postpartum depression

Mothers of fussy babies at higher risk of depressive symptoms

March 25, 2019

Science Daily/Michigan Medicine - University of Michigan

As FDA approval of the first postpartum depression drug hits the news, study looks at how infant fussiness and a baby's level of prematurity may influence the severity of maternal depressive symptoms.

 

It's no secret that fussy newborns can be especially challenging for parents already facing physical and mental exhaustion from caring for a new baby.

 

But now science backs up the impact on parents: The less soothable the infant, the more distressed the mother.

 

Mothers of highly irritable infants experience greater depressive symptoms, according to new University of Michigan-led research. The nationally representative study, which included data from more than 8,200 children and their parents, appears in Academic Pediatrics.

 

The study is also believed to be the first to explore whether the degree of a baby's prematurity in combination with infant fussiness may influence the severity of maternal depressive symptoms.

 

Researchers found that mothers of very preterm, fussy infants (born at 24-31 weeks) had about twice the odds of experiencing mild depressive symptoms compared to moms of very preterm infants without fussiness.

 

However, mothers of fussy babies born moderate-late preterm (32-36 weeks gestation) as well as mothers of full-term infants were about twice as likely to report moderate to severe depressive symptoms as moms of less irritable babies born at the same gestational age.

 

"We found that maternal depression risk varied by gestational age and infant fussiness," says senior author Prachi Shah, M.D., a developmental and behavioral pediatrician at U-M C.S. Mott Children's Hospital and an associate research scientist at U-M's Center for Human Growth and Development. "Mothers of fussy infants born late preterm and full term are more likely to experience more severe levels of maternal depression, than mothers of fussy infants who were born more preterm."

 

"These findings reinforce that all mothers caring for babies with more difficult temperaments may need extra help managing the emotional toll," she adds. "Early screening for infant fussiness may help identify mothers with depressive symptoms in need of support, but may be especially important for mothers of infants born mildly preterm, in whom the symptoms of depression are more severe."

 

Shah notes that while very preterm infants have higher morbidity than babies born later, the perinatal care of infants born very preterm may actually help buffer against more severe maternal depression.

 

Very preterm infants are often cared for in a neonatal ICU setting where part of the specialized care includes guidance focused on the vulnerabilities associated with preterm birth. As parents transition home they often receive an enhanced level of postnatal support and developmental follow up, including referrals to early intervention programs, home visiting and subsequent care in neonatal clinics.

 

"The additional support and services provided to families of very premature children help prepare parents for the potential challenges associated with caring for a preterm infant and may help mitigate the risk for maternal depressive symptoms," Shah says.

 

However, she notes that mild depressive symptoms may progress into more severe depressive symptoms, and should also be addressed as early as possible.

 

Additionally, researchers found that maternal characteristics associated with prenatal stress and socioeconomic disadvantages -- such as lower income, unmarried status and smoking -were associated with greater odds of both mild and moderate-severe maternal depressive symptoms.

 

Asian and black race were also associated with greater odds of moderate-severe depressive symptoms whereas Hispanic ethnicity was associated with lower odds of maternal depression. Authors say this raises questions regarding the role of culture as a potential risk or protective factor in the development of maternal depression.

 

The study included data from the Early Childhood Longitudinal Study, Birth Cohort. Maternal depressive symptoms were assessed through self-reported questionnaires at the baby's nine-month visit.

 

The study adds to previous research suggesting that mothers of more irritable infants report significantly less confidence and more stress than mothers of less fussy infants.

 

"Pediatricians and providers should pay close attention to mothers who describe difficulty soothing their babies," Shah says. "Early interventions may help reduce the risk of maternal depression that negatively impacts a child-parent relationship and that may be harmful to both the health of a mother and child."

https://www.sciencedaily.com/releases/2019/03/190325110321.htm

Forgotten fathers: New dads also at risk for postpartum depression

Study provides an in-depth look at new fathers' experiences with PPD

March 7, 2019

Science Daily/University of Nevada, Las Vegas

A new study offers an in-depth view of new fathers' experiences with postpartum depression (PPD). The study explores issues they encounter and how they can move beyond barriers they face in receiving diagnoses and treatment of the little-known phenomenon.

 

It's increasingly common to hear about new moms suffering from the baby blues. But what about new dads?

 

A new UNLV study, published last week in the Journal of Family Issues, offers an in-depth view of new fathers' experiences with postpartum depression (PPD). The study explores issues they encounter and how they can move beyond barriers they face in receiving diagnoses and treatment of the little-known phenomenon.

 

Between 5 and 10 percent of new fathers in the United States suffer from PPD, according to U.S. Centers for Disease Control and Prevention data. One study shows that the risk goes up to 24 to 50 percent for men whose partners suffer from PPD.

 

A team of researchers, led by UNLV Couple and Family Therapy professor Brandon Eddy, scoured blogs, websites, forums, and chat rooms for first-hand accounts from new dads. Six themes emerged:

 

·     Needing education.Fathers didn't know men could suffer from PPD and were surprised to learn others experienced it. Women who saw PPD in men were unsure of what to call it. Men complained about pushback or not receiving information from doctors or therapists, or frustration that the PPD resources they did manage to find focused solely on how to help their wives.

·     Adhering to gender expectations. Many dads felt pressured to espouse traditional "tough guy" stereotypes. In fact, one man who told another father to "suck it up" said he knew it was bad advice but explained that it's what's expected of men.

·     Repressing feelings.Men were reluctant to share their feelings for fear of sounding ridiculous or looking weak to their wives, who were the primary caregivers.

·     Overwhelmed.Many of the new dads found it difficult to express their emotions of confusion, exhaustion, helplessness, loneliness, and feeling trapped. Parents often suffer from lack of sleep after birth, which can exacerbate stress and depressive symptoms -- making them more irritable to their children's crying.

·     Resentment of baby.While many fathers expressed joy and excitement for the arrival of their children, others resented their baby's constant needs and attention. A few talked about suppressing urges to hurt the baby or themselves.

·     Experience of neglect.The dads felt lost, forgotten, and neglected -- by their wives, the health care system, and society. One father described "uncomfortably laughing" while reading PPD screening questions typically asked of women during routine checkups: "I began to feel like someone should be asking me the same questions." Another said men, who must simply wait while women do the hard work of pregnancy and labor and lack an umbilical cord connection to their children, had often shared with him similar stories of struggling with PPD: "There's no truly acceptable place or context for men to publicly reveal being challenged -- much less rocked to the core -- by what I call 'sudden parenthood'."

 

Overall, the findings complement previous studies on barriers for fathers suffering from PPD. UNLV researchers said encountering a lack of information and stigma often causes dads to distance themselves from their child and has been associated with marital difficulties.

 

Previous research elsewhere has found that paternal involvement has many positive outcomes for children, such as boys displaying less hostile behavior then children with absent dads, reduced delinquency for both sexes, considerably higher IQ scores for children in their early development years, and lower levels of emotional distress. That's on top of studies showing fathers who suffer from PPD report lower levels of communication with their partners, as well as increased rates of substance abuse and domestic violence.

 

"The expectations society gives to men of what they are supposed to be, what they are supposed to do, and how they do it was a significant factor on how many of these men chose to cope with life stressors," the UNLV researchers wrote.

 

"Because men are already less likely than women to seek professional help for depression, it is vital that the stigma of PPD decreases," they added. "Because paternal involvement is a significant factor in the healthy development of children, it would seem wise to make information about paternal PPD more available in order to combat its negative impact on families."

 

The U.S. Preventative Services Task Force -- an independent coalition of national experts -- recently recommended that all women be screened for depression before and after giving birth. There is no current assessment designed to specifically screen men for PPD.

 

"With the vast amount of research conducted on the importance of paternal involvement and the rising rates of PPD in fathers," researchers wrote, "it seems logical that fathers should also be included in this recommendation."

https://www.sciencedaily.com/releases/2019/03/190307091448.htm

Postpartum depression linked to mother's pain after childbirth

New study underscores importance of managing pain during recovery

Science Daily/October 14, 2018

American Society of Anesthesiologists

While childbirth pain has been linked to postpartum depression, the culprit may be the pain experienced by the mother following childbirth, rather than during the labor and delivery process.

 

Previous research has demonstrated the pain associated with giving birth may increase the risk of postpartum depression but has not specified which part of the labor process (e.g., before, during or after delivery) may be the source of the problem. This is the first study to differentiate postpartum pain from labor and delivery pain and identify it as a significant risk factor for postpartum depression.

 

"For many years, we have been concerned about how to manage labor pain, but recovery pain after labor and delivery often is overlooked," said Jie Zhou, M.D., M.B.A., lead author of the study and assistant professor of anesthesia at Brigham and Women's Hospital and Harvard Medical School, Boston. "Our research suggests we need to focus more on helping new mothers manage pain after the baby is born."

 

Symptoms of postpartum depression -- including extreme sadness, low energy, anxiety, crying episodes, irritability and changes in sleep or eating patterns -- affect about 1 in 9 women, according to the Centers for Disease Control and Prevention (CDC). Postpartum depression can lead to lower rates of breastfeeding and poor bonding with the baby.

 

In the study, Dr. Zhou's research group reviewed pain scores (from the start of labor to hospital discharge) for 4,327 first-time mothers delivering a single child vaginally or by cesarean delivery (C-section) at Brigham and Women's Hospital between June 1, 2015 and Dec. 31, 2017. They compared pain scores to the mothers' Edinburgh postnatal depression scale (EPDS) scores one week after delivery.

 

Dr. Zhou found postpartum depression was significantly associated with higher postpartum pain scores. Mothers with postpartum depression demonstrated more pain-related complaints during recovery and often needed additional pain medication. Women in the postpartum depression group were more likely to have delivered by C-section. They also had more reports of inadequate postpartum pain control.

 

A number of factors can contribute to postpartum depression. Researchers determined postpartum depression was higher among women who were overweight or obese; who suffered from a torn perineum (the area adjacent to the vaginal opening); who had a history of depression, anxiety or chronic pain; and whose babies were smaller and had lower Apgar scores, a scoring system used to assess the physical health of newborns one minute and five minutes after birth.

 

"While ibuprofen and similar pain medications are considered adequate for pain control after childbirth, clearly some women need additional help managing pain," said Dr. Zhou. "We need to do a better job identifying who is at risk for postpartum pain and ensure they have adequate postpartum care."

https://www.sciencedaily.com/releases/2018/10/181014142700.htm

Hair cortisol levels predict which mothers are more likely to suffer postpartum depression

November 13, 2017

Science Daily/University of Granada

Researchers from the University of Granada (UGR), who belong to the Brain, Mind and Behavior Research Center (CIMCYC, from its abbreviation in Spanish) and the Faculty of Psychology, have proven that cortisol levels (a steroid hormone secreted as a response to stress) present in the hair of pregnant women during the first or third trimesters of pregnancy may indicate which of them are more likely to suffer postpartum depression.

 

Their work, published in the PLoS ONE journal, showed that hair cortisol levels in women who developed postpartum depression were higher throughout pregnancy than those seen in women who hadn't developed it, being that difference statistically more significant during the first and third trimesters.

 

The UGR researchers carried out their study doing a follow-up on 44 pregnant women throughout the whole gestation period and after giving birth. Each trimester the mothers underwent a series of tests that evaluated their stress and psychopathological symptoms while simultaneously taking hair samples from which the researchers extracted the cortisol corresponding to the last three months.

 

The following days after labor the researchers evaluated the mothers' emotional state in order to assess who among them had developed postpartum depression.

 

Quarterly psychopathological symptoms

 

Additionally, the results of the study showed that the participants which developed postpartum depression showed higher levels of somatization during the first trimester. During the second trimester they showed higher levels of somatization, obsession-compulsion, depression and anxiety, and during the third trimester they showed higher levels of somatization and pregnancy-specific stress. Therefore, all those symptoms along with higher levels of cortisol would be indicators of a future postpartum depression.

 

As María Isabel Peralta Ramírez, lead researcher of the project says, the consequences of those results are very important in the prevention of postpartum depression, "since they show that there are various altered psychological and hormonal variables throughout the whole gestation period in comparison to those women who will not suffer postpartum depression. Detecting those differences is the key to anticipate the psychological state of the mother as well as the consequences for the baby that said state could mean."

 

This study belongs to the GESTASTRESS research project, in the research excellence framework of the Spanish Ministry of Economy and Competitiveness. Its primary goal has been to assess the effects of psychological stress on the mother throughout the whole gestation period as well as on birth variables, and on the baby's stress and neurodevelopment.

https://www.sciencedaily.com/releases/2017/11/171113111040.htm

Postpartum depression risk, duration and recurrence

September 26, 2017

Science Daily/PLOS

Postpartum affective disorder (AD), including postpartum depression (PPD), affects more than one in two hundred women with no history of prior psychiatric episodes, and raises the risk of later affective disorder for those women, according to a new study.

 

PPD is estimated to affect more than 5 percent of all women following childbirth, making it the most common postnatal complication of childbearing. In the new study, researchers analyzed data from the Danish national registries on 457,317 women who had a first child (and subsequent births) between 1996 and 2013 and had no prior psychiatric hospital contacts or use of antidepressants. Postpartum AD was defined as an antidepressant prescription fill or hospital contact for depression within six months after birth.

 

In the Danish cohort, 0.6% of all childbirths among women with no history of psychiatric disease led to postpartum AD. A year after their first treatment, 27.9% of these women were still in treatment; after four years, that number was 5.4%. For women with a hospital contact for depression after a first birth, the risk of postpartum AD recurrence was 21%; the recurrence was 15% for women who took antidepressants after a first birth. These rates mean that, compared to women without history of AD, postpartum AD is 46 and 27 times higher in subsequent births for women with postpartum AD after their first birth.

 

"These population-based figures provide valuable guidance to physicians treating women with PPD," the authors say. "It underlines the seriousness of single initial episodes and highlights the necessity of both primary and secondary preventive measures of which several exist."

https://www.sciencedaily.com/releases/2017/09/170926143559.htm

Postpartum depression least severe form of depression in mothers

Time frame when pregnant woman first develops depression determines severity, treatment of it

June 15, 2016

Science Daily/Northwestern University

Postpartum depression -- a household term since actress Brooke Shields went public in 2005 about her struggle with it -- is indeed serious. But depression that begins before or during pregnancy is often more severe because it lasts longer and usually goes undetected until the doctor screens for it after the birth of the baby, according to a new study.

 

Deciphering the onset time can impact how the doctor treats the woman's depression, such as intervening earlier with psychiatric help, if needed, said Sheehan Fisher, the study's corresponding author and an instructor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.

 

"There's a difference between postpartum depression and depression that started before or during the pregnancy. It's not a homogenous disorder, " Fisher said. "When clinicians see a mother during the postpartum period and diagnose her with depression, it's important for them to ask how long this depression has been an issue so they can assess the longevity and severity."

 

The study, recently published in the Journal of Affective Disorders, is one of the first to evaluate the rate of depression in mothers at the three onset time points: 24.9 percent of participants developed depression pre-pregnancy, 36.7 percent developed it during pregnancy (prenatal) and 38.4 percent developed depression during the postpartum period.

 

Mothers who develop depression during the postpartum period are more likely to be Caucasian, older, educated, married or cohabitating, and have private health insurance than mothers whose depression begins before or during pregnancy, the study found.

 

"Mothers who develop postpartum depression often experience protective risk factors such as better access to resources, fewer children and are more mature, which helps them adapt to the stress of pregnancy," Fisher said. "Once their babies are born, they show more obsessive-compulsive symptoms--like over-worrying about their baby's health--than mothers who developed depression before or during pregnancy."

 

Women who had depression before they became pregnant were more likely to experience hypersomnia or difficulty falling asleep. They also experienced more symptoms of paranoia, such as a psychotic episode, than women who developed depression during or after pregnancy. And they had a higher severity of postpartum depression than the other onset periods.

 

The proportion of mothers who had a bipolar disorder, which Fisher said is more severe than unipolar depression, was significantly higher among mothers whose depression onset was during the pre-pregnancy period (38.7 percent), compared with prenatal (22.6 percent) and postpartum (17.9 percent).

 

Agitation was the distinctive factor that differentiated mothers with unipolar and bipolar depression in the study. Mothers who had a bipolar disorder and developed depression during her pregnancy exhibited the highest amount of agitation.

 

The study evaluated depression symptoms during the four- to six-week postpartum period for 727 women from an urban women's hospital in Pittsburgh, Penn. This period was chosen because women typically visit their doctors for post-birth evaluations six weeks after birth, and the four- to six-week epoch is associated with the highest depression onset.

https://www.sciencedaily.com/releases/2016/06/160615142624.htm

 

 

Easing labor pain may help reduce postpartum depression in some women

October 26, 2016

Science Daily/American Society of Anesthesiologists (ASA)
Epidural anesthesia may do more than relieve pain during labor; in some women it may decrease the likelihood of postpartum depression, suggests a preliminary study.

"Labor pain matters more than just for the birth experience. It may be psychologically harmful for some women and play a significant role in the development of postpartum depression," said Grace Lim, M.D., director of obstetric anesthesiology at Magee Women's Hospital of the University of Pittsburgh Medical Center and lead investigator on the study. "We found that certain women who experience good pain relief from epidural analgesia are less likely to exhibit depressive symptoms in the postpartum period."

The researchers controlled for factors already known to increase the risk for postpartum depression, including pre-existing depression and anxiety, as well as post-delivery pain caused by tissue trauma during childbirth. After accounting for these factors, the study found that in some women, labor pain was still a significant risk factor for postpartum depression symptoms. And therefore, alleviating this pain might help reduce the risk for postpartum depression.

In the study, researchers reviewed the medical records of 201 women who used epidural analgesia and had their pain assessed using a 0-10 scale during labor. They calculated the percent improvement in pain (PIP) throughout labor after the implementation of epidural analgesia. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) six weeks after childbirth. Researchers found the higher the PIP scores, the lower the EPDS scores.

"Although we found an association between women who experience less pain during labor and lower risk for postpartum depression, we do not know if effective pain control with epidural analgesia will assure avoidance of the condition," said Dr. Lim. "Postpartum depression can develop from a number of things including hormonal changes, psychological adjustment to motherhood, social support, and a history of psychiatric disorders."

Labor pain may be more problematic for some women than others, the authors note. Additional research is needed to identify which women are more likely to experience severe labor pain and who would benefit the most from effective labor pain-control strategies to help reduce the risk and impact of pain on postpartum recovery.

Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/10/161026113938.htm

Low levels of 'anti-anxiety' hormone linked to postpartum depression

Effect measured in women already diagnosed with mood disorders

March 14, 2017
Science Daily/Johns Hopkins Medicine
In a small-scale study of women with previously diagnosed mood disorders, researchers report that lower levels of the hormone allopregnanolone in the second trimester of pregnancy were associated with an increased chance of developing postpartum depression in women already known to be at risk for the disorder.

In a report on the study, published online on March 7 in Psychoneuroendocrinology, the researchers say the findings could lead to diagnostic markers and preventive strategies for the condition, which strikes an estimated 15 to 20 percent of American women who give birth.

The researchers caution that theirs was an observational study in women already diagnosed with a mood disorder and/or taking antidepressants or mood stabilizers, and does not establish cause and effect between the progesterone metabolite and postpartum depression. But it does, they say, add to evidence that hormonal disruptions during pregnancy point to opportunities for intervention.

Postpartum depression affects early bonding between the mother and child. Untreated, it has potentially devastating and even lethal consequences for both. Infants of women with the disorder may be neglected and have trouble eating, sleeping and developing normally, and an estimated 20 percent of postpartum maternal deaths are thought to be due to suicide, according to the National Institute of Mental Health.

"Many earlier studies haven't shown postpartum depression to be tied to actual levels of pregnancy hormones, but rather to an individual's vulnerability to fluctuations in these hormones, and they didn't identify any concrete way to tell whether a woman would develop postpartum depression," says Lauren M. Osborne, M.D., assistant director of the Johns Hopkins Women's Mood Disorders Center and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "For our study, we looked at a high-risk population of women already diagnosed with mood disorders and asked what might be making them more susceptible."

For the study, 60 pregnant women between the ages of 18 and 45 were recruited by investigators at study sites at The Johns Hopkins University and the University of North Carolina at Chapel Hill. About 70 percent were white and 21.5 percent were African-American. All women had been previously diagnosed with a mood disorder, such as major depression or bipolar disorder. Almost a third had been previously hospitalized due to complications from their mood disorder, and 73 percent had more than one mental illness.

During the study, 76 percent of the participants used psychiatric medications, including antidepressants or mood stabilizers, and about 75 percent of the participants were depressed at some point during the investigation, either during the pregnancy or shortly thereafter.

During the second trimester (about 20 weeks pregnant) and the third trimester (about 34 weeks pregnant), each participant took a mood test and gave 40 milliliters of blood. Forty participants participated in the second-trimester data collection, and 19 of these women, or 47.5 percent, developed postpartum depression at one or three months postpartum. The participants were assessed and diagnosed by a clinician using criteria from the Diagnostic and Statistical Manual of Mental Disorders, version IV for a major depressive episode.

Of the 58 women who participated in the third-trimester data collection, 25 of those women, or 43.1 percent, developed postpartum depression. Thirty-eight women participated in both trimester data collections.

Using the blood samples, the researchers measured the blood levels of progesterone and allopregnanolone, a byproduct made from the breakdown of progesterone and known for its calming, anti-anxiety effects.

The researchers found no relationship between progesterone levels in the second or third trimesters and the likelihood of developing postpartum depression. They also found no link between the third-trimester levels of allopregnanolone and postpartum depression. However, they did notice a link between postpartum depression and diminished levels of allopregnanolone levels in the second trimester.

For example, according to the study data, a woman with an allopregnanolone level of 7.5 nanograms per milliliter had a 1.5 percent chance of developing postpartum depression. At half that level of hormone (about 3.75 nanograms per milliliter), a mother had a 33 percent likelihood of developing the disorder. For every additional nanogram per milliliter increase in allopregnanolone, the risk of developing postpartum depression dropped by 63 percent.

"Every woman has high levels of certain hormones, including allopregnanolone, at the end of pregnancy, so we decided to look earlier in the pregnancy to see if we could tease apart small differences in hormone levels that might more accurately predict postpartum depression later," says Osborne. She says that many earlier studies on postpartum depression focused on a less ill population, often excluding women whose symptoms were serious enough to warrant psychiatric medication -- making it difficult to detect trends in those women most at risk.

Because the study data suggest that higher levels of allopregnanolone in the second trimester seem to protect against postpartum depression, Osborne says in the future, her group hopes to study whether allopregnanolone can be used in women at risk to prevent postpartum depression. She says Johns Hopkins is one of several institutions currently participating in a clinical trial led by Sage Therapeutics that is looking at allopregnanolone as a treatment for postpartum depression.

She also cautions that additional and larger studies are needed to determine whether women without mood disorders show the same patterns of allopregnanolone levels linked to postpartum depression risk.

If those future studies confirm a similar impact, Osborne says, then tests for low levels of allopregnanolone in the second trimester could be used as a biomarker to predict those mothers who are at risk of developing postpartum depression.

Osborne and her colleagues previously showed and replicated in Neuropsychopharmacology in 2016 that epigenetic modifications to two genes could be used as biomarkers to predict postpartum depression; these modifications target genes that work with estrogen receptors and are sensitive to hormones. These biomarkers were already about 80 percent effective at predicting postpartum depression, and Osborne hopes to examine whether combining allopregnanolone levels with the epigenetic biomarkers may improve the effectiveness of the tests to predict postpartum depression.

Of note and seemingly contradictory, she says, many of the participants in the study developed postpartum depression while on antidepressants or mood stabilizers. The researchers say that the medication dosages weren't prescribed by the study group and were monitored by the participant's primary care physician, psychiatrist or obstetrician instead. "We believe that many, if not most, women who become pregnant are undertreated for their depression because many physicians believe that smaller doses of antidepressants are safer for the baby, but we don't have any evidence that this is true," says Osborne. "If the medication dose is too low and the mother relapses into depression during pregnancy or the postpartum period, then the baby will be exposed to both the drugs and the mother's illness."

Osborne and her team are currently analyzing the medication doses used by women in this study to determine whether those given adequate doses of antidepressants were less likely to develop symptoms in pregnancy or in postpartum.

Only 15 percent of women with postpartum depression are estimated to ever receive professional treatment, according to the U.S. Centers for Disease Control and Prevention. Many physicians don't screen for it, and there is a stigma for mothers. A mother who asks for help may be seen as incapable of handling her situation as a mother, or may be criticized by friends or family for taking a medication during or shortly after pregnancy.
 

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