Postpartum depression (PPD) is a common complication following childbirth, affecting approximately 10–20
Abstract Background Women on probation (community supervision) report high rates of adverse childhood experiences (ACEs) and ongoing trauma, yet little research has examined how trauma across the life course relates to perinatal outcomes during community supervision. This study examined associations between lifetime trauma and perinatal violence, infant separation, and postpartum mood symptoms among women who experienced pregnancy, childbirth, and postpartum while on probation. Methods We conducted a cross-sectional secondary analysis from N = 60 women in South-Central Texas who had a pregnancy within the past five years while on community supervision. Trauma exposures included selected ACEs and adulthood/perinatal trauma (domestic, intimate partner, and sexual violence). Outcomes were perinatal violence, permanent infant removal after childbirth, and postpartum mood symptoms (PHQ-2/GAD-2). We used logistic regression to examine associations between trauma exposures and outcomes; given the ordinal structure of key trauma measures, we used Kendall’s tau to estimate correlations between cumulative ACEs/lifetime trauma and perinatal outcomes. Results Participants spent an average of 5 years (SD = 3) on community supervision, and most reported partner violence ( n = 52, 87%); no mental health care in the year prior to their last arrest ( n = 55, 92%); and possible major depressive disorder ( n = 20, 33%) and generalized anxiety disorder ( n = 34, 57%). ACE prevalence included caregiver incarceration ( n = 34, 56%), physical abuse ( n = 25, 42%), witnessing abuse ( n = 27, 45%), foster care ( n = 17, 8%), and childhood sexual abuse ( n = 29, 48%); 25% reported four ( n = 9, 16%) or five ( n = 6, 10%) ACEs. Cumulative ACE exposure was correlated with perinatal violence ( p = 0.03), and childhood forced sexual intercourse was associated with perinatal violence ( p = 0.04). Trauma in adulthood was associated with permanent infant removal ( p = 0.003). Sexual violence in adulthood was correlated with cumulative ACE exposure and postpartum mood symptoms ( p = 0.006). Conclusions Trauma across the life course is associated with perinatal violence, infant removal, and postpartum mood symptoms among women on community supervision. Trauma-informed, gender-responsive perinatal and community supervision interventions are needed to improve safety, mental health, and family stability. Trial registration NA
To investigate the effects of a one-day diabetes clinic management model combined with probiotic supplementation in patients with gestational diabetes mellitus (GDM). A total of 682 patients diagnosed with GDM who received prenatal care at our hospital between January 2023 and May 2024 were enrolled in this study. All participants underwent oral glucose tolerance test (OGTT) screening at 24–28 weeks of gestation and attended the one-day diabetes clinic management program. Patients were divided into a probiotic group and a control group based on oral probiotic administration. Propensity score matching (PSM) was performed to balance baseline characteristics between the two groups. Generalized estimating equations (GEE) were applied to analyze intergroup differences and temporal trends in blood glucose, lipid metabolism, and inflammatory markers. Pearson correlation analysis was used to examine maternal and neonatal perinatal outcomes. After PSM, no statistically significant differences were observed in baseline characteristics between the two groups (P > 0.05). Generalized estimating equation (GEE) analyses revealed significant group-by-time interaction effects for fasting blood glucose (FPG) and C-reactive protein (CRP). After Benjamini–Hochberg false discovery rate (FDR) correction for multiple testing, lower levels of FPG and CRP were observed in the probiotic group at several follow-up time points, with group differences emerging gradually over the intervention period. Triglycerides showed only a nominally significant group effect without adjustment. Total gestational weight change differed statistically between the two groups. GEE analyses indicated weak crude associations between probiotic supplementation, maternal group B streptococcal colonization (GBS), and neonatal jaundice; however, these associations were no longer statistically significant following FDR correction. Probiotic supplementation combined with one-day diabetes clinic management was associated with lower FPG and CRP levels among women with GDM. Weak associations between probiotic use, maternal GBS colonization and neonatal jaundice disappeared after adjustment for multiple testing, and these findings can only be used to generate hypotheses. As an observational study, this analysis cannot confirm clinical benefits of probiotics. All observed findings represent exploratory associations, which require further verification in randomized controlled trials. This observational study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500100649) on April 11, 2025. Registration was delayed because the research team was initially unaware that registration is mandatory for observational clinical studies.
Abstract Introduction Gestational diabetes increases the risk of neonatal macrosomia, which is associated with maternal and neonatal morbidity. However, the definition of macrosomia is inconsistent and includes both a fixed weight limit and a gestational age-dependent percentile. This study aimed to evaluate the association between different definitions of macrosomia and short-term neonatal outcome in pregnancies complicated by gestational diabetes. Material and methods In this retrospective single-center cohort study, 882 women with gestational diabetes and a singleton pregnancy were included. Adverse neonatal outcome was defined as 5-min Apgar score below eight and/or admission to the neonatal intensive care unit. We compared three different definitions of macrosomia: 1.) birthweight ≥ 4000 g, 2.) birthweight > 90th percentile, and 3.) length-related birthweight > 90th percentile. Eutrophic newborns served as controls and small-for-gestational-age infants were excluded. Additionally, umbilical artery Doppler parameters were explored. Results Overall, 220 out of 882 newborns (24.9%) met at least one definition of macrosomia: 129 (14.6%) with birthweight ≥ 4000 g, 126 (14.3%) with birthweight > 90th percentile, and 205 (23.2%) with length-related birthweight > 90th percentile. Short-term adverse neonatal outcome occurred in 6.2% ( n = 55). In the total cohort, macrosomia was not associated with adverse outcome. Newborns with a birthweight > 90th percentile showed a higher, but not statistically significant, rate of adverse outcome (odds ratio (OR) 1.5 [0.8–3.1], p = 0.231). In analyses restricted to macrosomic infants, those with birthweight > 90th percentile had higher rates of adverse outcome compared with those ≤ 90th percentile (8.7% vs. 1.1%; OR 8.9, 95% CI 1.1–70.2). This remained associated after adjustment for preterm birth (adjusted OR 8.8, 95% CI 1.1–71.4), although preterm birth was the strongest overall predictor. The effect was mainly observed in infants weighing < 4000 g. Umbilical artery Doppler showed limited predictive value. Conclusions Macrosomia represents a heterogeneous group not uniformly associated with adverse short-term neonatal outcome. Within this cohort, birthweight > 90th percentile, particularly in infants < 4000 g, was associated with higher rates of adverse outcome, whereas fixed weight thresholds were not. Gestational age–adjusted definitions may better identify at-risk neonates.
BACKGROUND: Radiofrequency ablation of the mitral isthmus (MI) is unreliable. Vein of Marshall (VOM) ethanol infusion can improve MI ablation success and eliminate local MI autonomic innervation. The role of pulsed field ablation (PFA) in MI ablation and its autonomic effect is unclear. We evaluated the transmurality of endocardial PFA at the MI and its autonomic effects, using real-time epicardial VOM electrograms and VOM high-frequency stimulation. METHODS: Patients undergoing atrial fibrillation ablation (n=71) were prospectively enrolled. MI ablation (endocardial to VOM) was delivered using FaraPulse (N=31), PulseSelect (N=9), or Affera (N=31) while monitoring VOM epicardial electrograms to assess transmurality, defined as VOM signal elimination after 20 minutes. MI block was assessed using differential pacing from the left atrial appendage and VOM. High-frequency stimulation from the VOM was performed before and after PFA. VOM ethanol infusion was administered when MI ablation was incomplete. RESULTS: Endocardial PFA led to durable epicardial electrogram attenuation in 52.1% (FaraPulse in 38.7%, PulseSelect in 44.4%, and Affera in 67.7%; P <0.05). Myocardial capture with VOM pacing persisted in 43.7% (FaraPulse in 45.2%, PulseSelect in 100%, and Affera in 25.8%; P <0.05). Pseudoblock (epicardial-only MI conduction and MI delays) was present in 38%. MI block was achieved with PFA alone in 45% (32/71) of patients; VOM ethanol infusion achieved MI block in an additional 38% (27/71) of patients for a cumulative 83% (59/71); and coronary sinus ablation was used in the remaining 17% (12/71). After PFA, VOM high-frequency stimulation elicited intact parasympathetic responses evidenced as atrioventricular block. CONCLUSIONS: Across all 3 PFA platforms, endocardial ablation of the MI is not reliably transmural and does not ablate VOM parasympathetic innervation. VOM ethanol infusion can complete transmurality and denervation of the MI.
