Postpartum care: Discussions and counseling for the peripartum period.

BACKGROUND: Traditionally, postpartum care is confined to inpatient care immediately post birth and one appointment approximately six weeks postpartum. Data supports a continuum of care model as best for the health of mother and baby. Despite most women having significant concerns about the postpartum period, these concerns are frequently incompletely addressed by providers. We surveyed prenatal and postpartum patients to understand their concerns and experiences discussing postpartum care with providers. METHODS: Cross sectional surveys were administered between June 2019 and May 2021. Principal component analysis was used to show higher than average (positive) or lower than average (negative) conversations with providers about postpartum care examined by race, education, and parity. Chi squared tests were conducted to examine the significance of specific postpartum concerns. RESULTS: 421/450 patient surveys were analyzed, based on completion. Most patients were White (193), had post graduate degrees (188), privately insured (236), married (248), first time pregnant (152), and used doctors as their primary provider (267). Patients with lower education, higher parity and Black patients without postgraduate degrees reported higher than average postpartum counseling. Additionally, most patients expressed significant concerns about postpartum exhaustion (65.8%), breastfeeding (62.3%), pain (61.2%), physical activity (54.9%) and the baby blues (50.4%). CONCLUSIONS: Postpartum concerns are incompletely and inconsistently addressed amongst patients based on race, parity, and education. A continuum of care approach, beginning in the third trimester, through the postpartum period, may provide better counseling to address all patients' concerns.

Practices of sickle cell disease genetic screening and testing in the prenatal population.

BACKGROUND: Genetic screening and testing are technologies historically underutilized in Black populations despite predicting diseases like sickle cell disease (SCD), which is predominantly found in Blacks. We surveyed prenatal patients to understand choices, beliefs and experiences surrounding genetic screening and testing, specifically for SCD. METHODS: In this cross-sectional study, we surveyed 322 women during prenatal visits. Responses were analyzed to identify barriers to care and education about testing and screening for SCD. Patients rated whether they agreed or disagreed with statements regarding sickle cell health behaviors. We used χ2 tests to compare categorical variables by self-reported race. Binary logistic regression was used to determine the odds ratios and confidence intervals for each outcome. RESULTS: Women were a mean (SD) age of 33.3 (6.1). 42.9% of patients self-identified as White while 41.3% of patients self- identified as Black. Screening questions were adjusted for differences in race, insurance, and education levels to show significant differences in responses between Blacks and Whites for screening for SCD (p = 0.047, OR 95% CI = 0.455 [0.210-0.989]) and plans to meet with genetic counselors (p = 0.049, OR 95% CI = 0.299 [0.090-0.993]). The statements "if sickle cell is not in their family, then it is likely not in themselves or their children," was significantly different between Black and White populations (p = 0.011, OR 95% CI = 0.207 [0.081-0.526]). CONCLUSION: Our findings suggest gaps in screening, testing, education, and pregnancy management choices between Black and White patients. Research should focus on decreasing these healthcare gaps and improving education that address concerns about SCD for relevant populations.

Intestinal gas homeostasis: disposal pathways.

BACKGROUND: Patients with functional gut disorders frequently complain of gas-related symptoms, but the role of intestinal gas in this context is not clear, because intestinal gas homeostasis is incompletely understood. Our aim was to compare the proportion of the gas produced by colonic fermentation that is evacuated per anus and that eliminated via alternative pathways. METHODS: In 20 healthy subjects, gas evacuated per anus was collected for 4 h after a standard flatulogenic test meal. Paired studies were performed without and with high-rate infusion of exogenous gas (24 mL/min) into the jejunum to wash-out of the gut the endogenous gas produced by bacterial fermentation. The exogenous gas infused was labeled (5% SF6) to calculate the proportion of endogenous gas evacuated. KEY RESULTS: In the experiments with gaseous wash-out, 1817 ± 139 mL of endogenous gas was produced over the 4-h study period. However, in the experiments without wash-out (basal conditions), 376 ± 43 mL were evacuated, indicating that only 23 ± 3% of the gas produced was finally eliminated per anus, while the rest (77 ± 3%) had been previously eliminated via alternative pathways. CONCLUSIONS & INFERENCES: Intestinal gas homeostasis is a highly dynamic process by which a large proportion of the gas produced by bacterial fermentation of meal residues is rapidly absorbed into the blood and/or metabolized by gas-consuming microorganisms, and only a relatively modest proportion is eliminated per anus. These data contribute to clarify the complex dynamics of intestinal gas and may help interpret the pathophysiology of gas-related symptoms.