations (r > 0.43) were recorded between serum NEFAs and milk long-chain FAs, monounsaturated FAs, C18:0, and C18:1 within each farm and for both farms combined. Two prediction models for serum log(NEFA) using milk components as predictors were developed by stepwise regression. The prediction model with the best fit (R2 = 0.52) included days in milk, fat-to-protein ratio, and C18:1, C18:12 and C14:0 expressed as g/100 g of milk fat. An essential finding is that, despite different concentrations of NEFAs, and of most milk components observed in the evaluated herds, there were no significant interactions between farm and any of the FAs, so the same regression coefficients could be used for the prediction models in both farms. Validation of these findings in a greater number of herds would allow for the use of milk FAs to identify energy−imbalanced cows in herds under different farm conditions.

This study aimed to evaluate the effects of prepartum supplementation levels on the productive and nutritional performance and metabolic responses of Nellore cows in a grazing system. Forty-four pregnant Nellore cows multiparous with an initial mean gestation time of 230 days, average initial body weight (BW) of 541 ± 19 kg, and body condition score (BCS) of 5.5 ± 1.7 were used and distributed in a completely randomized design, with four treatments and 11 cows per treatment. The treatments evaluated consisted of four supplementation levels in the prepartum period with a duration of 60 days, according to the following scheme: 0.0 (Control = CON); 0.5 (LOW); 1.0 (Medium = MED) and; 1.5 (High = HIG) kg per animal day-1 of supplement. The supplement was composed of wheat meal and urea, and formulated to contain 22% of crude protein (CP). A positive linear effect (P < 0.05) was observed on the intake of CP and CP:digested organic matter (DOM) ratio as supplementation levels were increased. In addition, a quadratic effect (P < 0.05) was detected on the intake of neutral detergent fiber corrected for ash and protein (apNDF), digested neutral detergent fiber, and DOM with increasing supplementation levels in the prepartum period, in which MED cows had higher intakes compared to CON, LOW, and HIG cows. Prepartum supplementation levels did not affect (P > 0.10) the average daily gain in the prepartum or postpartum periods and, BCS of the dams, and BW of calves at birth or 45 days of age. In the prepartum period, supplementation levels did not affect (P > 0.10) the blood concentrations of total proteins, albumin, globulins, glucose, cholesterol, triglycerides, non-esterified fatty acids, and beta-hydroxybutyrate in the experimental cows. In conclusion, the provision of 1.0 kg of supplement per animal per day during the last 60 days of pregnancy improves prepartum nutritional performance and postpartum milk production of grazing beef cows.

Participants in biomonitoring studies who receive personal exposure reports seek information to reduce exposures. Many chemical exposures are driven by systems-level policies rather than individual actions; therefore, change requires engagement in collective action. Participants' perceptions of collective action and use of report-back to support engagement remain unclear. We conducted virtual focus groups during summer 2020 in a diverse group of peripartum people from cohorts in the Environmental influences on Child Health Outcomes (ECHO) Program (N = 18). We assessed baseline exposure and collective action experience, and report-back preferences. Participants were motivated to protect the health of their families and communities despite significant time and cognitive burdens. They requested time-conscious tactics and accessible information to enable action to reduce individual and collective exposures. Participant input informed the design of digital report-back in the cohorts. This study highlights opportunities to shift responsibility from individuals to policymakers to reduce chemical exposures at the systems level.

Background Medical complications in peripartum patients are uncommon are uncommon. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study examined peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center. Methods We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (LOS) and hospital length of stay (HLOS). Results Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average age was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1–4.25) and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7–12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (2–12) and 8 days (5–17). High SOFA score was linked to longer HLOS, as was APACHE II. Conclusions Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

Simple Summary: The transition period for high-yielding dairy cows, marked by calving and the onset of lactation, presents a substantial risk of oxidative stress. This stress can have adverse effects on cow health and milk production yield. Our research aimed to assess the effectiveness of selenitetriglycerides as an oral supplement for alleviating oxidative stress in periparturient cows. We conducted a trial involving 12 dairy cows, divided into two groups: one group received the selenitetriglyceride supplement, while the other served as a control group receiving placebo supplementation. The study assessed key indicators of oxidative stress and overall health, including serum selenium levels, non-esterified fatty acids, glutathione peroxidase, catalase concentrations, and liver gene expression profiles related to antioxidant activity. The results demonstrated a significant enhancement in antioxidant levels and the stabilization of oxidative markers in supplemented cows. These findings suggest that selenitetriglyceride supplementation may serve as an effective strategy to enhance antioxidant defenses in dairy cows during this critical period. The implications of this study extend to improving both animal welfare and productivity in the dairy industry, potentially benefiting the agricultural sector and consumer health by promoting more sustainable dairy practices. The transition period in high-yielding dairy cows is a critical phase marked by an elevated risk of oxidative stress. This study evaluated the effect of oral selenitetriglyceride supplementation on oxidative stress management in periparturient cows. A controlled experiment was conducted on 12 cows, divided into two groups: the experimental group (STG) received selenitetriglycerides (0.5 mg Se/kg BW), while the control group (CON) was given a placebo, starting 12 days before calving until the calving day. Blood and liver tissue samples were collected at predetermined intervals around the time of parturition. The study observed a significant increase in serum selenium levels and NEFA stabilization in the STG group compared with the control. Antioxidant parameters indicated elevated GSH-Px and CAT concentrations in the STG group. Liver gene expression analysis revealed a significant increase in SOD2 mRNA levels in the STG group (FC = 4.68, p < 0.01). Conversely, GSH-Px3 expression significantly decreased (FC = 0.10, p < 0.05) on the 7th day postpartum in the CON group. However, SOD1, SOD3, and CAT expressions remained stable in both groups. These findings highlight the beneficial role of selenitetriglycerides in enhancing antioxidant capacity and influencing specific gene expressions associated with oxidative stress management in dairy cows during the peripartum period. [ABSTRACT FROM AUTHOR]

Background: Medical complications in peripartum patients are uncommon. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study examined peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center. Methods: We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (LOS) and hospital length of stay (HLOS). Results: Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1-4.25) and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7-12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (2-12) and 8 days (5-17). High SOFA score was linked to longer HLOS, as was APACHE II. Conclusions: Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Objective. The nutritional potential of maize's Puma hybrids was evaluated as silage forage in 50% of the pregnant ewe's diet. Materials and methods. Sixty-one pregnant ewes were used, assigned to the groups: Centli Puma (N = 21), Tsiri Puma (N = 20) and Tlaoli Puma (N = 20) and their weight, body condition (CC), FAMACHA and metabolic profile in gestation were measured, as well as milk production and quality at 15 and 30 days of lactation. In lambs, birth temperature and weight were measured. Results. The weight and CC of the ewes during pregnancy and lactation were not affected by the group (p>0.05). On the other hand, the estimated feed intake was higher in the ewes of the Centli group (p<0.0001), while the FAMACHA values were better in the Centli and Tlaoli groups (p<0.05). Proteins, glucose, cholesterol and β hydroxybutyrate during pregnancy and milk production and composition during lactation were not affected by the group (p>0.05). Neither did the weight of the lambs and their body temperature vary among the three groups (p>0.05). Conclusions. The use of Puma corn hybrid silages developed for grain production has good and similar response in the productive and metabolic parameters of sheep, as well in the lambs. [ABSTRACT FROM AUTHOR]

In the peripartum period, euthyroidism is essential for maternal-fetal health. More and more studies have found that thyroid diseases may lead to female infertility, increase the risk of pregnancy -related complications such as gestational hypertension, thyroid crisis, spontaneous abortion, preterm birth, and stillbirth, and may impair the neurological and intellectual development of offspring. The diagnostic criteria of thyroid diseases during pregnancy are different from those of non-pregnant women due to the unique physiological changes of thyroid in this special period. Moreover, the symptoms and signs of perinatal thyroid diseases often overlap with the physiological manifestations of pregnancy, which increases the difficulty of clinical diagnosis. Thyroid diseases are common endocrine disease in the peripartum period, and its situation is complex, its diagnostic and treatment strategies should consider the safety of both mothers and infants. Relevant updated guidelines have been issued by domestic and foreign professional societies, which provided detailed suggestions regarding clinical managements of thyroid diseases during peripartum period. This review combined with the latest research evidence comparatively analyzes and interprets the main points of diagnosis and treatment of the recent guidelines at home and abroad, in order to provide references for clinicians regarding the diagnosis and treatment of perinatal thyroid diseases. [ABSTRACT FROM AUTHOR]

The administration of yeast products as feed additives has been proven to beneficially affect animal productivity through energy, oxidative, and immune status improvement. This study evaluated a combination of Saccharomyces cerevisiae live yeast (LY) with yeast postbiotics (rich in mannan-oligosaccharides (MOS) and beta-glucans) and selenium (Se)-enriched yeast on ewes' milk performance and milk quality, energy and oxidative status, and gene expression related to their immune system during the peripartum period. Ewes were fed a basal diet (BD; F:C = 58:42 prepartum and 41:59 postpartum) including inorganic Se (CON; n = 27), the BD supplemented with a LY product, and inorganic Se (AC; n = 29), as well as the combination of the LY, a product of yeast fraction rich in MOS and beta-glucans, and organic-Se-enriched yeast (ACMAN; n = 26) from 6 weeks prepartum to 6 weeks postpartum. The β-hydroxybutyric acid concentration in the blood of AC and ACMAN ewes was lower (compared to the CON) in both pre- and postpartum periods (p < 0.010). Postpartum, milk yield was increased in the AC and ACMAN Lacaune ewes (p = 0.001). In addition, the activity of superoxide dismutase (p = 0.037) and total antioxidant capacity (p = 0.034) measured via the 2,2-Azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) method was increased in the blood plasma of the ACMAN postpartum. Higher ABTS values were also found (p = 0.021), while protein carbonyls were reduced (p = 0.023) in the milk of the treated groups. The relative transcript levels of CCL5 and IL6 were downregulated in the monocytes (p = 0.007 and p = 0.026 respectively), and those of NFKB were downregulated in the neutrophils of the ACMAN-fed ewes postpartum (p = 0.020). The dietary supplementation of ewes with yeast postbiotics rich in MOS and beta-glucans, and organic Se, improved energy status, milk yield and some milk constituents, and oxidative status, with simultaneous suppression of mRNA levels of proinflammatory genes during the peripartum period. [ABSTRACT FROM AUTHOR]

Perinatal mental disorders are one of the most common disorders during pregnancy and may lead to adverse maternal and offspring outcomes. There is an increasing number of women currently at risk for emotional problems such as anxiety and depression during pregnancy and childbirth, and women with previous mental disorders are also at risk of relapse during pregnancy. At the same time, the lack of clinical guidelines for the diagnosis and treatment of perinatal mental disorders has made the work of clinicians even more challenging. The expert writing group integrated the latest medical evidence and clinical practice in related fields at home and abroad to form the expert consensus, consisting of the epidemiology and pathogenesis, clinical manifestations, clinical evaluation, diagnosis, treatment and management of perinatal mental disorders, which can provide reference and guidance for practical clinical work. The consensus advocates comprehensive, whole-process, hierarchical, multidisciplinary and collaborative diagnosis and treatment, to help frontline clinicians screen, rationally assess and clinically diagnose perinatal pregnant women as soon as possible, as well as provide necessary psychological interventions and clinical medication for them.

ObjectiveThe aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.Study designThis population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities.ResultsThe overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01-1.74) for women with overweight BMI and 2.03 (95% CI: 1.57-2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95-1.66) for overweight women and 1.38 (95% CI: 1.04-1.84) for women with obesity. The ORs suggested a dose-response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.ConclusionPre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.Key points· Pre-pregnancy obesity affects maternal health.. · Effects may extend to peripartum cardiomyopathy.. · The risk includes peripartum cardiomyopathy that emerges postpartum..

Introduction: Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility. Methods: This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed. Results: All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period. Conclusion: Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes. [ABSTRACT FROM AUTHOR]

Acquired cardiovascular conditions are a leading cause of maternal morbidity and mortality. A growing number of pregnant women have acquired and heritable cardiovascular conditions and cardiovascular risk factors. As the average age of childbearing women increases, the prevalence of acute coronary syndromes, cardiomyopathy, and other cardiovascular complications in pregnancy are also expected to increase. This document, the third of a 5-part series, aims to provide practical guidance on the management of such conditions encompassing pre-conception through acute management and considerations for delivery.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal cardiac channelopathy characterized by episodes of ventricular tachycardia (VT) during exercise or in stressful situations. As the peripartum period creates a stressful environment, we describe our approach of this rare condition in a very common situation, child birth.

Abstract Background Despite interventions improving maternal and newborn morbidity and mortality, progress has been sluggish, especially in hard-to-reach indigenous communities. Sociocultural beliefs in these communities more often influence the adoption of particular behaviors throughout pregnancy, childbirth, and postpartum. Therefore, this study identified sociocultural beliefs and practices during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in the Manyara region, Tanzania. Methods The study was a descriptive qualitative design. We used purposive sampling to select twelve participants among community members who were indigenous women of Manyara who had ever experienced pregnancy. In-depth interviews were audio-recorded and transcribed verbatim, and organized manually. We used manual coding and inductive-deductive thematic analysis. Results The study’s findings showed that sociocultural beliefs and practices are widespread, covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. For example, the use of herbal preparations to augment labor was reported. Previously, most women preferred home delivery; however, the practice is changing because of increased knowledge of home delivery complications and the accessibility of the facilities. Nevertheless, women still practice hazardous behaviors like applying strange things in the birth canal after delivery, increasing the risk of puerperal infection. Conclusions Sociocultural practices are predominant and widely applied throughout the peripartum period. These beliefs encourage adopting specific behaviors, most harmful to both mother and fetus. These sociocultural practices tend to affect the utilization of some essential maternal and child health practices. Eliminating unsafe peripartum practices will increase the use of medical services and ultimately improve outcomes for both mothers and their newborns. Public health interventions must recognize the cultural context informing these cultural practices in marginalized indigenous communities. Healthcare providers should routinely take the history of commonly traditional practices during the peripartum period to guide them in providing quality care to women by correcting all harmful practices.

BackgroundPreterm birth in the United States is associated with maternal clinical factors such as diabetes, hypertension and social factors including race, ethnicity, and socioeconomic status. In California, 8.7% of all live births are preterm, with African American and Black families experiencing the greatest burden. The impact of paternal factors on birth outcomes has been studied, but little is known about the experience of men of color (MOC). The purpose of this study was to explore the experiences of MOC who are partners to women at medical and social risk for preterm birth.MethodsThis study used a qualitative research design and focus group methods. The research was embedded within an existing study exploring experiences of women of color at risk for preterm birth conducted by the California Preterm Birth Initiative.ResultsTwelve MOC participated in the study and among them had 9 preterm children. Four themes emerged from thematic analysis of men's experiences: (1) "Being the Rock": Providing comfort and security; (2) "It's a blessing all the way around": Keeping faith during uncertainty; (3) "Tell me EVERYTHING": Unmet needs during pregnancy and delivery; (4) "Like a guinea pig": Frustration with the healthcare system. Participants identified many barriers to having a healthy pregnancy and birth including inadequate support for decision making, differential treatment, and discrimination.ConclusionsThis study shows novel and shared narratives regarding MOC experiences during pregnancy, birth, and postpartum periods. Healthcare providers have an essential role to acknowledge MOC, their experience of discrimination and mistrust, and to assess needs for support that can improve birth outcomes. As MOC and their families are at especially high social and medical risk for preterm birth, their voice and experience should be central in all future research on this topic.

Food taboos encompass food restrictions practiced by a group that go beyond individual preferences. During pregnancy and lactation, food taboos may contribute to inadequate nutrition and poor maternal and infant health. Restriction of specific fish, meat, fruits and vegetables is common among peripartum women in many Southeast Asian countries, but data from Cambodia are lacking. In this mixed‐methods study, 335 Cambodian mothers were asked open‐ended questions regarding dietary behaviours during pregnancy and up to 24 weeks postpartum. Descriptive statistics and content analysis were used to characterize food taboos and multiple logistic regression analyses were conducted to identify predictors of this practice. Participants were 18–44 years of age, all of Khmer ethnicity and 31% were primiparous. Sixty‐six per cent of women followed food taboos during the first 2 weeks postpartum, whereas ~20% of women restricted foods during other peripartum periods. Pregnancy taboos were often beneficial, including avoidance of sugar‐sweetened beverages, coffee and alcohol. Conversely, postpartum avoidances typically included nutrient‐dense foods such as fish, raw vegetables and chicken. Food taboos were generally followed to support maternal and child health. No significant predictors of food taboos during pregnancy were identified. Postpartum, each additional live birth a woman had reduced her odds of following food taboos by 24% (odds ratio [95% confidence interval]: 0.76 [0.61–0.95]). Specific food taboo practices and rationales varied greatly between women, suggesting that food taboos are shaped less by a strict belief system within the Khmer culture and more by individual or household understandings of food and health during pregnancy and postpartum. Key messages: Most food taboos were practiced early postpartum, with women restricting a wide range of foods in their diets based on differing rationales. Rather than tradition or superstition, rural Cambodian women followed food taboos most commonly to support varying aspects of maternal and infant health.Although food avoidances in pregnancy had potential to benefit health (e.g., sugar‐sweetened beverages or alcohol), postpartum restrictions included nutrient‐rich foods (e.g., fish, chicken, or beef).The widespread practice of food taboos in Cambodia, yet lack of cohesiveness and predictors for these practices, warrants a deeper exploration of peripartum dietary behaviours and their health impacts. [ABSTRACT FROM AUTHOR]

Cystic meconium peritonitis (CMP), type Ⅱ complex meconium peritonitis, is a pseudocyst wrapping the leakage and partial intestinal loop with the fibrous tissue caused by meconium stimulation due to long-term unsealed fetal intestinal perforation. Prenatal ultrasound is the main method of diagnosing CMP, and CMP is characterized by the irregular shape of pseudocyst wall and uneven internal echo inside in the abdominal cavity, with calcification strong echo within or on the pseudocyst wall. The intestinal tract may be enveloped. Since magnetic resonance imaging (MRI) can more directly show the location and extent of the diseased intestinal segment, it helps to distinguish the anatomical location between abdominal cyst and intestinal tract. With certain advantages, MRI can be used for the diagnosis of complex CMP and the differential diagnosis of other cystic lesions in the abdominal cavity. Intrauterine genetics and viral infection -related prenatal diagnosis are recommended for the pregnant women with the CMP and high-risk factors. The isolated CMP requires the dynamic monitoring, including maternal and fetal general conditions, fetal growth and development, as well as changes in pseudocyst. Fetal abdominal paracentesis and cyst fluid aspiration treatment can relieve symptoms and prolong gestational age if necessary. The delivery pattern should be determined, based on the obstetric indications of the mother and fetus, combined with the wishes of the pregnant woman′s family and multidisciplinary collaborative treatment conditions. Newborn with CMP should be treated with surgery as soon as possible, paying attention to postoperative complications and long-term intestinal function recovery. Patients who need parenteral nutrition should be followed up for long-term prognosis, and intestinal transplantation may be considered if necessary. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI), and more specifically deep learning, models have demonstrated the potential to augment physician diagnostic capabilities and improve cardiovascular health if incorporated into routine clinical practice. However, many of these tools are yet to be evaluated prospectively in the setting of a rigorous clinical trial–a critical step prior to implementing broadly in routine clinical practice. To describe the rationale and design of a proposed clinical trial aimed at evaluating an AI-enabled electrocardiogram (AI-ECG) for cardiomyopathy detection in an obstetric population in Nigeria. The protocol will enroll 1,000 pregnant and postpartum women who reside in Nigeria in a prospective randomized clinical trial. Nigeria has the highest reported incidence of peripartum cardiomyopathy worldwide. Women aged 18 and older, seen for routine obstetric care at 6 sites (2 Northern and 4 Southern) in Nigeria will be included. Participants will be randomized to the study intervention or control arm in a 1:1 fashion. This study aims to enroll participants representative of the general obstetric population at each site. The primary outcome is a new diagnosis of cardiomyopathy, defined as left ventricular ejection fraction (LVEF) < 50% during pregnancy or within 12 months postpartum. Secondary outcomes will include the detection of impaired left ventricular function (at different LVEF cut-offs), and exploratory outcomes will include the effectiveness of AI-ECG tools for cardiomyopathy detection, new diagnosis of cardiovascular disease, and the development of composite adverse maternal cardiovascular outcomes. This clinical trial focuses on the emerging field of cardio-obstetrics and will serve as foundational data for the use of AI-ECG tools in an obstetric population in Nigeria. This study will gather essential data regarding the utility of the AI-ECG for cardiomyopathy detection in a predominantly Black population of women and pave the way for clinical implementation of these models in routine practice. Clinicaltrials.gov: NCT05438576. [ABSTRACT FROM AUTHOR]

Abstract Background Persistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes. Methods A case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother’s length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS). Results Seventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46–3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Cardiovascular disease is the leading cause of pregnancy-related mortality, and it has gradually increased over time; this rise has been attributed to numerous reasons including the growing number of women with congenital heart disease who are surviving to childbearing age. Valve surgery during pregnancy is a high risk, with a fetal and maternal mortality rate of 35% and 9%, respectively. Prior knowledge about the cardiovascular disease opens up a host of options for the mother even during pregnancy, but presentation in the 3rd trimester puts both the mother and the baby at risk. Simultaneous caesarean section and maternal cardiac surgery is a suitable option for this subset of patients, and with this study we aim to assess its outcomes and feasibility. Methods: This is a retrospective study of five pregnant patients who presented with predominant symptoms of heart failure in the 3rd trimester between June 2019 and June 2021. Intraoperative and postoperative intensive care unit charts of all the patients were reviewed. Results: All five patients underwent simultaneous cesarean section and maternal cardiac surgery successfully with no fetal or maternal mortality and are doing well in the follow-up period. Conclusion: Cesarean section followed by definitive maternal cardiac surgery in the same sitting is a safe and feasible approach in the management of such patients. A well-prepared team is pivotal for a safe delivery with a cardiopulmonary bypass machine on standby. Specialized multidisciplinary care in the antepartum, peripartum, and postpartum period is essential to improve outcomes.

The transition period in high-yielding dairy cows is a critical phase marked by an elevated risk of oxidative stress. This study evaluated the effect of oral selenitetriglyceride supplementation on oxidative stress management in periparturient cows. A controlled experiment was conducted on 12 cows, divided into two groups: the experimental group (STG) received selenitetriglycerides (0.5 mg Se/kg BW), while the control group (CON) was given a placebo, starting 12 days before calving until the calving day. Blood and liver tissue samples were collected at predetermined intervals around the time of parturition. The study observed a significant increase in serum selenium levels and NEFA stabilization in the STG group compared with the control. Antioxidant parameters indicated elevated GSH-Px and CAT concentrations in the STG group. Liver gene expression analysis revealed a significant increase in SOD2 mRNA levels in the STG group (FC = 4.68, p < 0.01). Conversely, GSH-Px3 expression significantly decreased (FC = 0.10, p < 0.05) on the 7th day postpartum in the CON group. However, SOD1, SOD3, and CAT expressions remained stable in both groups. These findings highlight the beneficial role of selenitetriglycerides in enhancing antioxidant capacity and influencing specific gene expressions associated with oxidative stress management in dairy cows during the peripartum period.

Indoor Residual Spraying (IRS), the application of insecticides on the inside walls of dwellings, is used by 84 countries for malaria control. Although effective in preventing malaria, this practice results in elevated insecticide exposure to >100 million people, most of whom are Africans. Pyrethroid insecticides and dichlorodiphenyl trichloroethane (DDT) are currently used for IRS. Animal and in vitro studies suggest that pyrethroids and DDT interfere with thyroid hormone homeostasis but human studies are inconsistent and no prior study has investigated this question in a population residing in an area where IRS is conducted. Our objective was thus to evaluate whether prenatal exposure to pyrethroids, DDT or DDT's breakdown product dichlorodiphenyl dichloroethylene (DDE) is associated with altered thyroid hormone levels among neonates from Limpopo, South Africa, where pyrethroids and DDT are used annually to control malaria. We measured serum DDT/E and urinary pyrethroid metabolite concentrations in maternal peripartum samples from 717 women participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a birth cohort study conducted in Limpopo's Vhembe district. We measured total thyroxine (T4) and thyroid-stimulating hormone (TSH) in dried blood spots collected via heel stick. We found that all pyrethroid metabolites were positively associated with TSH; trans-DCCA and 3-PBA showed the strongest associations with a 12.3% (95%CI = 3.0, 22.3) and 14.0% (95%CI = 0.5, 30.2) change for each 10-fold increase in biomarker concentration, respectively. These associations were substantially stronger among children from households below the South African food poverty line. DDT and DDE were associated with lower total T4 among boys only (β = -0.27 μg/dL per 10-fold increase; 95%CI = -0.47, -0.04). Results suggest that prenatal exposure to DDT, DDE and pyrethroid insecticides is associated with changes in neonatal thyroid hormones consistent with hypothyroidism/hypothyroxinemia and that sex and poverty modify associations. Further research is needed to confirm these findings and examine whether they have implications for child development.

The administration of yeast products as feed additives has been proven to beneficially affect animal productivity through energy, oxidative, and immune status improvement. This study evaluated a combination of Saccharomyces cerevisiae live yeast (LY) with yeast postbiotics (rich in mannan-oligosaccharides (MOS) and beta-glucans) and selenium (Se)-enriched yeast on ewes’ milk performance and milk quality, energy and oxidative status, and gene expression related to their immune system during the peripartum period. Ewes were fed a basal diet (BD; F:C = 58:42 prepartum and 41:59 postpartum) including inorganic Se (CON; n = 27), the BD supplemented with a LY product, and inorganic Se (AC; n = 29), as well as the combination of the LY, a product of yeast fraction rich in MOS and beta-glucans, and organic-Se-enriched yeast (ACMAN; n = 26) from 6 weeks prepartum to 6 weeks postpartum. The β-hydroxybutyric acid concentration in the blood of AC and ACMAN ewes was lower (compared to the CON) in both pre- and postpartum periods (p < 0.010). Postpartum, milk yield was increased in the AC and ACMAN Lacaune ewes (p = 0.001). In addition, the activity of superoxide dismutase (p = 0.037) and total antioxidant capacity (p = 0.034) measured via the 2,2-Azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) method was increased in the blood plasma of the ACMAN postpartum. Higher ABTS values were also found (p = 0.021), while protein carbonyls were reduced (p = 0.023) in the milk of the treated groups. The relative transcript levels of CCL5 and IL6 were downregulated in the monocytes (p = 0.007 and p = 0.026 respectively), and those of NFKB were downregulated in the neutrophils of the ACMAN-fed ewes postpartum (p = 0.020). The dietary supplementation of ewes with yeast postbiotics rich in MOS and beta-glucans, and organic Se, improved energy status, milk yield and some milk constituents, and oxidative status, with simultaneous suppression of mRNA levels of proinflammatory genes during the peripartum period.

BackgroundIndoor residual spraying (IRS) of insecticides, conducted in low- and middle-income countries to control malaria, may result in high exposure to dichlorodiphenyltrichloroethane (DDT), its breakdown product dichlorodiphenyldichloroethylene (DDE), or pyrethroids. Animal studies suggest in utero exposure to these chemicals may increase childhood infection frequency.ObjectivesWe investigated associations between maternal DDT/E and pyrethroid metabolite concentration and child infection associations in an IRS setting in which susceptibility factors are common and infections are leading causes of child morbidity and mortality.MethodsUsing gas chromatography-mass spectrometry, we measured serum DDT/E and urinary pyrethroid metabolite concentrations in peripartum samples from 674 women participating in the Venda Health Examination of Mother, Babies and their Environment (VHEMBE) study. Counts of persistent child fevers, otitis media, and severe sore throat between 1 and 2 y of age were ascertained from maternal interviews. Associations between DDT/E and pyrethroid metabolite concentrations and infections were estimated using zero-inflated Poisson regression. We estimated relative excess risks due to interaction (RERI) with poverty, maternal energy intake, and maternal HIV status.ResultsConcentrations of DDT/E, particularly p,p'-DDE, were associated with higher rates of persistent fevers [IRR=1.21 (95% CI: 1.01, 1.46)], for a 10-fold increase in p,p'-DDE). This association was stronger among children from households below versus above the South African food poverty line [IRR=1.31 (95% CI: 1.08, 1.59) vs. IRR=0.93 (95% CI: 0.69, 1.25), respectively] and for children whose mothers had insufficient versus sufficient caloric intake during pregnancy [IRR=1.30 (95% CI: 1.07, 1.58) vs. IRR=0.96 (95% CI: 0.72, 1.28), respectively].ConclusionsIn utero IRS insecticide exposure may increase childhood infection rates. This was particularly apparent among children from poorer households or whose mothers had low energy intake during pregnancy. https://doi.org/10.1289/EHP2657.

Long QT syndrome (LQTS) is a genetic heart disease caused by mutations in genes that lead to abnormalities in the structure or function of ion channels, and is characterized by prolonged QT interval and T -wave changes in the electrocardiogram (ECG), and it is prone to palpitation, synocope, arrhythmia, cardiac arrest and even sudden death. The most common genetic subtypes of LQTS patients are LQT1, LQT2, and LQT3. Different Genetic subtypes of LQTS have different mutation genes, triggers, and even ECG changes, so clarifying the genetic subtypes of patients can help clinical diagnosis, treatment and prevention of cardiac events. Effective prevention of cardiac events is one of the most important measures for patients with LQTS. During pregnancy and puerperium, women with LQTS will experience a series of physiological changes such as hormonal levels and hemodynamic changes, which may affect the risk of cardiac events associated with LQTS; their clinical management is also different from that of non -LQTS women, and it is necessary to review the research progress of its pathogenesis, diagnostic criteria, treatment options and perinatal management. [ABSTRACT FROM AUTHOR]

Background: Persistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes.Methods: A case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother's length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS).Results: Seventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46-3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p < 0.0001). Among mothers with ST, those with unexplained ST were 2.14 times more likely to have a CS (1.22-3.75, p = 0.008).Conclusion: Among pregnant patients, patients with ST have higher rates of CS.This association is unclear, however potential mechanisms include catecholamine surge, indolent infection, hormonal fluctuations, and medications. More studies are needed to explore the mechanism of ST in pregnant woman to determine the clinical significance and appropriate management. [ABSTRACT FROM AUTHOR]

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Background: Pregnancy imposes significant cardiovascular adaptations, including progressive increases in plasma volume and cardiac output. For most women, this physiological adaptation resolves at the end of pregnancy, but some women develop pathological dilatation and ultimately heart failure late in pregnancy or in the postpartum period, manifesting as peripartum cardiomyopathy (PPCM). Despite the mortality risk of this form of heart failure, the molecular mechanisms underlying PPCM have not been extensively examined in human hearts., Methods: Protein and metabolite profiles from left ventricular tissue of end-stage PPCM patients (N=6-7) were compared with dilated cardiomyopathy (DCM; N=5-6) and nonfailing donors (N=7-18) using unbiased quantitative mass spectrometry. All samples were derived from the Sydney Heart Bank. Data are available via ProteomeXchange with identifier PXD055986. Differential protein expression and metabolite abundance and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed., Results: Proteomic analysis identified 2 proteins, SBSPON (somatomedin B and thrombospondin type 1 domain-containing protein precursor) and TNS3 (tensin 3), that were uniquely downregulated in PPCM. SBSPON, an extracellular matrix protein, and TNS3, involved in actin remodeling and cell signaling, may contribute to impaired tissue remodeling and fibrosis in PPCM. Metabolomic analysis revealed elevated levels of homogentisate and deoxycholate and reduced levels of lactate and alanine in PPCM, indicating disrupted metabolic pathways and glucose utilization. Both PPCM and DCM shared pathways related to inflammation, immune responses, and signal transduction. However, thyroid hormone signaling was notably reduced in PPCM, affecting contractility and calcium handling through altered expression of PLN (phospholamban) and Sarcoendoplasmic Reticulum Calcium ATPase (SERCA). Enhanced endoplasmic reticulum stress and altered endocytosis pathways in PPCM suggested additional mechanisms of energy metabolism disruption., Conclusions: The present study reveals unique posttranslational molecular features of the PPCM myocardium, which mediates cellular and metabolic remodeling, and holds promise as potential targets for therapeutic intervention.

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition. Due to the scarcity of epidemiological data in North Africa, we conducted this study to assess the outcomes of PPCM in our region., Materials and Methods: This monocentric retrospective cohort study involving all patients diagnosed with PPCM was conducted between January 2010 and December 2022., Results: Twenty-seven PPCM patients, with a median age of 33 years (Interquartile range (IQR) = 9), were included. 52% of patients were diagnosed during the postpartum period. Dyspnea New York Heart Association III/IV(NYHA III/IV) was the most common functional symptom (85%). The median left ventricle ejection fraction (LVEF) was 30% (IQR = 11%). Atrial fibrillation occurred in 11.1% of patients, thromboembolic complications occurred in 18.5%, Pulmonary edema occurred in 85% of patients and cardiogenic shock occurred in 14.8% of patients, with two patients requiring Extracorporeal Membrane Oxygenation (ECMO) support. The predominant mode of delivery was a cesarean Sect. (82% of patients), and the indication for a cesarean delivery was obstetrical in 59% of patients. Prematurity occurred in 36% of newborns, and intrauterine fetal death occurred in one pregnancy. The median follow-up was 24 months [6-144 months]. LVEF recovery was noted in 67% of patients. Bromocriptine was administered to six patients (22%), and none of these patients died and out of them, five patients recovered their LVEF (83%). The overall mortality rate during the follow-up period was 15%, comprising three in-hospital cardiac deaths and one occurring two years later due to refractory advanced heart failure. No significant differences were observed between LVEF recovery and LVEF non-recovery groups. Factors significantly associated with mortality were multiparity, poor antenatal care (ANC) attendance, thromboembolic events, cardiogenic shock, and Pulmonary edema. Five patients with LV recovery subsequently became pregnant, none experienced a relapse of PPCM. However, one of the descendants of a patient was diagnosed with dilated cardiomyopathy., Conclusion: This study revealed that the diagnosis of PPCM in our hospital is often delayed until symptoms become more advanced, resulting in high morbi-mortality., (© 2024. The Author(s).)

Background: Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality., Methods and Results: Mortality from 1999 to 2020, SVI, and demographic data were obtained from CDC databases. County-specific SVI rankings were linked to PPCM age-adjusted mortality rates (AAMRs), allowing for a comparative analysis of AAMRs across both cumulative populations and subpopulations to identify disparities. All US counties were then stratified into low- and high-SVI groups, facilitating comparison of SVI rankings by estimation of excess-deaths per 1 000 000 person-years attributable to greater social vulnerability and rate ratios (RR) through univariable Poisson regression. We identified a total of 1026 deaths related to PPCM between 1999 and 2020. Overall AAMR increased from 0.180 in 1999 to 0.326 in 2020. Black populations (AAMR: 1.081) and Southern US counties (AAMR: 0.444) had the highest AAMRs compared with other racial and US census groups, respectively. Higher SVI accounted for 0.172 excess deaths per 1 000 000 person-years (RR=1.800). Among Black and White populations, higher SVI also accounted for 0.248 and 0.071 excess deaths per 1 000 000 person-years, respectively. Similar impacts of greater social vulnerability were observed when comparing the US census regions (Northeast RR=1.609, Midwest RR=1.819, South RR=1.934, West RR=1.776)., Conclusions: PPCM mortality disparities exist across racial and geographic populations in the United States. A greater burden of social vulnerability is associated with higher PPCM mortality on a national level.

Cardiovascular disease is a major non-communicable disease globally, with increasing prevalence, posing a significant public health challenge. It is the leading non-obstetric cause of perinatal morbidity and mortality, with a substantial number of cardiac fatalities occurring in individuals without any known pre-existing cardiovascular disease. Peripartum cardiomyopathy is a type of de novo heart failure that occurs in pregnant women in the late stages of pregnancy or following delivery. Despite extensive research, diagnosing and managing peripartum cardiomyopathy remains challenging, resulting in significant morbidity and mortality. Recent advancements and novel approaches have been made to better understand and manage peripartum cardiomyopathy, including molecular and non-molecular biomarkers, genetic predisposition and risk prediction, targeted therapies, multidisciplinary care, and improved patient education. This narrative review provides a comprehensive overview and new perspectives on peripartum cardiomyopathy, covering its epidemiology, updated pathophysiological mechanisms, diagnosis, management, and future research directions for healthcare professionals, researchers, and clinicians., (© 2024. The Author(s).)

Cardiac arrhythmias are responsible for a significant portion of cardiovascular disease among pregnant people. As the incidence of arrhythmias in pregnancy continues to increase, anesthesiologists who care for obstetric patients should be experts managing arrhythmias in pregnancy. This article examines the most common arrhythmias encountered in pregnancy, including risk factors, diagnosis, and management strategies. Peripartum monitoring and labor analgesia recommendations are discussed. Additionally, management of cardioversion, management of pacemakers and implantable cardioverter-defibrillators, and advanced cardiac life support in the setting of pregnancy is reviewed., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Advances in medicine have enabled more patients with congenital heart disease (CHD) to become pregnant. However, these patients face significant challenges during the peripartum period. Current peripartum anesthesia guidelines for CHD patients mainly rely on case reports and small series., Methods: In this retrospective study at a high-volume tertiary care center, we analyzed peripartum anesthetic approaches, postpartum hemorrhage (PPH) incidence, and maternal outcomes in CHD patients stratified by the modified World Health Organization (mWHO) classification., Results: Among 85 473 deliveries between 2009 and 2023, 409 occurred in 282 patients with CHD. Cesarean deliveries were significantly more frequent in mWHO class III, p=0.005. Labor epidural analgesia was the most common analgesic modality for vaginal deliveries (epidural rate was 71.1% with no differences between mWHO classes). Anesthesia management for cesarean deliveries varied significantly by class p<0.001. While spinal anesthesia was predominant in classes I and II, combined spinal-epidural anesthesia was more common in class III. PPH incidence was 6.4%, with no significant difference across classes, and no association was found between mWHO class severity and PPH risk (OR 0.97; 95% CI; 0.93 to 1.02, p=0.2). Higher mWHO classes correlated with significantly higher intensive care unit (ICU) admission rates, longer hospital stays, and one-year cardiac hospitalizations., Conclusion: In this retrospective study on the peripartum anesthetic management and outcomes of CHD patients stratified by mWHO class, cases with greater mWHO class were more likely to deliver preterm, by cesarean delivery, with a combined spinal-epidural anesthetic and an arterial line placement for that cesarean delivery. They overall had a longer hospital stay and were more likely to be admitted to the ICU. However, the overall risk of PPH did not increase with mWHO class severity., (Copyright © 2024 Elsevier Ltd. All rights reserved.)