DESIGN: Multi-center cross-sectional study.
SETTING: Two tertiary medical centers in Malaysia.
PARTICIPANTS: A total of 59 patients with CAH who were raised as females and more than 10 years old, and their parents.
METHODS: The CAH respondents completed the validated and translated Body Image Disturbance Questionnaires (BIDQ). All CAH respondents and their parents underwent semi-structured interviews to explore their views on FG.
MAIN OUTCOME MEASURES: Body image disturbance score and perspectives on FG.
RESULTS: The 59 CAH respondents consisted of 12 children, 29 adolescents, and 18 adults. The majority were of Malay ethnicity (64.4%) with classical CAH (98.3%) and had undergone FG (n = 55, 93.2%). For the BIDQ scores, the median score (interquartile range) for general body image was 1.29 (0.71), range 1.00-3.29, whereas the genital appearance score was 1.07 (0.39), range 1.00-4.29, revealing a greater concern for general body parts over genitalia. With regards to FG, it was perceived as necessary. Infancy and early childhood were perceived as the best timing for first FG by both respondents and parents, most preferring single-stage over 2-stage surgery.
CONCLUSIONS: General body appearance concerns were greater than for genital appearance, with more impact on the patients' lives. Contrary to much international opinion, feminizing surgery was perceived as necessary and appropriate by CAH respondents and their families, and should be offered in infancy or early childhood. Future qualitative studies are recommended.
METHODS: A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices.
RESULTS: Average age was 29.61±4.71years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90±5.18kg. Mean postpartum weight retention was 3.12±4.76kg, 33.8% retaining ≥5kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention.
CONCLUSION: Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.