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BACKGROUND: Medicaid, unlike any other insurance mechanism, imposes a consent requirement on female patients desiring sterilization that must be completed at least 30 days, but no more than 180 days, before sterilization. Desired sterilization cannot be completed in the Medicaid population without this consent. Large-scale national evidence is lacking on the effect of this requirement. OBJECTIVE: This study aimed to explore the influence of insurance status on the achievement of postpartum sterilization after a self-reported unwanted birth in a nationally representative sample. STUDY DESIGN: This was a retrospective cohort analysis using data from the 2013-2015 National Survey of Family Growth. The National Survey of Family Growth uses a stratified, multistage clustered sample to make nationally representative estimates for men and women aged 15 to 44 years in the household population of the United States. The analysis was limited to a cohort of birthing people who reported their last birth as unwanted and who were insured by either Medicaid or private insurance. The survey was analyzed with the application of inverse probability of treatment weights to balance those with Medicaid and those with private insurance in addition to the survey weight. The association between completion of postpartum sterilization and insurance type was evaluated using weighted logistic regression, adjusting for demographic and clinical characteristics. RESULTS: In an adjusted and inverse probability of treatment weight balanced analysis of a weighted national sample representing 4,164,304 people (416 respondents), Medicaid-insured birthing people with history of unwanted births were found to have 56% lower odds of obtaining postpartum sterilization (odds ratio, 0.44; 95% confidence interval, 0.22-0.87; P=.019) than those with private insurance. CONCLUSION: This study adds to mounting evidence that insurance type plays a significant role in the achievement of desired postpartum sterilization, with individuals with Medicaid less likely to undergo the procedure. The findings call for policy reforms around sterilization policy in the United States, emphasizing the need for uniform consent procedures that do not discriminate based on insurance status.

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BACKGROUND: Essential Newborn care (ENC) is a High-quality universal newborn health care devised by the World Health Organization for the provision of prompt interventions rendered to newborns during the postpartum period. Even though conducting comprehensive studies could provide a data-driven approach to tackling barriers to service adoption, there was a dearth of studies in Ethiopia that assess the geographical variation and predictors of missing ENC. Hence, this study aimed to identify geographical, individual, and community-level predictors of missing ENC messages at the national level. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey, by using a weighted sample of 7,590 women who gave birth within two years prior to the survey. The spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was checked to figure out the non-randomness of the spatial variation of missing ENC in Ethiopia. Six items of care used to construct a composite index.0of ENC uptake were cord examination, temperature measurement, counselling on danger signs, counselling on breastfeeding, observation of breastfeeding, and measurement of birth weight. To assess the presence of significant differences in the mean number of ENC items across covariates, independent t-tests and one-way ANOVA were performed. Finally, a multilevel multivariable mixed-effect negative binomial regression was done by using STATA version 16. The adjusted incidence rate ratio (aIRR) with its corresponding 95% CI was used as a measure of association and variables with a p-value<0.05 were identified as significant predictors of ENC. RESULTS: The overall prevalence of missing ENC was 4,675 (61.6%) (95% CI: 60.5, 62.7) with a significant spatial variation across regions. The majority of Somali, Afar, south Amhara, and SNNPR regions had statistically significant hotspots for missing ENC. The mean (±SD) number of ENC items received was 1.23(±1.74) with a variance of 3.02 indicating over-dispersion. Living in the poorest wealth quintile (aIRR = 0.67, 95%CI: 0.51, 0.87), lack of Antenatal care (aIRR = 0.52, 95%CI: 0.49, 0.71), birth at home (aIRR = 0.27, 95% CI: 0.17, 0.34), living in rural area (aIRR = 0.39, 95% CI: 0.24, 0.57) were significant predictors of ENC uptake. CONCLUSION: The level of missing ENC was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the government and policymakers should devise strategies for hotspot areas to improve women's economic capabilities, access to education, and health-seeking behaviours for prenatal care and skilled delivery services to improve ENC uptake.

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INTRODUCTION: Postpartum anxiety after childbirth is a common condition among pregnant women due to reasons such as the uncertainty of experiencing pregnancy and childbirth for the first time, or previous negative experiences. Fear of childbirth can affect the mother's baby care process. OBJECTIVE: This study was conducted analytically with a single-subject design to determine the effects of maternal concerns about childbirth and the postpartum period on obsessive and compulsive behaviors related to baby care. MATERIALS AND METHODS: The study was conducted with 260 mothers. Data were collected using a descriptive information form, and the scales 'Fear of Childbirth and Postpartum Period', and 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care'. The data were analyzed using the SPSS™ software to calculate percentages, mean values, t tests, ANOVA, Pearson's correlation, and simple linear regression analysis. RESULTS: A statistically significant and positive correlation was found between participant scores of the 'Fear of Childbirth and Postpartum Period' and the 'Obsessive and Compulsive Behaviors of Mothers in the Postpartum Period Related to Baby Care' scales (p < 0.01). The regression model showed that 18.0% of the total variance in the obsessive and compulsive behaviors of mothers in the postpartum was explained by the fear of childbirth and the postpartum period (corrected R2 = 0.180). CONCLUSIONS: Fear of childbirth and the postpartum period were moderate. However, as the fear of women regarding childbirth and the postpartum period increased, their postpartum obsessive and compulsive behaviors about baby care also increased.

Introducción: La ansiedad del parto y el posparto es una condición común entre las mujeres embarazadas por la incertidumbre de vivir el embarazo y el parto por primera vez o por previas experiencias negativas. El miedo al parto puede afectar el proceso del cuidado del bebé de la madre. Objetivo: Determinar el efecto de las preocupaciones maternas sobre el parto y el puerperio y su efecto sobre las conductas obsesivas y compulsivas relacionadas con el cuidado del bebé. Materiales y métodos: El estudio se realizó con 260 madres. Los datos fueron recolectados en el formulario de información descriptiva y se usaron la "Escala de miedo al parto y al período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionados con el cuidado del bebé". Los datos fueron evaluados mediante el software SPSS™ mediante el cálculo de porcentajes, promedio, prueba t, ANOVA, correlación de Pearson y análisis de regresión múltiple. Resultados: Se encontró una correlación positiva y estadísticamente significativa entre la "Escala de miedo al parto y del período posparto" y la de "Comportamientos obsesivos y compulsivos de las madres en el período posparto relacionadas con el cuidado del bebé" (p < 0.01). En el modelo creado por análisis de regresión se observó que el 18,0% del cambio en la escala de comportamientos obsesivos-compulsivos estaba explicado por el miedo al parto y al puerperio (R2 corregido = 0,180). Conclusiones: En el estudio se determinó que el miedo al parto y al puerperio era moderado. Sin embargo, a medida que aumentaba el puntaje de miedo al parto y al período posparto, también aumentaban los comportamientos obsesivos y compulsivos de las madres en el puerperio relacionados con el cuidado del bebé.

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Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines.

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BACKGROUND: Body image dissatisfaction, leading to a variety of negative emotions and adverse pregnancy or birth outcomes. Studies on body image interventions for pregnant and postpartum women have been reported, yielding mixed results. Existing evidence lacks a comprehensive review of the effectiveness of body image interventions for pregnant and postpartum women. OBJECTIVE: The aim of this study was to systematically review interventions which aimed at improving body image during pregnancy and postpartum in women of childbearing age, and further to explore their effectiveness. METHODS: A comprehensive literature search was conducted using electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, SinoMed, CNKI, and Wanfang Database, to retrieve relevant studies. Body image was reported employing descriptive analysis, whereas the Cochrane Handbook tool was used to evaluate the quality and potential bias of each included study. RESULTS: Following established inclusion and exclusion criteria, 11 studies were identified from an initial 1,422 records for further analysis, involving 1290 participants. This systematic review grouped body image interventions into lifestyle interventions and psychological interventions based on their content. These interventions yielded more pronounced positive effects on improving body image in pregnant and postpartum women when compared to control groups. And, the statistical difference on psychological interventions is more significant on the whole. CONCLUSIONS: Our work offers a comprehensive overview of the effectiveness of body image interventions for pregnant and postpartum women. Psychological interventions are considered to be a suitable measure to improve body image for pregnant or postpartum women. Additional research and practical applications are recommended to enhance the mental health and well-being of perinatal women. TRIAL REGISTRATION: PROSPERO registry: CRD42024531531.

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OBJECTIVE: This review examines skin manifestations in women with spondyloarthritis, with a particular focus on psoriatic arthritis (PsA) and associated psoriasis. METHODS: A narrative review of the bibliography was conducted using the main databases (PubMed, Scopus, EMBASE). RESULTS: The review showed that the clinical course of PsA and psoriasis in women is influenced by hormonal fluctuations that occur at different stages of life, such as menstruation, pregnancy, postpartum, and menopause. Gender differences in the epidemiology of PsA and psoriasis are discussed and attributed to biological, hormonal, and environmental differences. The role of estrogen in modulating immune responses and its impact on the severity of PsA and psoriasis are reviewed. Special emphasis is placed on the psychosocial impact of visible skin lesions on women's quality of life and fertility problems associated with psoriasis. Treatment strategies are also taken into account, favoring personalized approaches that consider the safety of treatments during pregnancy and breastfeeding. CONCLUSIONS: The review highlights the importance of a holistic and gender-sensitive approach to the management of PsA and psoriasis in women, promoting the integration of physical treatment with support for emotional well-being.

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SARS-CoV-2 cell-mediated immunity remains understudied during pregnancy in unvaccinated Black African women living with HIV (WLWH) from low- and middle-income countries. We investigated SARS-CoV-2-specific T-cell responses 1 month following infection in 24 HIV-uninfected women and 15 WLWH at any stage during pregnancy or postpartum. The full-length spike (FLS) glycoprotein and nucleocapsid (N) protein of wild-type (WT) SARS-CoV-2, as well as mutated spike protein regions found in the Omicron variant (B.1.1.529) were targeted by flow cytometry. WT-specific CD4+ and CD8+ T cells elicited similar FLS- and N-specific responses in HIV-uninfected women and WLWH. SARS-CoV-2-specific T-lymphocytes were predominantly TNF-α monofunctional in pregnant and postpartum women living with and without HIV, with fever cells producing either IFN-γ or IL-2. Furthermore, T-cell responses were unaffected by Omicron-specific spike mutations as similar responses between Omicron and the ancestral virus were detected for CD4+ and CD8+ T cells. Our results collectively demonstrate comparable T-cell responses between WLWH on antiretroviral therapy and HIV-uninfected pregnant and postpartum women who were naïve to Covid-19 vaccination. Additionally, we show that T cells from women infected with the ancestral virus, Beta variant (B.1.351), or Delta variant (B.1.617.2) can cross-recognize Omicron, suggesting an overall preservation of T-cell immunity.

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Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenatal, delivery, and postpartum periods. Using all-payer claims data on Medicaid-covered live deliveries in Massachusetts, we used a difference-in-differences approach to compare measures before (the first quarter of 2016 through the fourth quarter of 2017) and after (the third quarter of 2018 through the fourth quarter of 2020) Medicaid ACO implementation among ACO and non-ACO patients. After three years of implementation, the Medicaid ACO was associated with statistically significant increases in the probability of a timely postpartum visit, postpartum depression screening, and number of all-cause office visits in the prenatal and postpartum periods, with no changes in severe maternal morbidity, preterm birth, postpartum glucose screening, or prenatal or postpartum emergency department visits. Changes in cesarean deliveries were inconclusive. Results suggest that implementing Medicaid ACOs in the thirty-eight states without them could improve maternal health care outpatient engagement, but alone it may be insufficient to improve maternal health outcomes.

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AIM: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave. DESIGN: A cross-sectional study. METHODS: This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction. RESULTS: The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction. PATIENT OR PUBLIC CONTRIBUTION: None.

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BACKGROUND: There are many factors effective on occurrence of post-partum anxiety and depression. COVID-19 pandemic, as a major health crisis, affected many countries and had undesirable mental health outcomes, especially for the vulnerable population. The aim of this study was to evaluate the prevalence of post-partum anxiety and depression and their related factors during COVID-19 pandemic. METHODS: The present descriptive cross-sectional study was conducted on 360 mothers who delivered their child during COVID-19 pandemic and had referred to the comprehensive urban health canter of Lenjan city two months after their delivery (from November 10th, 2021, until March 19th, 2022). Data were gathered using 3 questionnaires including demographic characteristics, Edinburgh Postnatal Depression Scale (EPDS), and Beck Anxiety Inventory (BAI). Data were analyzed using SPSS software version 24 and the level of significance was set at p < 0.05. RESULTS: The prevalence of anxiety and post-partum depression was 27% and 20%, respectively. None of the demographic characteristics had a significant relationship with anxiety and depression. Related factors to post-partum anxiety included desired pregnancy, premenstrual syndrome, marital conflicts, history of mother's hospitalization due to COVID-19, compliance rate with preventive health measures for COVID-19, stressful events, and social support. CONCLUSION: It is suggested to screen mothers to detect significant related factors of post-partum anxiety and depression in other future pandemics or epidemics to support them.

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BACKGROUND: Perinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents' lived experiences of social stressors and facilitators of perinatal psychological well-being. METHODS: Participants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed. RESULTS: Sixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care. CONCLUSIONS: Our results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country's social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

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BACKGROUND: Persistent hypertension is common after preeclampsia and is causally tied to later cardiovascular risks. This study examined whether being HIV-infected and on antiretroviral therapy (ART) is associated with persistent postpartum hypertension among women diagnosed with preeclampsia. METHODS: We conducted a six-month prospective cohort study at Kanyama and Women and Newborn hospitals from January 01, 2022, to June 30, 2023, among 190 women diagnosed with preeclampsia (59 HIV-positive, 131 HIV-negative). Sociodemographic and clinical characteristics were collected at delivery, six weeks, three months and six months after giving birth. Persistent hypertension was diagnosed if a participant presented with elevated blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg and/or taking medication for hypertension at the study visit. We used a generalized estimating equation to describe the relationship between treated HIV and persistent hypertension six months following delivery. RESULTS: We retained 136 participants (71.6%) to six months postpartum, at a median age of 30 years. Overall, persistent hypertension at six weeks, three months, and six months postpartum was common (37.4%, 17.1% and 16.9%, respectively). Six-week postpartum prevalence was higher in the HIV group than HIV-negative group (54.6% vs 28.8%, p<0.001), with no measurable difference at three months (24.3% vs 13.2%, p = 0.145) or six months (18.2% vs 16.3%, p = 0.787). Multivariable analysis demonstrates higher odds (adjusted odds ratio [aOR] = 1.68, 95% CI: 1.09-2.60) of persistent hypertension among the HIV+treatment group than HIV-negative counterparts after accounting for age, body mass index and time since delivery. CONCLUSION: We demonstrate an elevated risk of persistent hypertension among postpartum women with comorbid preeclampsia and treated HIV. Peripartum patients in HIV-endemic settings may benefit from timely detection of hypertension and treatment interventions to improve health outcomes.

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To explore the relationship between postpartum psychological disorders and emotion regulation strategies and analyze the influencing factors of postpartum psychological disorders. This study was conducted using a cross-sectional design. A total of 230 postpartum women hospitalized in the Second Affiliated Hospital of Xuzhou Medical University from October 2022 to March 2023 were selected as the investigation objects. A general data questionnaire, Hamilton Anxiety Scale, Hamilton Depression Scale, Pittsburgh Sleep Quality Index, and Emotion Regulation Questionnaire were administered to the enrolled women. Pearson correlation analysis was used to assess the association between the Hamilton Anxiety Scale, Hamilton Depression Scale, Pittsburgh Sleep Quality Index, and Emotion Regulation Questionnaire. Furthermore, logistic regression was employed to assess the influencing factors of postpartum psychological disorders. Pearson correlation analysis showed that cognitive reappraisal was negatively correlated and expression inhibition was positively associated with anxiety, depression, and sleep quality symptoms (all P < .05). Logistic regression results demonstrated that the mode of delivery, number of births, feeding method, and pressure to breastfeed were risk factors affecting postpartum psychological disorders (P < .05). Cognitive reappraisal is an effective emotion regulation strategy that can relieve postpartum psycho-neurological symptoms by reducing the symptoms of anxiety, depression, and sleep disorders. Along with encouraging pregnant women to adopt positive emotional regulation strategies, medical personnel should focus on the stress associated with cesarean section, artificial feeding, and pressure to breastfeed and adopt required intervention measures to decrease the occurrence of postpartum psychological and neurological symptoms.

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This cross-sectional study assesses emergency department (ED) admissions for hypertensive disorders of pregnancy and post partum between 2006 and 2020.

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BACKGROUND: Safety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). METHODS: A subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared. RESULTS: Six hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up. CONCLUSIONS: Markers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/TDF in pregnancy.

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BACKGROUND: Diabetes in pregnancy is associated with short and long-term adverse health outcomes for mothers and babies. The condition disproportionately impacts Pacific, Maaori, and Indian pregnancies. Those with diabetes are offered intensive support during pregnancy, but in many centres, no additional support following birth beyond routine care. The aim of this study was to determine the postpartum needs for mothers and whaanau (family) impacted by diabetes in pregnancy, to inform co-design of a new service to improve metabolic and developmental outcomes for infants. METHODS: Pregnancies complicated by diabetes were identified using a local diabetes registry. Mothers with a diagnosis of GDM or T2DM and gave birth between January 2022 -June 2022 were eligible for the study. A total of 19 parents (18 mothers, 1 father) were interviewed. Participants primarily identified as Maaori (6), Pacific (6), Indian (3), Asian (2), and New Zealand European (2). Interviews took place between December 2022 and February 2023, between 5-13 months post-pregnancy. Interviews facilitated by an externally contracted local Pacific mother, with a professional background in social work were conducted using Koorero and Talanoa, Maaori and Pacific methods of qualitative data collection, to capture the lived experiences of participants. A multidisciplinary group reviewed and coded interview transcripts. Themes were presented back to participants and stakeholders for feedback and refinement. Four over-arching themes were illustrated with exemplar quotes. RESULTS: Four themes described the importance of 1) Finding a balance between what is "best practice" and what is best for me, my baby and my whaanau, 2) The need for individualised and culturally appropriate care, 3) Centrality of whaanau and family to the pregnancy and postpartum journey, 4) The pervasive negative impact of diabetes on taha hinegaro (well-being) beyond childbirth. CONCLUSION: People who are affected by diabetes in pregnancy have ongoing physical, psychological, and social needs. A holistic, whaanau-centred approach is required to ensure optimal health and well-being outcomes of mothers, infants and whaanau. The findings of this study will inform a new targeted model of care for infants and whaanau affected by diabetes in pregnancy.

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A 20's primiparous woman, following spontaneous expulsion of intrauterine death of the fetus at 30 weeks of gestation, presented on post-partum day 8 with acute onset flaccid quadriparesis and breathing difficulty, which had rapidly progressed to involve the legs on day 3 up to her upper limbs on post-partum day 5. Following examination, Guillain Barre Syndrome (GBS) with ascending diaphragmatic involvement was diagnosed, and plasma exchange was initiated. She developed raised blood pressure, headache, sudden onset visual loss with 2 episodes of generalized seizures on post-partum day 14. Brain MRI and clinical suspicion helped diagnose Posterior Reversible Encephalopathy Syndrome (PRES). The patient was treated with anticonvulsants and antihypertensive agents. She regained her vision over the next two days, completed the treatment for GBS, and made a good recovery with independence for advanced activities of daily living on follow-up.

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INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality. The risk of developing cardiovascular diseases following HDP is high. Arterial stiffness is a prognostic indicator for cardiovascular disease in the general population, and it is elevated during pregnancy in women with HDP. No systematic reviews have been conducted to determine if arterial stiffness remains elevated beyond puerperium in these women with HDP. METHODS AND ANALYSIS: We will conduct a systematic literature search in the following electronic databases: Medline, PubMed, Embase, Cochrane Library, Google Scholar, Web of Science and CINAHL. The review will consider studies that investigate arterial stiffness in women who had HPD and are between 43 days and 10 years postdelivery and under 60 years of age. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. Estimates of mean ± SD for arterial stiffness indices (cfPWV, AIx and AIx@75) for the women in the included studies will be obtained. For studies where the estimates were reported as the median and IQR, approximate estimates of mean ± SD will be calculated by using the low and high end of the range, median and sample size. Data from the individual studies will be pooled by use of a random-effects model. The risk of bias assessment will be assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Quality Assessment Scale as appropriate. Sources of heterogeneity will be explored by sensitivity and subgroup analyses. ETHICS AND DISSEMINATION: No ethics approval is required as only published data will be used in this study. The research study's outcomes will be shared through scientific conferences and peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42023461867.

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Patients with low back pain caused by sacroiliac joint (SIJ) dysfunction have an impaired quality of life, due to reported pain, disability and activity limitations. There is increasing evidence that minimally invasive sacroiliac joint fusion (MISJF) results in improvement in pain, disability and quality of life in these patients. Some studies have reported improvements in daily physical activity following MISJF but based on bias-prone self-reports. Our aim was to provide objective data on daily physical activity in patients with SIJ dysfunction. Daily physical activity in daily life of participants was measured using a triaxial accelerometer for seven consecutive days, before surgery and 3 months after surgery. Recorded daily activities were the daily number of events and total time spent sitting or lying, standing, walking, cycling, high-activity and number of steps and sit-to-stand transfers. The quality of life was assessed by the validated Dutch EQ-5D-5 L-questionnaire. No statistical differences were observed between daily physical activity in patients with SIJ dysfunction before and 3 months after MISJF. As compared to matched controls, high-intensity physical activity was lower in both the pre- and postoperative period (p = 0.007) for patients with SIJ dysfunction. The quality of life improved significantly in patients after MSIJF, from 0.418 to 0.797 (p = 0.021) but did not reach the level of controls (1.000). Daily physical activity in patients with postpartum SIJ dysfunction does not improve 3 months following MISJF, while quality of life does improve significantly. The discrepancy between these two observations is food for new research.

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