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Why we need to start prioritising postpartum care

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With some studies suggesting as many as six out of seven women miss vital postnatal visits, FemTech World investigates why we need to change the narrative around postpartum recovery.

Sandra Wirström was working in the digital health sector in Sweden when she had her two daughters. She experienced birth injuries both times and she was surprised by the lack of data and support around post-natal care.

“I had to fight for every single piece of information and every single doctor appointment. I was extremely frustrated that nothing has been digitalised when it comes to the postpartum care,” says Sandra.

Sandra’s experience applies to hundreds of women across the UK. Recent figures show that six out of seven new mothers in England are not getting a check-up of their health six weeks after giving birth, despite such appointments becoming a new duty on the NHS. Of those who attend one, only 15 per cent have a dedicated consultation with a GP to discuss their physical and mental health, according to the National Childbirth Trust (NCT).

Another US study from the American College of  Obstreticians and Gynecologists revealed that as many as 40 per cent of women do not attend a postpartum medical visit after giving birth.

“Nothing has been done when it comes to postpartum digitalisation,” says Sandra. “So, about a year ago when I was on one of my walks with my second daughter, I thought ‘okay, we need to do something about this and change the narrative around postpartum care’.”

Soon after that Sandra met Astrid Gyllenkrok Kristensen, who was as passionate about women’s health as Sandra and like so many other mothers out there, struggled with the physical and emotional recovery process after giving birth.

They decided to set up LEIA, an app co-developed with midwives and medical experts that offers women personalised physical and mental health support during the postpartum months, also known as the fourth trimester.

“There are hundreds of apps to help you during pregnancy and everyone asks you how you feel,” says Astrid. “Post-delivery, you are left on your own in what seems to be the most overwhelming and sometimes traumatising time of your life. Out of 140 million women giving birth each year 90 per cent will experience emotional or physical difficulties, from breastfeeding complications to postnatal depression and pelvic dysfunction.

“When we started looking into this, we found that there were a couple of key issues leading to women struggling in silence,” Astrid continues. “The lack of digitalisation that Sandra mentioned is one of them, along with the lack of medical experts. Women do not get the information they need. They end up self-diagnosing and they have no idea who to turn to. There’s no structure and globally, the healthcare chain is very fragmented.

“There’s also a massive stigmatisation in society surrounding postpartum. The narrative, especially in Sweden, is that you’re supposed to give birth, and then within a week, go for power walk and have friends over.”

A study from the polling company Survation, revealed that 85 per cent of the 893 mothers in England interviewed over a month said their appointments were mainly or equally about the baby’s health and they did not get the chance to talk to the GP about their mental wellbeing.

Astrid says: “One of the problems of women are not getting the health care they need is because the healthcare system is not focused on the women’s perspective and is not based on their needs.

“Studies show us that suicide is now one of the leading causes of death in new mothers, up to one year after giving birth and this is something that shows the acceleration of the problem. The system is broken.”

The pandemic has only amplified this. Research by the Maternal Mental Health Alliance shows that more mothers than usual have been struggling during the pandemic because restrictions on social contact means they have been denied support from family and friends, which has led to more anxiety and loneliness.

LEIA is an app based on science and self-lived experiences of motherhood. Astrid explains that: “Together with both private and public health care, we created a medical advisory board to make sure that we achieve our primary focuses to create a solution and meet the needs of new mothers.”

“Before going into the product, what we wanted to do was to create an app that would help by giving women AI or data driven insights about their emotional and physical health, to help understand what’s going on in their head, what’s going on in their body and what the recovery process in the fourth trimester is.

“But we also wanted to include the partner within that experience, because men are also getting diagnosed with depression. Seeing it as a unit and not just pinpointing the woman, is something that we feel is integral for a healthy recovery.”

Astrid highlights how crucial postpartum check-ups really are when it comes to mental health.

“One of the key things during these visits is to screen women for postnatal depression, which is normally done face-to-face with a questionnaire called EPDS – Edinburgh Postnatal Depression Scale. With LEIA, we’ve digitalised screening models for both postnatal depression, but also pelvic dysfunction, identifying women in risk at a much earlier stage. This means even before giving birth, we’ll be able to identify women at risk of postnatal depression.”

However, changing the narrative around postpartum care is as important as offering women the support they need.

Astrid says that: “Most people understand the first three trimesters and the changes in the women’s bodies because that narrative has been established.

“So, we want to establish a narrative around postpartum as well. People need to know that there’s a physical recovery and it takes a year for the body to recover after childbirth. We think that by educating people about the recovery process we can normalise it and start breaking down the stigma.”

Sandra adds: “There’s been a boom in the femtech market focusing on fertility and pregnancy.

“In the past years, there has been a digital transformation in areas such as fertility,  period tracking and menopause. However, there are still a lot of things to do, especially when it comes to postpartum care. We’re still not getting educated enough about what is happening in our body after giving birth.”

LEIA’s data-driven approach aims to influence improvements in public health.

Globally, research data on postpartum care is limited. Amid a lack of awareness of postpartum conditions, however, investment in further studies and in developing options which address postpartum symptoms is also limited, says Astrid.

“We all know that politics is driven by economics,” she says.

“By collecting this data, we will be able to show how the lack of investment and support is actually affecting women. We have to put a number on the problem before they actually start looking into it.”

Sandra agrees: “It’s not only our perspective and our motivation, we are in fact putting the mothers in focus in everything we do by building an app for the mothers out there.”

Clearly, fundamental changes will be required to adequately address postpartum challenges in future. The success of LEIA in starting a conversation around postpartum care is, however, an important first step in driving this change.

Find out more about LEIA here.

 

 

 

 

Pregnancy

More than half of women with gestational diabetes face harmful stigma, research reveals

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More than half of women with gestational diabetes report stigma from healthcare staff, family, friends and wider society, new research shows.

A survey of 1,800 UK women found widespread emotional distress at diagnosis of the condition, a form of high blood sugar that develops during pregnancy, with effects lasting beyond birth.

Gestational diabetes affects around one in 20 pregnancies in the UK, and the findings highlight the wider toll on women diagnosed with the condition.

The study was funded by Diabetes UK and led by researchers at King’s College London and University College Cork.

Dr Elizabeth Robertson, director of research and clinical at Diabetes UK, said: “Stigma can have a dangerous and devastating impact on pregnant women diagnosed with gestational diabetes, particularly at a time when emotions and anxieties may already be heightened.

“We know that stigma can lead to shame, isolation and poorer mental health, and may discourage people from attending healthcare appointments, potentially increasing the risk of serious complications.

“This research highlights the urgent need for better support systems, based on understanding and empathy to ensure no one feels blamed or judged during their pregnancy.”

More than two-thirds of women, 68 per cent, reported anxiety at diagnosis, while 58 per cent felt upset and 48 per cent experienced fear.

The psychological impact continued beyond birth, with 61 per cent saying the condition negatively affected their feelings about future pregnancies.

Nearly half of women, 49 per cent, felt judged for having gestational diabetes, while 47 per cent felt judged because of their body size.

More than 80 per cent felt other people did not understand gestational diabetes, and more than a third, 36 per cent, concealed their diagnosis from others.

Gestational diabetes stigma was also common in healthcare settings, with 48 per cent reporting that professionals made assumptions about their diet and exercise, and more than half, 52 per cent, feeling judged based on their blood glucose results.

Many women described a loss of control and a sense of disruption during pregnancy.

Nearly two-thirds, 64 per cent, felt they were denied a normal pregnancy, while 76 per cent reported a lack of control over their pregnancy.

More than a third, 36 per cent, felt abandoned by healthcare services after giving birth, and one in four, 25 per cent, continued to experience depression or anxiety postpartum.

Focus group participants described harmful stereotypes, including assumptions that they were ‘lazy’, had ‘poor eating habits’ or ‘lacked willpower’.

Comments from family and friends included remarks such as “should you be eating that?” and “you must have eaten too much, that’s why you have gestational diabetes.”

The researchers are calling for targeted interventions alongside structured emotional support for women during and after pregnancies affected by gestational diabetes, to improve both mental and physical health outcomes.

Professor Angus Forbes, lead researcher from King’s College London, said: “Stigma and emotional distress are far more common in women diagnosed with gestational diabetes than many realise.

“Everyday interactions, even with those who mean well, can deepen this harm, shaping women’s emotional wellbeing and the choices they feel able to make.

“It’s clear that meaningful action is needed to protect women’s mental and physical health.”

Risk factors for gestational diabetes include living with overweight or obesity, having a family history of type 2 diabetes, and being from a South Asian, Black or African Caribbean or Middle Eastern background.

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Mental health

Lifting weights shows mental health and cognitive benefits in older women, study finds

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Weightlifting can improve memory and mental health in older women, whether they lift heavier or lighter weights, a clinical trial has found.

The study suggests structured exercise could offer a non-drug way to help protect the ageing mind.

As people age, physical abilities often decline and the risk of cognitive impairment rises.

Women can also face a higher risk of depression and anxiety later in life because of menopause, hormonal changes and shifting social factors.

Over time, poor mental health can speed up physical and cognitive decline.

Medical professionals often recommend cardiovascular and resistance training to help preserve physical independence.

Beyond building muscle and strength, lifting weights may also help protect the brain.

The research team recruited 120 women with an average age of 68 who were not taking part in any structured exercise programmes.

Before the intervention, independent cardiologists screened the volunteers using diagnostic stress tests to make sure they could take part safely.

The researchers then divided the women into three equal groups based on their baseline physical strength to ensure a balanced comparison.

The first group followed a resistance training programme using heavier weights for eight to 12 repetitions.

The second performed the same exercises using slightly lighter weights for 10 to 15 repetitions. The third acted as a control group and remained sedentary throughout the trial.

For three months, the active groups visited the university fitness facility three mornings a week.

Under the direct supervision of qualified fitness experts, participants completed three sets of eight different full-body exercises. These included weight machines and free weights, with movements such as chest presses, leg extensions, seated rows and bicep curls.

As the women grew stronger over the 12 weeks, supervisors progressively increased the weight they lifted.

This ensured participants stayed within their assigned repetition range while maintaining proper breathing and movement technique. Researchers also told all participants not to start any new exercise outside the laboratory setting.

The scientists carried out a broad set of cognitive and psychological tests before the programme began and again shortly after it ended.

They used the Montreal Cognitive Assessment to measure spatial skills, short-term memory and language processing.

The team also used several standardised surveys to track symptoms of geriatric depression and general anxiety.

Other tests assessed executive function, the mental processes involved in planning, focusing attention and multitasking.

In the Trail Making Test, the women had to connect a scattered sequence of numbers and letters as quickly as possible to assess cognitive flexibility.

In another verbal test, they had to name as many words beginning with the letter F, or as many animals as possible, within 60 seconds.

The researchers also used a computerised Stroop test to assess inhibitory control. In this visual test, the women saw words such as “red” or “black” displayed in conflicting ink colours, such as green.

They had to suppress the automatic urge to read the word and instead press a button matching the ink colour.

After the three-month intervention, both groups of weightlifters showed clear improvements in their test scores.

Their performance on the overall cognitive assessment rose, and their reaction times in executive function tests fell substantially.

The control group showed no such improvements, and in some categories their mental performance worsened slightly.

The structured exercise also reduced the severity of mood disorders among the active participants.

Scores for depressive symptoms fell by roughly 34 per cent in the lower repetition group and 24 per cent in the higher repetition group. Anxiety scores fell by more than 40 per cent in both groups.

The researchers said these improvements met the threshold for a clinically meaningful difference.

In practical terms, that means the psychological benefits were large enough for the women to notice in their daily emotional state.

The trial found no major differences in outcomes between the two repetition strategies, suggesting both intensities worked equally well against cognitive decline.

The study has several caveats that may shape future research into the neurological benefits of structured exercise.

The testing relied heavily on self-reported psychological surveys, which can be affected by subjective bias or temporary changes in mood.

The team also did not closely track differences in the women’s light daily physical activity outside the gym.

The researchers also said the social structure of the fitness programme may have contributed to the emotional benefits.

For 12 weeks, the active participants exercised in a shared, supportive environment, with regular contact with peers and supervisors.

This kind of consistent social interaction can help reduce loneliness and provide psychological relief.

Future trials will need to isolate whether different exercise durations or extra social interaction change these positive neural effects.

Even so, the results suggest resistance training could offer an accessible way to help treat mild cognitive and mood problems.

Regular weightlifting may benefit the mind as well as the muscles in older adults.

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Mental health

Poor mental health, poverty and pollution significantly raise women’s heart failure risk – study

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Poor mental health, poverty and pollution can raise women’s heart failure risk, with up to one in four cases potentially preventable, a study has found.

UK Biobank data from more than 230,000 women suggest that depression, socioeconomic hardship and exposure to polluted environments are linked to a significantly higher risk of heart failure in women.

Heart failure happens when the heart becomes too weak or too stiff to pump blood effectively around the body.

High blood pressure, high cholesterol, smoking and diabetes are among the better-known risk factors often targeted in public health campaigns.

Peige Song from China’s Zhejiang University and her team found that living in polluted areas, having poor mental wellbeing, facing socioeconomic deprivation and experiencing chronic inflammatory conditions such as lupus, in which the immune system attacks the body’s own tissues, make women more prone to heart failure.

These risks, however, are often overlooked.

The researchers found that mental wellbeing, environmental exposures, socioeconomic circumstances and reproductive history together contributed almost as much risk for heart failure as all well-known risk factors combined.

The study also found that risk rises with socioeconomic hardship and chronic inflammatory conditions such as lupus or rheumatoid arthritis, approaching the impact of conventional risk factors.

Song said: “[The study] is a call to redefine prevention in women’s cardiovascular health, integrating biological, psychosocial and structural determinants into a unified, equitable approach.

“One in four heart-failure cases in women could be prevented if all under-recognised risk factors were eliminated, assuming causal relationships.”

While completely eliminating all risks is not realistic, Song said “even partial reductions through better mental health services, social equity policies and environmental regulations could yield significant public health benefits”.

Catherine Pirkle, a women’s health specialist at the University of Hawaiʻi at Mānoa in the US, who was not involved in the study, said: “These calculations show convincingly that under-recognised and female-specific risk factors contribute significantly to heart failure in women, independently of the well-established ones.”

Song said: “It’s important to understand that heart health is influenced by more than just blood pressure or cholesterol.

“Factors like mental wellbeing, reproductive milestones and socioeconomic conditions all matter. Awareness and advocacy for comprehensive, gender-sensitive care are key.”

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