[Do previous abortions cause fear of childbirth?]

BACKGROUND

Abortion is a matter that concerns many women, and we have little knowledge about the effects of such experiences with regard to later pregnancies. The objective of the study was to investigate whether a previous history of abortion has an effect on later development of fear of childbirth, adjusted for the woman's mental health, parity, previous stillbirths and socio-demographic factors.

MATERIAL AND METHODS

The study included 2,753 pregnant women from Akershus University Hospital. Information was collected with the aid of questionnaires in the 18th and 32nd week of gestation, as well as retrievals from the hospital's system of birth records. Fear of childbirth was measured on the Wijma scale (W-DEQ).

RESULTS

The prevalence of fear of childbirth (defined as W-DEQ ≥ 85) amounted to 11.7% among women who had undertaken two or more elective abortions and 7.8% among those who had no previous abortions. This trend was not statistically significant and disappeared completely in the adjusted analyses. Nor did we find any correlation between spontaneous abortions and fear of childbirth. The mental health of the woman was the one factor that was most strongly associated with fear of childbirth, an association that we have found also on a previous occasion in analyses of a smaller proportion of this cohort.

INTERPRETATION

We found no co-variance between previous abortion history and fear of childbirth.

Paternal mental health and socioemotional and behavioral development in their children

OBJECTIVE

To examine the association between symptoms of psychological distress in expectant fathers and socioemotional and behavioral outcomes in their children at age 36 months.

METHODS

The current study is based on data from the Norwegian Mother and Child Cohort Study on 31 663 children. Information about fathers' mental health was obtained by self-report (Hopkins Symptom Checklist) in week 17 or 18 of gestation. Information about mothers' pre- and postnatal mental health and children's socioemotional and behavioral development at 36 months of age was obtained from parent-report questionnaires. Linear multiple regression and logistic regression models were performed while controlling for demographics, lifestyle variables, and mothers' mental health.

RESULTS

Three percent of the fathers had high levels of psychological distress. Using linear regression models, we found a small positive association between fathers' psychological distress and children's behavioral difficulties, B = 0.19 (95% confidence interval [CI] = 0.15-0.23); emotional difficulties, B = 0.22 (95% CI = 0.18-0.26); and social functioning, B = 0.12 (95% CI = 0.07-0.16). The associations did not change when adjusted for relevant confounders. Children whose fathers had high levels of psychological distress had higher levels of emotional and behavioral problems.

CONCLUSIONS

This study suggests that some risk of future child emotional, behavioral, and social problems can be identified during pregnancy. The findings are of importance for clinicians and policy makers in their planning of health care in the perinatal period because this represents a significant opportunity for preventive intervention.

Insomnia and depressive symptoms in late pregnancy: a population-based study

A population-based questionnaire study of 2,816 women was conducted in week 32 of pregnancy to estimate the prevalence of and risk factors for insomnia and depressive symptoms. The Bergen Insomnia Scale (BIS) measured insomnia. The Edinburgh Postnatal Depression Scale (EPDS) measured depressive symptoms. The prevalence of insomnia (DSM-IV-TR criteria) was 61.9%, and mean BIS score 17.5 (SD = 10.5), significantly higher than among the general population. The prevalence of depressive symptoms (EPDS ≥ 10) was 14.6%. Depressive symptoms were strongly associated with insomnia during late pregnancy, especially with sleep durations <5 or >10 hours, sleep efficiency <75%, daytime impairment, and long sleep onset latency. Pelvic girdle pain and lower back pain was associated with insomnia, but not with depressive symptoms.

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

OBJECTIVE

To study the prognosis for pelvic girdle pain, and to explore the association between presence of emotional distress during pregnancy and pelvic girdle syndrome 6 months after delivery.

DESIGN

Longitudinal population study.

SETTING

Norway, for the period 1999-2008.

POPULATION

A follow-up of 41 421 women in the Norwegian Mother and Child Cohort who reported pelvic girdle pain at 30 weeks of gestation.

METHODS

Data were obtained by self-administered questionnaires in weeks 17 and 30 of gestation, and 6 months after delivery.

MAIN OUTCOME MEASURE

Pelvic girdle syndrome 6 months after delivery, defined as pain in the anterior pelvis and on both sides in the posterior pelvis.

RESULTS

Six months after delivery, 78.0% of the women had recovered, 18.5% reported persistent pain in one or two pelvic locations, 3.0% reported pelvic girdle syndrome and 0.5% reported severe pelvic girdle syndrome. The recovery rates decreased with increasing levels of pain severity in pregnancy. Being emotionally distressed at two time points during pregnancy was associated with the presence of pelvic girdle syndrome (adjusted OR 1.5, 95% CI 1.2-1.9) and severe pelvic girdle syndrome (adjusted OR 1.9, 95% CI 1.1-3.1), after adjustment for pain severity in pregnancy, other medical conditions, body mass index, age at menarche, previous low back pain, and smoking during pregnancy.

CONCLUSIONS

In this follow-up of women with pelvic girdle pain in pregnancy, the recovery rates after delivery were high. Our findings suggest that the presence of emotional distress during pregnancy is independently associated with the persistence of pelvic girdle pain after delivery.

Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression

PURPOSE

We describe exercise level in mid-pregnancy, associated sociodemographic variables, and investigate the association between exercise in mid-pregnancy and subsequent low-back pain, pelvic girdle pain and depression at 32 weeks of pregnancy.

MATERIAL AND METHODS

The study included 3482 pregnant women participating in the Akershus Birth Cohort study (response rate 80.5%). Data were collected by a questionnaire in pregnancy weeks 17-21, pregnancy week 32 and electronic birth journal. The results were analysed by logistic regression and are presented as crude (cOR) and adjusted OR (aOR) with 95% CI.

RESULTS

Only 14.6% of the respondents followed the current exercise prescription for exercise during pregnancy (≥3 times a week, >20 min at moderate intensity). One-third of the study sample exercised less than once a week at pregnancy weeks 17-21. Women exercising either 1-2 times or ≥3 times a week at mid-pregnancy were more often primiparous, higher-educated and had less often prepregnacy body mass index >30 kg/m2 compared with women exercising less than once a week. Women who exercised ≥3 times a week were less likely to report pelvic girdle pain (aOR: 0.76, 95% CI 0.61 to 0.96), while women exercising 1-2 times a week were less likely to report low-back pain (aOR: 0.80, 95% CI 0.66 to 0.97) and depression (aOR: 0.66, 95% CI 0.48 to 0.91).

CONCLUSIONS

Few Norwegian women follow current exercise prescriptions for exercise in mid-pregnancy. The results may indicate an association between exercising mid-pregnancy and lower prevalence of low-back pain, pelvic girdle pain and depression in late pregnancy.

Fear of childbirth, mental health, and medication use during pregnancy

The aim of this work was to study the associations between medication use, fear of childbirth, and maternal mental health. Pregnant women (n = 1,984) were recruited through routine antenatal care at a Norwegian hospital from November 2008 through April 2010. Data were collected by three self-completed questionnaires at pregnancy week 17 and 32 and at 8 weeks postpartum. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Checklist (SCL-25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). In total, 57.7 % of the women used medications during pregnancy. Analgesics were used by 55.8 % of the women and psychotropic medications by 1.8 %. In all, 7.8 % of the women reported fear of childbirth (W-DEQ >85), the prevalence of anxiety (SCL >18) was 11.8 % and the prevalence of depression (EPDS >13) was 8.1 %. Fear of childbirth was significantly associated with use of psychotropic drugs (OR 3.63; 95 % CI 1.39-9.43) but not with the use of analgesics or medications in general. The presence of symptoms of anxiety or depression increased the magnitude of this association. Fear of childbirth is associated with an increased use of psychotropic medication. This finding could not only be explained by an overlap between fear of childbirth and impaired mental health.

The buffering effect of relationship satisfaction on emotional distress in couples

Background

Marital distress and depression frequently co-occur, and partnership quality is associated with depressive symptoms and mental disorders in both men and women. One aim of this study was to investigate the contribution of a set of risk factors for emotional distress among men and women in couples, with a special focus on satisfaction with partner relationship. The most important aim was to investigate the extent to which high relationship satisfaction in couples acts as a buffer against stressful events.

Methods

Pregnant women and their husbands (n = 62,956 couples) enrolled in the Norwegian Mother and Child Cohort Study completed a questionnaire with questions about emotional distress, relationship satisfaction, and other risk factors. Twelve potential risk factors were included in the analyses, including relationship satisfaction, demographic characteristics, and somatic diseases in men and women. Associations between the predictor variables and emotional distress were estimated by multiple linear regression analysis. Cross-spousal effects, in which data reported by one of the spouses predicted emotional distress in the other, were also investigated. Possible interaction effects between certain risk factors and self-reported and partner's relationship satisfaction were tested and further explored with regression analyses in subsamples stratified by relationship satisfaction scores.

Results

The unique effects of relationship satisfaction were of similar sizes for both men and women: substantial for self-reported (β = -0.23 and β = -0.28, respectively) and weak for partner-reported satisfaction (β = -0.04 and β = -0.02, respectively). Other relatively strong risk factors were somatic disease, first-time motherhood, and unemployment. Self-reported as well as partner-reported relationship satisfaction appeared to strongly buffer the effects of a number of stressors.

Conclusions

Partner relationship dissatisfaction is strongly associated with emotional distress in men and women. Good partner relationship, both as perceived by the individual him(her)self and by the spouse, quite strongly moderates adverse effects of various types of emotional strain.

The Wijma Delivery Expectancy/Experience Questionnaire: a factor analytic study

Fear of childbirth (FOC) is an important women's health issue. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is currently the most frequently used instrument to measure FOC. The scale is designed to measure different aspects of FOC but is conceptualized as a uni-dimensional instrument. Our aim was to investigate the underlying factor structure of the W-DEQ version A. A total of 1642 women scheduled to give birth at Akershus University Hospital (Norway) during 2009 and 2010 completed the W-DEQ in the third trimester. Validity and reliability were estimated by means of exploratory and confirmatory factor analyses and correlations with other relevant variables. Results confirmed a multidimensional structure of the W-DEQ. Six factors were identified, each measuring different domains: 'Fear', 'Negative appraisal', 'Loneliness', 'Lack of self-efficacy', 'Lack of positive anticipation', and 'Concerns for the child'. The final model resulted in a 25-item version of the instrument with adequate psychometric properties. Subfactors correlated differently with several relevant variables. Especially the factor 'Fear' was highly correlated with both the overall W-DEQ and several important outcomes. Future studies could examine whether this factor may serve as a good proxy for the full W-DEQ version A.

Maternal emotional distress in pregnancy and delivery of a small-for-gestational age infant

OBJECTIVE

To assess the association between maternal emotional distress in pregnancy and delivery of a small-for-gestational age offspring.

DESIGN

A cohort study in pregnancy.

SETTING

Fifty hospitals with a maternity ward in Norway during 1998-2008.

POPULATION

Seventy-one thousand eight hundred and ninety-eight women with a singleton pregnancy in the Norwegian Mother and Child Cohort Study were followed from early pregnancy to delivery.

METHODS

Information on presence of emotional distress was obtained through self-administered questionnaires in pregnancy weeks 17 and 30 and on birthweight, gestational length at delivery and sex by linkage to the Medical Birth Registry of Norway. Emotional distress was measured by short forms of the Hopkins Symptom Checklist-25.

MAIN OUTCOME MEASURE

Small-for-gestational age offspring (birthweight <2.5th percentile).

RESULTS

Being emotionally distressed at gestational weeks 17 and 30 was not significantly associated with subsequent delivery of a small-for-gestational age infant (adjusted odds ratio 1.16; 95% confidence interval 0.87-1.54). This estimate was adjusted for smoking in pregnancy, parity, diabetes, pre-eclampsia, body mass index, education and maternal age.

CONCLUSIONS

Emotional distress during pregnancy was not associated with subsequent delivery of a small-for-gestational age infant.

Partner relationship satisfaction and maternal emotional distress in early pregnancy

Background

Recognition of maternal emotional distress during pregnancy and the identification of risk factors for this distress are of considerable clinical- and public health importance. The mental health of the mother is important both for herself, and for the physical and psychological health of her children and the welfare of the family. The first aim of the present study was to identify risk factors for maternal emotional distress during pregnancy with special focus on partner relationship satisfaction. The second aim was to assess interaction effects between relationship satisfaction and the main predictors.

Methods

Pregnant women enrolled in the Norwegian Mother and Child Cohort Study (n = 51,558) completed a questionnaire with questions about maternal emotional distress, relationship satisfaction, and other risk factors. Associations between 37 predictor variables and emotional distress were estimated by multiple linear regression analysis.

Results

Relationship dissatisfaction was the strongest predictor of maternal emotional distress (β = 0.25). Other predictors were dissatisfaction at work (β = 0.11), somatic disease (β = 0.11), work related stress (β = 0.10) and maternal alcohol problems in the preceding year (β = 0.09). Relationship satisfaction appeared to buffer the effects of frequent moving, somatic disease, maternal smoking, family income, irregular working hours, dissatisfaction at work, work stress, and mother's sick leave (P < 0.05).

Conclusions

Dissatisfaction with the partner relationship is a significant predictor of maternal emotional distress in pregnancy. A good partner relationship can have a protective effect against some stressors.

Postnatal care: a cross-cultural and historical perspective

Childbirth and the immediate postpartum period represent a major transition in a woman's life. This period is considered a vulnerable time for the mother and child in most societies, and rituals for this transition are common. In this study, we present some examples of postpartum customs in a cross-cultural and historical perspective. Also, we present the current knowledge on the possible impact of postnatal care on mental health. Systematic literature searches were performed in Medline, PsycINFO, and the Science Citation Index Expanded (ISI) for the time period 1966 through May 2010. Reference lists in books on pregnancy and childbirth from the University Library in Oslo were used to obtain additional information. We found that the postnatal period seems to be universally defined as 40 days. Most cultures have special postnatal customs, including special diet, isolation, rest, and assistance for the mother. The uniformity of customs across different cultures is striking. However, many postnatal customs that were common before 1950 are no longer existent. The focus on rest and assistance for the mother after delivery has gradually decreased. Studies of associations of postnatal care and mental health in the mother are limited and show inconsistent results. More knowledge is needed on postnatal care and mental health.

Pelvic girdle pain in pregnancy: the impact of parity

OBJECTIVE

The purpose of this study was to estimate the association of parity with pelvic girdle syndrome (PGS; pain in anterior and bilateral posterior pelvis).

STUDY DESIGN

We included 75,939 pregnant women in the Norwegian Mother and Child Cohort Study. Data were obtained by self-administered questionnaires.

RESULTS

By pregnancy week 30, 15% of the women had developed PGS. Among first-time mothers, 11% of the women reported PGS, compared with 18% of the women with 1 previous delivery and 21% of women with 2 previous deliveries. The odds ratios for PGS of having had 1 or 2 previous deliveries were 1.9 (95% confidence interval [CI], 1.9-2.0) and 2.4 (95% CI, 2.3-2.6), respectively, after adjustment for other study factors. For PGS with severe pain, the corresponding odds ratios were 2.6 (95% CI, 2.3-2.9) and 3.8 (95% CI, 3.3-4.3).

CONCLUSION

The risk of the development of PGS increased with number of previous deliveries, which suggests that parity-related factors play a causal role.

Sleep and depression in postpartum women: a population-based study

STUDY OBJECTIVES

(1) To describe the prevalence of and risk factors for postpartum maternal sleep problems and depressive symptoms simultaneously, (2) identify factors independently associated with either condition, and (3) explore associations between specific postpartum sleep components and depression.

DESIGN

Cross-sectional.

SETTING

Population-based.

PARTICIPANTS

All women (n = 4191) who had delivered at Stavanger University Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks postpartum. The response rate was 68% (n = 2830).

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of sleep problems, defined as PSQI > 5, was 57.7%, and the prevalence of depression, defined as EPDS > or = 10, was 16.5%. The mean self-reported nightly sleep duration was 6.5 hours and sleep efficiency 73%. Depression, previous sleep problems, being primiparous, not exclusively breastfeeding, or having a younger or male infant were factors associated with poor postpartum sleep quality. Poor sleep was also associated with depression when adjusted for other significant risk factors for depression, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression.

CONCLUSIONS

Poor sleep was associated with depression independently of other risk factors. Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.

Sexual function in men treated for testicular cancer

INTRODUCTION

Testicular germ cell cancer (TGCC) patients may be at risk of developing sexual dysfunction after treatment.

AIM

The aim of this study was to assess the prevalence of sexual dysfunctions in TGCC patients 3 to 5 years after treatment, and relate findings to biochemical hypogonadism, treatment intensity, and the expected prevalence in the Swedish male population.

METHODS

A questionnaire study on 129 consecutive TGCC patients 3 to 5 years post-treatment was performed. Comparators were an age-matched nationally representative group of men (N = 916) included in a study on sexual life in Sweden.

MAIN OUTCOME MEASURES

Sexual functions (including erectile dysfunctional distress), time since last intercourse, sexual satisfaction, and experience of sexological treatment seeking were assessed using the same questions used in the epidemiological study on sexual life in Sweden. The findings in TGCC patients were correlated to biochemical signs of hypogonadism and type of oncological treatment: Surveillance, adjuvant chemotherapy, adjuvant radiotherapy, or standard doses of chemotherapy.

RESULTS

A higher proportion of TGCC patients than comparators were likely to report low sexual desire (odds ratio [OR] 6.7 [95% confidence interval {CI} 2.1-21]) as well as erectile dysfunction (OR 3.8 [95% CI 1.4-10]). No significant differences were observed regarding erectile dysfunctional distress, change of desire over time, interest in sex, premature or delayed ejaculation, time since last intercourse, need for or receiving sexual advice, or sexual satisfaction. Hypogonadism did not predict erectile dysfunction (OR 1.1 [95% CI 0.26-4.5]) or low sexual desire (OR 1.2 [95% CI 0.11-14]). Treatment modality had no obvious impact on sexual function.

CONCLUSION

Men treated for testicular cancer had higher risk of having low sexual desire and erectile dysfunction 3 to 5 years after completion of therapy than comparators. These sexual dysfunctions were not significantly associated with treatment intensity or hypogonadism.

Subjective and objective sleep among depressed and non-depressed postnatal women

OBJECTIVE

Women sleep less in the postnatal period and it has been suggested that mothers diagnosed with depression alternatively could be suffering from the effects of chronic sleep deprivation.

METHOD

From a population-based study, we recruited 42 women, of whom 21 scored >or=10 on the Edinburgh Postnatal Depression Scale. Sleep was registered by the Pittsburgh Sleep Quality Index (PSQI), sleep diaries and actigraphy 2 months after delivery.

RESULTS

There were significant differences in subjective sleep measured retrospectively by the PSQI between depressed and non-depressed women. In contrast, there were no significant differences in sleep measured prospectively by sleep diaries and actigraphy. Both depressed and non-depressed women had impaired sleep efficiency (82%) and were awake for about 1.5 h during the night. Primipara had worse sleep, measured by actigraphy, compared with multipara.

CONCLUSION

Measured objectively and prospectively, women with depression did not have worse sleep than non-depressed women.

Fear during labor: the impact of sexual abuse in adult life

Our aim was to study the occurrence of extreme fear during labor and its association with previous sexual abuse in adult life. All postpartum women (n = 414) in two municipalities in Norway participated in a questionnaire study. Self-reported fear during labor was categorized as "no fear/some fear/extreme fear". Sexual abuse was measured by the Abuse Assessment Screen (AAS). Three percent of the women reported extreme fear during labor, 13% some fear and 84% no fear. In total, 12% had been sexually abused as an adult. Among the women with extreme fear during labor, however, one third had a history of sexual abuse in adult life (crude odds ratio 3.7; 95% CI: 1.0-3.7). When controlling for depression in pregnancy, duration of labor and mode of delivery, the adjusted odds ratio for extreme fear during labor was 4.9 (95% CI: 1.2-19.1). The results suggest that women with a history of sexual abuse in adult life have an increased risk of extreme fear during labor.

Diabetes mellitus and pelvic girdle syndrome in pregnancy--is there an association?

OBJECTIVE

Increased levels of relaxin, a hormone structurally belonging to the insulin-like growth factor family, has been associated with both pelvic girdle pain and type 1 diabetes in pregnancy. However, an association between pelvic girdle pain in pregnancy and diabetes has not been investigated. The aim of this study was to investigate whether or not an association exists between diabetes and pelvic girdle syndrome.

DESIGN

Cross-sectional questionnaire study.

SETTING

All women 18-40 years old, in two municipalities in Norway during 1998-1999 were eligible for the study. Sample. A total of 1,816 women with at least one prior delivery constituted the study sample.

METHODS

Pelvic girdle syndrome during last pregnancy was the outcome variable, defined as pain in the anterior pelvis and bilateral posterior pelvis. The impact of diabetes on developing pelvic girdle syndrome was estimated as odds ratios in logistic regression analyses.

RESULTS

Diabetes increased the risk of pelvic girdle syndrome (adjusted odds ratio 7.3; 95% confidence interval: 1.8-28.5). In addition, age > or =25 years at delivery and obesity (body mass index > or =35) were associated with pelvic girdle syndrome. Parity and time since delivery were not significantly associated with pelvic girdle syndrome.

CONCLUSIONS

The results in multivariate analyses indicate an association between pelvic girdle syndrome and diabetes. The causes of pelvic girdle pain are not known. However, our results encourage further exploration of hormonal factors.