A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews.

Postpartum depression (PPD) adversely affects the health and well being of many new mothers, their infants, and their families. A comprehensive understanding of biopsychosocial precursors to PPD is needed to solidify the current evidence base for best practices in translation. We conducted a systematic review of research published from 2000 through 2013 on biological and psychosocial factors associated with PPD and postpartum depressive symptoms. Two hundred fourteen publications based on 199 investigations of 151,651 women in the first postpartum year met inclusion criteria. The biological and psychosocial literatures are largely distinct, and few studies provide integrative analyses. The strongest PPD risk predictors among biological processes are hypothalamic-pituitary-adrenal dysregulation, inflammatory processes, and genetic vulnerabilities. Among psychosocial factors, the strongest predictors are severe life events, some forms of chronic strain, relationship quality, and support from partner and mother. Fully integrated biopsychosocial investigations with large samples are needed to advance our knowledge of PPD etiology.

Biological and Psychosocial Predictors of Postpartum Depression: Systematic Review and Call for Integration

Depression is the most common psychiatric disease among women, exhibiting a prevalence which is 2-3x higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. A dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis is the most prominent endocrine change seen in depression and normalization of the HPA axis is a major target of recent therapies. Females exhibit different stress sensitivities than males which might contribute to their increased vulnerability for depression. Maternal stress or depression during pregnancy and/or postpartum is particularly concerning as early developmental influences can affect the maturation of the offspring as well as the mental health of the mother. Despite the urgent need for more information on depression in females, especially during pregnancy and postpartum, most animal models of depression have utilized only males. Given the sex differences in incidence of depression and treatment, it is vitally important to create or validate animal models of depression in females. This review will focus on the association between stress, glucocorticoids and depression in humans, with a special focus on depression in women during pregnancy and postpartum and on animal models of postpartum depression and the consequences for the offspring.

Depression during pregnancy and postpartum: contribution of stress and ovarian hormones.

Colorectal cancer is the second leading cause of cancer death in the United States, and the number of new cases annually is approximately equal for men and women. Several nutritional factors are likely to have a major influence on risk of this cancer. Physical inactivity and excessive adiposity, especially if centrally distributed, clearly increase the risk of colon cancer. Hyperinsulinemia may be an important underlying risk factor. In conjunction with obesity and physical inactivity, which induce a state of insulin resistance, certain dietary patterns that stimulate insulin secretion, including high intakes of red and processed meats, saturated and trans-fats, and highly processed carbohydrates and sugars, may increase the risk of colon cancer. There is evidence suggesting that some component of red meat may independently increase the risk of colorectal cancer, and some micronutrients may be important as protective agents. Currently, the evidence is strongest for folate and calcium. Folate may be especially important in alcohol drinkers because alcohol appears to increase the risk, particularly when folate intake is low. This interaction may be related to the antifolate properties of alcohol. In contrast to earlier studies, more recent epidemiologic studies have generally not supported a strong influence of dietary fiber or fruits and vegetables, although these have other health benefits, and their consumption should be encouraged. The majority of colon cancers, as well as many other conditions, may be prevented by lifestyle alterations in the intake of these nutritional factors, in addition to other factors, such as smoking.

Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidence.

Postpartum maternal health care is a neglected aspect of women's health care. This neglect is evident in the limited national health objectives and data related to maternal health. Missed opportunities for enhancing the health care of postpartum women occur in the scope of routine postpartum care. Differing perceptions of maternal needs between nurses and new mothers also contribute to inadequate health care. Therefore, collecting national data on postpartum maternal morbidity, reforming postpartum care policies, providing holistic and flexible maternal health care, encouraging family support and involvement in support groups, and initiating educational programs are recommended. Further research is needed on issues related to postpartum maternal health.

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Continuing education module: postpartum maternal health care in the United States: a critical review.

Background Previous research suggests early postpartum fatigue (PPF) plays a significant role in the development of postpartum depression (PPD). Predicting risk for PPD via early identification of PPF may provide opportunity for intervention. Objective To replicate and extend previous studies concerning the impact of PPF on symptoms of PPD and to describe the relationships among PPF, PPD, and other variables using the theory of unpleasant symptoms. Design Correlational, longitudinal study. Setting Participants' homes. Participants Convenience sample of 42 community-dwelling women recruited before 36 weeks of pregnancy. Main Outcome Measures PPF, depressive symptoms, and stress measured during prenatal weeks 36 to 38, and on Days 7, 14, and 28 after childbirth. Salivary cortisol was measured as a physiological marker of stress. Results Significant correlations were obtained between PPF and symptoms of PPD on Days 7, 14, and 28, with Day 14 PPF levels predicting future development of PPD symptoms in 10 of 11 women. Perceived stress, but not cortisol, was also correlated with symptoms of PPD on Days 7, 14, and 28. Women with a history of depression had elevated depression scores compared to women without, but no variable was as effective at predicting PPD as PPF. Conclusions Fatigue by Day 14 postpartum was the most predictive variable for symptoms of PPD on Day 28 in this population.

/pdf/the-impact-of-fatigue-on-the-development-of-postpartum-kjxg6ppplr.pdf

The Impact of Fatigue on the Development of Postpartum Depression

Research on faculty orientation programs: Guidelines and directions for nurse educators

Where are the leaders

Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.

https://www.jognn.org/article/S0884-2175(15)34216-7/pdf

Obesity and Nutrition in Women Throughout Adulthood

Because nutrition plays a critical role in infant growth and development, healthcare providers need current and accurate information in order to address parental concerns about infant nutrition. Although the benefits of breastfeeding are well recognized, mothers may decide not to breastfeed, and parents may have concerns about when to introduce foods other than human milk or formula. Findings from several studies indicate that parents continue to have questions related to infant feeding throughout infancy. Because nurses interact with parents during pregnancy, labor, birth, the postpartum, and routine infant care visits, nurses are a natural choice for parents to gain information about their babies. This article presents an update on select issues related to term infant nutrition, and specifically examines formula feeding, nutrient supplementation, introduction of solids, the use of juices, the vegetarian mother and infant, and infant colic.

Karen Morin

Papers

The Impact of Fatigue on the Development of Postpartum Depression

Research on faculty orientation programs: Guidelines and directions for nurse educators

Where are the leaders

Obesity and Nutrition in Women Throughout Adulthood

Current thoughts on healthy term infant nutrition: the first twelve months.