Electroencephalographic Correlates of Mental Performance of Emotional Personal and Scenic Situations: I. Characteristics of Local Synchronization

An electroencephalogram (EEG) was recorded in 19 standard derivations in two groups of subjects (student actors and nonactors) during emotionally positive and negative mental recalls of personal experiences (test 1) or mental reproduction of scenic situations (test 2), as well as during mental count of time. Statistical comparison of EEG spectral power estimations in the frequency bands , , ₁, ₂, ₁, and ₂ showed that the induction of emotionally positive and emotionally negative states led to statistically significant changes in the EEG absolute power (local synchronization) simultaneously in many derivations and frequency bands. Analysis of all possible comparisons and changes in frequency bands showed that bilateral prefrontal and temporal cortical areas are most active during the internal induction of emotional states. Emotionally positive states were characterized, predominantly, by higher local EEG power than emotionally negative states. The EEG power changes accompanying internal induction of emotionally negative and positive states were of the same order in the case of reproduction of a presented situation (scenic material), whereas, in the case of recall of personal experience, emotionally negative states were accompanied by substantially weaker EEG spectral changes than emotionally positive states. The internal induction of emotional states on the basis of scenic material was accompanied by a pronounced increase in the power of the EEG range over the whole cortical surface. EEG reactions to induction of emotional states were generally stronger in actors than in nonactors. In case of emotional induction on the basis of scenic material, qualitative differences in the EEG reactions were also revealed between the groups. The findings are discussed in comparison with known data of investigations into regional cerebral blood flow during internal emotional induction and EEG studies of internal and external emotional induction.     

Pregnancy-related myocardial infarction

Introduction

The risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but also with high neonatal complications. Advancing maternal age and other risk factors for cardiovascular diseases may further increase the risk of ischaemic heart disease in young women.

Methods

We searched the coronary angiography database of a Dutch teaching hospital to identify women with acute myocardial infarction who presented during pregnancy or postpartum between 2011 and 2013.

Results

We found two cases. Both women were in their early thirties and both suffered from myocardial infarction in the postpartum period. Acute myocardial infarction was due to coronary stenotic occlusion in one patient and due to coronary artery dissection in the other patient. Coronary artery dissection is a relatively frequent cause of myocardial infarction during pregnancy. Both women were treated by percutaneous coronary intervention and survived.

Conclusion

Physicians should be aware of the increased risk of myocardial infarction when encountering pregnant or postpartum women presenting with chest pain.

     

Gender-Dependent Frequency–Spatial Organization of the Brain Cortex Activity during Convergent and Divergent Thinking: I. Analysis of the EEG Power

The frequency–spatial organization of the brain cortex activity of men and women was studied during convergent (CTh) and divergent (DTh) thinking by means of EEG power mapping in a broad frequency band. Right-handed 17- to 23-year-old students (36 men and 30 women) participated in the study. Mental arithmetic was used as a model of CTh. Functional changes in the EEG patterns in the ₁ and ₁ frequency bands were distinct in CTh: the activation of the frontal cortical regions with a predominant involvement of right-hemispheric mechanisms of sustained attention was characteristic of the men, whereas, in the women, desynchronization of the ₁ rhythm was shifted to the caudal part of the cortex with a stronger left-hemispheric control over the calculating operations. This difference may be indicative of the involvement of different attention mechanisms and, consequently, the predominant use of the verbal or visuospatial strategies of CTh in men and women. Regardless of the gender, DTh was accompanied by an increase in the EEG power in the ₂ band. The successful performance of a divergent task was determined by different frequency components of the brain activation in men and women. In men, successful performance was associated with a substantial increase in the power of the ₂ rhythm and weak EEG desynchronization in the ₁ band; in women, successful performance was characterized by a lower increase in the amplitude of the ₂ oscillations as compared to noncreative persons and stronger EEG desynchronization in the ₁ band. The reciprocal changes in the power of the ₁ and ₂ rhythms in men and women during successful DTh may reflect the difference in interactions between cortical and subcortical structures in the regulation of voluntary, involuntary, and differential attention.     

EEG Features in Women with a Complicated Pregnancy

Clinical and EEG spectral analysis was carried out in 14 pregnant women (five women at risk of preterm labor and four with miscarriage). It was shown that the baseline EEG pattern of women with the persistent threat of preterm labor was characterized by the high spectral power of the -rhythm and its predisposition to hypersynchronization. In the miscarriage group, virtually a complete absence of the -rhythm and the predominance of generalized both high-frequency and slow low-amplitude rhythms are noted in most pregnant women. The data obtained allow a risk group characterized by either a hypersynchronous unstable -rhythm or its absence to be identified among pregnant women.     

Gender Differences in Hemispheric Spatiotemporal EEG Patterns upon Reproduction of Verbal Information

Changes in EEG power and coherence were studied in ten men and ten women during mental reproduction of dichotically presented lists of words. The EEG was recorded with 14 electrodes located over symmetric points of the left and right hemispheres. In all subjects, the mental reproduction was accompanied by an increase in the power of the ₁ rhythm in the frontal regions and a decrease in the power of the ₁ and ₂ rhythms in the caudal regions of the hemispheres. A decrease in the power of the ₂ rhythm in the caudal regions of the hemispheres was greater in women than in men. Gender differences were also observed in the left- and right-hemispheric coherence reactivity. During word reproduction, men showed a higher EEG coherence in the ₂ band in the right hemisphere, while women displayed a greater increase in the coherence of the ₁ and ₂ rhythms in the left hemisphere. Lateral differences in reactivity of the intrahemispheric coherence in these frequency bands were observed only in women and were caused by a decrease in coherent interactions in the right hemisphere and their increase in the left hemisphere. These gender differences can be associated with different strategies of information memorization: men involve predominantly episodic memory, and women use semantic polymodal encoding.     

EEG correlates of the states of visual and auditory attention in healthy subjects

In order to determine more accurately the EEG markers of different types of attention (AT) of a healthy adult, 14 young healthy subjects (aged 18–30 years) were subjected to spectral coherent analysis of the electrical activity of the brain in the baseline state and during activation of different forms of AT (the orienting response to the sound tone and opening of the eyes, involuntary and voluntary visual AT). In the last two cases, specially developed computer-aided techniques were used. The quantitative differences in the states were assessed on the basis of nonparametric (the Mann-Whitney test) and parametric (Student’s t test) statistics. In three subjects, EEG and fMRI comparisons of the brain response to opening of the eyes were made. It was shown that the activation of different forms of AT in healthy subjects is accompanied by considerable diffuse nonspecific changes in the EEG spectral coherent characteristics (a decrease in the average spectral frequency and power, as well as in coherence) in combination with more local, more often oppositely directed shifts in the region of the cortical representation of the working analyzer. Complex systemic rearrangements of the brain activity involving all components of the activating system, as well as the specifics of different forms of AT connected with the rearrangement of activity between its divisions, are reflected in the diffuse changes of intercentral interaction. For example, marked reactivity of the symmetrical frontopolar (F _p1-F _p2) and the anterotemporal (F ₇-F ₈) cortical areas with unidirectional maximum shifts during voluntary AT is likely to reflect the responses of the frontothalamic component of the activating system. The reciprocity of the behavior of interhemispheric frontopolar and temporal relationships seems to be determined by the activity of its different components: frontothalamic and hippocampal. The local component of the EEG response to opening of the eyes in the form of increased α coherence in the occipital areas is coupled with increased oxygenation of blood in the cortical representation of the visual analyzer (the +BOLD effect of the fMRI response).     

Glucocorticoid receptor gene polymorphisms and disease activity during pregnancy and the postpartum period in rheumatoid arthritis

Introduction

The mechanism underlying the spontaneous improvement of rheumatoid arthritis (RA) during pregnancy and the subsequent postpartum flare is incompletely understood, and the disease course varies widely between pregnant RA patients. In pregnancy, total and free levels of cortisol increase gradually, followed by a postpartum decrease to prepregnancy values. The glucocorticoid receptor (GR) polymorphisms BclI and N363S are associated with relatively increased glucocorticoid (GC) sensitivity, whereas the 9β and ER22/23EK polymorphisms of the GR gene are associated with a relatively decreased GC sensitivity. We examined the relation between the presence of these GR polymorphisms and level of disease activity and disease course of RA during pregnancy and postpartum.

Methods

We studied 147 participants of the PARA study (Pregnancy-Induced Amelioration of Rheumatoid Arthritis study), a prospective study investigating the natural improvement during pregnancy and the postpartum flare in women with RA. Patients were visited, preferably before pregnancy, at each trimester and at three postpartum time points. On all occasions, disease activity was scored by using DAS28. All patients were genotyped for the GR polymorphisms BclI, N363S, 9β, and ER22/23EK and divided in groups harboring either polymorphisms conferring increased GC sensitivity (BclI and N363S; GC-S patients) or polymorphisms conferring decreased GC sensitivity (9β or 9β + ER22/23EK; GC-I patients). Data were analyzed by using a mixed linear model, comparing GC-S patients with GC-I patients with respect to improvement during pregnancy and the postpartum flare. The cumulative disease activity was calculated by using time-integrated values (area under the curve, AUC) of DAS28 in GC-I patients versus GC-S patients. Separate analyses were performed according to the state of GC use.

Results

GC-S patients treated with GC had a significantly lower AUC of DAS28 in the postpartum period than did GC-I patients. This difference was not observed in patients who were not treated with GCs. During pregnancy, GC-S and GC-I patients had comparable levels of disease activity and course of disease.

Conclusions

Differences in relative GC sensitivity, as determined by GR polymorphisms, are associated with the level of disease activity in the postpartum period in GC-treated patients, but they do not seem to influence the course of the disease per se.     

Gender differences in brain networks during verbal Sternberg tasks: A simultaneous near‐infrared spectroscopy and electro‐encephalography study

Gender differences in psychological processes have been of great interest in a variety of fields including verbal fluency, emotion processing and working memory. Previous studies suggested that women outperform men in verbal working memory (VWM). However, the inherent mechanisms are still unclear. To obtain a deeper insight into the gender differences in brain networks in VWM, this study used near‐infrared spectroscopy (NIRS) and electro‐encephalography (EEG) simultaneously to investigate gender‐related brain networks during verbal Sternberg tasks. NIRS results confirmed that women surpass men in VWM from the perspective of both brain activation and connectivity. Results of EEG (effective connectivity and event‐related spectral power) showed that men tend to use a more visuospatial strategy to encode memory. In addition, novel analysis methods of brain networks can provide useful information about the gender specifics of brain functions. Gender‐related pseudo‐color maps constructed from all channels of average HbO₂ activity during low‐ and high‐load tasks (from 0 to 6 seconds after beginning).      

Clinical Presentation and Birth Outcomes Associated with Respiratory Syncytial Virus Infection in Pregnancy

Background

Respiratory syncytial virus (RSV) is the most important cause of viral pneumonia in children worldwide. A maternal vaccine may protect both the mother and infant from RSV illness. The epidemiology and clinical presentation of RSV in pregnant and postpartum women is not well-described.

Methods

Data were collected from a prospective, randomized trial of influenza immunization in pregnant women in rural southern Nepal. Women were enrolled in their second trimester of pregnancy and followed until six months postpartum. Active weekly home-based surveillance for febrile respiratory illness was performed. Mid-nasal swabs collected with episodes of respiratory illness were tested for RSV by real-time polymerase chain reaction.

Results

RSV was detected in 14 (0.4%) illness episodes in 3693 women over 3554 person-years of surveillance from 2011–2014. RSV incidence was 3.9/1000 person-years overall, and 11.8/1000 person-years between September and December. Seven (50%) women sought care for RSV illness; none died. Of the 7 (50%) illness episodes during pregnancy, all had live births with 2 (29%) preterm births and a median birthweight of 3060 grams. This compares to 469 (13%) preterm births and a median birthweight of 2790 grams in women without RSV during pregnancy. Of the 7 mothers with postpartum RSV infection, RSV was detected in 4 (57%) of their infants.

Conclusions

RSV was an uncommon cause of febrile respiratory illness in mothers during pregnancy in Nepal. These data will inform prevention and therapeutic strategies against RSV in resource-limited settings.     

Characteristic Features of EEG Spectral Characteristics in Persons with Deviant Sexual Behavior

The study was performed with participation of 59 right-handed men. The normal group consisted of 19 subjects, and 40 patients with organic brain lesions who had commited sexual offenses were divided into two groups: 19 patients with a diagnosis of paraphilia (pathology of sexual drive) made up the main test group, and 21 patients without such a diagnosis formed the control group. A monopolar EEG was recorded in 16 standard leads in the states of rest (eyes closed) and general activation (eyes open) and during presentation of cognitive tests. The following EEG features manifest in all the frequency ranges and functional states were revealed in the group of patients with paraphilias as compared to the control groups: a substantially increased level of interhemispheric coherence (ICoh) and increased spectral density in the posterotemporal area (T ₅, T ₆), a significantly decreased ICoh level between the F _3/4 and C _3/4 leads in the frontocentral area, and lower spectral densities in the leads Fp ₂, C ₄, and P ₄. Analysis of reactions to loads presented showed that the general arousal in the group of patients with paraphilias was characterized by significantly greater shifts of EEG parameters associated with the desynchronization reaction (as compared to the control groups) and statistically significant disorders of interhemispheric interaction and EEG reactivity in the right hemisphere in the range during performance of a visuospatial (right-hemispheric) task. The results suggest the formation of a stationary activation focus in the right hemisphere with signs of involvement of the limbic structures in patients with paraphilias.     

Biological Principles of Individual Differences in the Temperament of Children in the Second Half of the First Year of Life. Communication III: Psychophysiological Principles of Excitability and Activity

Correlations between individual differences in EEG characteristics of attention control systems and temperamental traits of children at the age of 11 months were studied. A sample of 88 healthy mono- and dizygotic twins at the ages of 10 to 11.5 months was examined. The EEG was recorded in the state of sustained attention to visual stimulus. Temperamental features were estimated by the Balleyguier's Questionnaire. Dependence of the scores on each of the basic temperamental traits (excitability, activity, and sociability) on the amplitudes of spectral frequency bands in 12 EEG leads was determined. To this end, the standard and stepwise linear regression techniques and multivariate discriminant analysis with training and test samples were applied. The intrapair correlations in mono- and dizygotic twins were compared in order to analyze the nature of individual differences in spectral characteristics of the EEG range. The main results are as follows. In 11-year-old children in the state of attention, the interindividual variability of spectral amplitudes in the band of the EEG recorded from the main cortical areas is caused, predominantly, by genetic factors. The extent of excitability inversely depends on the level of synchronization in the basic range (6.8–7.6 Hz), which includes both the rhythm in the retrosplenial cortical leads and the rhythms in the anterocentral cortical areas during sustained attention. The degree of passiveness is directly correlated with the level of synchronization in the higher subrange (8.4–8.8 Hz) of the rhythm in the anterocentral cortical areas during visual attention. It is suggested that certain individual differences in the temperament of one-year-old children are genetically determined by specific features of the inhibitory control over the functional state of the brain cortex.     

Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

Background

Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection.

Methods and Findings

We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0–4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001). Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5–2.1) or postpartum women (HR 1.1, 95% CI 0.6–1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2–3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2–4.4). However, the small number of studies limited power to detect associations and sources of heterogeneity.

Conclusions

Pregnancy and the postpartum period are times of persistent HIV risk, at rates similar to “high risk” cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT. Please see later in the article for the Editors'' Summary     

Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal,Population-Based Study

Background

Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.

Methods

A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.

Results

After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.

Limitations

Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.

Conclusions

Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.     

Changes in EEG Power Spectra During Biofeedback of Slow Cortical Potentials in Epilepsy

The goal of the study was to explore parallel changes in EEG spectral frequencies during biofeedback of slow cortical potentials (SCPs) in epilepsy patients. Thirty-four patients with intractable focal epilepsy participated in 35 sessions of SCP self-regulation training. The spectral analysis was carried out for the EEG recorded at the same electrode site (Cz) that was used for SCP feedback. The most prominent effect was the increase in the 2 power (6.0–7.9 Hz) and the relative power decrement in all other frequency bands (particularly 1, 2, and 2) in transfer trials (i.e., where patients controlled their SCPs without continuous feedback) compared with feedback trials. In the second half of the training course (i.e., sessions 21–35) larger power values in the , , and bands were found when patients were required to produce positive versus negative SCP shifts. Both across-subject and across-session (within-subject) correlations between spectral EEG parameters, on the one hand, and SCP data, on the other hand, were low and inconsistent, contrary to high and stable correlations between different spectral variables. This fact, as well as the lack of considerable task-dependent effects during the first part of training, indicates that learned SCP shifts did not directly lead to the specific dynamics of the EEG power spectra. Rather, these dynamics were related to nonspecific changes in patients' brain state.     

A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines

Background

The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care.

Methods

A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed.

Results

The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test.

Conclusion

We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services.     

A correlation of EEG characteristics of pregnant women with the level of their anxiety

It has been shown that the EEG of pregnant women with high anxiety level is characterized by a lower occipital alpha and theta rhythm spectral power if compared to the EEG of women with low anxiety level. The frequency of the alpha rhythm of their EEG was reliably higher. Pregnant women with high anxiety level with a pregnancy interruption threat diagnosis have an essentially lower occipital alpha rhythm spectral power than women of this group without such a diagnosis. And vice versa, the occipital alpha rhythm spectral power in the EEG of pregnant women with low anxiety level with a pregnancy interruption threat diagnosis is essentially higher and its frequency essentially lower than the EEG of women without that diagnosis. The data received are interpreted as a change in hormone regulation during the pregnancy period, as well as psychogenic influence on the pregnancy.     

EEG Spectral Characteristics in Junior Schoolchildren with Learning Problems

EEG spectral characteristics were studied in two age groups (7–8.5 and 8.5–10 years) of mentally healthy children and children with learning problems at rest and during performance of a Raven test. It was shown that slow frequencies are more pronounced in the EEG of 7- to 8.5-year-old children with learning problems than in EEG of healthy children of the same age group. An immature form of EEG activation, i.e., an increase not only in the but also in the frequencies during activity, was characteristic of these children. The reaction of the activation of the definitive type develops between the 8.5–10 years of age. This reaction is correlated with an increase in the efficiency of the sensory perceptive and sensorimotor activity. The distinctive feature of children with learning problems between 8.5–10 years of age is a greater expression of slow frequencies in the baseline EEG of the frontal (in particular, left frontal) areas of the cortex. The obtained results are considered as a reflection of a retardation of the functional maturation of the brain structures responsible for the deficit of involuntary and voluntary attention and the disorder of a systemic organization of perception and analytical–synthetic brain activity as compared to the normal age characteristics. Possible neurophysiological mechanisms responsible for learning problems in junior schoolchildren are discussed on the basis of the obtained results and evidence from the literature.     

Energy Metabolism and Spectral EEG Characteristics of Students with Different Neuroticism and Anxiety Levels in an Examination Stress Situation

Characteristics of the energy metabolism, external ventilation, and spectral characteristics of the EEG in an examination situation were studied in students with high and low neuroticism and situational anxiety. Higher energy expenditures, CO₂ concentration, and the value of O₂ in the exhaled air were observed in students with high neuroticism and situational anxiety during the stressful preexam situation. In addition, they were characterized by more pronounced -rhythm in the EEG spectra on right derivations and -rhythm in EEG spectra of both frontal and right central and parietal regions of the cortex. High values of the respiratory quotient, flow rate, and respiration frequency were observed in students with low neuroticism and situational anxiety before the examination at heightened energy expenditures. They did not display a more pronounced - and -rhythms in EEG spectra of the analyzed cortex areas.     

The effect of high-intensity breastfeeding on postpartum glucose tolerance in women with recent gestational diabetes

Background

Although breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes.

Methods

In this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum.

Results

Among 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n?=?70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n?=?18) (46% vs. 78%, p?=?0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41?±?1.02 vs. 2.28?±?1.05, p?=?0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding.

Conclusions

In Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.

     

Efficacy of Enhanced HIV Counseling for Risk Reduction during Pregnancy and in the Postpartum Period: A Randomized Controlled Trial

Introduction

Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants.

Methods

Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n = 733) and control arms (n = 747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum.

Results

There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0^.71–1^.44) or HIV-positive participants (aRR 0^.86, 95% CI 0^.61–1^.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0^.72,95% CI 0^.59–0^.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67–1.75).

Discussion

An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01683461","term_id":"NCT01683461"}}NCT01683461