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Huang D, Liu Z, Liu X, Bai Y, Wu M, Luo X, Qi H. Stress and Metabolomics for Prediction of Spontaneous Preterm Birth: A Prospective Nested Case-Control Study in a Tertiary Hospital. Front Pediatr 2021; 9:670382. [PMID: 34557457 PMCID: PMC8452860 DOI: 10.3389/fped.2021.670382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Spontaneous preterm birth (sPTB) is the leading cause of infant morbidity and mortality worldwide. Deficiency of effective predict methods is an urgent problem that needs to be solved. Numbers of researchers spare no efforts to investigate differential indicators. To evaluate the value of the differential indicators, a prospective nested case-control study was carried out. Among an overall cohort of 1,050 pregnancies, 20 sPTB pregnancies, and 20 full-term pregnancies were enrolled in this study. Participants were followed-up until labor. The psychological profile was evaluated utilizing the Zung Self-Rating Depression Scale at 11-14 weeks. Stress-related biomarker-cortisol and metabolites were detected by Electrochemiluminescence Immunoassay (ECLIA) and Gas Chromatography-Mass Spectrometry (GC-MS) in serum samples during pregnancy, respectively. The expression level of cortisol was up-regulated in serum and the score of the Zung Self-Rating Depression Scale was significantly higher in the sPTB group when compared to the control group. Note that, 29 metabolomics were differentially expressed between the sPTB group and the control group. The scores of the Zung Self-Rating Depression Scale, the level of cortisol, Eicosane, methyltetradecanoate, and stearic acid in serum were selected to establish the model with lasso logistic regression. Validation of the model yielded an optimum corrected AUC value of 89.5%, 95% CI: 0.8006-0.9889 with a sensitivity of 100.0%, and specificity of 78.9%. In conclusion, this study establishes a prediction model of sPTB with five variables, which may predict sPTB more accurately and sensitively in the second trimester.
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Affiliation(s)
- Dongni Huang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China.,Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Zheng Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Yuxiang Bai
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Mengshi Wu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Xin Luo
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Joint International Research Laboratory of Reproduction and Development of Chinese Ministry of Education, Chongqing Medical University, Chongqing, China
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Baas MAM, van Pampus MG, Stramrood CAI, Dijksman LM, Vanhommerig JW, de Jongh A. Treatment of Pregnant Women With Fear of Childbirth Using EMDR Therapy: Results of a Multi-Center Randomized Controlled Trial. Front Psychiatry 2021; 12:798249. [PMID: 35222106 PMCID: PMC8866441 DOI: 10.3389/fpsyt.2021.798249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Fear of childbirth (FoC) occurs in 7. 5% of pregnant women and has been associated with adverse feto-maternal outcomes. Eye Movement Desensitization and Reprocessing (EMDR) therapy has proven to be effective in the treatment of posttraumatic stress disorder (PTSD) and anxiety; however, its effectiveness regarding FoC has not yet been established. The aim was to determine the safety and effectiveness of EMDR therapy for pregnant women with FoC. This single-blind RCT (the OptiMUM-study, www.trialregister.nl, NTR5122) was conducted in the Netherlands. FoC was defined as a score ≥85 on the Wijma Delivery Expectations Questionnaire (WDEQ-A). Pregnant women with FoC and a gestational age between 8 and 20 weeks were randomly assigned to EMDR therapy or care-as-usual (CAU). The severity of FoC was assessed using the WDEQ-A. Safety was indexed as worsening of FoC symptoms, dropout, serious adverse events, or increased suicide risk. We used linear mixed model analyses to compare groups. A total of 141 women were randomized (EMDR n = 70; CAU n = 71). No differences between groups were found regarding safety. Both groups showed a very large (EMDR d = 1.36) or large (CAU d = 0.89) reduction of FoC symptoms with a mean decrease of 25.6 (EMDR) and 17.4 (CAU) points in WDEQ-A sum score. No significant difference between both groups was found (p = 0.83). At posttreatment, 72.4% (EMDR) vs. 59.6% (CAU) no longer met the criteria for FoC. In conclusion, the results are supportive of EMDR therapy as a safe and effective treatment of FoC during pregnancy, albeit without significant beneficial effects of EMDR therapy over and above those of CAU. Therefore, the current study results do not justify implementation of EMDR therapy as an additional treatment in this particular setting.
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Affiliation(s)
- M A M Baas
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - C A I Stramrood
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - L M Dijksman
- Department of Quality and Safety, St. Antonius Hospital, Nieuwegein, Netherlands
| | - J W Vanhommerig
- Department of Research and Epidemiology, OLVG, Amsterdam, Netherlands
| | - A de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit University Amsterdam, Amsterdam, Netherlands.,PSYTREC, Bilthoven, Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom.,Institute of Health and Society, University of Worcester, Worcester, United Kingdom.,School of Psychology, Queen's University, Belfast, United Kingdom
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53
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Thomson M, Sharma V. Pharmacotherapeutic considerations for the treatment of posttraumatic stress disorder during and after pregnancy. Expert Opin Pharmacother 2020; 22:705-714. [PMID: 33225773 DOI: 10.1080/14656566.2020.1854727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Posttraumatic stress disorder (PTSD) affects 3-4% of the pregnant and postpartum population. Despite its high prevalence, there has been very little research on how the disorder should be managed in this population. This is of importance as untreated PTSD has been associated with adverse outcomes both in pregnancy and in child development.Areas covered: In this article, the authors discuss the existing literature on the pharmacological treatment of PTSD. As guidelines and clinical trials in the treatment of perinatal PTSD are non-existent, they extrapolate the existing data from non-perinatal populations while considering the safety of medications in pregnancy and breastfeeding.Expert opinion: First-line treatment of perinatal PTSD ideally involves evidence-based psychotherapy rather than pharmacotherapy. However, pharmacotherapy may be required in situations of inadequate response, psychiatric co-morbidities, limited access to psychotherapy, or patient preference. The first-line pharmacotherapy options are the antidepressants sertraline, paroxetine, fluoxetine, and venlafaxine. Of these medications, sertraline has the best safety profile in pregnancy and postpartum and is thus the preferred agent. Clinical studies and consensus guidelines in the treatment of perinatal PTSD are needed given the high prevalence of the disorder and the significant risks associated with inadequate treatment.
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Affiliation(s)
- Michael Thomson
- Department of Psychiatry, Western University, Parkwood Institute Mental Health Building, London, Ontario, Canada
| | - Verinder Sharma
- Department of Psychiatry, Department of Obstetrics and Gynecology, Western University, Parkwood Institute, London, Ontario, Canada
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Sperlich M. Social Determinants of Maternal Mental Health and the Need for Integrated Models of Care. J Womens Health (Larchmt) 2020; 29:1023-1024. [DOI: 10.1089/jwh.2020.8508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mickey Sperlich
- School of Social Work, University at Buffalo—The State University of New York, Buffalo, New York, USA
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Stevens NR, Holmgreen L, Hobfoll SE, Cvengros JA. Assessing Trauma History in Pregnant Patients: A Didactic Module and Role-Play for Obstetrics and Gynecology Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10925. [PMID: 32704539 PMCID: PMC7373354 DOI: 10.15766/mep_2374-8265.10925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/09/2020] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Assessing and addressing patient histories of trauma constitute a critical component of care for vulnerable populations such as pregnant patients, yet they often go unrecognized in obstetric care. Obstetric providers may feel poorly equipped to address this issue comfortably and effectively. METHODS We designed this didactic module for obstetric residents with previous experience taking patient histories and delivering clinical care. The module was delivered with a faculty member and three additional facilitators with expertise in communication skills training. The session included 60 minutes of background information followed by a 15-minute presentation of a communication template for assessing trauma history. Using a practice case, residents had 45 minutes to practice in small groups, with the facilitators serving as the patient in the role-play. RESULTS In the 2015-2016 academic year, 21 obstetric residents participated in this module. All residents (100%) endorsed favorable beliefs regarding the importance of assessing trauma history and using trauma-informed care. On average, three-fourths (77%) demonstrated basic awareness of issues related to trauma in medical populations. Most residents (>85%) reported a high sense of efficacy in delivering trauma-informed care in some areas, while fewer (64%) reported efficacy specifically in educating patients about signs and symptoms of traumatic stress. DISCUSSION The module was well received overall, with participants indicating that clinical training in trauma-informed communication was needed to enhance their sense of efficacy in this area. This learning exercise provided training in a critical communication skill while highlighting areas for further development.
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Affiliation(s)
- Natalie R. Stevens
- Assistant Professor, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
- Corresponding Author:
| | - Lucie Holmgreen
- Assistant Professor, Department of Psychological Science, Gustavus Adolphus College
| | | | - Jamie A. Cvengros
- Associate Professor, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
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56
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Nillni YI, Shayani DR, Finley E, Copeland LA, Perkins DF, Vogt D. The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans' Perinatal Outcomes Following Separation From Military Service. J Trauma Stress 2020; 33:248-256. [PMID: 32291816 PMCID: PMC7864116 DOI: 10.1002/jts.22509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 01/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Danielle R. Shayani
- Department of Psychiatry, Boston University School of Medicine,Northeastern University
| | - Erin Finley
- Veterans Evidence-based Research Dissemination and Implementation Center, South Texas Veterans Health Care System,Departments of Medicine and Psychiatry, UT Health San Antonio
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System,Department of Population and Quantitative Health Science, University of Massachusetts Medical School
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness, and Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University
| | - Dawne Vogt
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
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57
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Rashid HU, Khan MN, Imtiaz A, Ullah N, Dherani M, Rahman A. Post-traumatic stress disorder and association with low birth weight in displaced population following conflict in Malakand division, Pakistan: a case control study. BMC Pregnancy Childbirth 2020; 20:166. [PMID: 32183725 PMCID: PMC7077167 DOI: 10.1186/s12884-020-2841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background The northern part of the province of Khyber Pakhtunkhwa in Pakistan experienced armed conflict since September 2007 till the autumn of 2011. Conflict involved widespread insurgency activity and military intervention including in 2009 internally displacing the 2.5 million people of the valley of Swat to live in camps, with relatives, or in rented accommodation across the region for approximately 4 months. It was during this period the current study was conducted to determine whether Post-Traumatic Stress Disorder in pregnant women was independently associated with Low Birth Weight (LBW) in an area affected by conflict and militancy. Methods A case control study was conducted in tertiary care hospitals of district Peshawar, Khyber Pakhtunkhwa. Two hundred twenty-five cases (neonates with birth weight < 2.5 kg) and 225 controls (neonates with birth weight of > 2.5 kg) were enrolled within 24 h of delivery. Post-Traumatic Stress Disorder was assessed through the MINI Neuropsychiatric Interview 5.0, a validated questionnaire along with the birth weight of the newborn. Maternal anthropometry, anemia and other sociodemographic details were also obtained during data collection. Data was analyzed using statistical package (STATA version 14). Logistic regression analysis of the association between LBW and all variables collected with a p-value of < 0.25 on uni-variate analysis were entered. Results A total of 450 newborn and mother pairs participated in the study with 225 cases and 225 controls. On univariate analysis factors significantly associated with LBW include: less than 5 years of paternal schooling and PTSD. On logistic regression, PTSD was independently associated with low birth weight in the presence of other factors like maternal/paternal schooling, gravida, history of preterm, BMI of the mother and maternal anemia. Conclusion PTSD was found to be independently associated with LBW. In light of the current findings and other similar literature, intervention programs should be considered for pregnant women exposed to traumatic events.
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Affiliation(s)
- Haroon Ur Rashid
- Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Phase V, Hayatabad, Peshawar, Pakistan
| | - Muhammad Naseem Khan
- Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Phase V, Hayatabad, Peshawar, Pakistan. .,Department of Psychological Medicine, University of Liverpool, Liverpool, UK.
| | - Ayesha Imtiaz
- Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Phase V, Hayatabad, Peshawar, Pakistan
| | | | - Mukesh Dherani
- Department of Psychological Medicine, University of Liverpool, Liverpool, UK
| | - Atif Rahman
- Department of Psychological Medicine, University of Liverpool, Liverpool, UK.,Human Development Research Foundation, Islamabad, Pakistan
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Gokhale P, Young MR, Williams MN, Reid SN, Tom LS, O'Brian CA, Simon MA. Refining Trauma-Informed Perinatal Care for Urban Prenatal Care Patients with Multiple Lifetime Traumatic Exposures: A Qualitative Study. J Midwifery Womens Health 2020; 65:224-230. [PMID: 32083380 DOI: 10.1111/jmwh.13063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Because lifetime trauma exposure has been linked to multiple adverse pregnancy outcomes, there is a need for all perinatal care providers to be versed in trauma-informed care practices. However, there are few data to guide trauma-informed practice during the perinatal period. The objective of this study was to refine ongoing development of a trauma-informed care framework for perinatal care by conducting a qualitative study of all trauma experiences and preferred screening practices of pregnant patients at an urban prenatal clinic. METHODS In this qualitative study, we conducted semistructured interviews with 30 women receiving prenatal care at an urban clinic. Participants also completed a trauma history questionnaire. Inductive coding was used to generate themes and subthemes. RESULTS Participants described multiple lifetime traumatic exposures as well as background exposure to community violence. Not all participants desired routine trauma screening; factors limiting disclosure included fear of retraumatization and belief that prior trauma is unrelated to the current pregnancy. Strong therapeutic relationships were identified as critical to any trauma history discussion. DISCUSSION This study supports a trauma-informed care approach to caring for pregnant women with prior traumatic exposures, including trauma screening without retraumatization and trusting patient-provider relationships.
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Affiliation(s)
- Priyanka Gokhale
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Maria R Young
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | - Shayla N Reid
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Laura S Tom
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Catherine A O'Brian
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Burris HH, Riis VM, Schmidt I, Gerson KD, Brown A, Elovitz MA. Maternal stress, low cervicovaginal β-defensin, and spontaneous preterm birth. Am J Obstet Gynecol MFM 2020; 2:100092. [PMID: 32671334 DOI: 10.1016/j.ajogmf.2020.100092] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Spontaneous preterm birth (sPTB) is a major contributor to infant mortality and its etiology remains poorly understood. Host immunity and maternal stress may play a role in the pathogenesis of sPTB but mechanisms are poorly delineated. Antimicrobial proteins in the cervicovaginal space, such as beta defensins, modulate immune responses to bacteria and have been shown to modulate the risk of sPTB from non-optimal microbiota. While stress is known to induce immunological changes, no study has examined the interplay between maternal stress and the immune response in association with sPTB. Objectives Our objectives were to determine whether psychosocial stress was associated with a mediator of the immune system in the cervicovaginal space, beta defensin-2, and to examine the combined impact of high stress and low cervicovaginal beta defensin-2 levels on the odds of sPTB. Study Design From the Motherhood & Microbiome cohort study (n=2000), we performed a secondary, nested case-control study, frequency matched by race/ethnicity, of 519 pregnant women (110 sPTB and 409 term). Stress and cervicovaginal beta defensin-2 levels were measured at 16-20 weeks of gestation. Stress was dichotomized at a score of 30 on Cohen's Perceived Stress Scale (PSS-14). We measured cervicovaginal beta defensin-2 levels with ELISA and dichotomized at the median. We modeled associations of high stress and low cervicovaginal beta defensin-2 levels using multivariable logistic regression. We also compared the proportion of women with high stress and low cervicovaginal beta defensin-2 levels among women with spontaneous preterm and term births using Chi-Square tests. We modeled adjusted associations of stress and cervicovaginal beta defensin-2 levels with odds of sPTB using logistic regression. Results The majority of the study population was non-Hispanic black (72.8%), insured by Medicaid (51.1%), and had a PSS-14 score < 30 (80.2%). High stress was associated with reduced adjusted odds of low beta defensin-2 levels (aOR 0.63, 95% CI: 0.38 -0.99). In a model adjusted for race and smoking, both high stress (aOR 1.72, 95% CI: 1.03-2.90) and low beta defensin-2 (aOR 1.58, 95% CI: 1.004-2.49) were associated with increased odds of sPTB. We then built a model of the four possible combinations of low and high stress and low and high beta defensin-2 levels with the odds of sPTB. Women with either high stress (aOR 1.37, 95% CI: 0.68 - 2.78) or low beta defensin-2 (aOR 1.40, 95% CI: 0.83-2.34), had slightly elevated but not significantly increased odds of sPTB compared to women with neither exposure. However, women with both high stress and low beta defensin-2 had significantly elevated odds of sPTB compared to women with neither exposure (aOR 3.16, 95 % CI: 1.46 - 6.84). Conclusion High perceived stress and low cervicovaginal beta defensin-2 levels are associated with higher odds of sPTB, and when present concurrently, they result in the highest odds of sPTB in a largely non-Hispanic black cohort. Our findings warrant further work to examine social determinants of health and the host cervicovaginal immune responses that may modulate the pathogenesis of sPTB.
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Affiliation(s)
- Heather H Burris
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Valerie M Riis
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Isabel Schmidt
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kristin D Gerson
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Maternal-fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amy Brown
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michal A Elovitz
- Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Maternal-fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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60
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Cubbin C, Kim Y, Vohra-Gupta S, Margerison C. Longitudinal measures of neighborhood poverty and income inequality are associated with adverse birth outcomes in Texas. Soc Sci Med 2020; 245:112665. [PMID: 31778899 PMCID: PMC8601022 DOI: 10.1016/j.socscimed.2019.112665] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/30/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Inequity in adverse birth outcomes between black and white women in the U.S. is persistent, despite decades of research and prevention efforts. Neighborhood environments are plausibly related to pre-pregnancy health and other risk factors for adverse birth outcomes and may help explain black/white inequities. Despite the fact that neighborhoods change over time, most prior work has relied upon cross-sectional measures of neighborhood economic contexts. METHODS We used birth certificates for non-Hispanic black and white women in Texas (2009-2011, N = 470,896) to examine whether longitudinal measures of neighborhood economic context (poverty and income inequality, based on census tract data from 1990 to 2010) were associated with preterm birth, low birthweight and small-for-gestational-age (SGA) with hierarchical generalized linear models. We also tested whether (1) the longitudinal measures explained black/white inequities or (2) moderated the effect of race on the birth outcomes. Finally, we compared the models with longitudinal measures to models with cross-sectional measures of neighborhood economic context. RESULTS Longitudinal measures of neighborhood economic context were associated with all three birth outcomes, but did not explain racial inequities. Except for income inequality and SGA, there was no evidence of moderation by race. Substituting cross-sectional measures of economic context for longitudinal ones resulted in similar findings. CONCLUSION Policies that either address structural neighborhood-level economic disadvantage or mitigate the effects of such disadvantage are warranted to improve the health of mothers and prevent adverse birth outcomes.
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Affiliation(s)
- Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Yeonwoo Kim
- School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109-2013, USA
| | - Shetal Vohra-Gupta
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Claire Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, Room B601, East Lansing, MI, 48824, USA
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Nagle-Yang S, Phillips M, Albaugh A, Zhao L, Amin J, Ahmad E, Hatters Friedman S. Depression, anxiety, and attachment among women hospitalized on an antepartum unit. Int J Psychiatry Med 2019; 54:395-407. [PMID: 30924701 DOI: 10.1177/0091217419837071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To examine the prevalence of depression, anxiety, attachment issues, and associated factors among pregnant women hospitalized on an antepartum unit. Method Ninety-eight women hospitalized on an antepartum unit reported demographic and social information and were evaluated with screening tools for depression, anxiety, and maternal–fetal attachment. Data were analyzed using descriptive statistics and logistical regression analysis. Results Over one third (36%) of participants screened at risk for depression. Almost half (47%) reported elevated state anxiety and over one third (37%) reported elevated trait anxiety. Depression and anxiety were frequently comorbid. Positive screens for depression and anxiety were associated with decreased maternal-fetal attachment. Those who screened at risk for depression and anxiety in this sample often had a personal or family history of depression or anxiety or a history of intimate partner victimization. Substance use was common among those with elevated anxiety. Only a minority (15%) of at-risk participants had been referred to mental health treatment. Conclusions Women hospitalized on antepartum units had an elevated risk of depression and anxiety. Depression and anxiety were strongly comorbid in this population. Screening efforts to increase detection of perinatal depression and anxiety are recommended on obstetrical antepartum units.
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Affiliation(s)
- Sarah Nagle-Yang
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - MacKenzie Phillips
- University Hospitals Cleveland Medical Center, Cleveland Regional Perinatal Network, Cleveland, OH, USA
| | - Avril Albaugh
- University Hospitals Cleveland Medical Center, Cleveland Regional Perinatal Network, Cleveland, OH, USA
| | - Lulu Zhao
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jaina Amin
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Erum Ahmad
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Hatters Friedman
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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62
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Chen Y, Yang X, Guo C, Liao Y, Guo L, Chen W, Chen I, Krewski D, Wen SW, Xie RH. Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2019; 29:200-209. [PMID: 31532326 DOI: 10.1089/jwh.2019.7750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Results: Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Conclusions: Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
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Affiliation(s)
- Yanfang Chen
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, Jiangsu, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lixing Guo
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Wenjun Chen
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ri-Hua Xie
- Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
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63
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A Matched Cohort Study of the Association Between Childhood Sexual Abuse and Teenage Pregnancy. J Adolesc Health 2019; 65:384-389. [PMID: 31196780 DOI: 10.1016/j.jadohealth.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE This matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population. METHODS A total of 661 girls (aged 13-18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled. RESULTS Results indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups. CONCLUSIONS Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.
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64
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Powers A, Woods-Jaeger B, Stevens JS, Bradley B, Patel MB, Joyner A, Smith AK, Jamieson DJ, Kaslow N, Michopoulos V. Trauma, psychiatric disorders, and treatment history among pregnant African American women. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 12:138-146. [PMID: 31464464 DOI: 10.1037/tra0000507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. METHOD The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. RESULTS Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. CONCLUSION Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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65
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Scrafford KE, Grein K, Miller-Graff LE. Effects of Intimate Partner Violence, Mental Health, and Relational Resilience on Perinatal Health. J Trauma Stress 2019; 32:506-515. [PMID: 31356701 DOI: 10.1002/jts.22414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 01/09/2023]
Abstract
Intimate partner violence (IPV) during and prior to pregnancy has been linked to higher rates of pregnancy complications and early labor and delivery. However, to our knowledge, no studies have examined prenatal mental health problems and relational resilience as parallel mechanisms by which past-year IPV exposure impacts pregnancy and labor. The current study aimed to (a) examine the contribution of IPV exposure to pregnancy complications and early labor and delivery, controlling for childhood adversity, and (b) assess prenatal mental health and relational resilience as mediators of the effect of IPV exposure on pregnancy complications and early labor and delivery. We hypothesized that IPV would predict higher levels of mental health problems and lower levels of relational resilience, each of which would contribute to women's risk of labor complications such that fewer mental health problems and higher levels of relational resilience would each be associated with fewer pregnancy complications and early labor and delivery. Participants were (n = 76) interviewed during pregnancy and 6 weeks postdelivery. No direct effect of IPV exposure on either pregnancy complications or labor complications was found. Parallel indirect effects of IPV on labor via prenatal mental health, indirect effect size = -.09; 95% CI [-.224, -.011]; and relational resilience, indirect effect size = .13, 95% CI [.036, .329] were found. Brief, empirically tested IPV screens at prenatal clinics may help healthcare providers better identify IPV-exposed patients. Clinical interventions targeting prenatal mental health and relational resilience may help improve labor outcomes for IPV-exposed mothers.
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Affiliation(s)
- Kathryn E Scrafford
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, Indiana, USA
| | - Katherine Grein
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, Indiana, USA
| | - Laura E Miller-Graff
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, Indiana, USA
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66
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Abstract
BACKGROUND Occupational exertion is associated with a higher risk of preterm delivery, although studies of leisure time activities generally document reduced risks. Less is known about the risk of preterm delivery immediately following episodes of moderate or heavy physical exertion. METHODS We conducted a case-crossover study of 722 women interviewed during their hospital stay for early preterm delivery, defined by a gestational age before 34 weeks, and after 20 weeks. Interviews occurred between March 2013 and December 2015 in seven hospitals in Lima, Peru. RESULTS The incidence rate ratio (RR) of early preterm delivery was 5.82-fold higher (95% confidence interval [CI] = 4.29, 7.36) in the hour following moderate or heavy physical exertion compared with other times and returned to baseline in the hours thereafter. The RR of early preterm delivery within an hour of physical exertion was lower for exertion at moderate intensity (RR = 2.43; 95% CI = 1.50, 3.96) than at heavy intensity (RR = 23.62; 95% CI = 15.54, 35.91; P-homogeneity < 0.001). The RR of early preterm delivery was lower in the hour following moderate physical exertion among women who habitually engaged in physical exertion >3 times per week in the year before pregnancy (RR = 1.56; 95% CI = 0.81, 3.00) compared with more sedentary women (RR = 6.91; 95% CI = 3.20, 14.92; P-homogeneity = 0.003). CONCLUSIONS Our study showed a heightened risk of early preterm delivery in the hour following moderate or heavy physical exertion.
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67
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Jairaj C, Fitzsimons CM, McAuliffe FM, O'Leary N, Joyce N, McCarthy A, Cassidy E, Donnelly J, Tully E, Imcha M, Austin J, Doolin K, Farrell C, O'Keane V. A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health 2019; 22:349-355. [PMID: 30069707 DOI: 10.1007/s00737-018-0893-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
Ireland has the second-highest birth rate in Europe and poorly developed perinatal psychiatry services. There are no screening services for antenatal depression and no data available on prevalence rates of depression among women attending the Irish obstetric services. The aim of this study was to assess the prevalence rates of depression during pregnancy in a population sample in Ireland using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. Pregnant women during all stages of pregnancy were recruited from five maternity hospitals throughout the Republic of Ireland. Approximately 5000 EPDS questionnaires were collected. Information on the participant's age, gestational week, gravidity, parity, and level of education attained was also collected. A score of > 12 was used as a measure of probable depression. Overall, 15.8% of pregnant women scored > 12 in the EPDS. There was a significant association between gestational week and rates of depression, with increasing rates occurring with advancing pregnancy (p < 0.001). Overall, higher socioeconomic groups were over-represented in the sample although we replicated the well-established findings of higher EPDS scores in women with lower educational attainment (p < 0.005). This study demonstrates that prevalence rates of probable antenatal depression are high among women attending the obstetric services in Ireland and highlight the importance of increasing awareness of antenatal depression. These high rates of antenatal depression may be related to certain conditions that are specific to an Irish setting: the absence of screening for depression in the context of grossly under-resourced perinatal psychiatry services. These findings provide indirect confirmatory evidence for the need for streamlined mental health services within reproductive health services.
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Affiliation(s)
- Chaitra Jairaj
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Clara Mai Fitzsimons
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, Obstetrics & Gynaecology, University College Dublin, Dublin, Ireland.,National Maternity Hospital, Holles Street, Dublin, Ireland
| | - Niamh O'Leary
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Niamh Joyce
- Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Eugene Cassidy
- Department of Psychiatry and Neurobehavioural Sciences, University College Cork, Cork, Ireland
| | - Jennifer Donnelly
- Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Elizabeth Tully
- Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Jackie Austin
- Health Service Executive, Dublin South West, Dublin, Ireland
| | - Kelly Doolin
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Chloe Farrell
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Veronica O'Keane
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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68
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Grasso DJ, Ford JD, Greene CA. Preliminary psychometrics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A) in an urban prenatal healthcare clinic. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 11:927-935. [PMID: 31135171 DOI: 10.1037/tra0000476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The primary objective of the current study was to examine preliminary psychometric characteristics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A), a novel self-report instrument that inventories childhood and adulthood trauma-related experiences and assesses symptoms of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual for Mental Disorders (5th ed.; [DSM-5] American Psychiatric Association, 2013). Designed for efficient administration and interpretation by nonclinically trained professionals, the STRESS-A is a promising tool for use in settings where mental health professionals are lacking. METHOD A sample of 170 women in their third trimester of pregnancy and receiving services at an urban prenatal health care clinic completed the STRESS-A and a battery of instruments measuring mental health functioning, perceived stress, and emotion dysregulation. Tests of reliability and validity were conducted, including confirmatory factor analysis to examine the fit of STRESS-A symptom criteria relative to PTSD symptom structures supported in the literature. RESULTS Results provide initial support for internal consistency, reliability, and convergent and construct validity in a largely Hispanic pregnancy sample. The STRESS-A symptom structure fit well with several that have been supported in the literature, including the 4-factor model of the DSM-5. CONCLUSION The STRESS-A is a promising tool for assessing risk associated with trauma exposure and probable DSM-5-based PTSD. Findings support its utility in a high-risk pregnancy cohort, a population that is underserved, yet shows high rates of trauma exposure and associated symptoms. Addressing maternal trauma-related impairment may have important implications for healthy fetal and child development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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69
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Women's Perceptions of Living a Traumatic Childbirth Experience and Factors Related to a Birth Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091654. [PMID: 31085980 PMCID: PMC6539242 DOI: 10.3390/ijerph16091654] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/02/2022]
Abstract
Although identified by the World Health Organization (WHO) as a global health priority, maternal mental health does not receive much attention even in the health systems of developed countries. With pregnancy monitoring protocols placing priority on the physical health of the mother, there is a paucity of literature documenting the traumatising effects of the birth process. To address this knowledge gap, this qualitative descriptive study aimed to investigate women perceptions of living a traumatic childbirth experience and the factors related to it. Qualitative data, collected via semi-structured interviews with 32 participants recruited from parent support groups and social media in Spain, were analyzed through a six-phase inductive thematic analysis. Data analysis revealed five major themes―“Birth Plan Compliance”, “Obstetric Problems”, “Mother-Infant Bond”, “Emotional Wounds” and “Perinatal Experiences”—and 13 subthemes. The majority of responses mentioned feelings of being un/misinformed by healthcare personnel, being disrespected and objectified, lack of support, and various problems during childbirth and postpartum. Fear, loneliness, traumatic stress, and depression were recurrent themes in participants’ responses. As the actions of healthcare personnel can substantially impact a birth experience, the study findings strongly suggest the need for proper policies, procedures, training, and support to minimise negative consequences of childbirth.
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70
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Nash MC, Kip KE, Wang W, Custer M, O'Rourke K. Post-traumatic stress disorder and hypertensive disorders of pregnancy among military women. Paediatr Perinat Epidemiol 2019; 33:238-247. [PMID: 31006884 DOI: 10.1111/ppe.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Women are more likely to develop post-traumatic stress disorder (PTSD) than men. Limited research exists evaluating the risk of hypertensive disorders of pregnancy (HDP) among military women with PTSD. METHODS We conducted a retrospective cohort study using US Department of Defense (DoD) data comprised of all active-duty women giving birth to their first, liveborn singleton infant using DoD-sponsored health insurance from 1 January 2004 to 31 December 2008 (n = 34 176). Birth hospitalisation records, maternal mental health visits, and Post-Deployment Health Assessment (PDHA) and Reassessment (PDHRA) screenings were included. The HDP outcome (yes vs no) was defined using ICD-9-CM codes in the maternal birth hospitalisation record. Women fit into one of four PTSD exposure categories (confirmed, probable, possible, none). Confirmed cases had a PTSD ICD-9-CM diagnosis code. Probable/possible cases were classified using PDHA screening items. We used multiple log-linear regression to assess PTSD (confirmed, any vs none) and the risk of HDP overall, and then explored effect modification by military service and demographic variables. We assessed the risk of HDP among deployed mothers with PTSD (confirmed, probable/possible vs none) who completed a PDHA, and explored effect modification by race/ethnicity. We also assessed risk of HDP with differing PTSD lead times. RESULTS Overall, PTSD was not associated with HDP except among mothers whose PTSD was diagnosed ≥1 year prior to conception (RR 1.42, 95% CI 1.06, 1.90). CONCLUSIONS Post-traumatic stress disorder preceding conception by at least a year appeared to confer an increased risk of HDP, but further research is needed using more thorough PTSD assessment.
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Affiliation(s)
| | - Kevin E Kip
- College of Public Health, University of South Florida, Tampa, Florida
| | - Wei Wang
- College of Public Health, University of South Florida, Tampa, Florida
| | - Michael Custer
- College of Public Health, University of South Florida, Tampa, Florida
| | - Kathleen O'Rourke
- College of Public Health, University of South Florida, Tampa, Florida
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71
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Smith A, Twynstra J, Seabrook JA. Antenatal depression and offspring health outcomes. Obstet Med 2019; 13:55-61. [PMID: 32714436 DOI: 10.1177/1753495x19843015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Depression is the most common mental disorder during pregnancy, with prevalence rates between 4% and 20%. The objective of this review was to synthesize the literature on the association between antenatal depression and offspring birth outcomes, as well as developmental, behavioral, and psychiatric outcomes. Methods A search of PubMed, Cochrane, and Medline databases was conducted for articles published until December 2017. Articles focusing on the effects of antenatal depression on the offspring were selected to be reviewed. Reference lists of all studies were examined for any missed articles. A total of 32 articles were included in this review. Results Antenatal depression is associated with preterm birth, excessive infant crying, and offspring mental health problems. Untreated antenatal depression is strongly associated with adverse effects on the infant nervous system. Conclusion Antenatal depression increases the likelihood of poor offspring health outcomes. Research should investigate whether medication use confounds this relationship.
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Affiliation(s)
- Alexandra Smith
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
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72
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Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med 2019; 36:315-322. [PMID: 31003246 DOI: 10.1055/s-0039-1678750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
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Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Laurie Zephyrin
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia.,Department of Obstetrics and Gynecology, VA Harbor Medical Center, New York City, New York.,Department of Obstetrics and Gynecology, New York School of Medicine, New York, NY
| | - Anne Meoli
- VHA, SimLEARN National Simulation Center, Orlando, Florida
| | - Avanthi Hulugalle
- New York University College of Global Public Health, New York City, New York
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | - Lisa Callegari
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ileana V Galvan
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Kristen E Gray
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristin O Haeger
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Claire Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, Florida
| | - Erica W Ma
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Suzanne L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shivani M Reddy
- VA Boston Healthcare System, Boston, Massachusetts.,Center for Advanced Methods Development, RTI International, Waltham, Massachusetts
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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73
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Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV. Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans. Semin Reprod Med 2019; 36:361-370. [PMID: 31003251 DOI: 10.1055/s-0039-1678749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
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Affiliation(s)
- Lori M Gawron
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - April F Mohanty
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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74
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Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence. Clin Obstet Gynecol 2019; 61:591-603. [PMID: 29596076 DOI: 10.1097/grf.0000000000000368] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting ~500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period.
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75
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Wallwiener S, Goetz M, Lanfer A, Gillessen A, Suling M, Feisst M, Sohn C, Wallwiener M. Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies. Arch Gynecol Obstet 2019; 299:755-763. [PMID: 30734864 DOI: 10.1007/s00404-019-05075-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/31/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the real-life epidemiology of mental disorders during pregnancy and their impact on birth outcome in an unselected low-risk population in Germany. METHODS Claims data of the Techniker Krankenkasse (TK) were analyzed as part of a retrospective observational study over a one-year period from 01/2008 to 12/2008 including 38,174 pregnant women. ICD-10 codes were clustered into four diagnostic groups: depression, anxiety disorders, somatoform/dissociative disorders and acute stress reactions. The relationship between mental disorders, birth mode and infant weight was tested using chi-squared tests and multivariate logistic regression. Main outcome measures included the prevalence of mental disorders during pregnancy, performed cesarean sections and infants born underweight. RESULTS N = 16,639 cases with at least one diagnosis from the four mental disorder diagnostic groups were identified: 9.3% cases of depression, 16.9% cases with an anxiety disorder, 24.2% cases with a somatoform/dissociative disorder, and 11.7% cases of acute stress reactions. Women diagnosed with a mental disorder were more likely to deliver their child by cesarean section ([depression: OR =1.26 (95% CI 1.14-1.39); anxiety: OR 1.11 (95% CI 1.02-1.19); somatoform disorders: OR 1.12 (95% CI 1.05-1.20); acute stress reactions: OR 1.17 (95% CI 1.07-1.28)]. Furthermore, infants of women diagnosed with an ICD-10 code for depression during pregnancy were more likely to be underweight and/or delivered preterm [OR =1.34 (95% CI 1.06-1.69)]. CONCLUSIONS We observed substantially high prevalence rates of mental disorders during pregnancy which urgently warrant more awareness for validated screening and adequate treatment options.
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Affiliation(s)
- Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Maren Goetz
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Anne Lanfer
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Andrea Gillessen
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Marc Suling
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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76
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Williams KE, Koleva H. Identification and Treatment of Peripartum Anxiety Disorders. Obstet Gynecol Clin North Am 2019; 45:469-481. [PMID: 30092922 DOI: 10.1016/j.ogc.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety disorders in the peripartum period are common and frequently overlooked. They can present de novo or as exacerbations of generalized anxiety disorder, obsessive compulsive disorder, panic disorder and social anxiety disorder, or posttraumatic stress disorder. Calculating a score on the Edinburgh postnatal depression scale is a useful method of screening for these disorders while also screening for perinatal depression. Treatment includes psychotherapy, specifically cognitive behavioral therapy, and antidepressants, the choice of which should be balanced between the severity of symptoms and impact of functioning, risks of untreated illness, and the risks associated with the use of medications in pregnancy and lactation. In summary, anxiety disorders in the peripartum period should be recognized and treated promptly.
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Affiliation(s)
- Katherine E Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Hristina Koleva
- Department of Psychiatry, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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77
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Slopen N, Roberts AL, LeWinn KZ, Bush NR, Rovnaghi CR, Tylavsky F, Anand KJS. Maternal experiences of trauma and hair cortisol in early childhood in a prospective cohort. Psychoneuroendocrinology 2018; 98:168-176. [PMID: 30170311 DOI: 10.1016/j.psyneuen.2018.08.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Maternal trauma can have intergenerational consequences but little is known about whether maternal traumas affect key biological domains associated with mental health in their offspring. The objective of this study was to examine maternal lifetime history of traumatic events through mid-gestation in relation to offspring cortisol production in early childhood. METHODS The sample was comprised of 660 children (49.9% Black, 44.4% White) from a longitudinal study of mother-offspring dyads in Shelby County, Tennessee, followed from mid-gestation to child age 4 years (enrolled 2006-2011). Maternal lifetime history of traumatic life events were assessed mid-gestation using the Traumatic Life Events Questionnaire. Total cortisol output among offspring was measured using hair cortisol concentrations at ages 1 to 4 years. RESULTS Associations of maternal trauma history with child hair cortisol varied by child's age. No association was observed at age 1 or 2. In adjusted regression models, at ages 3 and 4, offspring of mothers in the third (β = 0.99, P < .01), fourth (β=0.72, P < .05), and fifth (β=0.83, P < .01) quintiles of trauma exposure history had elevated (natural log) hair cortisol concentrations, relative to mothers in the lowest quintile (P-trend = 0.003). The associations were not attenuated after adjustment for theorized pathways, including premature birth, maternal postpartum depression, and maternal parenting stress. CONCLUSIONS Maternal lifetime trauma exposures are associated with offspring hair cortisol concentrations. Future research is needed to determine intermediary mechanisms and functional significance of elevated hair cortisol concentration in young children.
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Affiliation(s)
- Natalie Slopen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MA, United States.
| | - Andrea L Roberts
- Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Kaja Z LeWinn
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
| | - Nicole R Bush
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States; Department of Pediatrics, University of California, San Francisco, CA, United States
| | - Cynthia R Rovnaghi
- Pain/Stress Neurobiology Lab, Child Health Research Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Frances Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Nashville, TN, United States
| | - Kanwaljeet J S Anand
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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78
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Katon JG, Ma EW, Sayre G, Zephyrin LC, Cordasco KM, Yano EM, Fortney JC. Women Veterans’ Experiences with Department of Veterans Affairs Maternity Care: Current Successes and Targets for Improvement. Womens Health Issues 2018; 28:546-552. [DOI: 10.1016/j.whi.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
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Abstract
Behavioral and emotional problems are one of the most frequent chronic conditions diagnosed among children born prematurely. The high prevalence of these pathologies is a matter of concern because of their impact on family life, school performance, and social interaction, but also because of current limitations in early detection and access to treatment. This is a review of the various mechanisms by which premature birth affects social and emotional development, and a discussion about strategies that may help support emotional and social development in this high-risk population.
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Affiliation(s)
- Angela Leon Hernandez
- Neonatology Division, Emory University School of Medicine, 49 Jesse Hill Jr drive SE, Atlanta, GA 30030, USA.
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80
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Lomonaco-Haycraft KC, Hyer J, Tibbits B, Grote J, Stainback-Tracy K, Ulrickson C, Lieberman A, van Bekkum L, Hoffman MC. Integrated perinatal mental health care: a national model of perinatal primary care in vulnerable populations. Prim Health Care Res Dev 2018; 20:e77. [PMID: 29911521 PMCID: PMC6567896 DOI: 10.1017/s1463423618000348] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 01/10/2018] [Accepted: 03/16/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15-20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal-child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health. METHODS A multidisciplinary team of physicians, behavioral health providers, public health, and administrators was assembled at Denver Health, an integrated hospital and community health care system that serves as the safety net hospital to the city and county of Denver, CO. This team was brought together to create a universal screen-to-treat process for PMAD's in perinatal clinics and to adapt the existing Integrated Behavioral Health (IBH) model into a program better suited to the health system's obstetric population. Universal prenatal and postnatal depression screening was implemented at the obstetric intake visit, a third trimester prenatal care visit, and at the postpartum visit across the clinical system. At the same time, IBH services were implemented across our health system's perinatal care system in a stepwise fashion. This included our women's care clinics as well as the family medicine and pediatric clinics. These efforts occurred in tandem to support all patients and staff enabling a specially trained behavioral health provider (psychologists and L.C.S.W.'s) to respond immediately to any positive screen during or after pregnancy. RESULTS In August 2014 behavioral health providers were integrated into the women's care clinics. In January 2015 universal screening for PMADs was implemented throughout the perinatal care system. Screening has improved from 0% of women screened at the obstetric care intake visit in August 2014 to >75% of women screened in August 2016. IBH coverage by a licensed psychologist or licensed clinical social worker exists in 100% of perinatal clinics as of January 2016. As well, in order to gain sustainability, the ability to bill same day visits as well as to bill, and be reimbursed for screening and assessment visits, continues to improve and provide for a model that is self-sustaining for the future. CONCLUSION Implementation of a universal screening process for PMADs alongside the development of an IBH model in perinatal care has led to the creation of a program that is feasible and has the capacity to serve as a national model for improving perinatal mental health in vulnerable populations.
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Affiliation(s)
- Kimberly C. Lomonaco-Haycraft
- Department of Integrated Behavioral Health, Department of Psychiatry and General Internal Medicine, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | - Jennifer Hyer
- Department of Obstetrics & Gynecology and Psychiatry, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | - Britney Tibbits
- Department of Integrated Behavioral Health, Department of Psychiatry and General Internal Medicine, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | - Jennifer Grote
- Department of Integrated Behavioral Health, Department of Psychiatry and General Internal Medicine, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | | | | | - Alison Lieberman
- Department of Integrated Behavioral Health, Department of Psychiatry and General Internal Medicine, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | - Lies van Bekkum
- Department of Integrated Behavioral Health, Department of Psychiatry and General Internal Medicine, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
| | - M. Camille Hoffman
- Department of Obstetrics & Gynecology and Psychiatry, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
- Department of Psychiatry, Denver Health & Hospital Authority, University of Colorado School of Medicine, CO, USA
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81
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Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev 2018; 66:136-148. [PMID: 29935979 DOI: 10.1016/j.cpr.2018.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | | | - Laura Mayer
- Department of Psychiatry, Boston University School of Medicine, United States
| | - Snezana Milanovic
- Department of Psychiatry, Boston University School of Medicine, United States
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Weinreb L, Wenz-Gross M, Upshur C. Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy. Arch Womens Ment Health 2018; 21:299-312. [PMID: 29116416 DOI: 10.1007/s00737-017-0794-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.
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Affiliation(s)
- Linda Weinreb
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Melodie Wenz-Gross
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Carole Upshur
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA
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83
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Li Y, Rosemberg MAS, Seng JS. Allostatic load: A theoretical model for understanding the relationship between maternal posttraumatic stress disorder and adverse birth outcomes. Midwifery 2018; 62:205-213. [PMID: 29709774 DOI: 10.1016/j.midw.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse birth outcomes such as preterm birth and low birth weight are significant public health concerns and contribute to neonatal morbidity and mortality. Studies have increasingly been exploring the predictive effects of maternal posttraumatic stress disorder (PTSD) on adverse birth outcomes. However, the biological mechanisms by which maternal PTSD affects birth outcomes are not well understood. Allostatic load refers to the cumulative dysregulations of the multiple physiological systems as a response to multiple social-ecological levels of chronic stress. Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. However, the mediating role of allostatic load is less understood when it comes to maternal PTSD and adverse birth outcomes. OBJECTIVE To propose a theoretical model that depicts how allostatic load could mediate the impact of maternal PTSD on birth outcomes. METHOD We followed the procedures for theory synthesis approach described by Walker and Avant (2011), including specifying focal concepts, identifying related factors and relationships, and constructing an integrated representation. We first present a theoretical overview of the allostatic load theory and the other 4 relevant theoretical models. Then we provide a brief narrative review of literature that empirically supports the propositions of the integrated model. Finally, we describe our theoretical model. FINDINGS/CONCLUSIONS The theoretical model synthesized has the potential to advance perinatal research by delineating multiple biomarkers to be used in future. After it is well validated, it could be utilized as the theoretical basis for health care professionals to identify high-risk women by evaluating their experiences of psychosocial and traumatic stress and to develop and evaluate service delivery and clinical interventions that might modify maternal perceptions or experiences of stress and eliminate their impacts on adverse birth outcomes.
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Affiliation(s)
- Yang Li
- University of Missouri Sinclair School of Nursing, USA
| | - Marie-Anne Sanon Rosemberg
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109 USA
| | - Julia S Seng
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109 USA.
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84
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Denckla CA, Mancini AD, Consedine NS, Milanovic SM, Basu A, Seedat S, Spies G, Henderson DC, Bonanno GA, Koenen KC. Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender. Psychol Med 2018; 48:1139-1147. [PMID: 28889814 PMCID: PMC5845817 DOI: 10.1017/s0033291717002549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. METHODS The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. RESULTS Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. CONCLUSIONS There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.
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Affiliation(s)
- C. A. Denckla
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | | | | | | | - A. Basu
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S. Seedat
- Stellenbosch University, Cape Town, South Africa
| | - G. Spies
- Stellenbosch University, Cape Town, South Africa
| | | | - G. A. Bonanno
- Teacher’s College, Columbia University, New York City, USA
| | - K. C. Koenen
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
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85
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Katon J, Cypel Y, Raza M, Zephyrin L, Reiber G, Yano EM, Barth S, Schneiderman A. Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations. Matern Child Health J 2018; 21:376-386. [PMID: 27449782 DOI: 10.1007/s10995-016-2122-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To characterize the pregnancy outcomes of women Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans including prevalence of preterm delivery, low birth weight, and macrosomia, and to highlight methodological limitations that can impact findings. Methods A retrospective cohort study was conducted starting in 2014 analyzing data from the 2009 to 2011 National Health Study for a New Generation of US Veterans, which sampled Veterans deployed and not deployed to OIF/OEF. All pregnancies resulting in a live birth were included, and categorized as occurring among non-deployers, before deployment, during deployment, or after deployment. Outcomes included preterm birth, low birth weight, and macrosomia. The association of deployment with selected outcomes was estimated using separate general estimating equations to account for lack of outcome independence among women contributing multiple pregnancies. Adjustment variables included maternal age at outcome, and race/ethnicity. Results There were 2276 live births (191 preterm births, 153 low birth weight infants, and 272 macrosomic infants). Compared with pregnancies before deployment, pregnancies among non-deployers and those after deployment appeared to have greater risk of preterm birth [non-deployers: odds ratio (OR) = 2.16, 95 % confidence interval (CI) 1.25, 3.72; after deployment: OR = 1.90, 95 % CI 0.90, 4.02]. A similar pattern was observed for low birth weight. No association of deployment with macrosomia was detected. Discussion Compared with non-deployers, those who eventually deploy appear to have better pregnancy outcomes prior to deployment, but this advantage is no longer apparent after deployment. Non-deployers may not be an appropriate reference group to study the putative health impacts of deployment on pregnancy outcomes.
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Affiliation(s)
- Jodie Katon
- US Department of Veterans Affairs (VA), Office of Patient Care Services, Women's Health Services, Washington, DC, USA. .,VA Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, 1660 South Columbia Way S-152, Seattle, WA, 98108, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
| | - Yasmin Cypel
- VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA
| | - Mubashra Raza
- VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA
| | - Laurie Zephyrin
- US Department of Veterans Affairs (VA), Office of Patient Care Services, Women's Health Services, Washington, DC, USA.,New York Harbor VA Healthcare System, New York, NY, USA
| | - Gayle Reiber
- VA Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, 1660 South Columbia Way S-152, Seattle, WA, 98108, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - Shannon Barth
- VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA
| | - Aaron Schneiderman
- VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA
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86
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Ogasawara K, Inoue T. Long-run effects of early childhood exposure to cholera on final height: Evidence from industrializing Japan. SSM Popul Health 2018; 4:66-70. [PMID: 29349274 PMCID: PMC5769111 DOI: 10.1016/j.ssmph.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022] Open
Abstract
Pandemic cholera is one of the most topical and urgent issues in many developing countries. However, although a growing body of research has shown the negative long-run effects of infectious disease exposure on human health, the long-run influences of early childhood exposure to cholera have thus far been understudied. To bridge this gap in the body of knowledge, we draw both on new data describing adult height from 1899 to 1910 from comprehensive official Japanese army records and on data recording the regional variation in the intensity of cholera pandemics. By using a difference-in-differences estimation strategy, we find that exposure to pandemic cholera had stunting effects on the final height of men at that time. Our estimates also suggest that early-infancy exposure to cholera seems to have a stronger long-run effect on adult height than late-infancy exposure.
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Affiliation(s)
- Kota Ogasawara
- Graduate School of Social Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba 263-8522, Japan
| | - Tatsuki Inoue
- Graduate School of Economics, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Kang-Yi CD, Kornfield SL, Epperson CN, Mandell DS. Relationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control Group. Psychiatr Serv 2018; 69:300-307. [PMID: 29137553 PMCID: PMC5937933 DOI: 10.1176/appi.ps.201700097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to identify whether pregnancy complications differ between women with and without a psychiatric disorder diagnosis prior to pregnancy. METHODS Women who gave birth between 2007 and 2009 in Pennsylvania and were enrolled in Medicaid from one year prior to their pregnancy until their delivery were included (N=9,930); those with psychiatric disorders were compared with a matched control group (N=4,965 for each). Logistic regression analysis estimated the odds of having a pregnancy complication among those with a psychiatric diagnosis prior to pregnancy, adjusting for demographic characteristics and chronic general medical conditions. RESULTS Compared with the control group, women with a psychiatric disorder prior to pregnancy had greater odds of having at least one pregnancy complication (odds ratio=1.48, 95% confidence interval=1.37-1.61). Compared with the control group, their odds of antepartum hemorrhage were 1.50 times higher, their odds of preterm labor were 1.45 times higher, and their odds of preterm birth were 1.61 times higher. CONCLUSIONS Women with psychiatric disorders prior to pregnancy were more likely to experience pregnancy complications, including pregnancy hemorrhage, preterm labor, and preterm birth, after the analysis controlled for age, race-ethnicity, and chronic illness status before and during pregnancy. The finding of an association between psychiatric disorders and a higher complication risk suggests the importance of population-based preconception interventions for women with psychiatric disorders and prenatal monitoring to reduce the risk of pregnancy complications in this group.
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Affiliation(s)
- Christina D Kang-Yi
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sara L Kornfield
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - C Neill Epperson
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David S Mandell
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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88
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van Loenhout JAF, Gil Cuesta J, Abello JE, Isiderio JM, de Lara-Banquesio ML, Guha-Sapir D. The impact of Typhoon Haiyan on admissions in two hospitals in Eastern Visayas, Philippines. PLoS One 2018; 13:e0191516. [PMID: 29381720 PMCID: PMC5790240 DOI: 10.1371/journal.pone.0191516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/05/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We investigated the short-term impact of Typhoon Haiyan, one of the strongest typhoons ever to make landfall, on the pattern of admissions in two hospitals in Eastern Visayas, the Philippines. METHODS This study took place at Eastern Visayas Regional Medical Center (EVRMC) in Tacloban, and Ormoc District Hospital (ODH) in Ormoc. We determined whether there were differences in the pattern of admissions between the week before and the three weeks after Haiyan by using information on sex, age, diagnosis, ward and outcome at discharge from patient records. RESULTS There was a drop in admissions in both hospitals after Haiyan as compared to before. Admissions climbed back to the baseline after ten days in EVRMC and after two weeks in ODH. When comparing the period after Haiyan to the period before, there was a relative increase in male versus female admissions in ODH (OR 2.8, 95%CI 1.7-4.3), but not in EVRMC. Patients aged ≥50 years and 0-14 years had the highest relative increase in admissions. There was a relative decrease in admissions for the ICD10 group 'Pregnancy, childbirth and the puerperium' (OR 0.4, 95%CI 0.3-0.6), and an increase in 'Certain infectious and parasitic diseases' (OR 2.1, 95%CI 1.2-3.5), mainly gastroenteritis, and 'Diseases of the respiratory system' (OR 1.8, 95%CI 1.0-3.0), mainly pneumonia, compared to all other diagnosis groups in ODH. Out of all reasons for admission within the study period, 66% belong to these three ICD-10 groups. Data on reasons for admission were not available for EVRMC. CONCLUSIONS The observed reduction in patients after the Typhoon calls for ensuring that hospital accessibility should be protected and reinforced, especially for pregnant women, by trying to remove debris in the direct hospital vicinity. Hospitals in areas prone to tropical cyclones should be prepared to treat large numbers of patients with gastroenteritis and pneumonia, as part of their disaster plans.
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Affiliation(s)
- Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Julita Gil Cuesta
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Jason Echavez Abello
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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89
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Cook N, Ayers S, Horsch A. Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. J Affect Disord 2018; 225:18-31. [PMID: 28777972 DOI: 10.1016/j.jad.2017.07.045] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined. METHOD A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria. RESULTS 26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication. LIMITATIONS Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity. CONCLUSION Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
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Affiliation(s)
- Natalie Cook
- The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre-Decker 2, CH-1011 Lausanne, Switzerland.
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90
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Khoramroudi R. The prevalence of posttraumatic stress disorder during pregnancy and postpartum period. J Family Med Prim Care 2018; 7:220-223. [PMID: 29915763 PMCID: PMC5958573 DOI: 10.4103/jfmpc.jfmpc_272_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction and Objective: The majority of formerly conducted studies have focused on the prevalence of posttraumatic stress disorder merely during pregnancy period; however, pregnancy period is by itself accompanied with the stress of getting pregnant again; therefore, the present study was conducted to evaluate the prevalence of posttraumatic stress disorder (PTSD) during pregnancy and postpartum period. Methods: A total of 3475 articles were found by searching keywords of PTSD, pregnancy, stress, and birth, through various research databases, including PubMed, Google Scholar, and Science Direct; 37 papers turned out to be completely relevant, 18 of which had provided through examination of the prevalence of intended disorder. Results: The prevalence rate varied from 0% to 21% in community-related samples; this rate varied from 0% to 43% in high-risk samples. Conclusion: PTSD is a common phenomenon during pregnancy and postpartum period, and it might get worse and worse unless it is diagnosed and treated after delivery. Thus, it is recommended to assess pregnancy and postpartum services.
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Affiliation(s)
- Rozita Khoramroudi
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
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91
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Sperlich M, Seng JS, Li Y, Taylor J, Bradbury-Jones C. Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues. J Midwifery Womens Health 2017; 62:661-672. [DOI: 10.1111/jmwh.12674] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
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92
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Polimanti R, Amstadter AB, Stein MB, Almli LM, Baker DG, Bierut LJ, Bradley B, Farrer LA, Johnson EO, King A, Kranzler HR, Maihofer AX, Rice JP, Roberts AL, Saccone NL, Zhao H, Liberzon I, Ressler KJ, Nievergelt CM, Koenen KC, Gelernter J. A putative causal relationship between genetically determined female body shape and posttraumatic stress disorder. Genome Med 2017; 9:99. [PMID: 29178946 PMCID: PMC5702961 DOI: 10.1186/s13073-017-0491-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background The nature and underlying mechanisms of the observed increased vulnerability to posttraumatic stress disorder (PTSD) in women are unclear. Methods We investigated the genetic overlap of PTSD with anthropometric traits and reproductive behaviors and functions in women. The analysis was conducted using female-specific summary statistics from large genome-wide association studies (GWAS) and a cohort of 3577 European American women (966 PTSD cases and 2611 trauma-exposed controls). We applied a high-resolution polygenic score approach and Mendelian randomization analysis to investigate genetic correlations and causal relationships. Results We observed an inverse association of PTSD with genetically determined anthropometric traits related to body shape, independent of body mass index (BMI). The top association was related to BMI-adjusted waist circumference (WCadj; R = –0.079, P < 0.001, Q = 0.011). We estimated a relative decrease of 64.6% (95% confidence interval = 27.5–82.7) in the risk of PTSD per 1-SD increase in WCadj. MR-Egger regression intercept analysis showed no evidence of pleiotropic effects in this association (Ppleiotropy = 0.979). We also observed associations of genetically determined WCadj with age at first sexual intercourse and number of sexual partners (P = 0.013 and P < 0.001, respectively). Conclusions There is a putative causal relationship between genetically determined female body shape and PTSD, which could be mediated by evolutionary mechanisms involved in human sexual behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s13073-017-0491-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Ananda B Amstadter
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System and Veterans Affairs Center of Excellence for Stress and Mental Health, La Jolla, CA, USA
| | - Lynn M Almli
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System and Veterans Affairs Center of Excellence for Stress and Mental Health, La Jolla, CA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lindsay A Farrer
- Department of Medicine, Biomedical Genetics Division, Boston University School of Medicine, Boston, MA, USA
| | - Eric O Johnson
- Fellow Program and Behavioral Health and Criminal Justice Division RTI International, Research Triangle Park, NC, USA
| | - Anthony King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN 4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - John P Rice
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Nancy L Saccone
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard University, Cambridge, MA, USA.,Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Veterans Affairs San Diego Healthcare System and Veterans Affairs Center of Excellence for Stress and Mental Health, La Jolla, CA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Boston, MA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Departments of Neuroscience and of Genetics, Yale University School of Medicine, New Haven, CT, USA
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93
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Gestational and Postnatal Cortisol Profiles of Women With Posttraumatic Stress Disorder and the Dissociative Subtype. J Obstet Gynecol Neonatal Nurs 2017; 47:12-22. [PMID: 29175262 DOI: 10.1016/j.jogn.2017.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD. DESIGN Prospective, longitudinal, biobehavioral cohort study. SETTING Prenatal clinics at academic health centers in the Midwest region of the United States. PARTICIPANTS Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD. METHODS In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic measures. Generalized estimating equations were used to determine group differences. RESULTS Generalized estimating equations showed that women with the dissociative subtype of PTSD had the highest and flattest gestational cortisol level curves. The difference was greatest in early pregnancy, when participants in the dissociative subtype group had cortisol levels 8 times greater in the afternoon and 10 times greater at bedtime than those in the nonexposed control group. CONCLUSION Women with the dissociative subtype of PTSD, a complex form associated with a history of childhood maltreatment, may have toxic levels of cortisol that contribute to intergenerational patterns of adverse health outcomes.
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94
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Predictors and Patterns of Psychiatric Treatment Dropout During Pregnancy Among Low-Income Women. Matern Child Health J 2017; 22:226-236. [PMID: 29143169 DOI: 10.1007/s10995-017-2394-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective This study compared psychiatric treatment discontinuation rates among pregnant women using psychotropic medications, outpatient psychotherapy, or both before conception. Methods Using data from Pennsylvania Medicaid Fee-For-Service and Managed Care Organization claims and Medicaid enrollment, 3030 women were identified who gave birth between 2007 and 2009, had ≥ 1 claim for psychiatric treatment during the 120 days prior to pregnancy, and were enrolled in Medicaid until they delivered. Kaplan-Meier and Cox regression analyses were used to estimate psychiatric treatment dropout rate during pregnancy and examine relationships between treatment dropout and age, race/ethnicity, and pre-pregnancy psychiatric diagnosis and treatment pattern. Results After the first trimester, the probability of discontinuing psychotropic medications was 83 versus 37.8% for cessation of psychotherapy among combined treatment users. Two or more psychotherapy sessions in the 4 months prior to pregnancy were associated with decreased psychotherapy dropout during pregnancy. Psychotherapy during pregnancy was associated with prenatal psychotropic medication adherence. Conclusions To retain women in treatment during pregnancy, when discontinuation from care is common, innovative models of care should consider type of pre-pregnancy mental healthcare and individual characteristics.
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95
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Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS. Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry 2017; 74:1145-1152. [PMID: 28903165 PMCID: PMC5710298 DOI: 10.1001/jamapsychiatry.2017.2733] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Registry data show that maternal panic disorder, or anxiety disorders in general, increase the risk for adverse pregnancy outcomes. However, diagnoses from registries may be imprecise and may not consider potential confounding factors, such as treatment with medication and maternal substance use. OBJECTIVE To determine whether panic disorder or generalized anxiety disorder (GAD) in pregnancy, or medications used to treat these conditions, are associated with adverse maternal or neonatal pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted between July 1, 2005, and July 14, 2009, recruited women at 137 obstetric practices in Connecticut and Massachusetts before 17 weeks of pregnancy and reassessed them at 28 (±4) weeks of pregnancy and 8 (±4) weeks postpartum. Psychiatric diagnoses were determined by answers to the World Mental Health Composite International Diagnostic Interview. Assessments also gathered information on treatment with medications and confounding factors, such as substance use, previous adverse birth outcomes, and demographic factors. EXPOSURE Panic disorder, GAD, or use of benzodiazepines or serotonin reuptake inhibitors. MAIN OUTCOMES AND MEASURES Among mothers: preterm birth, cesarean delivery, and hypertensive diseases of pregnancy. Among neonates: low birth weight, use of minor respiratory interventions, and use of ventilatory support. RESULTS Of the 2654 women in the final analysis (mean [SD] age, 31.0 [5.7] years), most were non-Hispanic white (1957 [73.7%]), 98 had panic disorder, 252 had GAD, 67 were treated with a benzodiazepine, and 293 were treated with a serotonin reuptake inhibitor during pregnancy. In adjusted models, neither panic disorder nor GAD was associated with maternal or neonatal complications of interest. Most medication exposures occurred early in pregnancy. Maternal benzodiazepine use was associated with cesarean delivery (odds ratio [OR], 2.45; 95% CI, 1.36-4.40), low birth weight (OR, 3.41; 95% CI, 1.61-7.26), and use of ventilatory support for the newborn (OR, 2.85; 95% CI, 1.2-6.9). Maternal serotonin reuptake inhibitor use was associated with hypertensive diseases of pregnancy (OR, 2.82; 95% CI, 1.58-5.04), preterm birth (OR, 1.56; 95% CI, 1.02-2.38), and use of minor respiratory interventions (OR, 1.81; 95% CI, 1.39-2.37). With maternal benzodiazepine treatment, rates of ventilatory support increased by 61 of 1000 neonates and duration of gestation was shortened by 3.6 days; with maternal serotonin reuptake inhibitor use, gestation was shortened by 1.8 days, 152 of 1000 additional newborns required minor respiratory interventions, and 53 of 1000 additional women experienced hypertensive diseases of pregnancy. CONCLUSIONS AND RELEVANCE Panic disorder and GAD do not contribute to adverse pregnancy complications. Women may require treatment with medications during pregnancy, which can shorten the duration of gestation slightly. Maternal treatment with a serotonin reuptake inhibitor is also associated with hypertensive disease of pregnancy and cesarean delivery.
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Affiliation(s)
- Kimberly Ann Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut,Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
| | | | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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96
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Geller PA, Stasko EC. Effect of Previous Posttraumatic Stress in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2017; 46:912-922. [PMID: 28667832 DOI: 10.1016/j.jogn.2017.04.136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry. DATA SOURCES Electronic databases Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists supplemented the electronic search. STUDY SELECTION Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included. DATA EXTRACTION Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes. DATA SYNTHESIS Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD. CONCLUSION Women's health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.
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97
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Gelaye B, Zheng Y, Medina-Mora ME, Rondon MB, Sánchez SE, Williams MA. Validity of the posttraumatic stress disorders (PTSD) checklist in pregnant women. BMC Psychiatry 2017; 17:179. [PMID: 28494804 PMCID: PMC5427611 DOI: 10.1186/s12888-017-1304-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K505F, Boston, MA, 02115, USA.
| | - Yinnan Zheng
- 000000041936754Xgrid.38142.3cDepartment of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K505F, Boston, MA 02115 USA
| | | | - Marta B. Rondon
- 0000 0001 0673 9488grid.11100.31Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Sixto E. Sánchez
- grid.441917.eUniversidad Peruana de Ciencias Aplicadas, Lima, Peru ,Asociación Civil PROESA, Lima, Peru
| | - Michelle A. Williams
- 000000041936754Xgrid.38142.3cDepartment of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K505F, Boston, MA 02115 USA
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98
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Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, Phibbs CS. Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia. Paediatr Perinat Epidemiol 2017; 31:185-194. [PMID: 28328031 DOI: 10.1111/ppe.12349] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior work shows that Post-traumatic Stress Disorder (PTSD) predicts an increased risk of preterm birth, but the causal pathway(s) are uncertain. We evaluate the associations between PTSD and antepartum complications to explore how PTSD's pathophysiology impacts pregnancy. METHODS This retrospective cohort analysis of all Veterans Health Administration (VA)-covered deliveries from 2000-12 used the data of VA clinical and administration. Mothers with current PTSD were identified using the ICD-9 diagnostic codes (i.e. code present during the antepartum year), as were those with historical PTSD. Medical and administrative data were used to identify the relevant obstetric diagnoses, demographics and health, and military deployment history. We used Poisson regression with robust error variance to derive the adjusted relative risk estimates (RR) for the association of PTSD with five clinically relevant antepartum complications [gestational diabetes (GDM), preeclampsia, gestational hypertension, growth restriction, and abruption]. Secondary outcomes included proxies for obstetric complexity (repeat hospitalisation, prolonged delivery hospitalisation, and caesarean delivery). RESULTS Of the 15 986 singleton deliveries, 2977 (19%) were in mothers with PTSD diagnoses (1880 (12%) current PTSD). Mothers with the complication GDM were 4.9% and those with preeclampsia were 4.6% of all births. After adjustment, a current PTSD diagnosis (reference = no PTSD) was associated with an increased risk of GDM (RR 1.4, 95% confidence interval (CI) 1.2, 1.7) and preeclampsia (RR 1.3, 95% CI 1.1, 1.6). PTSD also predicted prolonged (>4 day) delivery hospitalisation (RR 1.2, 95% CI 1.01, 1.4), and repeat hospitalisations (RR 1.4, 95% CI 1.2, 1.6), but not caesarean delivery. CONCLUSIONS The observed association of PTSD with GDM and preeclampsia is consistent with our nascent understanding of PTSD as a disruptor of neuroendocrine and cardiovascular health.
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Affiliation(s)
- Jonathan G Shaw
- HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Steven M Asch
- HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Jodie G Katon
- VA Puget Sound Health Care System, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, Seattle, WA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Kate A Shaw
- Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, CA
| | - Rachel Kimerling
- HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
| | - Susan M Frayne
- HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Ciaran S Phibbs
- HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA
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Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:162-172. [PMID: 28966563 DOI: 10.1176/appi.focus.20160042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Anxiety symptoms may present differently between women and men, and at different points in the female lifespan. The female lifespan includes distinct epochs of hormonal function, including puberty, the premenstruum, in some women pregnancy or postpartum, and the menopausal transition. These stages give rise to important treatment considerations when treating anxiety in women. When making assessments, the clinician should consider reproductive events and hormonal status, as well as sex differences in anxiety presentation. This review is structured to: 1) Define major epochs of the female lifespan, 2) Provide a brief summary of the major anxiety disorders, with a focus on prevalence and presentation in the context of sex differences and at points in the female lifespan, 3) Describe potential biopsychosocial underpinnings of anxiety disorders among women, 4) Provide guidelines for assessment and differential diagnosis, and 5) Describe treatment options with attention to reproductive events such as pregnancy.
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Affiliation(s)
- Liisa Hantsoo
- Clinical Psychologist & Instructor, Penn Center for Women's Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania
| | - C Neill Epperson
- Professor of Psychiatry and Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania and Director of the Penn Center for Women's Behavioral Wellness and Penn PROMOTES Research on Sex and Gender in Health, Perelman School of Medicine, University of Pennsylvania
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100
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Baas MAM, Stramrood CAI, Dijksman LM, de Jongh A, van Pampus MG. The OptiMUM-study: EMDR therapy in pregnant women with posttraumatic stress disorder after previous childbirth and pregnant women with fear of childbirth: design of a multicentre randomized controlled trial. Eur J Psychotraumatol 2017; 8:1293315. [PMID: 28348720 PMCID: PMC5345578 DOI: 10.1080/20008198.2017.1293315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022] Open
Abstract
Background: Approximately 3% of women develop posttraumatic stress disorder (PTSD) after giving birth, and 7.5% of pregnant women show a pathological fear of childbirth (FoC). FoC or childbirth-related PTSD during (a subsequent) pregnancy can lead to a request for an elective caesarean section as well as adverse obstetrical and neonatal outcomes. For PTSD in general, and several subtypes of specific phobia, eye movement desensitization and reprocessing (EMDR) therapy has been proven effective, but little is known about the effects of applying EMDR during pregnancy. Objective: To describe the protocol of the OptiMUM-study. The main aim of the study is to determine whether EMDR therapy is an effective and safe treatment for pregnant women with childbirth-related PTSD or FoC. In addition, the cost-effectiveness of this approach will be analysed. Method: The single-blind OptiMUM-study consists of two two-armed randomized controlled trials (RCTs) with overlapping design. In several hospitals and community midwifery practices in Amsterdam, the Netherlands, all eligible pregnant women with a gestational age between eight and 20 weeks will be administered the Wijma delivery expectations questionnaire (WDEQ) to asses FoC. Multiparous women will also receive the PTSD checklist for DSM-5 (PCL-5) to screen for possible PTSD. The clinician administered PTSD scale (CAPS-5) will be used for assessing PTSD according to DSM-5 in women scoring above the PCL-5 cut-off value. Fifty women with childbirth-related PTSD and 120 women with FoC will be randomly allocated to either EMDR therapy carried out by a psychologist or care-as-usual. Women currently undergoing psychological treatment or women younger than 18 years will not be included. Primary outcome measures are severity of childbirth-related PTSD or FoC symptoms. Secondary outcomes are percentage of PTSD diagnoses, percentage caesarean sections, subjective childbirth experience, obstetrical and neonatal complications, and health care costs. Results: The results are meant to provide more insight about the safety and possible effectiveness of EMDR therapy during pregnancy for women with PTSD or FoC. Conclusion: This study is the first RCT studying efficacy and safety of EMDR in pregnant women with PTSD after childbirth or Fear of Childbirth.
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Affiliation(s)
- M. A. M. Baas
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - C. A. I. Stramrood
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L. M. Dijksman
- Department of Epidemiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Quality and Safety, St. Antoniusziekenhuis, Nieuwegein, the Netherlands
| | - A. de Jongh
- Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - M. G. van Pampus
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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