BACKGROUND: Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women\'s use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out-patient clinic visits, in relation to maternal country of birth.
METHODS: A population-based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014-2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre-gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish-born women as reference.
RESULTS: Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49-3.15; multiparous aOR 2.78, CI 2.59-2.98), Somalia (primiparous aOR 2.61, CI 2.34-2.92; multiparous aOR 1.87, CI 1.79-1.97), and India (primiparous aOR 2.52, CI 2.14-2.97; multiparous aOR 2.61, CI 2.33-2.93), compared to Swedish-born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08-1.6), Iraq (aOR 1.30, CI 1.16-1.46), and Iran (aOR 1.23, CI 1.04-1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02-1.76) and Somalia (aOR 1.24, CI 1.11-1.38). Specialized out-patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35-1.59), Iran (aOR 1.31, CI 1.22-1.42) and Afghanistan (aOR 1.31, CI 1.18-1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20-1.41) and Iraq (aOR 1.15, CI 1.11-1.20), however less common in women from some other countries.
CONCLUSIONS: The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish-born women, regardless of parity and pre-gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not.

OBJECTIVE: Women with GDM display adverse lifetime cardio-metabolic health. We examined whether early metformin in GDM could impact cardio-metabolic risk factors postpartum.
METHODS: EMERGE, a double-blind, placebo-controlled trial randomized pregnancies 1:1 to placebo or metformin at GDM diagnosis and followed participants from randomization until 12±4 weeks postpartum. In total 478 pregnancies were available for postpartum maternal assessment, 237 and 241 assigned to metformin and placebo respectively. Weight (kg), body mass index (BMI) (kg/m2), waist circumference (cm) and blood pressure (mmHg) were measured, infant feeding method documented and bloods drawn for a 75 gram oral glucose tolerance test, fasting insulin, C peptide and lipid analysis.
RESULTS: Despite similar weight and BMI at trial randomization, participants receiving metformin had significantly lower weight (79.5±15.9 vs 82.6±16.9kg; p=0.04) and BMI (29.3(5.6) vs 30.5(5.4); p=0.018) at the postpartum visit. However no difference in weight change from randomisation to 12 weeks postpartum was observed between metformin and placebo groups. Overall 29% (n=139) of the cohort met criteria for prediabetes or diabetes, with no positive impact with metformin. There were also no differences in measurements of insulin resistance, blood pressure or lipids between groups.
CONCLUSIONS: Early metformin use in GDM did not impact important cardio-metabolic parameters in the early postpartum period despite significant benefits in weight gain and insulin use in pregnancy.

In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville\'s Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale\'s total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.

The postpartum period is critical for the health and well-being of birthing people, yet little is known about the range of health care services and supports needed during this time. Maternity care patients are often targeted for clinical interventions based on \"low risk\" or \"high risk\" designations, but dichotomized measures can be imprecise and may not reflect meaningful groups for understanding needed postpartum care. Using claims data from privately insured patients with childbirths between 2016 and 2018, this study identifies categories and predictors of postpartum care utilization, including the use of maternal care and other, nonmaternal, care (eg, respiratory, digestive). We then compare identified utilization-based categories with typical high- and low-risk designations. Among 269 992 patients, 5 categories were identified: (1) low use (55% of births); (2) moderate maternal care use, low other care use (25%); (3) moderate maternal, high other (8%); (4) high maternal, moderate other (7%); and (5) high maternal, high other (5%). Utilization-based categories were better at differentiating postpartum care use and were more consistent across patient profiles, compared with high- and low-risk dichotomies. Identifying categories of postpartum care need beyond a simple risk dichotomy is warranted and can assist in maternal health services research, policymaking, and clinical practice.
The time after childbirth is important for the health of a parent who has just given birth, and postpartum experiences and needs vary widely. We studied health care data for privately insured people who gave birth and identified 5 categories of health care use in the postpartum period. None of the categories we uncovered fit the common model of a single visit at 6 weeks postpartum as the sole care needed or used postpartum. Typically, patients are divided into high-risk and low-risk groups, but our research shows that this is insufficient and masks important differences among patients within these dichotomous groups. Using advanced statistical methods to identify categories of health care use after childbirth may improve postpartum health by better targeting resources to those who need them the most.

We retrospectively analyzed the effects of dry period length (DPL) on milk yield and postpartum health using 152 commercial dairy farm data, including 46,228 dairy cows in Hokkaido, Japan, and examined the optimal DPL. The DPL was divided into eight categories: ≤25, 26-35, 36-45, 46-55, 56-65 (reference), 66-75, 76-85, and ≥86 d. The total milk yields (the sum of milk yield during the 55 d before and the 305 d milk yield after calving) of cows with DPL of ≤55 d did not differ from the reference group. Cows with DPL of ≤55 d had lower odds ratios (OR) of a displaced abomasum (DA), ketosis, milk fever (MF), and abnormal milk fat-to-protein ratio but had higher puerperal fever (PF) and stillbirth ORs than the reference group. Cows with a DPL of 46-55 d had the lowest PF and stillbirth ORs among the short DPL categories. The extremely short (≤25 d) and long (≥86 d) DPL increased the ORs of mastitis and abnormal liner score of somatic cell counts (SCCs) compared with the reference group. We conclude that shortening DPL can reduce postpartum health problems without reducing milk yield and that the optimal DPL is 46-55 d.

OBJECTIVE: Urinary incontinence (UI) is common in the postpartum period; however, most studies focus on the early postpartum period and assess prevalence at only one or two time points. We hypothesized that UI would be prevalent across the first 2 years postpartum. Our secondary objective was to evaluate risk factors for postpartum UI among a nationally representative, contemporary sample.
METHODS: This cross-sectional, population-based study used National Health and Nutrition Examination Survey (2011-2018) data for parous women within 24 months following delivery. Prevalence of UI, UI subtypes, and severity were estimated. Multivariate logistic regression was used to estimate adjusted odds (aOR) of UI for exposures of interest.
RESULTS: Among 560 postpartum women, prevalence of any UI was 43.5%. Stress UI was most common (28.7%), and most women (82.8%) experienced mild symptoms. There was no significant change in prevalence of UI across the 24 months following delivery (R2 = 0.004). Individuals with postpartum UI tended to be older (30.3 ± 0.5 versus 28.8 ± 0.5 years) and had higher BMI (31.1 ± 0.6 versus 28.9 ± 0.6). In multivariate analysis, odds of postpartum UI were higher for women who had had a prior vaginal delivery (aOR 2.0, 95% CI: 1.3-3.3), prior delivery of a baby weighing 9 lb (4 kg) or more (aOR 2.5, 95% CI: 1.3-4.8), or who reported current smoking (aOR 1.5, 95% CI: 1.0-2.3).
CONCLUSIONS: During the first 2 years postpartum 43.5% of women report UI, with relatively stable prevalence over this period. This high prevalence supports screening for UI after delivery regardless of risk factors.

BACKGROUND: Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown.
OBJECTIVE: The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum.
METHODS: This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety.
RESULTS: Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community).
CONCLUSIONS: Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors.

Our objectives were to evaluate the effects of complete replacement of supplementary inorganic salts of trace minerals (ITM; cobalt (Co), copper (Cu), manganese (Mn), zinc (Zn) sulfates and sodium (Na) selenite) by organic trace minerals (OTM; Co, Cu, Mn, Zn proteinates, and selenized yeast) in both pre- and postpartum diets on trace minerals (TM) concentrations in body fluids and liver, antioxidant and inflammation biomarkers in blood, and postpartum health of dairy cows. Pregnant cows were blocked by parity and body condition score and randomly assigned to ITM (n = 136) or OTM (n = 137) 45 d before expected calving. Both groups received the same pre- and postpartum diets except for the source of supplementary TM. The day of calving was considered study d 0 and blood was collected on d -45, -21, -14, -10, -7, -3, 0, 3, 7, 10, 14, 23, 65, and 105 for analyses of TM and biomarkers. Concentrations of TM were also investigated in the liver (d 105), milk (d 7, 23, 65, 105), urine (d -21, 21, 65, 105), ruminal fluid and feces (d -21, 21, 65). Incidence of clinical and subclinical health conditions were evaluated. Complete replacement of ITM by OTM resulted in greater concentration of selenium (Se) in serum (0.084 vs. 0.086 µg/mL; P < 0.01), milk (0.24 vs. 0.31 µg/g; P < 0.01), and ruminal fluid (0.54 vs. 0.58 µg/g; P = 0.06), and reduced concentration of Se in urine (1.54 vs. 1.23 µg/g; P<0.01). For concentration of Co in serum, an interaction between treatment and time was detected (P < 0.01). Cows supplemented with OTM had greater concentrations of Co on d -7 and 0 (0.30 vs. 0.33 ng/mL; P < 0.01) but lower concentrations of Co on d 23, 65, and 105 (0.34 vs. 0.31 ng/mL; P < 0.05), in addition to reduced concentration of Co in feces (1.08 vs. 0.99 µg/g; P = 0.04) and, for multiparous only, in urine (0.019 vs. 0.014 µg/g; P < 0.01). Cows supplemented with OTM had lower postpartum concentrations of glutamate dehydrogenase (20.8 vs. 17.8 U/L; P < 0.05) and higher albumin on d -10 (36.0 vs. 36.7 g/L; P = 0.04) and 23 (36.9 vs. 37.6 g/L; P = 0.03) relative to calving. Primiparous cows fed OTM had lower concentration of ceruloplasmin in plasma (55 vs. 51 mg/L; P ≤ 0.05). Cows supplemented with OTM had less incidence of lameness (14% vs. 7%; P = 0.05), elevated nonesterified fatty acids (NEFA) (61% vs. 44%; P < 0.01), and multiple metabolic problems (35% vs. 20%; P < 0.01). Despite the lack of differences in Cu, Mn, and Zn concentrations and antioxidant capacity, complete replacement of ITM by OTM altered concentrations of Se and Co, supported liver and hoof health, and reduced the risk of postpartum elevated NEFA.
Trace minerals (TM) are important for oxidative balance and immunity of cows. Different forms of TM are available for dietary supplementation of dairy cows. We tested whether replacing inorganic salts of TM by organic sources of TM in both pre- and postpartum diets improve TM concentration in body fluids and liver, antioxidant capacity in blood, and postpartum health of dairy cows. Despite the lack of difference in antioxidant capacity and in concentrations of Cu, Mn, and Zn, the complete replacement of inorganic salts by organic sources altered concentrations of Se and Co in circulation, and reduced the concentration of biomarkers associated with inflammation and liver damage, and the risk of lameness and postpartum metabolic problems.

BACKGROUND: Mobile health, the use of mobile technology in delivering health care, has been found to be effective in changing health behaviors, including improving breastfeeding practices in postpartum women. With the widespread use of smartphones and instant messaging apps in Hong Kong, instant messaging groups could be a useful channel for delivering breastfeeding peer support.
OBJECTIVE: The aim of this paper is to study the feasibility and acceptability of an online instant messaging peer support group by trained peer counselors on improving breastfeeding outcome in primiparous women in Hong Kong.
METHODS: A two-arm, assessor-blind, randomized controlled feasibility study will be conducted on 40 primiparous women with the intention to breastfeed. Participants are recruited from the antenatal obstetrics and gynecology clinic of a public hospital in Hong Kong and randomly assigned at a 1:1 ratio to either intervention or control group. The intervention group receives peer support in an online instant messaging group with trained peer counselors on top of standard care, whereas the control group receives standard care. Breastfeeding outcome will be assessed for 6 months post partum or until weaned. The breastfeeding status, the proportion and duration of exclusive and any breastfeeding in each group, and the self-efficacy and attitude of participants will be assessed. The feasibility and acceptability of the study would also be assessed in preparation for a full randomized controlled trial.
RESULTS: This study (protocol version 1 dated January 5, 2021) has been reviewed and approved by the institutional review board of the University of Hong Kong, Hospital Authority Hong Kong West Cluster (reference UW 21-039), on January 26, 2021. Data collection is ongoing and expected to be completed in December 2021. The findings will be updated on clinical trial registry and disseminated in peer-reviewed journals.
CONCLUSIONS: This study aims to assess the feasibility and effectiveness of an online instant messaging peer support group in improving the breastfeeding outcome of primiparous women in Hong Kong. Its findings could inform the feasibility of a full-scale trial with this intervention design.
BACKGROUND: ClinicalTrials.gov NCT04826796; https://clinicaltrials.gov/ct2/show/NCT04826796.
UNASSIGNED: DERR1-10.2196/32338.

OBJECTIVE: We estimate the effect of the Affordable Care Act\'s (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages.
METHODS: Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women without children, postpartum mothers, and mothers of children older than one year in expansion states to non-expansion states, before and after the expansions.
RESULTS: The ACA\'s Medicaid expansion increased Medicaid coverage among adult women with incomes between 101 and 200% of the federal poverty line (FPL) without children by 10.7 percentage points (54 percent, p < 0.01). Coverage of mothers with children older than one year increased by 9.5 percentage points (34 percent, p < 0.01). Coverage of mothers with infants rose by 7.9 percentage points (21 percent, p < 0.01).
CONCLUSIONS: Within the population of adult reproductive-aged women, we find a \"fanning out\" of effects from the ACA\'s Medicaid expansions. Childless women experience the largest gains in coverage while mothers of infants experience the smallest gains; mothers of children greater than one year old fall in the middle. These results are consistent with ACA gains being the smallest among the groups least targeted by the ACA, but also show substantial gains (one fifth) even among postpartum mothers.