UNASSIGNED: Based on the secreted frizzled-related protein 2 (SFRP2)-Wnt/β-catenin signaling pathway, this study explored the effect and mechanism of Cuiru Keli (CRKL) in the treatment of postpartum hypogalactia.
UNASSIGNED: A rat model of postpartum hypogalactia was established by gavaging 2 mL of 1.6 mg/mL bromocriptine mesylate to female rats on the third day after delivery. Female rats with a delivery time difference of less than 48 hours were selected and randomly assigned to 7 groups, including a normal group (without any modeling or medication), a model group, a CRKL low-dose group of model group model rats receiving CRKL at the dose of 3 g/kg, a CRKL medium-dose group of model rats receiving CRKL at the dose of 6 g/kg, a CRKL high-dose group of model rats receiving CRKL at the dose of 9 g/kg, a positive drug group of model rats receiving domperidone at the dose of 3 mg/kg, and a negative control (NC) group of model rats receiving normal saline. Each group contained 6 rats. Except for the normal and model groups, the remaining 5 groups were continuously administered with the respective intervention drugs at the specified doses by gavage once a day for 10 days. Changes in the total litter mass of the offspring in the 7 groups within 10 days were measured, and HE staining was performed to identify pathological changes in the mammary tissue (MT). Six groups of rats (excluding the positive control group) were used to observe the pathological changes of eosinophils in pituitary tissue. ELISA was performed to determine the content of prolactin (PRL) in serum, immunohistochemical staining was used to determine the expression of prolactin receptor (PRLR) in MT, and RT-qPCR was used to determine the mRNA expression of genes related to lactation in MT. Network pharmacology and molecular docking were used to study the therapeutic effect and mechanism of CRKL on postpartum hypogalactia, particularly whether it acted through the SFRP2-Wnt/β-catenin signaling pathway. The mechanism of CRKL treatment was further validated by detecting mRNA (RT-qPCR) and protein expression (Western blot) of related pathway genes. Cell experiments were conducted using primary culture rat mammary epithelial cells (RMEC) from rat MT. RMEC were divided into four groups, including a normal group (primary culture RMEC, untreated), SFRP2 overexpression group (primary cultured RMEC treated with SFRP2 overexpression vector), SFRP2 overexpression+CRKL group (receiving treatment for SFRP2 overexpression group plus 10% drug-containing serum), and negative control group (primary culture RMEC treated with empty vector). The effect of CRKL on the expression of lactation-related genes FASN, CSN2, and GLUT1 mRNA after SFRP2 overexpression was detected by RT-qPCR.
UNASSIGNED: In this study, CRKL was administered at a dose of 3 g/kg in the CRKL low-dose group, 6 g/kg in the medium-dose group, and 9 g/kg in the high-dose group (P<0.05 or P<0.01). Compared with the model group, CRKL at all doses significantly increased the total litter weight gain of the offsprings within 10 days (P<0.05 or P<0.01), and effectively increased lactation (P<0.01), the area of mammary lobules, and the size and filling of acinar cavities. CRKL at all doses also increased the number of eosinophils that secreted PRL in the pituitary gland of the postpartum hypogalactia rat model, and increased the content of PRL in the serum (P<0.05 or P<0.01). CRKL promoted the secretion and expression of PRL in postpartum hypogalactic model rats. In addition, it significantly promoted the expression of genes related to milk fat, milk protein, and lactose synthesis in MT (P<0.05 or P<0.01). Network pharmacology predicted that the Wnt signaling pathway might be a key pathway for CRKL in treating postpartum hypogalactia. The molecular docking results showed that related chemical components in CRKL had good binding ability with CCND1 and SFRP2. Compared with the model group, CRKL at all doses inhibited the expression of SFRP2 gene in vivo (P<0.01) and activated the mRNA and protein expression of CCND1 and c-Myc in the Wnt/β-catenin signaling pathway in MT (P<0.05 or P<0.01). Cell experiments showed that, compared to the normal group, SFRP2 overexpression reduced the mRNA expression of milk synthesis-related genes FASN, CSN2, and GLUT1 in RMEC (P<0.01). The CCK8 results indicated that 10% of the drug-containing serum was the effective concentration administered to cells (P<0.01). After administering drug-containing serum, the expression of the lactation-related genes FASN, CSN2, and GLUT1 were up-regulated (compared with the SFRP2 overexpression group, P<0.01).
UNASSIGNED: CRKL alleviates postpartum hypogalactia through the SFRP2-Wnt/β-catenin signaling pathway. SFRP2 might be a potential new target for the diagnosis and treatment of postpartum hypogalactia. This reveals a new mechanism of CRKL in treating postpartum hypogalactia and promotes its clinical application.

UNASSIGNED: Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue.
UNASSIGNED: This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro.
UNASSIGNED: A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother\'s age (odds: 0.97; p = 0.03), mother\'s body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother\'s BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02).
UNASSIGNED: Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers\' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

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UNASSIGNED: A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.
UNASSIGNED: This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a cross-sectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8,889 pregnant women and 77,012 women who had delivered between January 1, 2013, and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.
UNASSIGNED: The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (Adjusted Odds Ratio [AOR]: 12.23, 95% Confidence Interval [CI]: 9.06-16.60) and the postpartum period (AOR: 16.72, 95% CI: 14.85-18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, hystory of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.
UNASSIGNED: CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.

BACKGROUND: Interference with activities of daily living can negatively impact maternal practices both physically and psychologically. This study aimed to explore the patterns of interference with activities of daily living and perineal pain among Japanese women until 1 month postpartum. Furthermore, we aimed to describe how both perineal pain and delivery-related factors were associated with interference with activities of daily living.
METHODS: This study was part of a larger prospective longitudinal study conducted at five maternity hospitals in Japan. The participants were 293 women who had full-term vaginal deliveries and singleton infants. Participants self-evaluated their perineal pain and interference with activities of daily living using a 100 mm visual analogue scale and \'behaviour that interferes with daily life scale\' at day 1, day 5, and 1 month postpartum. We used a linear mixed model to calculate the fixed-effects parameter estimates and their 95% confidence intervals. Interference with activities of daily living, which included difficulty sitting, difficulty moving, and difficulties with excretion and cleanliness, were set as the dependent variables.
RESULTS: The final analysis included 184 participants with a mean age of 31.5±4.5 years. Perineal pain and the three sub-scales of interference with activities of daily living reduced from day 1 to 5 postpartum, and further from day 5 to 1 month postpartum (perineal pain, p<0.01, p<0.01; difficulty sitting, p<0.01, p<0.01; difficulty moving, p<0.01, p<0.01; difficulties with excretion and cleanliness, p<0.01, p<0.01). These tendencies did not change, even adjusted for independent variables using a mixed model. In the mixed model for follow-up data, perineal pain was a significantly and positively associated with three sub-scales of interference with activities of daily living, even after adjusted for perineal injury and episiotomy.
CONCLUSIONS: Positive relationships were observed between perineal pain and interference with activities of daily living until 1 month postpartum, although both reduced. To promote maternal role attainment through child-rearing since early postpartum, midwives should pay additional attention to mothers\' perineal pain as it could negatively affect their daily life and child-rearing.

The association of postpartum cardiac reverse remodeling (RR) with urinary proteome, particularly in pregnant women with cardiovascular (CV) risk factors who show long-term increased risk of cardiovascular disease and mortality is unknown. We aim to profile the urinary proteome in pregnant women with/without CV risk factors to identify proteins associated with postpartum RR. Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6 months postpartum. Shotgun HPLC-MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR. An increase in arterial stiffness was documented from 3rd trimester to 6 months after delivery, being significantly elevated in women with CV risk factors. In addition, the presence of at least one CV risk factor was associated with worse LVM RR. We identified 6 and 11 proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system\'s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery. Urinary proteome showed a predicting potential for identifying pregnant women with incomplete postpartum RR.

UNASSIGNED: To determine the impact of breastfeeding on the risk of postpartum glucose intolerance in women with gestational diabetes.
UNASSIGNED: Sub-analysis of two multi-centric prospective cohort studies (BEDIP-N and MELINDA) in 1008 women with gestational diabetes. Data were collected during pregnancy and at a mean of 12 weeks postpartum. Multivariate logistic regression was used to estimate the effect of breastfeeding on glucose intolerance, with adjustment for ethnicity, education, income, professional activity and BMI.
UNASSIGNED: Of all participants, 56.3% (567) breastfed exclusively, 10.1% (102) gave mixed milk feeding and 33.6% (339) did not breastfeed. Mean breastfeeding duration was 3.8 ± 2.4 and 3.7 ± 2.1 months in the breastfeeding and mixed milk feeding groups (p=0.496). The rate of glucose intolerance was lower in both the breastfeeding [22.3% (126)] and mixed milk feeding [25.5% (26)] groups compared to the no breastfeeding group [29.5% (100)], with an adjusted OR of 0.7 (95% CI 0.5-1.0) for glucose intolerance in the breastfeeding group compared to no breastfeeding group and an adjusted OR of 0.7 (95% CI 0.4-1.2) for the mixed milk feeding group compared to the no breastfeeding group. Postpartum, breastfeeding women had a lower BMI, less often postpartum weight retention, lower fasting triglycerides, less insulin resistance and a higher insulin secretion-sensitivity index-2 than the mixed milk feeding and no breastfeeding group. The mixed milk feeding group was more often from an non-White background, had a lower blood pressure and lower fasting triglycerides compared to the no breastfeeding group.
UNASSIGNED: Breastfeeding (exclusive and mixed milk feeding) is associated with less glucose intolerance and a better metabolic profile in early postpartum in women with gestational diabetes.

Postnatal depression is a common and severe complication of childbirth. It is an important public health problem with significant implications for both mothers and children. The exact mechanisms underlying and the factors influencing the occurrence of postnatal depression remain unclear. The literature suggests that certain dietary deficiencies during pregnancy and the postnatal period may contribute to a greater risk of maternal depression. This review focuses on the role of selenium in postnatal depression. It collects evidence from published interventional and observational studies investigating the relationship between selenium intake during the antenatal and postnatal periods and the mental status of postpartum women and summarises information about biological mechanisms that may underlie the association between selenium status and postnatal depression. The review includes studies identified through electronic searches of Medline (via PubMed) and Google Scholar databases until December 2023. Despite the small number of relevant studies and their potential methodological limitations, the findings suggest that optimizing selenium status may support the prevention and treatment of postnatal depression. Further longitudinal and interventional studies are necessary to confirm the clinical significance of these effects.

The objective was to investigate associations of serum vitamin D concentration with depressive symptoms and assess the impact that vitamin D concentration has on the occurrence of depressive symptoms in 20-44-year-old pregnant women, postpartum women, non-pp women (non-pregnant/postpartum women), and men, including a separate subgroup analysis of postpartum breastfeeding and non-breastfeeding women. The study populations were selected from the 2007-2018 NHANES public data. Subjective interview data and objective laboratory data including depressive symptoms, serum vitamin D concentration, nutrient intake, and demographic information were utilized. Two diet patterns were created using principal component analysis, and a Bayesian multinomial model was fit to predict the depression outcomes for each subpopulation. The estimates for the log vitamin D slope parameter were negative for all cohorts; as vitamin D increased, the probability of having no depression increased, while the probability of depression decreased. The pregnant cohort had the steepest vitamin D slope, followed by postpartum women, then non-pp women and men. Higher vitamin D concentration had more impact on decreasing depression risk in pregnant and postpartum women compared to non-pp women and men. Among postpartum women, higher vitamin D concentration had a greater influence on decreasing breastfeeding women\'s depression risk than non-breastfeeding women.

Background and Objectives: One of the most significant psychiatric problems in women is depression related to the perinatal period. Our study aims to determine the frequency and course of depressive symptomatology in the perinatal period with particular reference to objective rate and outcome of postpartum depression. Materials and Methods: One hundred and eighty-eight pregnant/postnatal women were included in a prospective, longitudinal, observational study during which the depressive symptomatology was estimated at the third trimester of pregnancy, and the first, sixth, and twelfth month\' postpartum. All participants completed a semi-structured sociodemographic questionnaire constructed for research purposes, the Edinburgh Postnatal Depression Scale, Toronto Alexithymia Scale, Beck Anxiety Inventory, and The Mood Disorder Questionnaire at each time point. Postpartum depression diagnosis was confirmed by a trained and certified psychiatrist with long-standing experience. For a better understanding of the trajectory of depressive symptomatology and genuine postpartum depression, we classified depression into those with new-onset and those left over from the previous observation period. Results: In general, 48.9% of participants in the study were depressed at some point during the investigation. A total of 10.6% of women were depressed in the third trimester. The highest percentage of new-onset depression (25%) was in the first month after giving birth and was maintained for up to six months, after which the appearance was sporadic. Most of the postpartum depression resolved in the period from the first month to the sixth month after childbirth (20.7%). The episodes mainly had characteristics of unipolar depression. Conclusions: Our results imply that a new onset of depression is most intensive during the first six months, and after that, it is sporadic. Further studies are needed to explore whether all depressive symptomatology in the postnatal period is the same, or perhaps postpartum depression, classified in this way, has specific characteristics, etiology, and consequently different treatment and preventive options.