Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal study

BACKGROUND

This prospective study aims to investigate whether severe fear of childbirth increases pain perceptions during birth and whether co-occurring maternal health and birth factors as well as length and weight of the child explain the association.

METHODS

The study sample comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort. Data from the hospital birth's record and questionnaires at weeks 17-19 and 32 of pregnancy and 8 weeks postpartum were used (n = 1649). Analysis of variance and analysis of covariance were conducted to examine whether ratings of labor pain differed significantly between women with and without severe fear of childbirth and which factors explained the difference.

RESULTS

Women with severe fear of childbirth experienced significantly more labor pain than women without severe fear of childbirth (P < .01). However, when controlling for symptoms of maternal depression and anxiety, use of epidural/spinal anesthetic or nitrous oxide gas, and menstrual pain, this difference was no longer significant (P = .09).

DISCUSSION

Although the results show that labor pain is related to multiple physiological and psychological factors in a complex manner, symptoms of maternal depression and anxiety seem to play a central role for the experience of labor pain, and should therefore be focused on by health practitioners.

The prospective relationship between postpartum PTSD and child sleep: A 2-year follow-up study

BACKGROUND

The main aim of this study was to examine the prospective impact of maternal postpartum PTSD on several standardized child sleep variables two years postpartum in a large, population-based cohort of mothers. Moreover, we investigated the influence of numerous potential confounding maternal and child factors. Finally, we tested potential reverse temporal associations between child sleep eight weeks postpartum and maternal PTSD symptoms two years postpartum.

METHODS

This study is part of the population-based Akershus Birth Cohort, a prospective cohort study at Akershus University Hospital, Norway. Data from the hospital's birth record, from questionnaires at 17 weeks gestation, eight weeks and two years postpartum were used. At two years postpartum, 39% of the original participants could be retained, resulting in a study population of n = 1480. All child sleep variables significantly correlated with postpartum PTSD symptoms were entered into multiple linear regression analyses, adjusting for confounding factors.

RESULTS

Postpartum PTSD symptoms were related to all child sleep variables, except daytime sleep duration. When all significant confounding factors were included into multivariate regression analyses, postpartum PTSD symptoms remained a significant predictor for number and duration of night wakings (β = 0.10 and β = 0.08, respectively), duration of settling time (β = 0.10), and maternal rating of their child's sleep problems (β = 0.12, all p<.01. Child sleep at eight weeks postpartum was not significantly related to maternal sleep two years postpartum when controlling for postpartum PTSD at eight weeks.

LIMITATIONS

Child outcomes were based on maternal reporting and might be influenced by maternal mental health.

CONCLUSIONS

Our results showed for the first time that maternal postpartum PTSD symptoms were prospectively associated with less favorable child sleep, thus increasing the risk of developmental or behavioral problems through an indirect, but treatable pathway. Early detection and treatment of maternal postpartum PTSD may prevent or improve sleep problems and long-term child development.

Prevalence of postpartum depressive symptoms in a multiethnic population and the role of ethnicity and integration

BACKGROUND

Postpartum depression (PPD) may have adverse effects on both mother and child. The aims were to determine the prevalence of postpartum depressive symptoms, PPDS, identify associations with ethnicity and with the level of social integration.

METHOD

Population-based, prospective cohort study of 643 pregnant women (58% ethnic minorities) attending primary antenatal care in Oslo. Questionnaires regarding demographics and health issues were collected through interviews. PPDS was defined as a sum score ≥ 10 by the Edinburgh Postnatal Depression Scale, used as the main outcome in logistic regression analyses, first with ethnicity, second with level of integration as main explanatory factors.

RESULTS

The prevalence of PPDS was higher in ethnic minorities 12.7% (95% CI: 9.31-16.09) than in Western Europeans 4.8% (2.26-7.34). Adverse life events, lack of social support and depressive symptoms during the index pregnancy were other significant risk factors. Western European with PPDS were more likely to have had depressive symptoms also during pregnancy than women from ethnic minorities (72.2% versus 33.3%, p = 0.041). When replacing ethnicity with integration, a low level of integration was independently associated with PPDS (2.1 (1.11-3.95)).

LIMITATIONS

Cases with PPDS were limited. Heterogeneity in the ethnic groups is a concern.

CONCLUSION

Both point prevalence and new onset of PPDS was higher among ethnic minorities than among Western Europeans. Low level of integration was associated with PPDS. Our findings suggest that clinicians should be aware of the increased risk of new cases of PPDS among ethnic minorities compared to Western European women and offer evidence-based care accordingly.

Pelvic Floor Muscle Training Program in Pregnant Nepalese Women- A Feasibility Study

Aims: Obstetric Fistula is one of the common pelvic floor dysfunctions that affects the women’s quality of life. PFMT is recommended as first line treatment for prevention and treatment of pelvic floor dysfunctions. There is lack of knowledge on the feasibility of performing a PFMT program in pregnant Nepalese women. The aim was to develop a Pelvic floor muscle training (PFMT) program and to assess the feasibility of the program by assessing attendance to antenatal follow-up visits and adherence to PFMT. Methods: The PFMT program included development of education material (video, leaflet, and poster) and PFMT in different positions. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, symptoms of urinary incontinence, pelvic organ prolapse and depression questionnaires were collected at first and last visit. Number of antenatal follow-up visits, exercise diary records and motivation questions for performing PFMT were also collected.Compliers were defined as women attending four or more PFMT antenatal follow-up visits.  Results: Two hundred and fifty three pregnant women with mean age25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10(SD 3) were included. In total, 164 (65%) participants complied with the PFMT program and 89 (35%) did not comply.Eight percent of the women reported not doing PFMT and approximately 20% women over-reported to have performed PFMT. Conclusions: More than half of the women completed the PFMT program. Adherence to PFMT had inconsistent results.

The Impact of Postpartum Posttraumatic Stress and Depression Symptoms on Couples' Relationship Satisfaction: A Population-Based Prospective Study

The couple relationship is of particular importance in the transition to parenthood and in the early childhood years because it is related to the well-being and mental health of partners, children, and the family. One factor that may substantially influence relationship quality and couple satisfaction after childbirth is the woman’s experience of birth. Approximately 2–4% of women develop posttraumatic stress disorder (PTSD) after childbirth, with potentially wide-ranging negative consequences for the women themselves and their families. To date, some qualitative studies have explored the influence of postpartum PTSD on couple relationship satisfaction. However, quantitative studies are sparse, with mixed results and methodological limitations. We hypothesized that postpartum PTSD will be prospectively associated with low couple relationship satisfaction, even when taking into account a variety of potential confounding variables, and that the effect of postpartum PTSD symptoms on couple relationship satisfaction will be mediated by postpartum depression symptoms. This study is based on data from the Akershus Birth Cohort study, a prospective cohort study. Information from hospital records and questionnaires completed at 17 weeks gestational age, as well as at 8 weeks and 2 years postpartum were used (n = 1480). PTSD symptoms were measured by the Impact of Event Scale and couple relationship satisfaction was assessed using a modified version of the Mehrabians Marital Satisfaction Scale. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate correlations, multivariate regression analyses, and mediation analyses. Postpartum PTSD symptoms were prospectively related to low couple relationship satisfaction at 2 years postpartum, even when controlling for a considerable number of background factors. When including postpartum depression symptoms as predictor in the analyses, the effect of postpartum PTSD was no longer significant. Moreover, more detailed analyses showed that postpartum depression symptoms acted as a significant mediator, fully explaining the association of postpartum PTSD with couples’ relationship satisfaction. Early detection of couples’ relationship problems and the provision of professional help, particularly in high-risk couples may not only improve the quality of the couple relationship but also improve parenting and promote positive child outcomes.

Childbirth preferences and related fears - comparison between Norway and Israel

Background

Fear of childbirth (FOC) could have significant impact on women’s childbearing choices and experience. Culture affects the way women conceptualize childbirth, influencing the fears and expectations they may hold in relation to it. In the current study, we examined differences in childbirth preferences of cesarean section and use of epidural analgesia between Norwegian and Israeli pregnant women. Later, we used the Norwegian six-factor solution of the widely-used Wijma Delivery Expectancy Questionnaire (W-DEQ-A) to compare levels of the different FOC factors. Finally, we investigated differences in the associations between FOC and childbirth preferences between the two countries.

Methods

Secondary analysis of two large surveys. Women from Israel (n = 490) and Norway (n = 2918) were recruited during prenatal check-ups in community clinics and a university hospital. At around 32 weeks of gestation, all participants filled out questionnaires, including the W-DEQ-A. Statistical analysis included exploratory factor analysis, confirmatory factor analysis, M/ANOVA, Spearman’s Rho and Fisher’s Z tests for the significance of the difference between independent correlations.

Results

The Norwegian six-factor solution of the W-DEQ fit well with the Israeli data. Norwegian women were more concerned about loneliness, feeling less self-efficacy, negatively appraising birth, and lacking positive anticipation. Israeli women were more concerned about negative outcomes for the child and experienced greater general fear and fear of pain. Norwegian women preferred more cesarean sections compared to Israeli women, who preferred more epidural use than Norwegians. FOC factors were more strongly related to childbirth preferences among Norwegians.

Conclusions

Cultural differences between Israel and Norway are reflected by the differences seen in the levels of fear reported across the six factors. In Israel, birth culture is very medicalized, motherhood is highly revered, and there is an emphasis on having “perfect babies”. In contrast, Norwegian women have fewer children, and birth is considered more natural. This could explain why Israeli women were more concerned that their child might be harmed during birth, while Norwegian women were more concerned with the physical and emotional expectations of birth.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1997-5) contains supplementary material, which is available to authorized users.

Physical activity in pregnancy and postpartum depressive symptoms in a multiethnic cohort

INTRODUCTION

There is strong evidence that postpartum depression is associated with adverse health effects in the mother and infant. Few studies have explored associations between physical activity in pregnancy and postpartum depression. We aimed to investigate whether physical activity during pregnancy was inversely associated with postpartum depressive symptoms, PPDS in a multiethnic sample.

METHOD

Population-based, prospective cohort of 643 pregnant women (58% ethnic minorities) attending primary antenatal care from early pregnancy to postpartum in Oslo between 2008 and 2010. Data on demographics and health outcomes were collected during standardized interviews. PPDS was defined by a sum score ≥10 from the Edinburgh Postnatal Depression Scale (EPDS), 3 months after birth. Physical activity was recorded with Sense Wear™ Pro3 Armband (SWA) in gestational week 28 and defined as moderate-to-vigorous intensity physical activity (MVPA) accumulated in bouts ≥10 min.

RESULTS

Women who accumulated ≥150 MVPA minutes/week had significantly lower risk (OR = 0.2, 95% CI: 0.06-0.90), for PPDS compared to those who did not accumulate any minutes/week of MVPA, adjusted for ethnic minority background, depressive symptoms in the index pregnancy and self-reported pelvic girdle syndrome. The results for MVPA persisted in the sub-sample of ethnic minority women.

LIMITATIONS

Numbers of cases with PPDS were limited. The SWA does not measure water activities. Due to missing data for SWA we used multiple imputations.

CONCLUSION

Women meeting the physical activity recommendation (>150 MVPA min/week) during pregnancy have a lower risk of PPDS compared to women who are not active during pregnancy.

The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study

BACKGROUND

In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years.

METHODS

The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses.

RESULTS

Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization's breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables.

CONCLUSION

Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.

Nausea and vomiting in pregnancy - association with pelvic girdle pain during pregnancy and 4-6 months post-partum

Background

To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum.

Methods

Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used.

Results

Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women.

Conclusions

Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1764-7) contains supplementary material, which is available to authorized users.

Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study

Background

Migraine is a common headache disorder that affects mostly women. In half of these, migraine is menstrually associated, and ranges from completely asymptomatic to frequent pain throughout pregnancy.

Methods

The aim of the study was to define the pattern (frequency, intensity, analgesics use) of migrainous headaches among women with and without menstural migraine (MM) during pregnancy, and define how hormonally-related factors affect its intensity.

Results

The analysis was based upon data from 280 women, 18.6% of them having a self-reported MM. Women with MM described a higher headache intensity during early pregnancy and postpartum compared those without MM, but both groups showed improvement during the second half of pregnancy and directly after delivery. Hormonal factors and pre-menstrual syndrome had no effect upon headache frequency, but may affect headache intensity.

Conclusions

Individual treatment plan is necessary for women with migrainous headaches during pregnancy, especially for those suffering highest symptoms load.

Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study

OBJECTIVES

To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women's decisions to use EDA.

DESIGN

Longitudinal cohort study.

SETTING

Akershus University Hospital, Norway.

POPULATION

2596 women with singleton pregnancies and intended vaginal delivery.

METHODS

Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward.

MAIN OUTCOME MEASURE

Preference for EDA was indicated by the questionnaire item "I would prefer an epidural regardless" on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32.

RESULTS

Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)].

CONCLUSION

Fear of childbirth is significantly associated with women's choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.

Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine

Background

Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women.

Methods

Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use.

Results

Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7).

Conclusions

Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1399-0) contains supplementary material, which is available to authorized users.

Insomnia before and after childbirth: The risk of developing postpartum pain-A longitudinal population-based study

OBJECTIVE

To examine if insomnia before and after childbirth predicts the development of postpartum bodily pain.

METHODS

This study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current sample is comprised of 1480 women who participated at all three time points, yielding a participation rate of 32% of the 4662 women who originally consented to participate. The Bergen Insomnia Scale (BIS) was used to measure insomnia and a latent profile analysis (LPA) was used to identify subsets of women who shared a similar pattern of responses on the BIS-scale across the three time points. Pain was measured using the bodily pain scale, derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and symptoms of depression were measured by the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Using a latent profile analysis a three class model showed the best fit and identified one major group (55.6%) with a low BIS scores across all three time points, one group with intermediate BIS scores (32.9%), and a smaller group (11.5%) with higher BIS scores across all three times. The chronic high insomnia group had a 2.8-fold increased risk of reporting high levels of bodily pain. The chronic intermediate group was associated with a 2.2-fold increased risk of bodily pain at two years postpartum. Adjusting for demographics and lifestyle behaviors did not reduce any of the associations, while adjusting for depression significantly attenuated the associations. Additional adjustment for pain at eight weeks postpartum further reduced the magnitude of the associations, but both chronic intermediate insomnia and chronic high insomnia remained strongly associated with the onset of bodily pain in the fully adjusted models (RR=1.75, 95% CI: 1.37-2.23) and RR=1.63, 95% CI: 1.15-2.32, respectively).

CONCLUSIONS

The high prevalence of insomnia among women during and after childbirth, in combination with the strong prospective association with impaired physical health, emphasizes the importance of adequately identifying, preventing and treating insomnia for this population.

Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting. Previous studies have shown an association between HG and depressive symptoms during pregnancy, but little is known about the risk of maternal psychological distress following an HG pregnancy. The objective of the current study was therefore to assess the association between HG and emotional distress during and after pregnancy. This was a population-based pregnancy cohort study using data from the Norwegian Mother and Child Cohort Study. A total of 851/92,947 (0.9%) had HG. Emotional distress was measured by the Hopkins Symptom Checklist (SCL-5) in gestational weeks 17 and 32 and 6 and 18 months postpartum. The generalised estimating equations model was estimated for assessing time trends in emotional distress. Adjustments were made for previous HG, lifetime history of depression, maternal age, parity, BMI, smoking before pregnancy, physical activity, length of education, and pelvic girdle pain. Women with HG had higher odds for emotional distress than women without HG at the 17th (p < 0.001) and 32nd gestational weeks (p = 0.001) in addition to 6 months postpartum (p = 0.005) but not 18 months postpartum (p = 0.430). Adjusted odds for emotional distress varied significantly over time for women with and without HG (p = 0.035). Women with HG were more likely to report emotional distress compared to women without HG during pregnancy and 6 months postpartum, but the difference between the groups disappeared 18 months after birth. The results suggest that the increased risk of developing emotional distress may primarily be a consequence of HG.

History of depression and risk of hyperemesis gravidarum: a population-based cohort study

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by debilitating nausea and vomiting. HG has been associated with depression during pregnancy but the direction of the association remains unclear. The aim of this study was to assess whether previous depression is associated with HG. This is a population-based pregnancy cohort study using data from The Norwegian Mother and Child Cohort Study. The study reviewed 731 pregnancies with HG and 81,055 pregnancies without. Logistic regression analyses were performed to examine the association between a lifetime history of depression and hyperemesis gravidarum. Odds ratios were adjusted for symptoms of current depression, maternal age, parity, body mass index, smoking, sex of the child, education and pelvic girdle pain. A lifetime history of depression was associated with higher odds for hyperemesis gravidarum (aOR = 1.49, 95% CI (1.23; 1.79)). Two thirds of women with hyperemesis gravidarum had neither a history of depression nor symptoms of current depression, and 1.2% of women with a history of depression developed HG. A lifetime history of depression increased the risk of HG. However, given the fact that only 1.2% of women with a history of depression developed HG and that the majority of women with HG had no symptoms of depression, depression does not seem to be a main driver in the aetiology of HG.

The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study

BACKGROUND

Against the background of very limited evidence, the present study aimed to prospectively examine the impact of maternal postpartum post-traumatic stress disorder (PTSD) symptoms on four important areas of child development, i.e. gross motor, fine motor, communication and social-emotional development.

METHOD

This study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record as well as questionnaire data from 8 weeks and 2 years postpartum were used (n = 1472). The domains of child development that were significantly correlated with PTSD symptoms were entered into regression analyses. Interaction analyses were run to test whether the influence of postpartum PTSD symptoms on child development was moderated by child sex or infant temperament.

RESULTS

Postpartum PTSD symptoms had a prospective relationship with poor child social-emotional development 2 years later. This relationship remained significant even when adjusting for confounders such as maternal depression and anxiety or infant temperament. Both child sex and infant temperament moderated the association between maternal PTSD symptoms and child social-emotional development, i.e. with increasing maternal PTSD symptom load, boys and children with a difficult temperament were shown to have comparatively higher levels of social-emotional problems.

CONCLUSIONS

Examining four different domains of child development, we found a prospective impact of postpartum PTSD symptoms on children's social-emotional development at 2 years of age. Our findings suggest that both boys and children with an early difficult temperament may be particularly susceptible to the adverse impact of postpartum PTSD symptoms. Additional studies are needed to further investigate the mechanisms at work.

Pelvic pain after childbirth: a longitudinal population study

In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7 to 18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by 4 self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0 to 3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted OR: 0.48; 95% CI: 0.31-0.74 and adjusted OR: 0.65; 95% CI: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P = 0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.

Self-reported short sleep duration and insomnia symptoms as predictors of post-pregnancy weight change: Results from a cohort study

This study aims to investigate whether change in sleep duration and insomnia symptoms in the postpartum period is related to change in body mass index from before to 2 years after pregnancy. This study is based on self-report data from a Norwegian cohort, the AHUS Birth Cohort Study. Data were collected at 8 weeks (T1) and 2 years (T2) postpartum. Data from 812 women were analyzed. The results showed that only women with symptoms of insomnia at both T1 and T2 (persistent symptoms) had a greater increase in body mass index compared to women with no insomnia symptoms at T1 or T2.The results indicate that persistent insomnia symptoms are related to a greater increase in body mass index.

Personality and Perinatal Maternal Insomnia: A Study Across Childbirth

Personality may influence sleep in perinatal women. A follow-up study was conducted among 3,752 pregnant, then postpartum women at Akershus University Hospital, Norway. The Big Five personality dimensions were measured by the Mini-International Personality Item Pool in week 17 of pregnancy. Insomnia was measured by the Bergen Insomnia Scale in pregnancy week 32 and 8 weeks postpartum, along with self-reported sleep times. The Edinburgh Postnatal Depression Scale measured depression, and the Hopkins Symptom Checklist measured anxiety. Adjusted for current anxiety, depression, and demographic variables, the personality traits Neuroticism and Agreeableness were associated with insomnia in pregnancy. No personality traits were associated with postpartum insomnia. Extraversion was associated with longer postpartum sleep duration and better sleep efficiency, and Agreeableness with shorter sleep duration.