Obstetrics

Key clinical point: Management of shoulder dystocia with fetal manipulation (FM) increased the risk for obstetric anal sphincter injury (OASI), with FM being associated with an increased risk for OASI and severe neonatal morbidity.

Major finding: Shoulder dystocia managed with vs without FM resulted in significantly higher rates of OASI (21.1% vs 3.8%; odds ratio [OR] 6.72; 95% CI 2.7-15.8) but similar rates of severe neonatal morbidity. FM was associated with the occurrence of OASI (adjusted OR [aOR] 5.3; 95% CI 2.2-12.8) and was the only factor associated with severe neonatal morbidity (aOR 2.3; 95% CI 1.1-4.8).

Study details: Findings are from a retrospective observational study including 602 vaginal vertex deliveries in singleton pregnancies, which encountered shoulder dystocia that was managed with (n = 52) or without (n = 550) FM.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Diack B et al. Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management. Arch Gynecol Obstet. 2022 (Sep 23). Doi: 10.1007/s00404-022-06783-y

Key clinical point: Management of shoulder dystocia with fetal manipulation (FM) increased the risk for obstetric anal sphincter injury (OASI), with FM being associated with an increased risk for OASI and severe neonatal morbidity.

Major finding: Shoulder dystocia managed with vs without FM resulted in significantly higher rates of OASI (21.1% vs 3.8%; odds ratio [OR] 6.72; 95% CI 2.7-15.8) but similar rates of severe neonatal morbidity. FM was associated with the occurrence of OASI (adjusted OR [aOR] 5.3; 95% CI 2.2-12.8) and was the only factor associated with severe neonatal morbidity (aOR 2.3; 95% CI 1.1-4.8).

Study details: Findings are from a retrospective observational study including 602 vaginal vertex deliveries in singleton pregnancies, which encountered shoulder dystocia that was managed with (n = 52) or without (n = 550) FM.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Diack B et al. Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management. Arch Gynecol Obstet. 2022 (Sep 23). Doi: 10.1007/s00404-022-06783-y

Key clinical point: Management of shoulder dystocia with fetal manipulation (FM) increased the risk for obstetric anal sphincter injury (OASI), with FM being associated with an increased risk for OASI and severe neonatal morbidity.

Major finding: Shoulder dystocia managed with vs without FM resulted in significantly higher rates of OASI (21.1% vs 3.8%; odds ratio [OR] 6.72; 95% CI 2.7-15.8) but similar rates of severe neonatal morbidity. FM was associated with the occurrence of OASI (adjusted OR [aOR] 5.3; 95% CI 2.2-12.8) and was the only factor associated with severe neonatal morbidity (aOR 2.3; 95% CI 1.1-4.8).

Study details: Findings are from a retrospective observational study including 602 vaginal vertex deliveries in singleton pregnancies, which encountered shoulder dystocia that was managed with (n = 52) or without (n = 550) FM.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Diack B et al. Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management. Arch Gynecol Obstet. 2022 (Sep 23). Doi: 10.1007/s00404-022-06783-y

Key clinical point: A dose of 30 mg oral extended-release nifedipine (ER-nifedipine) every 24 hours until delivery effectively reduced the receipt of treatment for acute severe hypertension in individuals with preeclampsia with severe features.

Major finding: A significantly lower proportion of individuals who received 30 mg ER-nifedipine vs placebo required ≥1 dose of acute hypertension therapy for severe blood pressure that sustained for ≥10 minutes (34.0% vs 55.1%; relative risk 0.62; 95% CI 0.39-0.97). ER-nifedipine vs placebo use led to numerically lower cesarean deliveries (20.8% vs 34.7%) and neonatal intensive care unit admissions (29.1% vs 47.1%).

Study details: Findings are from a phase 4 trial including 110 individuals with singleton or twin gestation undergoing labor induction for preeclampsia with severe features who were randomly assigned to receive 30 mg oral ER-nifedipine or placebo every 24 hours until delivery.

Disclosures: This study was funded by The Ohio State University Department of Obstetrics and Gynecology. No conflicts of interest were declared.

Source: Cleary EM et al. Trial of intrapartum extended-release nifedipine to prevent severe hypertension among pregnant individuals with preeclampsia with severe features. Hypertension. 2022 (Oct 3). Doi: 10.1161/HYPERTENSIONAHA.122.19751

Key clinical point: A dose of 30 mg oral extended-release nifedipine (ER-nifedipine) every 24 hours until delivery effectively reduced the receipt of treatment for acute severe hypertension in individuals with preeclampsia with severe features.

Major finding: A significantly lower proportion of individuals who received 30 mg ER-nifedipine vs placebo required ≥1 dose of acute hypertension therapy for severe blood pressure that sustained for ≥10 minutes (34.0% vs 55.1%; relative risk 0.62; 95% CI 0.39-0.97). ER-nifedipine vs placebo use led to numerically lower cesarean deliveries (20.8% vs 34.7%) and neonatal intensive care unit admissions (29.1% vs 47.1%).

Study details: Findings are from a phase 4 trial including 110 individuals with singleton or twin gestation undergoing labor induction for preeclampsia with severe features who were randomly assigned to receive 30 mg oral ER-nifedipine or placebo every 24 hours until delivery.

Disclosures: This study was funded by The Ohio State University Department of Obstetrics and Gynecology. No conflicts of interest were declared.

Source: Cleary EM et al. Trial of intrapartum extended-release nifedipine to prevent severe hypertension among pregnant individuals with preeclampsia with severe features. Hypertension. 2022 (Oct 3). Doi: 10.1161/HYPERTENSIONAHA.122.19751

Key clinical point: A dose of 30 mg oral extended-release nifedipine (ER-nifedipine) every 24 hours until delivery effectively reduced the receipt of treatment for acute severe hypertension in individuals with preeclampsia with severe features.

Major finding: A significantly lower proportion of individuals who received 30 mg ER-nifedipine vs placebo required ≥1 dose of acute hypertension therapy for severe blood pressure that sustained for ≥10 minutes (34.0% vs 55.1%; relative risk 0.62; 95% CI 0.39-0.97). ER-nifedipine vs placebo use led to numerically lower cesarean deliveries (20.8% vs 34.7%) and neonatal intensive care unit admissions (29.1% vs 47.1%).

Study details: Findings are from a phase 4 trial including 110 individuals with singleton or twin gestation undergoing labor induction for preeclampsia with severe features who were randomly assigned to receive 30 mg oral ER-nifedipine or placebo every 24 hours until delivery.

Disclosures: This study was funded by The Ohio State University Department of Obstetrics and Gynecology. No conflicts of interest were declared.

Source: Cleary EM et al. Trial of intrapartum extended-release nifedipine to prevent severe hypertension among pregnant individuals with preeclampsia with severe features. Hypertension. 2022 (Oct 3). Doi: 10.1161/HYPERTENSIONAHA.122.19751

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Risk for shoulder dystocia was higher among women with gestational diabetes who showed a slowly improving glycemic control trajectory, highlighting the need for interventions that help achieve glycemic targets early after the diagnosis of gestational diabetes.

Major finding: Compared with women showing rapid improvements to attain optimal glycemic control, the risk for shoulder dystocia was higher among women showing slow improvements to attain suboptimal glycemic control (adjusted relative risk [aRR] 1.41; 95% CI 1.12-1.78) and was lower among women with stably optimal glycemic control from diagnosis to delivery (aRR 0.75; 95% CI 0.61-0.92).

Study details: Findings are from a population-based longitudinal cohort study including 26,774 women with gestational diabetes who received prenatal care.

Disclosures: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. The authors did not declare any conflicts of interest.

Source: Chehab RF et al. Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes. JAMA Netw Open. 2022;5(9):e2233955 (Sep 29). Doi: 10.1001/jamanetworkopen.2022.33955

Key clinical point: Use of low-dose aspirin significantly reduced preterm birth rates but had no significant effect on the risk for preeclampsia in pregnant women with chronic hypertension.

Major finding: In women with chronic hypertension, the use of low-dose aspirin vs placebo during pregnancy was associated with a significant reduction in preterm birth rates (22.2% vs 31.1%; odds ratio, 0.63; 95% CI 0.45-0.89) but a nonsignificant reduction in the risk for superimposed or preterm preeclampsia.

Study details: Findings are from a systematic review and meta-analysis of nine studies (retrospective cohort studies and randomized controlled trials) including 2150 women with chronic hypertension who received low-dose aspirin or placebo during pregnancy.

Disclosures: This study did not receive any specific funding. V Giorgione’s PhD was supported by a Marie Skłodowska-Curie grant unrelated to this study. The authors declared no conflicts of interest.

Source: Richards EMF et al. Low-dose aspirin for the prevention of superimposed pre-eclampsia in women with chronic hypertension: A systematic review and meta-analysis. Am J Obstet Gynecol. 2022 (Oct 6). Doi: 10.1016/j.ajog.2022.09.046

Key clinical point: Use of low-dose aspirin significantly reduced preterm birth rates but had no significant effect on the risk for preeclampsia in pregnant women with chronic hypertension.

Major finding: In women with chronic hypertension, the use of low-dose aspirin vs placebo during pregnancy was associated with a significant reduction in preterm birth rates (22.2% vs 31.1%; odds ratio, 0.63; 95% CI 0.45-0.89) but a nonsignificant reduction in the risk for superimposed or preterm preeclampsia.

Study details: Findings are from a systematic review and meta-analysis of nine studies (retrospective cohort studies and randomized controlled trials) including 2150 women with chronic hypertension who received low-dose aspirin or placebo during pregnancy.

Disclosures: This study did not receive any specific funding. V Giorgione’s PhD was supported by a Marie Skłodowska-Curie grant unrelated to this study. The authors declared no conflicts of interest.

Source: Richards EMF et al. Low-dose aspirin for the prevention of superimposed pre-eclampsia in women with chronic hypertension: A systematic review and meta-analysis. Am J Obstet Gynecol. 2022 (Oct 6). Doi: 10.1016/j.ajog.2022.09.046

Key clinical point: Use of low-dose aspirin significantly reduced preterm birth rates but had no significant effect on the risk for preeclampsia in pregnant women with chronic hypertension.

Major finding: In women with chronic hypertension, the use of low-dose aspirin vs placebo during pregnancy was associated with a significant reduction in preterm birth rates (22.2% vs 31.1%; odds ratio, 0.63; 95% CI 0.45-0.89) but a nonsignificant reduction in the risk for superimposed or preterm preeclampsia.

Study details: Findings are from a systematic review and meta-analysis of nine studies (retrospective cohort studies and randomized controlled trials) including 2150 women with chronic hypertension who received low-dose aspirin or placebo during pregnancy.

Disclosures: This study did not receive any specific funding. V Giorgione’s PhD was supported by a Marie Skłodowska-Curie grant unrelated to this study. The authors declared no conflicts of interest.

Source: Richards EMF et al. Low-dose aspirin for the prevention of superimposed pre-eclampsia in women with chronic hypertension: A systematic review and meta-analysis. Am J Obstet Gynecol. 2022 (Oct 6). Doi: 10.1016/j.ajog.2022.09.046

Offering shopping vouchers to pregnant women as an incentive to quit smoking showed promising results, a study found, despite most participants relapsing after giving birth.

Rewarding pregnant women with up to £400 to spend on Main Street, in addition to usual support, more than doubled the proportion who were still smoke-free late in their pregnancy, and could save the National Health Service money in the long term, according to the research, published in the BMJ, led by the University of Glasgow and the University of York, England.

Although the proportion of women in the United Kingdom who smoke during pregnancy has halved over the past 20 years, those who still do are more reluctant to engage with cessation services.

Interventions using financial incentives were pioneered in the United States, but there is a lack of evidence for how effective they might be in the United Kingdom.
 

Vouchers linked to passing saliva tests

The phase 3 Cessation in Pregnancy Incentives Trial was based on an earlier feasibility study in Glasgow and involved 941 pregnant women aged 16 or older, with a mean age of 27.9 years when they were recruited, from seven stop-smoking services in Scotland, Northern Ireland, and England between January 2018 and April 2020. Participants self-reported that they smoked at least one cigarette a week.

The cohort was randomised into two groups: a control group who received usual stop smoking support that included the offer of counselling by trained workers combined with free nicotine-replacement therapy, and an intervention group who were given the same interventional support plus targets to receive LoveToShop vouchers.

Although vouchers to the value of £400 were on offer, earning them depended on successfully reaching four milestones. They received a first £50 voucher for engaging with stop-smoking services and setting a quit date and further vouchers for being declared smoke-free by biochemical verification at specific time points in the pregnancy.

Factors including the mother’s age, years of smoking, income, use of nicotine-replacement therapy and e-cigarettes, timing of birth, and birth weight were taken into account.

The study found that 71% of the participants in the incentive group engaged with stop-smoking services and set a quit date, compared with 64% in the control group. By late pregnancy, 126 participants (27%) of the 471 in the intervention group were smoke-free, compared with 58 (12%) of the 470 in the control group.
 

Most women in the trial went back to smoking

However, abstinence rates measured 6 months after giving birth were low in both groups: 6% in the intervention group vs. 4% in the control group.

The researchers also reported no significant differences in birth weight between the two groups.

Overall, the birth weight of babies from 443 intervention participants and 450 controls showed no significant difference between groups (average 3.18 kg vs. 3.13 kg).

The researchers did find a clinically important but not significant 10% increase in birth weight in the subset of participants who adhered with their treatment allocation, but they said further analysis is needed to better understand the relevance of this finding.

Severity of preterm birth was similar between groups, and all serious adverse events, such as miscarriages and stillbirths, were considered unrelated to the intervention.

The researchers acknowledged some limitations to their investigation, including that only 23% of women screened by stop-smoking services were enrolled, and that almost all participants were White. Also, the onset of COVID-19 disrupted some of the trial processes.

However, they concluded that their trial “supports implementation advocated in NICE [National Institute for Health and Care Excellence] guidelines by showing an effective, cost-effective, and generalisable pragmatic bolt-on U.K. format for incentive payments” to reduce smoking rates in pregnancy.

A version of this article first appeared on MedscapeUK.

Offering shopping vouchers to pregnant women as an incentive to quit smoking showed promising results, a study found, despite most participants relapsing after giving birth.

Rewarding pregnant women with up to £400 to spend on Main Street, in addition to usual support, more than doubled the proportion who were still smoke-free late in their pregnancy, and could save the National Health Service money in the long term, according to the research, published in the BMJ, led by the University of Glasgow and the University of York, England.

Although the proportion of women in the United Kingdom who smoke during pregnancy has halved over the past 20 years, those who still do are more reluctant to engage with cessation services.

Interventions using financial incentives were pioneered in the United States, but there is a lack of evidence for how effective they might be in the United Kingdom.
 

Vouchers linked to passing saliva tests

The phase 3 Cessation in Pregnancy Incentives Trial was based on an earlier feasibility study in Glasgow and involved 941 pregnant women aged 16 or older, with a mean age of 27.9 years when they were recruited, from seven stop-smoking services in Scotland, Northern Ireland, and England between January 2018 and April 2020. Participants self-reported that they smoked at least one cigarette a week.

The cohort was randomised into two groups: a control group who received usual stop smoking support that included the offer of counselling by trained workers combined with free nicotine-replacement therapy, and an intervention group who were given the same interventional support plus targets to receive LoveToShop vouchers.

Although vouchers to the value of £400 were on offer, earning them depended on successfully reaching four milestones. They received a first £50 voucher for engaging with stop-smoking services and setting a quit date and further vouchers for being declared smoke-free by biochemical verification at specific time points in the pregnancy.

Factors including the mother’s age, years of smoking, income, use of nicotine-replacement therapy and e-cigarettes, timing of birth, and birth weight were taken into account.

The study found that 71% of the participants in the incentive group engaged with stop-smoking services and set a quit date, compared with 64% in the control group. By late pregnancy, 126 participants (27%) of the 471 in the intervention group were smoke-free, compared with 58 (12%) of the 470 in the control group.
 

Most women in the trial went back to smoking

However, abstinence rates measured 6 months after giving birth were low in both groups: 6% in the intervention group vs. 4% in the control group.

The researchers also reported no significant differences in birth weight between the two groups.

Overall, the birth weight of babies from 443 intervention participants and 450 controls showed no significant difference between groups (average 3.18 kg vs. 3.13 kg).

The researchers did find a clinically important but not significant 10% increase in birth weight in the subset of participants who adhered with their treatment allocation, but they said further analysis is needed to better understand the relevance of this finding.

Severity of preterm birth was similar between groups, and all serious adverse events, such as miscarriages and stillbirths, were considered unrelated to the intervention.

The researchers acknowledged some limitations to their investigation, including that only 23% of women screened by stop-smoking services were enrolled, and that almost all participants were White. Also, the onset of COVID-19 disrupted some of the trial processes.

However, they concluded that their trial “supports implementation advocated in NICE [National Institute for Health and Care Excellence] guidelines by showing an effective, cost-effective, and generalisable pragmatic bolt-on U.K. format for incentive payments” to reduce smoking rates in pregnancy.

A version of this article first appeared on MedscapeUK.

Offering shopping vouchers to pregnant women as an incentive to quit smoking showed promising results, a study found, despite most participants relapsing after giving birth.

Rewarding pregnant women with up to £400 to spend on Main Street, in addition to usual support, more than doubled the proportion who were still smoke-free late in their pregnancy, and could save the National Health Service money in the long term, according to the research, published in the BMJ, led by the University of Glasgow and the University of York, England.

Although the proportion of women in the United Kingdom who smoke during pregnancy has halved over the past 20 years, those who still do are more reluctant to engage with cessation services.

Interventions using financial incentives were pioneered in the United States, but there is a lack of evidence for how effective they might be in the United Kingdom.
 

Vouchers linked to passing saliva tests

The phase 3 Cessation in Pregnancy Incentives Trial was based on an earlier feasibility study in Glasgow and involved 941 pregnant women aged 16 or older, with a mean age of 27.9 years when they were recruited, from seven stop-smoking services in Scotland, Northern Ireland, and England between January 2018 and April 2020. Participants self-reported that they smoked at least one cigarette a week.

The cohort was randomised into two groups: a control group who received usual stop smoking support that included the offer of counselling by trained workers combined with free nicotine-replacement therapy, and an intervention group who were given the same interventional support plus targets to receive LoveToShop vouchers.

Although vouchers to the value of £400 were on offer, earning them depended on successfully reaching four milestones. They received a first £50 voucher for engaging with stop-smoking services and setting a quit date and further vouchers for being declared smoke-free by biochemical verification at specific time points in the pregnancy.

Factors including the mother’s age, years of smoking, income, use of nicotine-replacement therapy and e-cigarettes, timing of birth, and birth weight were taken into account.

The study found that 71% of the participants in the incentive group engaged with stop-smoking services and set a quit date, compared with 64% in the control group. By late pregnancy, 126 participants (27%) of the 471 in the intervention group were smoke-free, compared with 58 (12%) of the 470 in the control group.
 

Most women in the trial went back to smoking

However, abstinence rates measured 6 months after giving birth were low in both groups: 6% in the intervention group vs. 4% in the control group.

The researchers also reported no significant differences in birth weight between the two groups.

Overall, the birth weight of babies from 443 intervention participants and 450 controls showed no significant difference between groups (average 3.18 kg vs. 3.13 kg).

The researchers did find a clinically important but not significant 10% increase in birth weight in the subset of participants who adhered with their treatment allocation, but they said further analysis is needed to better understand the relevance of this finding.

Severity of preterm birth was similar between groups, and all serious adverse events, such as miscarriages and stillbirths, were considered unrelated to the intervention.

The researchers acknowledged some limitations to their investigation, including that only 23% of women screened by stop-smoking services were enrolled, and that almost all participants were White. Also, the onset of COVID-19 disrupted some of the trial processes.

However, they concluded that their trial “supports implementation advocated in NICE [National Institute for Health and Care Excellence] guidelines by showing an effective, cost-effective, and generalisable pragmatic bolt-on U.K. format for incentive payments” to reduce smoking rates in pregnancy.

A version of this article first appeared on MedscapeUK.

The three PPH articles examine the use of preventive B-Lynch suture, risk factors for failure of intrauterine tamponade, and trend changes in risk factors for PPH. Kuwabara and colleagues looked at the effectiveness of preventative B-Lynch sutures in patients at high risk for PPH. Their retrospective observational study included 38 of 663 patients who underwent cesarean section (CS) who received the B-Lynch procedure at their tertiary perinatal medical center in Gifu, Japan, between January 2019 and May 2021. Overall, 92% of patients who received the B-Lynch suture showed no apparent postoperative bleeding within 2 hours after the CS. A total of 24 patients required blood transfusion, none required hysterectomy, and only one patient with a twin pregnancy required additional treatment because of secondary PPH 5 days after the CS. This suggests that earlier use of B-Lynch sutures could be considered in patients at high risk for atony.

Gibier and colleagues examined risk factors for uterine tamponade failure in women with PPH. This was a population-based retrospective cohort study of 1761 women with deliveries complicated by PPH who underwent intrauterine tamponade within 24 hours of PPH to manage persistent bleeding. They noted that the intrauterine tamponade failure rate was 11.1%. Risk for intrauterine tamponade failure was higher in women with CS (adjusted odds ratio [aOR] 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-3.9), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0). They concluded that CS, preeclampsia, and uterine rupture were significant risk factors for failures in this procedure.

Sade and colleagues examined trend changes in the individual contribution of risk factors for PPH over more than two decades. Their population-based, retrospective, nested, case-control study included 285,992 pregnancies and suggested that, in their hospital setting in Israel, risks from perineal or vaginal tears were increasing while large-for-gestational-age fetuses decreased and other risk factors remained stable.

Finally, Wu and colleagues examined incidence and outcomes of AHRCP diseases during pregnancy and the puerperium. This observational analysis examined 41,174,101 patients hospitalized for pregnancy and during the puerperium in the National Inpatient Sample (NIS) database from January 1, 2008, to December 31, 2017. The study noted that 40,285 patients were diagnosed with AHRCP diseases during this period. The NIS is the largest publicly available all-payer database in the United States. The investigators found that the incidence of AHRCP diseases increased significantly between 2002 and 2017, especially pulmonary embolism in the puerperium. Although mortality showed a downward trend, it is still at a high level. They suggested that we should strengthen monitoring and management of AHRCP in pregnancy and puerperium, especially for Black women, those in the lowest-income households, and parturients over 35 years of age.

The three PPH articles examine the use of preventive B-Lynch suture, risk factors for failure of intrauterine tamponade, and trend changes in risk factors for PPH. Kuwabara and colleagues looked at the effectiveness of preventative B-Lynch sutures in patients at high risk for PPH. Their retrospective observational study included 38 of 663 patients who underwent cesarean section (CS) who received the B-Lynch procedure at their tertiary perinatal medical center in Gifu, Japan, between January 2019 and May 2021. Overall, 92% of patients who received the B-Lynch suture showed no apparent postoperative bleeding within 2 hours after the CS. A total of 24 patients required blood transfusion, none required hysterectomy, and only one patient with a twin pregnancy required additional treatment because of secondary PPH 5 days after the CS. This suggests that earlier use of B-Lynch sutures could be considered in patients at high risk for atony.

Gibier and colleagues examined risk factors for uterine tamponade failure in women with PPH. This was a population-based retrospective cohort study of 1761 women with deliveries complicated by PPH who underwent intrauterine tamponade within 24 hours of PPH to manage persistent bleeding. They noted that the intrauterine tamponade failure rate was 11.1%. Risk for intrauterine tamponade failure was higher in women with CS (adjusted odds ratio [aOR] 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-3.9), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0). They concluded that CS, preeclampsia, and uterine rupture were significant risk factors for failures in this procedure.

Sade and colleagues examined trend changes in the individual contribution of risk factors for PPH over more than two decades. Their population-based, retrospective, nested, case-control study included 285,992 pregnancies and suggested that, in their hospital setting in Israel, risks from perineal or vaginal tears were increasing while large-for-gestational-age fetuses decreased and other risk factors remained stable.

Finally, Wu and colleagues examined incidence and outcomes of AHRCP diseases during pregnancy and the puerperium. This observational analysis examined 41,174,101 patients hospitalized for pregnancy and during the puerperium in the National Inpatient Sample (NIS) database from January 1, 2008, to December 31, 2017. The study noted that 40,285 patients were diagnosed with AHRCP diseases during this period. The NIS is the largest publicly available all-payer database in the United States. The investigators found that the incidence of AHRCP diseases increased significantly between 2002 and 2017, especially pulmonary embolism in the puerperium. Although mortality showed a downward trend, it is still at a high level. They suggested that we should strengthen monitoring and management of AHRCP in pregnancy and puerperium, especially for Black women, those in the lowest-income households, and parturients over 35 years of age.

The three PPH articles examine the use of preventive B-Lynch suture, risk factors for failure of intrauterine tamponade, and trend changes in risk factors for PPH. Kuwabara and colleagues looked at the effectiveness of preventative B-Lynch sutures in patients at high risk for PPH. Their retrospective observational study included 38 of 663 patients who underwent cesarean section (CS) who received the B-Lynch procedure at their tertiary perinatal medical center in Gifu, Japan, between January 2019 and May 2021. Overall, 92% of patients who received the B-Lynch suture showed no apparent postoperative bleeding within 2 hours after the CS. A total of 24 patients required blood transfusion, none required hysterectomy, and only one patient with a twin pregnancy required additional treatment because of secondary PPH 5 days after the CS. This suggests that earlier use of B-Lynch sutures could be considered in patients at high risk for atony.

Gibier and colleagues examined risk factors for uterine tamponade failure in women with PPH. This was a population-based retrospective cohort study of 1761 women with deliveries complicated by PPH who underwent intrauterine tamponade within 24 hours of PPH to manage persistent bleeding. They noted that the intrauterine tamponade failure rate was 11.1%. Risk for intrauterine tamponade failure was higher in women with CS (adjusted odds ratio [aOR] 4.2; 95% CI 2.9-6.0), preeclampsia (aOR 2.3; 95% CI 1.3-3.9), and uterine rupture (aOR 14.1; 95% CI 2.4-83.0). They concluded that CS, preeclampsia, and uterine rupture were significant risk factors for failures in this procedure.

Sade and colleagues examined trend changes in the individual contribution of risk factors for PPH over more than two decades. Their population-based, retrospective, nested, case-control study included 285,992 pregnancies and suggested that, in their hospital setting in Israel, risks from perineal or vaginal tears were increasing while large-for-gestational-age fetuses decreased and other risk factors remained stable.

Finally, Wu and colleagues examined incidence and outcomes of AHRCP diseases during pregnancy and the puerperium. This observational analysis examined 41,174,101 patients hospitalized for pregnancy and during the puerperium in the National Inpatient Sample (NIS) database from January 1, 2008, to December 31, 2017. The study noted that 40,285 patients were diagnosed with AHRCP diseases during this period. The NIS is the largest publicly available all-payer database in the United States. The investigators found that the incidence of AHRCP diseases increased significantly between 2002 and 2017, especially pulmonary embolism in the puerperium. Although mortality showed a downward trend, it is still at a high level. They suggested that we should strengthen monitoring and management of AHRCP in pregnancy and puerperium, especially for Black women, those in the lowest-income households, and parturients over 35 years of age.

Does Instagram make new moms feel inadequate? Yes, suggests a new study that warns images of new mothers on social media may drive body dissatisfaction and feelings of not being good enough. 

Lead researcher Megan Gow, PhD, a National Health and Medical Research Council early career fellow at the University of Sydney Children’s Hospital Westmead Clinical School, says she wanted to find out if Instagram images reflected the actual population of postpartum women. 

“We were concerned images would be idealized, placing postpartum women, who are already a vulnerable group, at increased risk,” she says.  

The findings, published recently in the journal Healthcare, suggest social media may not be the right platform to target health messages to new moms.
 

A vulnerable time

The months after an infant’s birth are a vulnerable time for new moms. Women contend with huge hormone shifts, sleep deprivation, and a major life change – all while caring for a new child.

A 2021 Nestle study found 32% of parents feel isolated, while a 2017 online poll in the United Kingdom found 54% of new moms felt “friendless.” And according to the American Psychological Association, up to one in seven new mothers will face postpartum depression, while 9% will have posttraumatic stress disorder, according to Postpartum Support International. 

The pandemic may have worsened the isolation new mothers feel. A May 2022 study in the Journal of Psychiatric Research found U.S. rates of postpartum depression rose in the first year of the COVID-19 pandemic.

While new motherhood was stressful enough in the analog age, women today must contend with social media, which increases feelings of isolation. A June 2021 study published in Frontiers in Psychology said social media users between the ages of 26 and 35 reported higher rates of loneliness. That’s in line with Dr. Gow’s study, which noted 39% of Instagram’s monthly active users are women between the ages of 18 and 44. And nearly two-thirds of them – 63% – log onto the platform daily.

“The postpartum phase can feel very isolated, and being vocal about the postpartum shifts that all mothers go through helps set expectations and normalize the experience for those of us who are post partum,” says Catie de Montille, 36, a mother of two in Washington, D.C. 
 

Instagram sets the wrong expectations

Instagram sets unreasonable expectations for new mothers, Dr. Gow and her colleagues found in their study. 

She and her fellow researchers analyzed 600 posts that used #postpartumbody, a hashtag that had been posted on Instagram more than 2 million times by October 2022. Other hashtags like #mombod and #postbabybody have been used 1.9 million and 320,000 times, respectively.

Of the 600 posts, 409 (68%) focused on a woman as the central image. The researchers analyzed those 409 posts to find out if they reflected women’s post-childbirth reality.

They found that more than 9 in 10 posts (91%) showed women who appeared to have low body fat (37%) or average body fat (54%). Only 9% showed women who seemed to be overweight. And the researchers also found just 5% of images showed features commonly associated with a postpartum body, like stretch marks or scars from cesarean sections. 

Women need to be aware that “what is posted on Instagram may not be realistic and is not representative of the vast majority of women in the postpartum period,” Dr. Gow says. 

The images also did not portray women as physically strong.

Dr. Gow’s team examined 250 images for signs of muscularity. More than half, 52%, showed few or no defined muscles. That finding came even though more than half of the original 409 images showed women in fitness attire (40%), underwear (8%), or a bathing suit (5%).

According to Emily Fortney, PsyD, a licensed clinical psychologist in Sacramento, Calif., the study shows that health care workers must work harder to set expectations for new moms. 

“This is a deeper issue of how women are overall portrayed in the media and the pressure we face to return to some unrealistic size,” she says. “We need to be encouraging women to not focus on photos, but to focus on the postpartum experience in an all-encompassing way that includes both physical and mental health.”
 

Childbirth as an illness to overcome? 

While retail brands from Nike to Versace have begun to show a wider range of female shapes in advertisements and on the runway, postpartum women seem to be left out of this movement. Dr. Gow and her fellow researchers referred to a 2012 study that examined images in popular Australian magazines and concluded these photos likened the pregnant body to an illness from which women needed to recover. 

The images posted on Instagram indicate that belief is still pervasive. The images of postpartum women in fitness clothes suggest “that women want to be seen to be exercising as a means of breaking the ‘hold’ that pregnancy had on them or ‘repairing’ their postpartum body,” Dr. Gow and her fellow researchers say. 

New Orleans resident Sydney Neal, 32, a mother of two who gave birth to her youngest child in November 2021, said social media helped shape her view of what “recovery” would be like.

While Ms. Neal said some celebrities like Chrissy Teigen, a mother of two, have “kept it very real” on Instagram, she also “saw a lot of women on social media drop [their weight] quickly and post as if they were back to normal much faster than 6 months.”
 

Body-positive tools for new moms 

Dr. Gow is continuing to study this topic. Her team is currently doing a study that will ask women about social media use, how they feel about their bodies, and how their beliefs change after viewing images tagged with #postpartumbody. (Women with children under the age of 2 can access the survey here.) 

Because of the unrealistic images, Dr. Gow and her team said Instagram may not be a good tool for sharing health information with new moms.

But there are other options. 

Ms. de Montille, whose children were born in 2020 and 2022, used apps like Back to You and Expectful, and she follows Karrie Locher, a postpartum and neonatal nurse and certified lactation counselor, on Instagram. She said these tools focus on the mind/body connection, which “is better than focusing on the size of your jeans.” 

Women also should be able to turn to trusted health care professionals.

“Providers can start speaking about the romanticization of pregnancy and motherhood starting in prenatal care, and they can start speaking more about social media use and the pros and cons of use specifically in the perinatal period,” says Dr. Fortney. “This opens the door to a discussion on a wide range of issues that can actually help assess, prevent, and treat perinatal mood and anxiety disorders.”

Ms. Neal, the mother of two in New Orleans, said she wished her doctor had talked to her more about what to expect after giving birth. 

“I don’t really know how to crack the body image nut, but I think starting in a medical setting might be helpful,” she says.

A version of this article first appeared on WebMD.com.

Does Instagram make new moms feel inadequate? Yes, suggests a new study that warns images of new mothers on social media may drive body dissatisfaction and feelings of not being good enough. 

Lead researcher Megan Gow, PhD, a National Health and Medical Research Council early career fellow at the University of Sydney Children’s Hospital Westmead Clinical School, says she wanted to find out if Instagram images reflected the actual population of postpartum women. 

“We were concerned images would be idealized, placing postpartum women, who are already a vulnerable group, at increased risk,” she says.  

The findings, published recently in the journal Healthcare, suggest social media may not be the right platform to target health messages to new moms.
 

A vulnerable time

The months after an infant’s birth are a vulnerable time for new moms. Women contend with huge hormone shifts, sleep deprivation, and a major life change – all while caring for a new child.

A 2021 Nestle study found 32% of parents feel isolated, while a 2017 online poll in the United Kingdom found 54% of new moms felt “friendless.” And according to the American Psychological Association, up to one in seven new mothers will face postpartum depression, while 9% will have posttraumatic stress disorder, according to Postpartum Support International. 

The pandemic may have worsened the isolation new mothers feel. A May 2022 study in the Journal of Psychiatric Research found U.S. rates of postpartum depression rose in the first year of the COVID-19 pandemic.

While new motherhood was stressful enough in the analog age, women today must contend with social media, which increases feelings of isolation. A June 2021 study published in Frontiers in Psychology said social media users between the ages of 26 and 35 reported higher rates of loneliness. That’s in line with Dr. Gow’s study, which noted 39% of Instagram’s monthly active users are women between the ages of 18 and 44. And nearly two-thirds of them – 63% – log onto the platform daily.

“The postpartum phase can feel very isolated, and being vocal about the postpartum shifts that all mothers go through helps set expectations and normalize the experience for those of us who are post partum,” says Catie de Montille, 36, a mother of two in Washington, D.C. 
 

Instagram sets the wrong expectations

Instagram sets unreasonable expectations for new mothers, Dr. Gow and her colleagues found in their study. 

She and her fellow researchers analyzed 600 posts that used #postpartumbody, a hashtag that had been posted on Instagram more than 2 million times by October 2022. Other hashtags like #mombod and #postbabybody have been used 1.9 million and 320,000 times, respectively.

Of the 600 posts, 409 (68%) focused on a woman as the central image. The researchers analyzed those 409 posts to find out if they reflected women’s post-childbirth reality.

They found that more than 9 in 10 posts (91%) showed women who appeared to have low body fat (37%) or average body fat (54%). Only 9% showed women who seemed to be overweight. And the researchers also found just 5% of images showed features commonly associated with a postpartum body, like stretch marks or scars from cesarean sections. 

Women need to be aware that “what is posted on Instagram may not be realistic and is not representative of the vast majority of women in the postpartum period,” Dr. Gow says. 

The images also did not portray women as physically strong.

Dr. Gow’s team examined 250 images for signs of muscularity. More than half, 52%, showed few or no defined muscles. That finding came even though more than half of the original 409 images showed women in fitness attire (40%), underwear (8%), or a bathing suit (5%).

According to Emily Fortney, PsyD, a licensed clinical psychologist in Sacramento, Calif., the study shows that health care workers must work harder to set expectations for new moms. 

“This is a deeper issue of how women are overall portrayed in the media and the pressure we face to return to some unrealistic size,” she says. “We need to be encouraging women to not focus on photos, but to focus on the postpartum experience in an all-encompassing way that includes both physical and mental health.”
 

Childbirth as an illness to overcome? 

While retail brands from Nike to Versace have begun to show a wider range of female shapes in advertisements and on the runway, postpartum women seem to be left out of this movement. Dr. Gow and her fellow researchers referred to a 2012 study that examined images in popular Australian magazines and concluded these photos likened the pregnant body to an illness from which women needed to recover. 

The images posted on Instagram indicate that belief is still pervasive. The images of postpartum women in fitness clothes suggest “that women want to be seen to be exercising as a means of breaking the ‘hold’ that pregnancy had on them or ‘repairing’ their postpartum body,” Dr. Gow and her fellow researchers say. 

New Orleans resident Sydney Neal, 32, a mother of two who gave birth to her youngest child in November 2021, said social media helped shape her view of what “recovery” would be like.

While Ms. Neal said some celebrities like Chrissy Teigen, a mother of two, have “kept it very real” on Instagram, she also “saw a lot of women on social media drop [their weight] quickly and post as if they were back to normal much faster than 6 months.”
 

Body-positive tools for new moms 

Dr. Gow is continuing to study this topic. Her team is currently doing a study that will ask women about social media use, how they feel about their bodies, and how their beliefs change after viewing images tagged with #postpartumbody. (Women with children under the age of 2 can access the survey here.) 

Because of the unrealistic images, Dr. Gow and her team said Instagram may not be a good tool for sharing health information with new moms.

But there are other options. 

Ms. de Montille, whose children were born in 2020 and 2022, used apps like Back to You and Expectful, and she follows Karrie Locher, a postpartum and neonatal nurse and certified lactation counselor, on Instagram. She said these tools focus on the mind/body connection, which “is better than focusing on the size of your jeans.” 

Women also should be able to turn to trusted health care professionals.

“Providers can start speaking about the romanticization of pregnancy and motherhood starting in prenatal care, and they can start speaking more about social media use and the pros and cons of use specifically in the perinatal period,” says Dr. Fortney. “This opens the door to a discussion on a wide range of issues that can actually help assess, prevent, and treat perinatal mood and anxiety disorders.”

Ms. Neal, the mother of two in New Orleans, said she wished her doctor had talked to her more about what to expect after giving birth. 

“I don’t really know how to crack the body image nut, but I think starting in a medical setting might be helpful,” she says.

A version of this article first appeared on WebMD.com.

Does Instagram make new moms feel inadequate? Yes, suggests a new study that warns images of new mothers on social media may drive body dissatisfaction and feelings of not being good enough. 

Lead researcher Megan Gow, PhD, a National Health and Medical Research Council early career fellow at the University of Sydney Children’s Hospital Westmead Clinical School, says she wanted to find out if Instagram images reflected the actual population of postpartum women. 

“We were concerned images would be idealized, placing postpartum women, who are already a vulnerable group, at increased risk,” she says.  

The findings, published recently in the journal Healthcare, suggest social media may not be the right platform to target health messages to new moms.
 

A vulnerable time

The months after an infant’s birth are a vulnerable time for new moms. Women contend with huge hormone shifts, sleep deprivation, and a major life change – all while caring for a new child.

A 2021 Nestle study found 32% of parents feel isolated, while a 2017 online poll in the United Kingdom found 54% of new moms felt “friendless.” And according to the American Psychological Association, up to one in seven new mothers will face postpartum depression, while 9% will have posttraumatic stress disorder, according to Postpartum Support International. 

The pandemic may have worsened the isolation new mothers feel. A May 2022 study in the Journal of Psychiatric Research found U.S. rates of postpartum depression rose in the first year of the COVID-19 pandemic.

While new motherhood was stressful enough in the analog age, women today must contend with social media, which increases feelings of isolation. A June 2021 study published in Frontiers in Psychology said social media users between the ages of 26 and 35 reported higher rates of loneliness. That’s in line with Dr. Gow’s study, which noted 39% of Instagram’s monthly active users are women between the ages of 18 and 44. And nearly two-thirds of them – 63% – log onto the platform daily.

“The postpartum phase can feel very isolated, and being vocal about the postpartum shifts that all mothers go through helps set expectations and normalize the experience for those of us who are post partum,” says Catie de Montille, 36, a mother of two in Washington, D.C. 
 

Instagram sets the wrong expectations

Instagram sets unreasonable expectations for new mothers, Dr. Gow and her colleagues found in their study. 

She and her fellow researchers analyzed 600 posts that used #postpartumbody, a hashtag that had been posted on Instagram more than 2 million times by October 2022. Other hashtags like #mombod and #postbabybody have been used 1.9 million and 320,000 times, respectively.

Of the 600 posts, 409 (68%) focused on a woman as the central image. The researchers analyzed those 409 posts to find out if they reflected women’s post-childbirth reality.

They found that more than 9 in 10 posts (91%) showed women who appeared to have low body fat (37%) or average body fat (54%). Only 9% showed women who seemed to be overweight. And the researchers also found just 5% of images showed features commonly associated with a postpartum body, like stretch marks or scars from cesarean sections. 

Women need to be aware that “what is posted on Instagram may not be realistic and is not representative of the vast majority of women in the postpartum period,” Dr. Gow says. 

The images also did not portray women as physically strong.

Dr. Gow’s team examined 250 images for signs of muscularity. More than half, 52%, showed few or no defined muscles. That finding came even though more than half of the original 409 images showed women in fitness attire (40%), underwear (8%), or a bathing suit (5%).

According to Emily Fortney, PsyD, a licensed clinical psychologist in Sacramento, Calif., the study shows that health care workers must work harder to set expectations for new moms. 

“This is a deeper issue of how women are overall portrayed in the media and the pressure we face to return to some unrealistic size,” she says. “We need to be encouraging women to not focus on photos, but to focus on the postpartum experience in an all-encompassing way that includes both physical and mental health.”
 

Childbirth as an illness to overcome? 

While retail brands from Nike to Versace have begun to show a wider range of female shapes in advertisements and on the runway, postpartum women seem to be left out of this movement. Dr. Gow and her fellow researchers referred to a 2012 study that examined images in popular Australian magazines and concluded these photos likened the pregnant body to an illness from which women needed to recover. 

The images posted on Instagram indicate that belief is still pervasive. The images of postpartum women in fitness clothes suggest “that women want to be seen to be exercising as a means of breaking the ‘hold’ that pregnancy had on them or ‘repairing’ their postpartum body,” Dr. Gow and her fellow researchers say. 

New Orleans resident Sydney Neal, 32, a mother of two who gave birth to her youngest child in November 2021, said social media helped shape her view of what “recovery” would be like.

While Ms. Neal said some celebrities like Chrissy Teigen, a mother of two, have “kept it very real” on Instagram, she also “saw a lot of women on social media drop [their weight] quickly and post as if they were back to normal much faster than 6 months.”
 

Body-positive tools for new moms 

Dr. Gow is continuing to study this topic. Her team is currently doing a study that will ask women about social media use, how they feel about their bodies, and how their beliefs change after viewing images tagged with #postpartumbody. (Women with children under the age of 2 can access the survey here.) 

Because of the unrealistic images, Dr. Gow and her team said Instagram may not be a good tool for sharing health information with new moms.

But there are other options. 

Ms. de Montille, whose children were born in 2020 and 2022, used apps like Back to You and Expectful, and she follows Karrie Locher, a postpartum and neonatal nurse and certified lactation counselor, on Instagram. She said these tools focus on the mind/body connection, which “is better than focusing on the size of your jeans.” 

Women also should be able to turn to trusted health care professionals.

“Providers can start speaking about the romanticization of pregnancy and motherhood starting in prenatal care, and they can start speaking more about social media use and the pros and cons of use specifically in the perinatal period,” says Dr. Fortney. “This opens the door to a discussion on a wide range of issues that can actually help assess, prevent, and treat perinatal mood and anxiety disorders.”

Ms. Neal, the mother of two in New Orleans, said she wished her doctor had talked to her more about what to expect after giving birth. 

“I don’t really know how to crack the body image nut, but I think starting in a medical setting might be helpful,” she says.

A version of this article first appeared on WebMD.com.

The prosecution concluded its case on Oct. 13 against a nurse from Chester who is on trial for the murder of seven babies and the attempted murder of another 10 babies under her care. Lucy Letby, 32, who worked at the Countess of Chester Hospital, is accused of multiple baby murders in the hospital’s neonatal unit from June 2015 to June 2016. She denies all charges.

Manchester Crown Court heard how Ms. Letby allegedly attempted to kill the children by injecting them with air, milk, or insulin, including two brothers from a set of triplets and one premature baby girl, who was only 98 minutes old.

Prosecutor Nicholas Johnson KC said the circumstances of the girl’s death were “an extreme example even by the standards of this case.”

“There were four separate occasions on which we allege Lucy Letby tried to kill her,” he said. “But ultimately at the fourth attempt, Lucy Letby succeeded in killing her.”
 

Attempts to murder the child ‘cold-blooded’ and ‘calculated’, says prosecutor

In the first alleged attempt, Ms. Letby injected the girl, identified for legal reasons as Child I, with air, but she was “resilient,” said Mr. Johnson. After the second attempt, Ms. Letby had stood in the doorway of Child I’s darkened room and commented that she looked pale. The designated nurse then approached and turned on the light, noticing that the child wasn’t breathing. After a third attempt the child was found to have excess air in her stomach, which had affected her breathing. Child I was then transferred to Arrowe Park Hospital, where she was stabilized before she was returned to Chester.

After the fourth attempt, Child I’s medical alarm rang, leading a nurse to spot Ms. Letby by the child’s incubator. Child I died that morning, said Mr. Johnson, who described the nurse’s attacks as premeditated. “It was persistent, it was calculated, and it was cold-blooded.”

The judge, Mr. Justice Goss, and jury heard how shortly after the parents were told of their child’s death, Ms. Letby approached the mother, who testified that the nurse was “smiling and kept going on about how she was present at the baby’s first bath and how much the baby had loved it.” She also sent a sympathy card to the parents, and the prosecutor says she kept an image of the card on her phone.
 

Doctor interrupted another alleged attempt

Dr. Ravi Jayaram, a paediatric consultant, had become suspicious of Ms. Letby in a number of unexplained child deaths. He later interrupted her as she allegedly tried to kill another baby, identified as Child K. He noticed that the nurse was alone with the baby and walked into the room, seeing Ms. Letby standing over the child’s incubator. He was “uncomfortable” as he had “started to notice a coincidence between unexplained deaths, serious collapses, and the presence of Lucy Letby,” said the prosecutor.

“Dr. Jayaram could see from the monitor on the wall that Child K’s oxygen saturation level was falling dangerously low, to somewhere in the 80s,” said Mr. Johnson. “He said an alarm should have been sounding as Child K’s oxygen levels were falling.” Despite this, the nurse had not called for assistance.

“We allege she was trying to kill Child K when Dr. Jayaram walked in,” Mr. Johnson said, adding that the child’s breathing tube was found dislodged. The prosecutor said it was possible for this to happen in an active baby, but Child K was very premature and had been sedated.

Despite his concerns, Dr. Jayaram did not make a note of his suspicions. Later that morning, Ms. Letby was again at Child K’s incubator calling for help. The nurse was assisting the baby with her breathing and the breathing tube was found to have slipped too far into her throat. The child was transferred to another hospital but later died. Ms. Letby is not accused of Child K’s murder.

However, after the death of Child K, Ms. Letby was moved to day shifts “because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts,” said Mr. Johnson. She was removed from the neonatal ward in June 2016 and moved to clerical duties where she would not come into contact with children.
 

Post-it note: Admission or anguish?

At the end of the prosecution’s presentation, Mr. Johnson mentioned a Post-it on which Ms. Letby had written, “I AM EVIL I DID THIS.” In the defense’s opening statements, Ben Myers KC, said the note was an “anguished outpouring of a young woman in fear and despair when she realises the enormity of what’s being said about her, in a moment to herself.”

He added that the nurse was dealing with employment issues at the time it was written, including a grievance procedure with the NHS Trust where she worked. Another note was shown on screens to the jury, which read: “Not good enough. I’m an awful person. I will never have children or marry. Despair.” and “I haven’t done anything wrong.”

Mr. Myers said that Ms. Letby was the type of person who often scribbles things down and the note was “nothing more extraordinary than that.”

In presenting the defense case, Mr. Myers argued that there was no evidence of Letby hurting the children, and that the prosecution’s case was “driven by the assumption that someone was doing deliberate harm” and that this was combined with “coincidence on certain occasions of Miss Letby’s presence.”

“What it isn’t driven by is evidence of Miss Letby actually doing what is alleged against her,” he added.

“There is a real danger that people will simply accept the prosecution theory of guilt, and that’s all we have so far,” Mr. Myers said. “A theory of guilt based firmly on coincidence – if anything can be based firmly on coincidence.”

A version of this article first appeared on Medscape UK.

The prosecution concluded its case on Oct. 13 against a nurse from Chester who is on trial for the murder of seven babies and the attempted murder of another 10 babies under her care. Lucy Letby, 32, who worked at the Countess of Chester Hospital, is accused of multiple baby murders in the hospital’s neonatal unit from June 2015 to June 2016. She denies all charges.

Manchester Crown Court heard how Ms. Letby allegedly attempted to kill the children by injecting them with air, milk, or insulin, including two brothers from a set of triplets and one premature baby girl, who was only 98 minutes old.

Prosecutor Nicholas Johnson KC said the circumstances of the girl’s death were “an extreme example even by the standards of this case.”

“There were four separate occasions on which we allege Lucy Letby tried to kill her,” he said. “But ultimately at the fourth attempt, Lucy Letby succeeded in killing her.”
 

Attempts to murder the child ‘cold-blooded’ and ‘calculated’, says prosecutor

In the first alleged attempt, Ms. Letby injected the girl, identified for legal reasons as Child I, with air, but she was “resilient,” said Mr. Johnson. After the second attempt, Ms. Letby had stood in the doorway of Child I’s darkened room and commented that she looked pale. The designated nurse then approached and turned on the light, noticing that the child wasn’t breathing. After a third attempt the child was found to have excess air in her stomach, which had affected her breathing. Child I was then transferred to Arrowe Park Hospital, where she was stabilized before she was returned to Chester.

After the fourth attempt, Child I’s medical alarm rang, leading a nurse to spot Ms. Letby by the child’s incubator. Child I died that morning, said Mr. Johnson, who described the nurse’s attacks as premeditated. “It was persistent, it was calculated, and it was cold-blooded.”

The judge, Mr. Justice Goss, and jury heard how shortly after the parents were told of their child’s death, Ms. Letby approached the mother, who testified that the nurse was “smiling and kept going on about how she was present at the baby’s first bath and how much the baby had loved it.” She also sent a sympathy card to the parents, and the prosecutor says she kept an image of the card on her phone.
 

Doctor interrupted another alleged attempt

Dr. Ravi Jayaram, a paediatric consultant, had become suspicious of Ms. Letby in a number of unexplained child deaths. He later interrupted her as she allegedly tried to kill another baby, identified as Child K. He noticed that the nurse was alone with the baby and walked into the room, seeing Ms. Letby standing over the child’s incubator. He was “uncomfortable” as he had “started to notice a coincidence between unexplained deaths, serious collapses, and the presence of Lucy Letby,” said the prosecutor.

“Dr. Jayaram could see from the monitor on the wall that Child K’s oxygen saturation level was falling dangerously low, to somewhere in the 80s,” said Mr. Johnson. “He said an alarm should have been sounding as Child K’s oxygen levels were falling.” Despite this, the nurse had not called for assistance.

“We allege she was trying to kill Child K when Dr. Jayaram walked in,” Mr. Johnson said, adding that the child’s breathing tube was found dislodged. The prosecutor said it was possible for this to happen in an active baby, but Child K was very premature and had been sedated.

Despite his concerns, Dr. Jayaram did not make a note of his suspicions. Later that morning, Ms. Letby was again at Child K’s incubator calling for help. The nurse was assisting the baby with her breathing and the breathing tube was found to have slipped too far into her throat. The child was transferred to another hospital but later died. Ms. Letby is not accused of Child K’s murder.

However, after the death of Child K, Ms. Letby was moved to day shifts “because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts,” said Mr. Johnson. She was removed from the neonatal ward in June 2016 and moved to clerical duties where she would not come into contact with children.
 

Post-it note: Admission or anguish?

At the end of the prosecution’s presentation, Mr. Johnson mentioned a Post-it on which Ms. Letby had written, “I AM EVIL I DID THIS.” In the defense’s opening statements, Ben Myers KC, said the note was an “anguished outpouring of a young woman in fear and despair when she realises the enormity of what’s being said about her, in a moment to herself.”

He added that the nurse was dealing with employment issues at the time it was written, including a grievance procedure with the NHS Trust where she worked. Another note was shown on screens to the jury, which read: “Not good enough. I’m an awful person. I will never have children or marry. Despair.” and “I haven’t done anything wrong.”

Mr. Myers said that Ms. Letby was the type of person who often scribbles things down and the note was “nothing more extraordinary than that.”

In presenting the defense case, Mr. Myers argued that there was no evidence of Letby hurting the children, and that the prosecution’s case was “driven by the assumption that someone was doing deliberate harm” and that this was combined with “coincidence on certain occasions of Miss Letby’s presence.”

“What it isn’t driven by is evidence of Miss Letby actually doing what is alleged against her,” he added.

“There is a real danger that people will simply accept the prosecution theory of guilt, and that’s all we have so far,” Mr. Myers said. “A theory of guilt based firmly on coincidence – if anything can be based firmly on coincidence.”

A version of this article first appeared on Medscape UK.

The prosecution concluded its case on Oct. 13 against a nurse from Chester who is on trial for the murder of seven babies and the attempted murder of another 10 babies under her care. Lucy Letby, 32, who worked at the Countess of Chester Hospital, is accused of multiple baby murders in the hospital’s neonatal unit from June 2015 to June 2016. She denies all charges.

Manchester Crown Court heard how Ms. Letby allegedly attempted to kill the children by injecting them with air, milk, or insulin, including two brothers from a set of triplets and one premature baby girl, who was only 98 minutes old.

Prosecutor Nicholas Johnson KC said the circumstances of the girl’s death were “an extreme example even by the standards of this case.”

“There were four separate occasions on which we allege Lucy Letby tried to kill her,” he said. “But ultimately at the fourth attempt, Lucy Letby succeeded in killing her.”
 

Attempts to murder the child ‘cold-blooded’ and ‘calculated’, says prosecutor

In the first alleged attempt, Ms. Letby injected the girl, identified for legal reasons as Child I, with air, but she was “resilient,” said Mr. Johnson. After the second attempt, Ms. Letby had stood in the doorway of Child I’s darkened room and commented that she looked pale. The designated nurse then approached and turned on the light, noticing that the child wasn’t breathing. After a third attempt the child was found to have excess air in her stomach, which had affected her breathing. Child I was then transferred to Arrowe Park Hospital, where she was stabilized before she was returned to Chester.

After the fourth attempt, Child I’s medical alarm rang, leading a nurse to spot Ms. Letby by the child’s incubator. Child I died that morning, said Mr. Johnson, who described the nurse’s attacks as premeditated. “It was persistent, it was calculated, and it was cold-blooded.”

The judge, Mr. Justice Goss, and jury heard how shortly after the parents were told of their child’s death, Ms. Letby approached the mother, who testified that the nurse was “smiling and kept going on about how she was present at the baby’s first bath and how much the baby had loved it.” She also sent a sympathy card to the parents, and the prosecutor says she kept an image of the card on her phone.
 

Doctor interrupted another alleged attempt

Dr. Ravi Jayaram, a paediatric consultant, had become suspicious of Ms. Letby in a number of unexplained child deaths. He later interrupted her as she allegedly tried to kill another baby, identified as Child K. He noticed that the nurse was alone with the baby and walked into the room, seeing Ms. Letby standing over the child’s incubator. He was “uncomfortable” as he had “started to notice a coincidence between unexplained deaths, serious collapses, and the presence of Lucy Letby,” said the prosecutor.

“Dr. Jayaram could see from the monitor on the wall that Child K’s oxygen saturation level was falling dangerously low, to somewhere in the 80s,” said Mr. Johnson. “He said an alarm should have been sounding as Child K’s oxygen levels were falling.” Despite this, the nurse had not called for assistance.

“We allege she was trying to kill Child K when Dr. Jayaram walked in,” Mr. Johnson said, adding that the child’s breathing tube was found dislodged. The prosecutor said it was possible for this to happen in an active baby, but Child K was very premature and had been sedated.

Despite his concerns, Dr. Jayaram did not make a note of his suspicions. Later that morning, Ms. Letby was again at Child K’s incubator calling for help. The nurse was assisting the baby with her breathing and the breathing tube was found to have slipped too far into her throat. The child was transferred to another hospital but later died. Ms. Letby is not accused of Child K’s murder.

However, after the death of Child K, Ms. Letby was moved to day shifts “because the consultants were concerned about the correlation between her presence and unexpected deaths and life-threatening episodes on the night shifts,” said Mr. Johnson. She was removed from the neonatal ward in June 2016 and moved to clerical duties where she would not come into contact with children.
 

Post-it note: Admission or anguish?

At the end of the prosecution’s presentation, Mr. Johnson mentioned a Post-it on which Ms. Letby had written, “I AM EVIL I DID THIS.” In the defense’s opening statements, Ben Myers KC, said the note was an “anguished outpouring of a young woman in fear and despair when she realises the enormity of what’s being said about her, in a moment to herself.”

He added that the nurse was dealing with employment issues at the time it was written, including a grievance procedure with the NHS Trust where she worked. Another note was shown on screens to the jury, which read: “Not good enough. I’m an awful person. I will never have children or marry. Despair.” and “I haven’t done anything wrong.”

Mr. Myers said that Ms. Letby was the type of person who often scribbles things down and the note was “nothing more extraordinary than that.”

In presenting the defense case, Mr. Myers argued that there was no evidence of Letby hurting the children, and that the prosecution’s case was “driven by the assumption that someone was doing deliberate harm” and that this was combined with “coincidence on certain occasions of Miss Letby’s presence.”

“What it isn’t driven by is evidence of Miss Letby actually doing what is alleged against her,” he added.

“There is a real danger that people will simply accept the prosecution theory of guilt, and that’s all we have so far,” Mr. Myers said. “A theory of guilt based firmly on coincidence – if anything can be based firmly on coincidence.”

A version of this article first appeared on Medscape UK.

Patients with perinatal depression who used a specialized online tool showed improvement in symptoms, compared with controls who received routine care, based on data from 191 individuals.

Although perinatal depression affects approximately 17% of pregnant women and 13% of postpartum women, the condition is often underrecognized and undertreated, Brian Danaher, PhD, of Influents Innovations, Eugene, Ore., and colleagues wrote. Meta-analyses have shown that e-health interventions based on cognitive-behavioral therapy (CBT) can improve depression in general and perinatal depression in particular.

An e-health program known as the MomMoodBooster has demonstrated effectiveness at reducing postpartum depression, and the researchers evaluated the effectiveness of a perinatal version.

In a study published in the American Journal of Obstetrics & Gynecology, the researchers randomized 95 pregnant women and 96 postpartum women who met screening criteria for depression to routine care for perinatal depression, which included a 24/7 crisis hotline and a referral network or PDP plus a version of the MomMoodBooster with a perinatal depression component (MMB2). Participants were aged 18 and older, with no active suicidal ideation. The average age was 32 years; 84% were non-Hispanic, 67% were White, and 94% were married or in a long-term relationship. During the 12 weeks, each of six sessions became accessible online in sequence.

The primary endpoint was the change in outcomes at 12 weeks after the start of the program, with depressive symptom severity measured using the Patient Health Questionnaire (PHQ-9). Anxiety was assessed as a secondary outcome by using the Depression Anxiety Stress Scale. The minimal clinically important difference (MCID) was used to evaluate clinical significance, and was defined as a reduction in PHQ-9 of at least 5 points from baseline.

After controlling for perinatal status at baseline and assessment time, the MMB2 group had significantly greater decreases in depression severity and stress compared with the routine care group. In addition, based on MCID, significantly more women in the MMB2 group showed improvements in depression, compared with the routine care group (43% vs. 26%; odds ratio, 2.12; P = .015).

A total of 88 of the 89 women in the MMB2 group accessed the sessions, and approximately half (49%) viewed all six sessions.

Of the women who used the MMB2 program, 96% said that it was easy to use, 93% said they would recommend it, and 83% said it was helpful to them.

The study findings were limited by several factors including the lack of long-term follow-up data and inability to determine the durability of the treatment effects, the researchers noted. Another key limitation is the demographics of the study population (slightly older and a greater proportion of White individuals than the national average), which may not be representative of all perinatal women in the United States.

However, the results are consistent with findings from previous studies, including meta-analyses of CBT-based programs, the researchers wrote.

“When used in a largely self-directed approach, MMB2 could fill the gap when in-person treatment options are limited as well as for women whose circumstances (COVID) and/or concerns (stigma, costs) reduce the acceptability of in-person help,” they said. Use of e-health programs such as MMB2 could increase the scope of treatment for perinatal depression.
 

Expanding e-health options may improve outcomes and reduce disparities

Perinatal and postpartum depression is one of the most common conditions affecting pregnancy, Lisette D. Tanner, MD, of Emory University, Atlanta, said in an interview. “Depression can have serious consequences for both maternal and neonatal well-being, including preterm birth, low birth weight, and poor bonding, as well as delayed emotional and cognitive development of the newborn.

“While clinicians are encouraged to screen patients during and after pregnancy for signs and symptoms of depression, once identified, the availability of effective treatment is limited. Access to mental health resources is a long-standing disparity in medicine, and therefore research investigating readily available e-health treatment strategies is critically important,” said Dr. Tanner, who was not involved in the study.

In the current study, “I was surprised by the number of patients who saw a clinically significant improvement in depression scores in such a short period of time. An average of only 20 days elapsed between baseline and post-test scores and almost 43% of patients showed improvement. Mental health interventions typically take longer to demonstrate an effect, both medication and talk therapies,” she said.  

“The largest barrier to adoption of any e-health modality into clinical practice is often the cost of implementation and maintaining infrastructure,” said Dr. Tanner. “A cost-effectiveness analysis of this intervention would be helpful to better delineate the value of such of program in comparison to more traditional treatments.”

More research is needed on the effectiveness of the intervention for specific populations, such as groups with lower socioeconomic status and patients with chronic mood disorders, Dr. Tanner said. “Additionally, introducing the program in locations with limited access to mental health resources would support more widespread implementation.”

The study was supported by the National Institutes of Mental Health. The researchers had no financial conflicts to disclose. Dr. Tanner had no financial conflicts to disclose.

Patients with perinatal depression who used a specialized online tool showed improvement in symptoms, compared with controls who received routine care, based on data from 191 individuals.

Although perinatal depression affects approximately 17% of pregnant women and 13% of postpartum women, the condition is often underrecognized and undertreated, Brian Danaher, PhD, of Influents Innovations, Eugene, Ore., and colleagues wrote. Meta-analyses have shown that e-health interventions based on cognitive-behavioral therapy (CBT) can improve depression in general and perinatal depression in particular.

An e-health program known as the MomMoodBooster has demonstrated effectiveness at reducing postpartum depression, and the researchers evaluated the effectiveness of a perinatal version.

In a study published in the American Journal of Obstetrics & Gynecology, the researchers randomized 95 pregnant women and 96 postpartum women who met screening criteria for depression to routine care for perinatal depression, which included a 24/7 crisis hotline and a referral network or PDP plus a version of the MomMoodBooster with a perinatal depression component (MMB2). Participants were aged 18 and older, with no active suicidal ideation. The average age was 32 years; 84% were non-Hispanic, 67% were White, and 94% were married or in a long-term relationship. During the 12 weeks, each of six sessions became accessible online in sequence.

The primary endpoint was the change in outcomes at 12 weeks after the start of the program, with depressive symptom severity measured using the Patient Health Questionnaire (PHQ-9). Anxiety was assessed as a secondary outcome by using the Depression Anxiety Stress Scale. The minimal clinically important difference (MCID) was used to evaluate clinical significance, and was defined as a reduction in PHQ-9 of at least 5 points from baseline.

After controlling for perinatal status at baseline and assessment time, the MMB2 group had significantly greater decreases in depression severity and stress compared with the routine care group. In addition, based on MCID, significantly more women in the MMB2 group showed improvements in depression, compared with the routine care group (43% vs. 26%; odds ratio, 2.12; P = .015).

A total of 88 of the 89 women in the MMB2 group accessed the sessions, and approximately half (49%) viewed all six sessions.

Of the women who used the MMB2 program, 96% said that it was easy to use, 93% said they would recommend it, and 83% said it was helpful to them.

The study findings were limited by several factors including the lack of long-term follow-up data and inability to determine the durability of the treatment effects, the researchers noted. Another key limitation is the demographics of the study population (slightly older and a greater proportion of White individuals than the national average), which may not be representative of all perinatal women in the United States.

However, the results are consistent with findings from previous studies, including meta-analyses of CBT-based programs, the researchers wrote.

“When used in a largely self-directed approach, MMB2 could fill the gap when in-person treatment options are limited as well as for women whose circumstances (COVID) and/or concerns (stigma, costs) reduce the acceptability of in-person help,” they said. Use of e-health programs such as MMB2 could increase the scope of treatment for perinatal depression.
 

Expanding e-health options may improve outcomes and reduce disparities

Perinatal and postpartum depression is one of the most common conditions affecting pregnancy, Lisette D. Tanner, MD, of Emory University, Atlanta, said in an interview. “Depression can have serious consequences for both maternal and neonatal well-being, including preterm birth, low birth weight, and poor bonding, as well as delayed emotional and cognitive development of the newborn.

“While clinicians are encouraged to screen patients during and after pregnancy for signs and symptoms of depression, once identified, the availability of effective treatment is limited. Access to mental health resources is a long-standing disparity in medicine, and therefore research investigating readily available e-health treatment strategies is critically important,” said Dr. Tanner, who was not involved in the study.

In the current study, “I was surprised by the number of patients who saw a clinically significant improvement in depression scores in such a short period of time. An average of only 20 days elapsed between baseline and post-test scores and almost 43% of patients showed improvement. Mental health interventions typically take longer to demonstrate an effect, both medication and talk therapies,” she said.  

“The largest barrier to adoption of any e-health modality into clinical practice is often the cost of implementation and maintaining infrastructure,” said Dr. Tanner. “A cost-effectiveness analysis of this intervention would be helpful to better delineate the value of such of program in comparison to more traditional treatments.”

More research is needed on the effectiveness of the intervention for specific populations, such as groups with lower socioeconomic status and patients with chronic mood disorders, Dr. Tanner said. “Additionally, introducing the program in locations with limited access to mental health resources would support more widespread implementation.”

The study was supported by the National Institutes of Mental Health. The researchers had no financial conflicts to disclose. Dr. Tanner had no financial conflicts to disclose.

Patients with perinatal depression who used a specialized online tool showed improvement in symptoms, compared with controls who received routine care, based on data from 191 individuals.

Although perinatal depression affects approximately 17% of pregnant women and 13% of postpartum women, the condition is often underrecognized and undertreated, Brian Danaher, PhD, of Influents Innovations, Eugene, Ore., and colleagues wrote. Meta-analyses have shown that e-health interventions based on cognitive-behavioral therapy (CBT) can improve depression in general and perinatal depression in particular.

An e-health program known as the MomMoodBooster has demonstrated effectiveness at reducing postpartum depression, and the researchers evaluated the effectiveness of a perinatal version.

In a study published in the American Journal of Obstetrics & Gynecology, the researchers randomized 95 pregnant women and 96 postpartum women who met screening criteria for depression to routine care for perinatal depression, which included a 24/7 crisis hotline and a referral network or PDP plus a version of the MomMoodBooster with a perinatal depression component (MMB2). Participants were aged 18 and older, with no active suicidal ideation. The average age was 32 years; 84% were non-Hispanic, 67% were White, and 94% were married or in a long-term relationship. During the 12 weeks, each of six sessions became accessible online in sequence.

The primary endpoint was the change in outcomes at 12 weeks after the start of the program, with depressive symptom severity measured using the Patient Health Questionnaire (PHQ-9). Anxiety was assessed as a secondary outcome by using the Depression Anxiety Stress Scale. The minimal clinically important difference (MCID) was used to evaluate clinical significance, and was defined as a reduction in PHQ-9 of at least 5 points from baseline.

After controlling for perinatal status at baseline and assessment time, the MMB2 group had significantly greater decreases in depression severity and stress compared with the routine care group. In addition, based on MCID, significantly more women in the MMB2 group showed improvements in depression, compared with the routine care group (43% vs. 26%; odds ratio, 2.12; P = .015).

A total of 88 of the 89 women in the MMB2 group accessed the sessions, and approximately half (49%) viewed all six sessions.

Of the women who used the MMB2 program, 96% said that it was easy to use, 93% said they would recommend it, and 83% said it was helpful to them.

The study findings were limited by several factors including the lack of long-term follow-up data and inability to determine the durability of the treatment effects, the researchers noted. Another key limitation is the demographics of the study population (slightly older and a greater proportion of White individuals than the national average), which may not be representative of all perinatal women in the United States.

However, the results are consistent with findings from previous studies, including meta-analyses of CBT-based programs, the researchers wrote.

“When used in a largely self-directed approach, MMB2 could fill the gap when in-person treatment options are limited as well as for women whose circumstances (COVID) and/or concerns (stigma, costs) reduce the acceptability of in-person help,” they said. Use of e-health programs such as MMB2 could increase the scope of treatment for perinatal depression.
 

Expanding e-health options may improve outcomes and reduce disparities

Perinatal and postpartum depression is one of the most common conditions affecting pregnancy, Lisette D. Tanner, MD, of Emory University, Atlanta, said in an interview. “Depression can have serious consequences for both maternal and neonatal well-being, including preterm birth, low birth weight, and poor bonding, as well as delayed emotional and cognitive development of the newborn.

“While clinicians are encouraged to screen patients during and after pregnancy for signs and symptoms of depression, once identified, the availability of effective treatment is limited. Access to mental health resources is a long-standing disparity in medicine, and therefore research investigating readily available e-health treatment strategies is critically important,” said Dr. Tanner, who was not involved in the study.

In the current study, “I was surprised by the number of patients who saw a clinically significant improvement in depression scores in such a short period of time. An average of only 20 days elapsed between baseline and post-test scores and almost 43% of patients showed improvement. Mental health interventions typically take longer to demonstrate an effect, both medication and talk therapies,” she said.  

“The largest barrier to adoption of any e-health modality into clinical practice is often the cost of implementation and maintaining infrastructure,” said Dr. Tanner. “A cost-effectiveness analysis of this intervention would be helpful to better delineate the value of such of program in comparison to more traditional treatments.”

More research is needed on the effectiveness of the intervention for specific populations, such as groups with lower socioeconomic status and patients with chronic mood disorders, Dr. Tanner said. “Additionally, introducing the program in locations with limited access to mental health resources would support more widespread implementation.”

The study was supported by the National Institutes of Mental Health. The researchers had no financial conflicts to disclose. Dr. Tanner had no financial conflicts to disclose.