Emergency department use in the postpartum period: a retrospective cohort study.

Background: Visits to the emergency room (ED) by women in the postpartum period may reflect gaps in postpartum care and disparities in access to obstetric and primary care services. This study aimed to characterize the patients who visited the ED in the first year after delivery, their reasons for coming to the ED, and the care they received. Methods: The electronic health record was reviewed for all patients who delivered at University of Iowa Health Care between 2009 and 2023 and visited the ED within 365 days after delivery. Data drawn directly from the EHR included patient demographics and medical history, pregnancy and delivery information, and newborn characteristics. The charts were then reviewed manually for information regarding ED visits including time from delivery, chief complaint, diagnosis, and disposition. Results: 555 pregnancies had ED visits within one year of delivery, with a total 814 ED visits across the study sample. 46.7% of ED visits occurred in the first 30 days following delivery, and 35% of ED visits for obstetric complaints occurred in the first 2 weeks after delivery. Black patients visited the ED more often (mean=1.84 visits, SD=1.30) than white (mean=1.34, SD=0.92, p<0.001) or Hispanic patients (mean=1.35, SD=0.67, p = 0.004). The most common categories of chief complaint were obstetric (34.6%) and gastrointestinal (18.8%), while the most common categories of diagnosis were obstetric (31.8%) and immune/infectious (28.1%). Conclusions: Visits to the ED are common in the year following delivery. Almost half of these visits occur in the first 30 days after birth. The plurality of postpartum ED visits are due to obstetric complaints, especially in the first few weeks. Black women are more likely to use the ED during this period, potentially due to disparities in healthcare access. These findings suggest that some of these ED visits may be preventable, and that there is room for improvement in post-delivery follow-up, communication between patients and the obstetrics team, and access to outpatient obstetric care.

Excess neonatal testosterone causes male-specific social and fear memory deficits in wild-type mice.

Neurodevelopmental disorders (ND) disproportionately affect males compared to females, and Autism Spectrum Disorder (ASD) in particular exhibits a 4:1 male bias. The biological mechanisms of this female protection or male susceptibility have not been identified. There is some evidence to suggest that fetal/neonatal gonadal hormones, which play pivotal roles in many aspects of development, may contribute. Here, we investigate the role of testosterone administration during a critical period of development, and its effects on social approach and fear learning in C57BL/6J wildtype mice. Male, but not female mice treated with testosterone on the day of birth (PN0) exhibited deficits in both social behavior and contextual fear conditioning, whereas mice treated with the same dose of testosterone on postnatal day 18 (PN18) did not display such impairments. Testosterone administration did not induce anxiogenic effects or lead to changes in body weight compared to the vehicle-treated group. These impairmeants are relevant to ND and may help identify novel treatment targets.

The γ-Protocadherins Interact Physically and Functionally with Neuroligin-2 to Negatively Regulate Inhibitory Synapse Density and Are Required for Normal Social Interaction.

Cell adhesion molecules (CAMs) are key players in the formation of neural circuits during development. The γ-protocadherins (γ-Pcdhs), a family of 22 CAMs encoded by the Pcdhg gene cluster, are known to play important roles in dendrite arborization, axon targeting, and synapse development. We showed previously that multiple γ-Pcdhs interact physically with the autism-associated CAM neuroligin-1, and inhibit the latter's ability to promote excitatory synapse maturation. Here, we show that γ-Pcdhs can also interact physically with the related neuroligin-2, and inhibit this CAM's ability to promote inhibitory synapse development. In an artificial synapse assay, γ-Pcdhs co-expressed with neuroligin-2 in non-neuronal cells reduce inhibitory presynaptic maturation in contacting hippocampal axons. Mice lacking the γ-Pcdhs from the forebrain (including the cortex, the hippocampus, and portions of the amygdala) exhibit increased inhibitory synapse density and increased co-localization of neuroligin-2 with inhibitory postsynaptic markers in vivo. These Pcdhg mutants also exhibit defective social affiliation and an anxiety-like phenotype in behavioral assays. Together, these results suggest that γ-Pcdhs negatively regulate neuroligins to limit synapse density in a manner that is important for normal behavior.