Postpartum Fatigue and Inhibited Lactation

Background: Postpartum fatigue is a common disorder worldwide and affects both physical and mental functioning. In breastfeeding women, Prolactin (PRL) is not only involved in immunoregulation, but also responsible for lactation. Prolactin levels in women with chronic fatigue are higher than normal, but a chronic fatigue state inhibits postpartum lactation in humans. Objectives: This paper explored the inhibition mechanism of lactation by postpartum fatigue in rats. Methods: Postpartum fatigue models were built by forcing mother rats to stand in water and divided into 3-hour, 9-hour and 15-hour per day fatigue groups according to the underwater time. Mother rats and their offspring were reunited in a dry cage for 90 minutes every 3 hours for feeding. The expression of PRL, PRL receptor (PRLR), Janus Kinase 2 (JAK 2), and Signal transducers and activators of transcription 5 (STAT5) mRNA were analyzed and the microstructure of mammary gland were observed under light and electron microscopy. Results: The expression of pituitary PRL mRNA and its downstream signaling pathway JAK2 and STAT5 mRNA were down-regulated in the severe postpartum fatigue rats. PRL mRNA responses were dose-related to duration of fatigue. The expression of PRLR mRNA increased. Postpartum fatigue led to functional degeneration of mammary gland. The breast lobules were shrunk and the number of alveoli were decreased. Few milk protein granules and fat droplets were observed in the cytoplasm under transmission electron microscope. Conclusion: Postpartum fatigue inhibits the lactation by down-regulating the expression of PRL and PRL-dependent signaling pathway in rats.

HUBUNGAN KELELAHAN POSTPARTUM DENGAN MOTIVASI PEMBERIAN ASI

THE WOMEN'S CONDITION AFTER CHILDBIRTH UNDERGOES PHYSICAL AND PSYCHOLOGICAL CHANGES. CHANGES AFTER CHILDBIRTH CAUSE FATIGUE IN THE POSTPARTUM PERIOD. POSTPARTUM FATIGUE MAKES THE MOTIVATION OF BREASTFEEDING DECREASE. THIS STUDY AIMS TO FIND OUT THE RELATIONSHIP OF FATIGUE WITH MOTIVATION FOR BREASTFEEDING IN THE POSTPARTUM PERIOD. THE DESIGN OF THIS STUDY WAS A QUANTITATIVELY ANALYTICAL CORRELATION WITH A CROSSECTIONAL APPROACH PERFORMED ON 95 POSTPARTUM MOTHERS WITH PURPOSIVE SAMPLING TECHNIQUES. THE QUESTIONNAIRES USED ARE THE POSTPARTUM FATIGUE SCALE (PFS) AND BREASTFEEDING MOTIVATIONAL INSTRUCTIONAL MEASUREMENT SCALE (BMIMS). STATISTICAL ANALYSIS USES THE SPEARMAN RHO TEST WITH SIGNIFICANCE P<0.05. THE RESULTS OF THIS STUDY SHOWED THAT POSTPARTUM MOTHERS WHO EXPERIENCED HIGH LEVELS OF FATIGUE AS MUCH AS 91 (95.8%), MODERATE AS MUCH AS 2 (2.1%), LOW AS MANY AS 2 (2.1%) RESPONDENTS. THE MOTIVATION LEVEL OF BREASTFEEDING WAS LOW BY 50 (52.6%), AND THE MOTIVATION OF BREASTFEEDING WAS LOW AS MUCH AS 40 (47.4%) RESPONDENTS. THE CONCLUSION OF THIS STUDY THERE IS A SIGNIFICANT ASSOCIATION BETWEEN FATIGUE AND MOTIVATION OF BREASTFEEDING IN POSTPARTUM (P = 0.001). HEALTH SERVICE ARE EXPECTED TO IMPROVE THE QUALITY OF SERVICE IN THE POSTPARTUM PERIOD BY ASSESSING POSTPARTUM FATIGUE EARLY TO INCREASE MATERNAL MOTIVATION IN BREASTFEEDING.

Effectiveness of non-pharmacological interventions for reducing postpartum fatigue: a systematic review protocol

IntroductionPostpartum fatigue is a common symptom among new mothers after their pregnancy. It has a considerable negative impact on women’s functional and mental status as well as the development of babies. Identifying effective interventions to prevent or reduce postpartum fatigue is meaningful to improve the quality of life and avoid adverse outcomes of this vulnerable population. This systematic review aims to synthesise non-pharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperas.Methods and analysisThis review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will systematically search the Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases to identify clinical trials implementing non-pharmacological interventions conducted during 0–78 weeks postpartum for fatigue reduction. An additional search of OpenGrey will be conducted to identify grey literature. The search will be performed on 30 March 2021 without restrictions on time and language. Two independent reviewers will be responsible for study selection, data extraction and study quality assessment. The Cochrane risk-of-bias tool will be adopted to evaluate the risk biases of the included randomised controlled trials, and the Risk of Bias in Non-randomised Studies of Interventions will be applied to evaluate non-randomised controlled trials. Any disagreements will be referred to a third reviewer to reach a consensus. Findings will be qualitatively synthesised, and a meta-analysis will be conducted for the statistical combination if outcome data are sufficient and available.Ethics and disseminationThis systematic review will not involve the collection of primary data and will be based on published data. Therefore, ethics approval is not required. The final findings will be disseminated through peer-reviewed journals and academic conferences.PROSPERO registration numberCRD42021234869

Does a nurse-led postpartum self-care program for first-time mothers in Bangladesh improve postpartum fatigue, depressive mood, and maternal functioning?: a non-synchronized quasi-experimental study

Purpose: This study aimed to test the efficacy of a nurse-led postpartum self-care (NL-PPSC) intervention at reducing postpartum fatigue (PPF) and depressive mood and promoting maternal functioning among first-time mothers in Bangladesh.Methods: A non-synchronized quasi-experimental design was used. First-time mothers were recruited during postpartum (PP) and assigned to the experimental or control group (34 each). The experimental group attended the NL-PPSC—a 1-day intervention that focused on increasing self-efficacy—at a hospital in person. The control group received usual care. Data on PPF, depressive mood, maternal functioning, self-care behaviors, PP self-efficacy, and self-care knowledge were collected at 2 weeks PP (attrition 23.5%) and 6 weeks PP (attrition 16.1%). Data were analyzed using descriptive statistics, bivariate statistics, and linear mixed model analysis.Results: One-third (33.3%) of new mothers experienced depressive mood (Edinburgh Postnatal Depression Scale scores of ≥13 points). The NL-PPSC intervention statistically significantly decreased PPF (β=–6.17, SE=1.81, t=–3.39, p<.01) and increased maternal functioning at 6 weeks PP in the experimental group (β=13.72, t=3.73, p<.01) as opposed to the control group. Knowledge was also statistically significant for increased maternal functioning over time (β=.37, SE=.18, t=2.03, p<.05). However, no statistically significant differences in PP depressive mood were observed over time.Conclusion: The NL-PPSC intervention was feasible and effective at improving fatigue and maternal functioning in Bangladeshi mothers at 6 weeks PP. PP care knowledge was effective at improving maternal functioning; this finding supports the implementation of the NL-PPSC intervention for new mothers after childbirth.

Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: a meta-analysis

Background Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. This meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae. Methods The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until June 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions conducted during 0 ~ 78 weeks postpartum for fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. Cohen’s kappa coefficient was used to measure inter-rater agreement. The meta-analysis was conducted using Review Manager 5.3. Results Seventeen published clinical trials matched the eligibility criteria and ten studies involving 1194 participants were included in this meta-analysis. The intervention start time varied from immediately postpartum care to 1 year after delivery, and duration ranged from 1 day to 3 months. The results revealed that exercise (SMD = − 1.74, 95% CI = -2.61 to − 0.88) and drinking tea (MD = − 3.12, 95% CI = -5.44 to − 0.80) resulted in significant improvements in women’s postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD = − 2.89, 95% CI = -4.30 to − 1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed. Physical therapies including mother-infant skin-to-skin contact, taking warm showers and breathing lavender oil aroma were used for reducing postpartum fatigue. No significant risk of publication bias was found. Small number of included studies and sample sizes, not time-matched conditions of control groups, high heterogeneity and the risk of bias within the included studies were the main limitations of our review. Conclusions This review provides evidence that exercise and drinking tea may be effective nonpharmacological interventions for relieving postpartum fatigue. More effective and targeted exercise programs need to be further studied. Rigorous RCTs of drinking tea are needed. Caution is required when interpreting the findings due to the limitations of our study. Further studies are still needed to validate our findings and increase confidence in the results.

Construction and Evaluation of a Rat Model of Postpartum Fatigue

<b><i>Objectives:</i></b> The aim of the study was to construct and evaluate a rat model of postpartum fatigue. <b><i>Design:</i></b> This is an article about animal model building. <b><i>Methods:</i></b> Sprague-Dawley rats on the 1st day after delivery were randomized into control group and fatigue group. The deep sleep of rats was interfered with by forcing them to stand in water, to make the rats experience mental and physical fatigue. To maintain galactosis and lactation, rats and pups were caged for 90 min after every 3 h of separation. The control group was separated routinely without any stimulus. The model was evaluated from mental and physical fatigue on the 8th day and 15th day. The mental fatigue was evaluated by a water maze test and the rat’s 5-hydroxytryptamine (5-HT) level in hippocampus, while the physical fatigue was evaluated using lactic acid level in serum and duration of weight-loaded forced swimming. <b><i>Results:</i></b> Among the 7-day and 14-day modeling groups, compared with the control group, the success rate of water maze landing was significantly decreased, the time for water maze landing was significantly prolonged and 5-HT level in hippocampus significantly decreased in the fatigue group. With respect to physical fatigue, among the 7-day and 14-day modeling groups, the lactic acid level in serum in the fatigue group was significantly increased, and the duration of exhaustive swimming of rats was significantly shortened. <b><i>Limitations:</i></b> A small sample size was the main limitation of this study. <b><i>Conclusions:</i></b> We have successfully constructed a rat model of postpartum fatigue by forcing postpartum rats to stand in water, which was similar to a level of stress that contributes to the development of postpartum fatigue. Our model opens the door for future studies evaluating the effectiveness of pharmacological and behavioral therapies.

The Factors Influencing Fatigue of Postpartum Mothers

Background: Postpartum mothers are likely to experience physical and psychological changes. A new role as a parent provides new tasks for mothers in baby care. Most postpartum mothers experience fatigue after labor. Postpartum fatigue is affected by the baby and family. This study aims to identify factors associated with postpartum fatigue.Method: A cross-sectional study was designed. The sample in this research was 102 postpartum mothers who lived with her family in Bantul Yogyakarta. They were taken by using simple random sampling. The data were collected through the Postpartum Fatigue Scale (PFS), infant characteristic questionnaire (ICQ), and social support questionnaire. Factors associated with postpartum fatigue were analyzed using multiple logistic regressions.Results: Most of the respondents had a moderate level of fatigue (48%). Social support was found significant as the determinant factor of postpartum mother (AOR=4,38, 95% CI 1,709 – 11,256, p= 0,002).Conclusion: Respondents with a low social support level showed a significantly higher level of postpartum fatigue than respondents with good social support. It is essential to assist the family in helping mothers in infant care and postpartum care in the postpartum period. The factor associated with postpartum fatigue included infant temperament and family income.

Effectiveness of nonpharmacological interventions for reducing postpartum fatigue: A systematic review and meta- analysis

Background: Postpartum fatigue is the most common issue among postnatal women and it could not only seriously affect the health of mothers but also bring about adverse impacts on their offspring. However, postpartum fatigue is an ongoing research issue but is seldom treated. This systematic review and meta-analysis aims to synthesize nonpharmacological evidence and evaluate the effectiveness of interventions for reducing postpartum fatigue among puerperae.Methods: The Cochrane Library, PubMed, Embase, Web of Science, PsycINFO, CINAHL and ProQuest databases were searched for papers published from inception until February 2021. Grey literature was searched using OpenGrey. Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) evaluating nonpharmacological interventions for postpartum fatigue reduction were eligible for inclusion. The methodological quality of the included studies was independently assessed by two reviewers using the Cochrane risk-of-bias tool and the risk of bias in nonrandomized studies of interventions. The meta-analysis was conducted using Review Manager 5.3.Results: Seventeen published clinical trials matched the eligibility criteria for the systematic review, and thirteen studies involving 1686 participants were included in this meta-analysis. The results of the meta-analysis revealed that exercise (SMD= -1.74, 95% CI=-2.61 to -0.88), physical therapy (SMD= -0.50, 95% CI=-0.96 to -0.03) and drinking tea (MD= -3.12, 95% CI=-5.44 to -0.80) resulted in significant improvements in women’s postpartum fatigue at postintervention. Drinking tea may have beneficial effects on depression (MD= -2.89, 95% CI=-4.30 to -1.49). Positive effects of psychoeducational interventions on postpartum fatigue or depression were not observed.Conclusions: This review provides evidence that exercise, physical therapy and drinking tea are effective nonpharmacological interventions for relieving postpartum fatigue. Detailed instructions for postpartum exercise should be offered to puerperae. Physical therapy could be used in combination to enhance the intervention efficacy. Multiple daily cups of tea may be recommended. Psychoeducational interventions were ineffective for postpartum fatigue, but they could be integrated with the internet or smartphones to improve their effectiveness in the future. Fatigue-related nonpharmacological interventions of psychological outcomes still need to be studied.