The aim of the present study was to assess the capability of conduction velocity amplitudes and directions of propagation of electrohysterogram (EHG) waves to better distinguish between preterm and ...term EHG surface records. Using short-time cross-correlation between pairs of bipolar EHG signals (upper and lower, left and right), the conduction velocities and their directions were estimated using preterm and term EHG records of the publicly available Term-Preterm EHG DataSet with Tocogram (TPEHGT DS) and for different frequency bands below and above 1.0 Hz, where contractions and the influence of the maternal heart rate on the uterus, respectively, are expected. No significant or preferred continuous direction of propagation was found in any of the non-contraction (dummy) or contraction intervals; however, on average, a significantly lower percentage of velocity vectors was found in the vertical direction, and significantly higher in the horizontal direction, for preterm dummy intervals above 1.0 Hz. The newly defined features-the percentages of velocities in the vertical and horizontal directions, in combination with the sample entropy of the EHG signal recorded in the vertical direction, obtained from dummy intervals above 1.0 Hz-showed the highest classification accuracy of 86.8% (AUC=90.3%) in distinguishing between preterm and term EHG records of the TPEHGT DS.
We recently reported enhanced parasympathetic activation at rest throughout pregnancy associated with regular yoga practice. The present study presents a secondary analysis of data collected within a ...prospective cohort study of 33 pregnant women practicing yoga once weekly throughout pregnancy and 36 controls not involved in formal pregnancy exercise programs. The objective was to assess the impact of prenatal yoga on the autonomic nervous system stress response. Healthy pregnant women with singleton pregnancies were recruited in the first trimester. There was no significant difference in the maternal body mass index (BMI) between the yoga group and the controls (24.06 ± 3.55 vs. 23.74 ± 3.43 kg/m
,
= 0.693). Women practicing yoga were older (28.6 ± 3.9 vs. 31.3 ± 3.5 years,
= 0.005) and more often nulliparous (26 (79%) vs. 18 (50%),
= 0.001). We studied heart rate variability (HRV) parameters in the time domain (SDNN, standard deviation of regular R-R intervals, and RMSSD, square root of mean squared differences of successive R-R intervals) and frequency domain (ln(LF/HF), natural logarithm of low-frequency to high-frequency power), as well as synchronization indices of heart rate, blood pressure and respiration during and immediately following acute psychological stress of a standardized mental challenge test. Measurements were performed once per trimester before and after yoga or a 30 min moderate-intensity walk. Statistical comparison was performed using three-way analyses of variance (
< 0.05 significant). Time domain HRV parameters during and following mental challenge in the yoga group were significantly higher compared to the controls regardless of the trimester (
= 7.22,
= 0.009 for SDNN and
= 9.57,
= 0.003 for RMSSD, respectively). We observed no significant differences in the yoga group vs. the controls in terms of ln(LF/HF) and synchronization indices. Regular prenatal yoga practice was associated with a significantly reduced sympathetic response to mental challenge and quicker recovery after acute psychological stress. These effects persisted throughout pregnancy with regular practice.
Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia ...from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018.
GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny.
Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons.
A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.
This study aimed to explore whether the type of iron preparation used to treat postpartum anaemia affects the incidence of postpartum depression and whether the risk of postpartum depression is ...higher in postpartum patients with anaemia who were adequately treated compared to the general postpartum population.
Single-center, open-label, randomized trial. Women were allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose or oral ferrous sulphate. Intravenous iron was given in one or two doses, while ferrous sulphate as two 80 mg tablets once daily. Primary outcome was postpartum depression measured by Edinburgh Postnatal Depression Scale (EPDS) six weeks postpartum. Haematological parameters were analyzed as secondary outcomes. Kruskal-Wallis test was used for group comparison (p < 0.05 significant). The chi-square test was applied to compare categorical variables as well as the group of all subjects treated for anaemia in the study with the historical data for the Slovenian postpartum population.
Three-hundred women with postpartum anemia (hemoglobin < 100 g/L within 48-hours postpartum) were included between September 2020 and March 2022 in tertiary perinatal center. Most characteristics were similar across groups. EPDS score at six weeks postpartum did not differ between groups. The treatment modality of postpartum anaemia did not have a statistically significant effect on the EPDS score six weeks after treatment (p = 0.10), nor did it have a statistically significant effect on the difference in EPDS scores before and after treatment (p = 0.68). The proportions of participants who scored 10 or more points on the EPDS scores at six weeks postpartum were not statistically different between the groups (p = 0.79). The proportion of participants with an EPDS score of 10 or more at six weeks postpartum in the total study population did not differ significantly from previously reported proportion of postpartum women with EPDS score of 10 or more in the general population (12 % vs. 21 %; p < 0.001).
Maternal depression at 6 weeks postpartum did not differ in women treated for postpartum anemia with intravenous ferric carboxymaltose, intravenous ferric derisomaltose or oral ferrous sulphate. Participants with postpartum anaemia who are adequately treated with either oral or intravenous iron preparations are not at a higher risk of postpartum depression than the general population at six weeks postpartum.
•Adequately treated anemic patients with iron preparations are not at a higher risk of postpartum depression than the general population.•The incidence of postpartum depression was decreased regardless of the type of iron used.
Postpartum anemia is a very common maternal health problem and remains a persistent public health issue globally. It negatively affects maternal mood and could lead to depression, increased fatigue, ...and decreased cognitive abilities. It can and should be treated by restoring iron stores. However, in most health systems, there is typically a six-week gap between birth and the follow-up postpartum visit. Risks of postpartum maternal complications are usually assessed shortly after birth by clinicians intuitively, taking into account psychosocial and physical factors, such as the presence of anemia and the type of iron supplementation. In this paper, we investigate the possibility of using machine-learning algorithms to more reliably forecast three parameters related to patient wellbeing, namely depression (measured by Edinburgh Postnatal Depression Scale-EPDS), overall tiredness, and physical tiredness (both measured by Multidimensional Fatigue Inventory-MFI). Data from 261 patients were used to train the forecasting models for each of the three parameters, and they outperformed the baseline models that always predicted the mean values of the training data. The mean average error of the elastic net regression model for predicting the EPDS score (with values ranging from 0 to 19) was 2.3 and outperformed the baseline, which already hints at the clinical usefulness of using such a model. We further investigated what features are the most important for this prediction, where the EDPS score and both tiredness indexes at birth turned out to be by far the most prominent prediction features. Our study indicates that the machine-learning model approach has the potential for use in clinical practice to predict the onset of depression and severe fatigue in anemic patients postpartum and potentially improve the detection and management of postpartum depression and fatigue.
(1)
Postpartum anemia is a common maternal complication and is recognized as a cause of impaired quality of life, reduced cognitive abilities, and fatigue. Efficient iron supplementation for the ...treatment of postpartum anemia is an essential component of high-quality maternal care. The optimal mode of iron supplementation has not been determined yet, whether oral or intravenous. The objective of this study was to compare postpartum anemia treatment with intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate. (2)
A single-center, open-label, randomized controlled trial. Women with hemoglobin < 100 g/L within 48 h postpartum were randomly allocated to receive intravenous ferric carboxymaltose, intravenous ferric derisomaltose, or oral ferrous sulfate. Intravenous iron was given in one or two doses, while ferrous sulfate was given as two 80 mg tablets once daily. The primary outcome was maternal fatigue measured by the Multidimensional Fatigue Inventory (MFI) six weeks postpartum. Hemoglobin, ferritin, and transferrin saturation levels were analyzed as secondary outcomes. A Kruskal-Wallis test was used for group comparison (
< 0.05 significant). (3)
Three hundred women were included. The MFI score at six weeks postpartum did not differ between groups (median 38 (inter-quartile range (IQR) 29-47) in the ferric carboxymaltose group, median 34 (IQR 26-42) in the ferric derisomaltose group, and median 36 (IQR 25-47) in the ferrous sulfate group;
= 0.26). Participants receiving oral iron had lower levels of hemoglobin (135 (131-139) vs. 134 (129-139) vs. 131 (125-137) g/L;
= 0.008), ferritin (273 (198-377) vs. 187 (155-246) vs. 24 (17-37) µg/L;
< 0.001) and transferrin saturation (34 (28-38) vs. 30 (23-37) vs. 24 (17-37) %;
< 0.001) than those receiving ferric carboxymaltose or ferric derisomaltose. (4)
Intravenous ferric carboxymaltose, intravenous ferric derisomaltose, and oral ferrous sulfate had similar impacts on maternal fatigue at six weeks postpartum despite improved laboratory parameters in the intravenous groups.
The objective was to assess the effects of prenatal yoga on heart rate variability (HRV) and cardio-respiratory synchronization, used as proxies of autonomic nervous system activity. Sixty-nine ...healthy pregnant women were included; 33 in a yoga group attending at least one 90-min yoga class weekly throughout pregnancy, and 36 controls not involved in formal pregnancy exercise programs. Measurements of the time domain (SDNN, standard deviation of regular R-R intervals, and RMSSD, square root of mean squared differences of successive R-R intervals) and frequency domain (ln(LF/HF), natural logarithm of low-frequency to high-frequency power) HRV indices, as well as cardio-respiratory synchronization indexes were performed once per trimester before and after yoga or 30-min moderate-intensity walk. A statistical comparison was performed using a three-way analysis of the variance (p < 0.05 significant). Both the time domain and frequency domain HRV indices showed significant shifts towards parasympathetic dominance following yoga when compared to the controls throughout pregnancy (p = 0.002 for SDNN, p < 0.001 for RMSSD, and p = 0.006 for ln(LF/HF), respectively). There was a statistically non-significant trend towards higher synchronization between respiratory frequency and heart rate following yoga vs. controls (p = 0.057). Regular prenatal yoga was associated with enhanced parasympathetic activation persisting throughout pregnancy.
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